Ironman Wisconsin Diabetes Race Report

The day after the race, I quickly wrote up a race summary for Dr. Matt, who was in Snowmass, CO, busy, running his 3rd Diabetes Training Camp for 2008. The summary focuses mostly on the race itself and my diabetes management during the race. I thought I would include it here for anyone who might be interested. At the bottom, I've written a brief explanation of some of the diabetes lingo that I use here, for those who are less familiar with all this stuff! Photos are courtesy of Blair Ryan.

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Here's a brief lowdown on the diabetes stuff (mostly) from the race yesterday. But first, it was an amazing experience. We had nearly perfect weather and the Triabetes support crew was amazing. And trying to look good for the camera kept my pace up a little. ha! Well, until the end anyway...

I ate breakfast (60 g breakfast, oatmeal/banana/PB/milk) around 4:15, 45 minutes later than planned but 2:45 before the race. This didn't give me as much time to deal with pre-race highs and I was high and rising. I bolused 0.5 when I was still on the rise at 380. It had come down to around 320 by 6:40 so I ate about 10 g GU before hopping in the water. My basal from 5-8:30 was 0.9 and then it went up to 1.6 until 10 AM (at which point it was 0.7). The swim started at 7:00 AM. On the 2nd lap, I became worried about going low and was feeling tired, so I flipped over and ate a GU sea-otter style and immediately started feeling better with the next stroke I took--it was probably psychological because I think I was holding back on the effort a little to avoid going low. I started cramping in my calves the last half mile of the swim and it was painful and slowed me down. I think getting out of the water after the 1st lap at IMCDA helps in this regard. But I was able to finish in 1:46, a few minutes slower than IMCDA.

Coming out of the water my BG was 83--a little on the low side so I ate prob. 60 g carbs in transition. In retrospect, my BG was probably in a great place if I didn't eat but I had that big basal going and I panicked. (I really hate low BGs during a race.) About a mile into the bike I lost my water bottle in a place that was difficult to turn around and made a decision to continue. I begged some water off a volunteer along the route but didn't get another water bottle until about 45 min into the ride. I was probably dehydrated from the high BG's earlier and should have stopped somewhere for water, although I didn't have many options there. I considered briefly grabbing one of the bottles on the side of the road after a particularly bumpy stretch, and was eyeing all the volunteers for spare water. My heart rate was high which is pretty typical for me on the beginning of the bike. I did note that when I got some water at the 1st aid station, my heart rate came down fairly quickly; I'm not sure if it was due to getting the water into my body or just finally relaxing. My BGs shot up to something around 350 after 1 to 1.5 hours on the bike. I was pretty surprised, but then again not so much; I guess I shouldn't have eaten so much in T1. I just went ahead and bolused 1 U and waited a bit before eating more. Eventually it came down and then I was struggling to keep my BG up towards the end of the ride even though I spent the last 2 hours at 0.25 U/hr basal. At about 65 miles into the bike, my calves started cramping again and it was painful. I had been drinking a lot of water/Perpetuum/Gatorade, had taken a lot of salt in, and couldn't figure out what to do. Fortunately, at one of these moments, the camera crew came by and I thought, "Well I can't just be a baby and stop pedaling here." So I just tried to pedal through it. That actually worked pretty well to work out the cramps, and I discovered that if I worked at a harder gear with a lower cadence, I would cramp less frequently. But I was a little disappointed that I couldn't really put the pedal to the metal since otherwise I felt good. I finished up the the ride in 7:05, which is about 7 minutes slower than my CDA time. I wanted to go faster, because I felt stronger than before CDA, but the cramping really slowed me down. I suspect that the high BG/no water situation had something to do with it as well as the cramping on the swim. I was worried that I would cramp on the run but that didn't seem to be a big problem (except for when I drank cola instead of Gatorade--I noticed that also happened in CDA).

My BGs were a little on the low side (low 100s/90s) at the end of the bike and I think I shut down my pump for a half hour at the beginning of the run. I felt well-hydrated. My BG's were in the 90-100 range and I lowered my basal to 0.125. I was eating a GU every 40 minutes, and pretzels and Gatorade at almost all aid stations. (Granted maybe it was only 2-3 pretzels.) I shut down my pump another couple of times because I couldn't get my BGs up. I was eating probably 200-250 calories per hour, maybe more. I ate what I could. I had a couple episodes of low BGs--measured at 60s, 70s and dropping fast--but noticed that I didn't feel great (GI ickiness) when I shut down my pump. At the last turnaround around mile 18 my BG was pretty low and I felt on the verge of emotional breakdown so allowed myself to walk for a few minutes. I ate about 50 g carbs and then saw my BG rising. I was happy to see it rising steadily upwards until it hit 200, at which point I started to wonder if my pump was disconnected. I had a couple miles to go so nudged it with 0.2 U just in case there was a problem. I was sort of bummed that I couldn't run faster but happy I made it through. I felt pretty low energy-wise for a lot of the run, although I had some better moments here and there. I tried to pick it up when I could, and was happy to keep running through the end. When I was walking due to the 2nd low BG episode, a woman said, "Don't worry--there is plenty of time to finish." I started running after a few minutes and she wished me good luck.

I did notice a couple times the sort of fatigue come on that I experienced on the run in CDA 07 and on the bike in CDA 08. I am more alert to the initial symptoms (basically low BG feelings when the BG is normal--especially slight dizziness) and backed off right away when I felt this way on the 2nd loop of the bike. After I finished the race, I felt the same way and it might have something to do with blood pressure perhaps. My blood pressure was 100-110 (can't remember) over 50; I drank 3 cups of broth and it came to 110/60. Who knows I guess.

It was fantastic seeing everyone along the course and I was especially happy to see my partner in crime (or so I would like to think) Michelle after some hill somewhere and Ray and the camera crews and anyone in one of the blue IronFan T's. The IronKid crew on the run course was also fantastic and it was great to see Marissa and the rest cheering enthusiastically each time I passed by. Racing with 11 other type 1 athletes was such a pleasure for me; I had a big boost when I saw anyone on the course and it was such a comfort knowing that so many people "in the know" about diabetes were out there. And having that table for the swim was so incredibly helpful. It took a lot of stress out of the morning for me. I am pretty sore today and have a really weird bruise on my ankle but otherwise am doing okay. I had BGs >400 overnight and they are up again so I had better see what is going on.

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"Basal what?"
For those who are less familiar with diabetes terms, here's a primer. BG refers to blood glucose, which increases with food intake (especially carbs) and stress, and decreases with insulin and, often, exercise. Sometimes exercise can cause the BG to increase, and many other variables affect the rise & fall of BG. Insulin takes the glucose from the blood and helps to shuttle it into fat & muscle cells. Insulin must always be present and can be delivered through injection or insulin pump. I use an insulin pump, which delivers a "basal rate" of insulin throughout the day. I program this depending on my activity level; basal rates also change throughout the day. For me they are highest in the morning and lowest in the afternoon. When I eat a meal, or need to correct a high BG, I take a "bolus" which is basically like an injection except it's done with a pump. The Dexcom is a continuous glucose meter (CGM) which measures the glucose concentration beneath the skin every 5 minutes. It is calibrated to a BG meter and can give useful information on BG trending and values (as long as it has calibrated successfully).