Henry David Thoreau said “Not until we are lost do we begin to understand ourselves.”
My new friend Harry and I had been splashing through half frozen puddles on a (suspiciously) small path through a hilltop bog, visualising our glorious podium finish after the 44 mile run through the Brecon Beacons. We were feeling strong and had opened up a big lead on the field with the group behind us out of sight. But as we crested the ridge, I realised that we were WAY off track.
An important part of getting fitter, and improving both speed and endurance is training the body to burn fat at higher levels of intensity. This is really important for athletes who do the things I like doing – running (because they can go faster and further) and mountaineering (because mountaineers don’t have very good access to food to top up their limited carbohydrate stores).
One of the advantages of having diabetes is that I can observe how much carbohydrate I need to eat to keep my blood sugar stable. Does this mean that I have an insight into how well my body is adapting to burning fat? Can this help anyone else?
“And I’ve got you to thank for getting me into ultra-marathons” I said to Phil at the start of the CCC on Friday morning. I quickly reconsidered, before adding: “actually I won’t say that until I’ve finished”.
The last “run” five days before the ultra
A lot of preparation has gone into getting myself ready for the CCC tomorrow. The CCC is the little sister of the ultra-tour du mont-blanc (UTMB) – a mere 101km and 6100m of climbing. (The 6100 of downhill will be the difficult bit of course.) This is more than enough for me. I feel fit, strong and have no idea how fast I will go. I hope I’ll finish it of course.
They say that success in running ultras can be boiled down to winning the “ultra-eating” competition. One can expect to burn about 700 calories an hour. The body can absorb up to 300 calories an hour if one eats as much carbohydrate as possible. Competitors frequently suffer from nausea or vomiting, and this can lead to exhaustion if they cannot hold food down.
Last week was my one-year anniversary of my diagnosis. People refer to it as the “diaversary” but I really don’t like the word!
I can remember all too well the shock of my diagnosis. I could not concentrate on anything else for the two or three weeks following, and I had huge uncertainty about whether I would be able to continue to do the things I loved doing. I was lucky to have fantastic support from my wife, family, friends and medical team. What words of advice would I give someone else who is newly diagnosed? I’ve been thinking about it since my anniversary and here is what I came up with. Bare in mind that I’ve had the condition for a mere twelve months. There are probably loads of wiser diabetics who have better advice than me!
(In the Spring, I was a diabetic tiger. In the Summer I was a diabetic snail – running slow and steady with my house on my back)
I had everything I needed for four nights in the mountains. The diabetic snail was ready to go running!
With the cliffs above me blocking the way higher, I eyed up the only way onwards: a waist high stream a few metres across. The water was flowing fast before tumbling down a series of waterfalls dropping into the village I’d left half an hour before. Having scrambled up three hundred metres of imposingly steep grass and rocks I could verify that contrary to what my map told me, there was definitely no path and definitely no bridge. There was also no-way I could risk crossing the torrent without the possibility of plunging to a premature death far below. I cursed at yet another misadventure and turned round to retrace my steps. I slipped, and desperately hung on to my walking poles, digging them into the ground with my life flashing before my eyes. I averted my slide and broke one of my poles in the process. Walking up the 1700m to the next col had just got even harder.
I’m training for a 100km ultra marathon around mont blanc. I’m learning a lot about running, training, physiology and diabetes. Today though was all about the joy of running and being in the mountains.
It started with a four mile run in London at 5am. I hadn’t factored in just how heavy my bag was, and I had to really push it to make my train. The doors closed as I arrived on there platform, so I panicked, waving to the driver hoping that I wasn’t going to miss my second plane in a week! Luckily he let me on.
This is where it all started – running in Chamonix in September made me want to do an ultra marathon in Chamonix. I found out yesterday that I have a place in the CCC – a 100km race from Courmayeur in Italy to Chamonix. It includes 7500m of vertical height difference.
Waking glucose – it was perfect for a few weeks round the start of December
I’m still in the honeymoon phase. That means my body produces a small amount of its own insulin and is therefore capable of controlling my blood sugar to some extent. In theory, if I was sensitive enough to this insulin, could my body control its sugar levels like a healthy person? Who knows!
For a few weeks before Christmas, I was consistently waking up with blood glucose readings of between 5 and 6 mmol/litre. That is basically PERFECT. It’s what a healthy person would wake up with. I started noticing that, and I also noticed that it was often 5.7 regardless of what level it was when I went to bed.
