Thursday, June 26, 2008

Ironman Coeur d'Alene 2008 Race Report

(Note: this race report includes some details on diabetes management but I will write up another summary with more details and data, as well as pictures!) Glossary below is for those not familiar with diabetes lingo:
  • BG, blood glucose, blood sugar: the amount of glucose in the blood; in someone without diabetes, this is usually around 90-100 mg/dL;
  • BG meter (UltraMini): device to measure blood glucose, requires a drop of blood
  • Insulin pump: insulin delivery pump, used instead of injections; does not replace BG testing; I use an Animas pump which is waterproof, enabling me to wear it during the swim;
  • Dexcom: continuous glucose sensor, measures glucose subcutaneously, must be calibrated to a BG meter, does not always match up perfectly with BG but can be particularly useful to spot rising or falling glucose
  • Basal rate: the amount of insulin being infused at a constant rate from the insulin pump, usually varies with activity and time of day
  • Bolus: like an injection of insulin only through the pump, programmed manually
  • Insulin: hormone made by the pancreas, missing in people with type 1 diabetes; insulin allows glucose to move from blood into muscle and fat cells and causes a decrease in blood glucose concentration; carbohydrates cause an increase in blood glucose concentration and exercise has variable effects depending on the concentration of insulin and glucose in the blood.
When I signed up for Ironman Wisconsin for Triabetes, I wondered how I would handle Ironman Coeur d'Alene. For many reasons, I still wanted to do it but worried about the toll it might take. Would I be able to do both? That remains to be determined but after my positive experience on Sunday, I feel confident that my body will recover and I will be able to resume training for September. Last year, my recovery was very difficult and it took all I could muster to compete in the Big Kahuna Triathlon, a half-ironman triathlon which falls on the same day as Ironman Wisconsin. But the theme of this year's race was how much better things went than last year. The race still had its ups and downs, but I felt like I was able to achieve my goals in nutrition and hydration and to learn a lot about diabetes management that will help me have an even better race in September. Don't get me wrong--the race was hard and there were moments on the course where I pondered (fleetingly) how the Triabetes team would feel with one less member! Of course, pondering the next Ironman is not a wise thing to do after being on the course of the current one for 10 hours.

Late Saturday afternoon, I had a light dinner and headed back to the motel. I had finished packing my special needs bags and was ready for bed. Unfortunately, sleep would not come easily. I really wanted to have a working Dexcom sensor for the race, and the current one, which I had inserted a few days prior, was not calibrating well. I didn't want to reset it because I would have to wake up around 11 PM to calibrate, and I knew once I was awake it would be tough to fall asleep again. But it wasn't working and so I decided to reset it. I woke up later to calibrate and then again at 1 AM to check and see if it was working. No. I decided to get out of bed and put in a new sensor. So a couple hours after that, I got up to calibrate and then tried to sleep for a few minutes. I think I got about 3-4 hours sleep max. But, I did have a working Dexcom at least. I tried to comfort myself knowing I had slept less before marathons.

Race Day
Around 3:45 AM, I got out of bed and ate my breakfast of oatmeal, banana, peanut butter and a cup of soy milk. My basal rates were pretty high from my taper and I was happy to see that I never had a big pre-race spike from breakfast. Soon enough, we were all down at the race start, getting body-marked and doing last-minute things with our bikes and transition and special needs bags. The sky was mostly clear and the temperatures were pleasant. The only hitch in the forecast was for possible thunderstorms during the swim. I wondered how the swim director would handle that one. About 15 minutes before the start, my friend Jill and I made our way to the swim timing mats--it was crowded! I was a little anxious about getting to the beach before the gun went off, but we barely made it with about 4 minutes to spare. We headed over to the left, where I started last year, and stood for just a few moments until the canon blasted right in front of us. I guess it was time to start!

