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Guest Blog: Diabetes and Triathlon Â- can this really work?

TriBlogsby TriBlogsOct 9th 2012

By Eva Kapp

Diabetes and Triathlon Â- can this really work?

ThatÂ's a question I get asked a lot. This month marks my 25th anniversary of being a Type 1 Diabetic. I was diagnosed when I was 5 years old so I have been living with my Diabetes for pretty much all of my life. I guess I am pretty experienced in dealing with my Diabetes and know the ups and downs inside out. I have always been very sporty and my Diabetes has never stopped me from doing what I love: being active.

When I started getting involved in triathlons 2 years ago, I didnÂ't know anything about triathlon at all. Being talked into a club ride by a good friend of mine, it didnÂ't take long until I was hooked. At that point I couldnÂ't swim 25m front crawl without gasping for air at the other end. Managing blood sugar levels for more than an hour was a new challenge to me despite my sporty lifestyle as a diabetic.

Luckily, two years later, I can safely say that I have mastered the swim beyond 25m and have recently very successfully completed my first Middle Distance triathlon with a 6th place in my age group Â- despite Â- or maybe because of my diabetes?

To date, from my first ever sprint triathlon last year, it has been a challenging but incredibly rewarding journey for me and my Diabetes. I have an insulin pump which makes managing Diabetes particular during long endurance exercise a little easier. It is basically an external pancreas that is connected with me via a little tube and keeps Â"feedingÂ" me with insulin 24/7.

My first really long distance event was the bike leg of the Ironman Copenhagen in August last year as part of a relay team. The training for it involved many long hours on the bike on weekends to get me bike fit but also to experiment with nutrition and insulin reduction to avoid having blood sugar lows (hypo) or the opposite having highs. For those who donÂ't really know what Type 1 Diabetes is, please see http://www.patient.co.uk/health/type-1-diabetes. When I exercise I tend to reduce my basal rate to 50% an hour before exercise and maintain this reduction to the end. During my training when I was spending 3-6 hours on the bike, I reduced it right down to only 35%. I also experimented around with different types of food and how often I needed to eat on the bike to maintain my sugar levels without falling into a hypo or going the opposite Â- too high. A lot if it was also depending on the intensity I was cycling at so a hilly bike ride meant to eat more than a flatter one.

The strategy that really works for me is mixing carbohydrates that have a varied degree of how quickly they raise my blood sugar: I tend to eat a couple of wine gums/liquorice every 20-30 minutes and a muesli bar or banana every 45-60- minutes during both long training rides as well as races. My breakfast before a race consists mainly of protein in forms of eggs and only a small amount of carbohydrates (yoghurt/muesli with apple). The reason for this is that I find it easier to keep my blood sugar under control before the race starts. I have to strike the balance between eating carbs and injecting just about the right amount of insulin for it as otherwise my blood sugar levels are too low or too high before the start.

During the Ironman Copenhagen bike leg, I maintained this strategy and also reduced my basal rate to 35% one hour before the start and for the duration until ca 30 minutes before I crossed the finish line in 5hrs 55min.

With my confidence being lifted after managing my sugar levels really well over the Ironman bike leg, I decided to attempt a middle distance triathlon this year and signed up to do the Â"VitruvianÂ" at Rutland Water taking place on September 9th. ItÂ's a beautiful open water race around the Rutland Water lake with a 1.9km swim, 85km bike and a 21.5km run.

I had no idea how to train for this kind of distance and knew I would have enough on my plate with just managing my Diabetes. I decided to get my coach Andy on board so that I didnÂ't need to worry about training too much or too little. We started my training plan in January and with the information I had given Andy about my Diabetes and how I generally manage it, he was able to put a plan in place that fitted in well with my varying degrees of insulin sensitivity during the month:

As a female, my insulin demand varies quite considerably during my monthly cycle with different hormones being active during this time. I usually have 5-7 days where I need up to 30% more insulin per day and I usually have a week where I am highly sensitive to insulin and more prone to hypos.

Bearing this in mind, Andy planned my training weeks around this: Weeks 1-3 consisted of gradually building up my training in duration (and intensity; ca 11-14hrs/week). During the second and third week my insulin demand is the greatest and therefore I used the increased exercise to help keeping sugar levels down. Week 4 (ca 8hrs) was my recovery week, where I trained at reduced hours and at lower intensity. This was the week where I was highly sensitive to insulin and prone to hypos.

As for managing my sugar levels I have learnt a lot from training for a long endurance event:

• Use the training to understand blood sugar: I experimented with different types of carbs and quantities, basal rates, how much to eat for breakfast before and inject for it etc. It is trial and error but it is worth it. It made my race day a lot easier because by then I had practiced all kinds of scenarios where my blood sugar was not perfect and I had dealt with it accordingly.

• Weather and temperature: I found it surprising how quickly sugar levels can drop when swimming in cold water. I regularly observed drops of up to 100mg/dl so at the start of a swim I rather have it a little higher (200-220mg/dl).

• The Intensity of a training session has an impact on sugar levels: When doing a session on the bike or running that involves short efforts but at a high intensity, my blood sugar levels are not as likely to drop as doing long but lower intensity sessions. This is probably not very scientific but I know that an hour of hill reps on a bike is less likely to send me into a hypo than 2-3 hours of steady riding.

• Overtraining: Something that hadnÂ't crossed my mind but returning from a 30hr training camp week in March, I didnÂ't allow myself to recover sufficiently and struggled to keep sugar levels down. It should have been my insulin sensitive week but for no obvious reason, they were unusually high. Only when speaking to Andy later on, it dawned on me that this was an indication of overtraining. Whenever I now seem to struggle to maintain a stable blood sugar for no obvious reason (hormonal changes, illness) I now carefully check and assess if I have trained too hard and not rested enough.

• Adrenalin & pre-race nerves: ItÂ's nothing new to a Diabetic that stress can have an impact on blood sugar levels. The morning before a race, depending on how nervous I am, my blood sugar is usually higher. That is why I also prefer to have a low-carb breakfast so that my blood sugar doesnÂ't rise even more. I often inject a little bit of insulin (0.5-1 units) just to counteract this.

Below is what race day looked like:

Guest Blog: Diabetes and Triathlon – can this really work?
Guest Blog: Diabetes and Triathlon – can this really work?
Explanatory note: The ideal range that my blood sugar should stay in when not training is 80-120mg/dl and <160mg/dl after eating. Before I start to train or race I like to have my levels somewhere around 180-220mg/dl depending on duration, intensity and type of race.

I have learnt so much about my body and my diabetes over the past 9 month in the run up for the Vitruvian and I can say that it was worth every training session. My blood sugar on race day was spot on. Not only did I manage to complete the race in 5hr 22min and came 6th in my age group out of 42 woman but I also managed to keep my sugar levels very stable without any hypos or spikes.

I want to share this information because I think it is important for other Diabetics to see that Diabetes is not a reason to stop being active. I donÂ't see myself different to my fellow peers. OK, I might have to have a little more to think about when I train and race because next to practicing the swim, bike, run and transition, it is also practicing to manage Diabetes. BUT it doesn't stop me achieving what I have set myself out to do: Enjoying myself all the way to the finish line and prove that I can do what everyone else can: Racing like a proper triathlete;-)
Guest Blog: Diabetes and Triathlon – can this really work?
sarahleonardby member: sarahleonard, Oct 10th 2012 21:29
Great blog Eva! We can all take something from this, very informative and well very much worth a read.
by guest: ctpotato, Jan 12th 2013 17:33
Great post, very interesting1
 
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