Over the past month it’s been between 6 and 7 when I wake up. That’s still good, but not PERFECT. I’ve noticed the change in trend and want to know why.
(Click on charts to enlarge.)
The blue line in the chart above shows my average waking up glucose. You can see a golden period before Christmas, where average waking up glucose was about five despite average glucose when I went to bed (red line) being higher. For the rest of the time, glucose on waking is pretty well correlated to glucose when I went to sleep. This suggests that my long acting insulin (Lantus – I take it before bed and it acts like “background” insulin, staying in my system for 24 hours or more) dose is about right.
What explains the really good waking glucose levels, and what explains them not being quite as good now? Please forgive the very busy chart below – it shows average waking and bed time glucose, how many minutes of running I did a day on average and average grams of carbs I eat before bed.
It’s not lantus
My Lantus dose has been steadily dropping as I seem to become more sensitive to insulin over time. (You can see I took it down to just four units while I was skiing, but it’s back up to 5 now.) There’s no obvious correlation between Lantus dose and waking blood sugar.
It’s not what food I eat at bedtime
If my blood sugar is a bit low when I go to bed, I normally eat something so that I don’t get a hypo. Am I eating more before bed now than I was? You can see from the chart that the opposite is actually true – I was eating slightly more before bed at the same time as my waking blood sugar was best controlled.
Could it be the running?
The other line on the chart is the number of minutes I’ve run a day, on average. In the lead up to my ultra, I was doing a lot of running (between 50 and 70 miles a week, or over 40 minutes a day on average). I wonder if doing all this running makes my body sensitive enough to insulin to enable my own insulin production to control my blood glucose to the optimal level? I’m going to ask my doctor.
The chart below shows my waking blood glucose, with periods where I’ve done over 35 minutes a day of running on average. You can see that there’s a rough correlation between waking with blood sugar of between 5 and 6 and me doing lots of running.
I’m ramping up my running training again ahead of the London Marathon. I managed ten miles yesterday, 14 today and hopefully will do eight tomorrow. I’ll continue to monitor my waking glucose (of course!) and will be interested to see whether it starts coming in between 5 and 6 again.
I feel great to be running a lot again, and if it helps control my blood sugar better then that’s a nice bonus!
My aim for running the London Marathon for the JDRF is not only to raise cash for such a good cause, but also to show that people with type 1 diabetes can perform just as well as healthy people in athletic or sporting events. I signed up to the Marathon two weeks after my diagnosis when I had no idea how difficult it would be to run with type one. I’ve of course since found that with meticulous preparation, it’s possible to run long distances really fast – for instance with the ultra marathon I ran in December.
But whereas my aim for the ultra was to just finish it, my aim for the London Marathon is to finish it fast.
Just finished the ultra.
It was emotional!
I couldn’t believe it when I found myself in third place with ten miles to go.
Over the last six miles, the enormity of what I’ve gone through over the past five months hit me. I’ve been so busy learning how to adapt to type one and learning how to exercise with it that I haven’t really stopped to think.
But here I was doing my first ultra so soon afterwards and I was in contention for a podium finish. I was hit by such an immense feeling of pride at what I’d achieved that I found tears streaming down my face. The tears didn’t stop for miles and all the way I was thinking about all the people who had helped me get here.
So thank you everyone! Life is good.
The chart shows how my blood sugar was affected by exercise and the carbs I ate during the run. The green line represents the time I was running for.
I’ve said before that by character, I’m pretty happy-go-lucky. But for anyone doing an ultra, I’m told that preparation is key. This is doubly true for someone with diabetes.
To that end I’m making headway with a few things on the preparation list. Firstly, I don’t want to get injured with all this running I’m doing, so I made an appointment to see a physio today to get myself checked out and get advice on injury prevention. The session started out well (“you’ve got strong quads”) but quickly turned to character assassination (“you don’t use your calves or bum muscles and you have no flexibility”) and ended in daylight robbery (“I can solve all your problems in just five expensive one-to-one sessions”). But seriously, he gave me really good advice, and after coming to terms with the heavy investment I’m going to have to make in both time (daily exercises – I’m starting off with kneeling practice – it’s harder than it sounds!) and money, I’m hoping that it will reduce my chances of injury.
The next thing is a plan for nutrition when running. This is the really complicated bit for me. And it’s why I’m so looking forward to all my long runs: I can collect more data!