Where's the fire (or should I say "shark"), people?
The first lap of the swim was pretty rough. I tried to take the line near the buoys to avoid getting stuck far on the outside, but there was not a smooth line to be found. People seemed to be swimming frantically; perhaps because I held back a little at the start I was in a clump of more nervous swimmers? I'm not sure but it was pretty much impossible to get a rhythm going. And the corners were especially bad. My suggestion to race officials would be to emphasize swim etiquette at the Friday night athlete meeting. We hear a lot about cycling rules but the anonymity of the swim seems to lead to some pretty rude behavior--outright shoving and dunking are not uncommon! Who are you people who do that?

Hopping out of the water I looked for my friend who would help me to test my blood sugar between laps. There he was! I tested at 149, ate a GU and hopped back in for my second lap. My time after the first lap was about 48 minutes, faster than my Wildflower time by one minute and 2 minutes ahead of last year. I was happy with that but, more so, I was happy to see my BG was pretty much perfect. I was confident that I would not get low on the 2nd lap, and relaxed a bit. A few buoys in, though, my right bicep/shoulder injury flared up and it was painful throughout the rest of the swim. I was a little disappointed that I couldn't use my right arm fully but it seemed to slow me down by only a few minutes. I was very happy to see a time of 1:42 coming out of the water--a 13-minute improvement over last year.

And regarding the water temperature of the lake, it was nearly 60 degrees the morning of the race, and was not an issue for me. I did not wear the aqua socks or booties and actually felt a little warm when the sun came out during the swim. I did wear my nice Tyr black insulated cap under the pink cap, and that kept me comfortable. I'm glad I spent some time acclimating in the Bay and Lake Cd'A beforehand, though.

A ride through Kootenai County
The wet suit strippers did their job and I found myself preparing for the bike. My BG was a bit above 200, a little on the high side--I guess I should have left my basal a little higher. This year, I decided to wear the same thing for the swim and bike since I finally had some great tri shorts that were suitable for a long course triathlon. Thanks Team Pacific Bicycle! I grabbed my bike and made my way, pretty happy to be on the ride before 9 AM this year.

My goal for the ride was to keep it easy and to keep my heart rate around 150 bpm or less. It was tough those first few miles to stay below 160 bpm but I was pretty disciplined about slowing down; although what I really wanted to do was blast by a lot of people and catch up to the faster swimmers. I hate being left behind! One fun thing about being a slower swimmer is that I don't get passed by too many people on the bike, except for the random guy who, by his aero helmet and bike, seems to be in the wrong spot. The bike course is beautiful and I enjoyed the scenery more this year than last, perhaps because I was less anxious throughout the day. The only warm area was near the first section of rollers by Hayden Lake, and then we did have some moderate headwinds on the ride back to town. It was hard to complain too much since those headwinds were pretty nice tailwinds on the way out.

I can't remember why I waited so long to check my blood sugar on the first lap, but when I did, I was surprised to see a reading of 306. "Shoot! I thought I was going to have perfect blood sugar!" After such a great swim, I was hoping for perfect BG day! I did not get anxious but took a 0.5 U bolus and started drinking a bit more water. Since I recognized this as a pattern, I did not get concerned that I was having insulin or pump problems and knew it would come down if I just took some extra insulin. The BG continued to rise over the next 45-60 minutes--meanwhile, I continued to hydrate with water, took one salt tablet and bolused another 0.8 U insulin. The Dexcom showed that the rise was tapering off, and once I saw a plateau in BG (2 readings of 390), I resumed drinking my Perpetuum (4 scoops + 4 scoops electrolyte powder) and started eating the bananas offered at the aid stations. I had to stop a few times to use the portapotties because of all the water plus the high BG, but was not too worried about it. I was happy to see my BG settle down to 157 after a couple hours and the Dexcom showed that it was pretty stable.