On Saturday, I went down to the South Downs to do a 20 mile run. I decided getting the train out of london was a good idea, because at least the Downs have some hills which is good practice. I ran to my aunt and uncle’s house, and was greeted by another aunt, two cousins and a massive spaghetti bolognaise, which was a really nice surprise.
The run went really well (except having to stop ALL THE TIME to look at the map and figure out where I was going – oh, and to do those pesky blood tests). But my 20 miles took 3.5 hours, and apparently – according to Strava – I was actually moving for 2.5 hours. If that’s true that’s pretty quick. I didn’t take any short acting insulin (I want to avoid doing that whilst running because it’s too complicated and risky) and ate on average 30 grams of carbs per hour. This is good information about how much my body can process whilst exercising.
There are two problems though. Firstly, according to running websites, I need to eat more like 70g or carbs per hour whilst running an ultra. Secondly, my blood sugar went down to around 4 (or just under) a couple of times during the run. I was totally fine, and didn’t suffer symptoms of a hypo, but I probably need to give myself a bit more of a safety buffer if I don’t want to risk having problems at some point in the future. So next time I’m going to try to eat slightly more per hour – my theory is that if I eat more, my body might start producing it’s own insulin (I’m in the honey moon phase, so still produce some insulin) which will allow me to digest the extra carbs and eating more will give me a higher safety margin from hypos.
The other thing I’m finding with my training, is that I’m absolutely loving all this running! I enjoy the feeling of running along, and it’s great to be able to cover long distances in amazing scenery. I suppose this is part of the “gift of diabetes” – I’ve always enjoyed running, but I wouldn’t have attempted to do an ultra marathon this year if I hadn’t been diagnosed with type 1.
Finishing the Shakespeare Half Marathon pre-diagnosis this April. I felt about as bad as I look! Hopefully I’l be better prepared for the ultra!
As I’ve already written on this blog, I entered the London Marathon (running for the JDRF) straight after I was diagnosed.
I spend a lot of time in the mountains, and have discovered that I love running on mountain trails and I was starting to get into longer distance trail running before my diagnosis.
On top of this my good friend, Phil Reynolds did the Marathon de Sables a few years ago, and has done several ultra marathons since. He planted a seed in my head a couple of years ago, and it has since been quietly growing into a fully formed ambition to actually do one myself.
There is a very famous trail run in Chamonix every year in August. The Ultra Trail du Mont Blanc (UTMB). It involves running round the entire Mont Blanc Massive, which is 100 miles and 10,000m of ascent (more than Everest) non-stop. I was thinking I’d like to do that one day, and there is a “little sister” event called the CCC, which is a “mere” 100km and 7,500m of ascent. I’d like to be in a position to run it next August if possible.
Unfortunately, I discovered that the entry criteria for 2014 is to have already run an ultra marathon of a certain difficulty by the end of this year. There is no way I’ll be ready for that right? I decided to postpone for a year.
But the voice in my head didn’t go away. I found myself browsing the available events and found one in the Brecon Beacons on 7 December. 42 miles and 2300m ascent (more than twice up Ben Nevis), off-road in Wales on nearly the shortest day of the year. It sounds pretty difficult, but it’s about the easiest event I could find that qualifies.
So I entered last Monday, and started reading about training on Tuesday. Good job, as if I’d read about the training first, I might not have entered!
I basically have two months to train for it. I ramped up my running a bit last week. I ran 26km yesterday and to fit the miles in around my existing diary, I even found myself running 10k to a dinner party on Thursday and 10k home from the dinner party! After struggling home at 11pm, I can confirm that two helpings of pork belly and three glasses of wine will not be part of my ultramarathon nutrition plan!
Something I learned from Phil is that meticulous preparation in all things (from training, to nutrition to equipment – just read his blog) is vital in a successful ultra marathon attempt. I’m more of a happy go lucky character by nature, preferring the approach of the plucky English amateur rather than any kind of highly prepared professional. But the difficulty of running an ultra combined with the added challenge of managing my diabetes while I do it mean that I’m going to change that and do everything I can to arrive at the start line as well prepared as possible.
Am I crazy to do an ultra marathon before the London marathon? Maybe. But only because the ultra is going to be really long and tiring. From a diabetes management point of view it’s a different challenge. I want to run the London marathon fast whereas I just want to finish the ultra. That means stopping to test my blood won’t be an issue in the ultra whereas it’s going to be a real pain whilst running the marathon. Anyway, I’ll keep you updated with the training.
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