I felt great going into the second lap and ate all of my pretzels (but nothing else) from my special needs bag around mile 65. Riding back through town, I was trying to pass a slower rider who wouldn't move over to the right. He kept blocking me as we went around the corner and up the hill to Government Blvd. I took the hill a little fast and my heart rate was probably up because right after that, I started to feel pretty bad. It was as if my body was saying, "No you don't!" Unfortunately, that happened to be where my parents and another friend were waiting. I tried to muster a cheery "Hi" but thought they might be worried. I was barely moving and started to think about how unlikely it was that I could continue like this. How could I possibly finish the ride and then run a marathon? I was feeling some cognitive disconnect and a bit dizzy and thought my BG might be low, but it was a healthy 127. Hmm. I looked down at my odometer and saw "75" and then it struck me. "So this is that 80-mile thing that can happen on the bike." Last year, a sports psychologist, Jim Taylor, had spoken with our group about mental strategies for an ironman. In particular, he had noted that many people hit a point of mental fatigue around 80 miles on the bike. At that point, the day is starting to wear on you a bit, yet there is still a long way to go. Since the symptoms felt so similar to low blood sugar, I decided to eat a bit more and to just keep the pace low. For the next hour or so, whenever I pushed my heart rate above 152, the dizziness and spacey feeling would return, so I just kept things mellow for awhile. This meant going up the hills really slowly but I had promised myself not to worry about pace, especially on the bike. Eventually, I started feeling stronger again and for the last 20 miles of the ride, felt great.

Riding back into the transition area was a joy, even though I had 26.2 miles of running ahead of me. I like to run and felt ready to go. Plus, I was glad to ditch the bike for awhile. Expecting a slower time on the bike than last year, I was surprised to see a time of 6:58 on my watch. Great!

A lakeside run
Coming out of transition, I saw a group of friends who were there to cheer on Jill and me. They were cheering enthusiastically and I was happy to see them and so I returned with a vigorous cheer. A few slow steps into the run, though, I thought, "Hmm, maybe I could have toned it down just a bit there?" But, well, we owe a lot to those spectators who run around all day to keep us going, no? It wasn't too hard to smile when I saw my friends and family along the course; I had usually been looking forward to seeing them for miles.

My pace for the first few miles was okay, but it started to taper off a bit and I was having to eat a lot to keep my BGs above 80. During the first half-marathon, I had one (measured) dip below 80 and would periodically get it above 100. I kept adjusting my basal rate downward, but avoided shutting off the pump entirely, which had led to some problems last year. Still, last year I shut the pump down for three hours and it probably would have been helpful to just shut it off for 30 minutes when I was continuously below 100.

After the halfway mark, I ditched my Vitalyte bottle and decided to do cola and 1 GU per hour. Either I wasn't taking enough cola in, or else it wasn't being absorbed as well as the Vitalyte, because I had a sudden drop in my BG to 66 around mile 17 or 18. I had noticed my heart rate falling and pace dropping off but hadn't caught the falling BG. I ate a GU and started drinking Gatorade and shut down my pump for 30 minutes. I noticed at the 20 mile mark that it might be possible for me to break 14 hours if I could increase my pace a bit. But looking at my splits, I was getting slower and I decided to not worry about it. I hit the big hill of the course for the second and last time, and decided to walk it, noting that my walking pace was about the same as my running! Bummer! Anyway once I hit the turnaround, I resumed running. I was on the home stretch now. Only about 5 miles to go!

The weather was still pleasant with some overcast skies, if I remember, and I was happy to be running in the light. One spectator said, "You are going to see a beautiful sunset!" and I remember thinking, "Not if I can help it." I secretly wanted to finish before they handed out the glowsticks this time. But would it be possible at my 12 min/mi pace? I hit the 21-mile mark right at 8 PM, which would make finishing before 9 pretty tight. I didn't take a split again until mile 23 but was surprised to see 20:42 on my watch. That was about 10:20 per mile or nearly 2 minutes faster per mile than I had been going. Hmm, maybe I could make it after all! I noticed on the Dexcom that my BG had risen and was starting to plateau. I would have to race my BG to the finish, I thought. "We'll see if I can finish before it drops!" I kept drinking some gatorade and cola but didn't eat any more food for the remainder of the run. The next splits were 10:09 and 9:57 and I saw that I was going to make it. I was feeling strong and felt some pain but was not suffering too much. People were happy to see a happy runner and cheered me enthusiastically those last few miles. I rounded the last corner and had my own few moments of being a super star since I was pretty much alone for the home stretch. The finish at Coeur d'Alene is amazing and I waved my pump, UltraMini and Dexcom in the air in victory! Yay! The last 1.2 miles I finished at about a 10 min/mi pace although according to my Polar I was running at a 7:36 pace at my fastest. (Thanks Duane for making us do a time trial at mile 21 of our 22-mile run!) I had finished the marathon in 4:55, slower than I had hoped for but 27 minutes faster than last year.

My finishing time was 13:52:19, 50 minutes faster than last year. Splits were as follows:
  • swim: 1:42:42
  • T1: 8:48
  • bike: 6:58:10
  • T2: 7:04
  • run: 4:55:37
After crossing the finish line and receiving my medal and T shirt, I was asked if I needed any additional help. Last year I had about 4-5 people surrounding me and had a "catcher" escort me to the medical tent. When the volunteer at the finish let me go on my own this time, I was surprised. I guess last year I needed special attention! I felt surprisingly good and never experienced the post-race misery like last year. I felt properly hydrated but not overly bloated or puffy. Sure I was sore and a tad dizzy but overall I was doing great. I signed up for my massage, grabbed some pizza and visited with my teammates and coach who had already finished. Soon, my family and friends made their way to the athlete area and I greeted them, very thankful for their dedication in staying out there all day. It is a long day for them, and they deserve a lot of credit in getting us all across the finish. Thanks!

A celebration of humanity
Visiting with my parents the next morning, I asked if they enjoyed the Ironman experience. My mom had come last year but this was my dad's first time at any triathlon, let alone an Ironman. My dad suggested that the whole experience was a "celebration of humanity." After reflecting on that, I agree that the Ironman is indeed a celebration of what is possible for the human body and spirit; the coming together of family, friends and volunteers to make the day possible is an act of love. It is so uplifting to see spectators cheering on not only their own loved ones but other athletes who need some encouragement. And there are moments between athletes, little words of encouragement and assurance, that touch the spirit and remind us that we are all in this together.

Thank you
Thank you to all my friends and family supporting me on the course, online, through phone calls and emails and words of encouragement throughout my training. I was lucky to again be coached by Duane Franks and Dorette Sommer of Trifiniti and to have the added and much-needed expertise this year from Matt Corcoran and his staff at the Diabetes Training Camp. It was a big victory to me this year when I passed the aid station on the run where I had to stop for some time last year. Also thank you to my teammates from Triabetes and Team Pacific Bicycle, as well as my co-workers, whose support buoyed me along my way.

Now it's time to start thinking about September. After my experience this year in Cd'A I cannot wait to race IM Wisconsin with our Triabetes team. (Um, well don't take that too literally.) It will be amazing.


Scott K. Johnson said...

Way to go Anne! We're proud of you!

Wingman said...

Way to go Anne, great work avoiding a serious low and getting that blood sugar down on the bike - tough balancing act there!

Marcus Grimm said...

Anne - that is AWESOME!! Major congrats - you rocked it. :)

Lesley, Tim & Ty Anderson said...

Great! How in the world do you manage to remember all of those details????

Shawn said...

Wow - it was hard enough out there without having to manage BG! Very impressive, congrats.

That swim was rough, no doubt about it.

And I think your dad summed it up perfectly, that's been the best way that I've been able to describe it as well. It's an event that's both totally pointless and also means so much...

Liz Findlay said...

Anne-- wow. I am honestly wiping away at some tears right now. I loved picturing you wave your pump in the air as you came to finish line. What you have accomplished, ultimately, I think, is that you've proven to thousands of people that we all have our own "pumps" ;they may or may not be as visible as yours but none of us should be afraid to turn it into a driving force for a personal accomplishments. We are so blessed to have you as family. We love you and wish we could have been there in person to cheer you on --- but maybe in September???q

Arielle said...

Congratulations, Anne. It was great seeing you out there!

Lyrehca said...

Congratulations! Very inspiring!