So upcoming is: 11 Flights, 7 back-to-back Marathon challenges, 6 U.S destinations and a series of diabetes community and speaking events!
It sounds a little bit like a Christmas song… (and a pear tree anyone..?)
Flying over to New York (via Amsterdam) on Friday (September 5th) the next 5 weeks is going to be extremely busy – and I am looking forward to it! Of course there has been a lot of planning, preparing, organising and daring to make this happen, with still a few more details to be confirmed as well, in this post I share how things are shaping up for the Diathlete USA Tour 2014!
Firstly I would like to say a big thank you to tour sponsors DEXCOM. Their support has made this all possible and as a result I will be trying out one of the latest break through’s in diabetes management, their Dexcom G4 Continuing Blood Glucose monitoring sensor (CGM), which traces my blood glucose levels as I travel and run. Having never used a CGM before, I’m excited about this opportunity. Dexcom have also adapted the device which previously only operated in mg/dl (milligrams per deciliter ) to suit me using mmol/L (millimole per liter). I appreciate that for in the UK it is most common to use mmol/Ls when managing your blood glucose levels, whereas the USA it is more common to use mg/dls.
…It is kind of like the fact that in the USA they drive on the right, in Britain they drive on the left.
We like to be different! And as far as the majority of the world is concerned… you drive on the wrong side of the road!
To help people’s understanding, here is a basic comparison of Mg/dl to Mmol/L levels:
108 (spot on!)
6.0 (spot on!)
380 (way hyper!)
20.0 (way hyper!)
Where did the Idea for the ‘Manhattan Marathons’ challenge first come from?
Some point during 2013 I became introduced to a charity named Marjorie’s Fund with a global type 1 diabetes initiative. I had succeeded in ‘the impossible’ or so I was told it was, in running the length of mainland United Kingdom in 30 days and my next venture was a trip to Australia, where I would become an IDF Young Leader in Diabetes representing the UK and would also embark on a ‘Diathlete Down Under‘ tour. At that stage I had done a heck of a lot for charities in one year already! The 30/30 challenge was supporting Diabetes UK and JDRF UK, the Down Under Tour linked me with the International Diabetes Federation, I was fundraising for JDRF Australia and also spoke to Diabetes Australia at an event.
Supporting another charity, surely, was way out of the question!
But I looked at the initiative Marjorie’s Fund shared and to me it appealed in what their goals were. Many people with type 1 diabetes in the world are dying each year. Many are children. And it is preventable! It all comes down to the fact that in certain areas of the world the funds are not available. The resources are not provided. The education for control is not there. There is little care for the people with type 1 diabetes. There is much for discrimination. Ignorance comes into it, as a serious disease not being viewed seriously. It is not understood and there is a lack of awareness in many areas.
Marjorie’s Fund helps in these areas of the world – ‘thriving not just surviving’ being their motto. They support children and adolescents diagnosed with type 1 diabetes to not only receive care and education, to not just survive into adulthood – but to thrive into good health, or as good health as possible to go on and live full lives – as people with diabetes should be able to do. As I do in being someone who has the resources such as insulin and education to keep control.
I had shared emails with Dr Jason Baker and even had a few chats on Skype. He was intrigued with what I had managed to accomplish as ‘the Diathlete’ and the challenges I had endured, I was intrigued by what his charity that he had founded was doing. Jason also lives with type 1 diabetes and by founding Marjorie’s Fund, he was following what was in his heart from his experiences and the people, such as Marjorie, he had met along the way. We shared a lot in common there and decided to plan for the future. It just so happened that Dr Baker and Sandy of Marjorie’s Fund had a booth at the IDF World Diabetes Congress in Melbourne, where I was. We set up a meeting and discussed plans and from there… Manhattan Marathons was created.
Likewise to all my challenges, the routes I run tend to be completely random. I would run around Long Island! It worked out the distance would endure 7 marathons, therefore, we had a weeks-long challenge set up.
I caught up with Jason again in my hometown, he was over in London and I had an event on to introduce my latest challenge – it was great as we had Jason share his story, I invited the then Mayor of Bexley along, Sharon Massey, who done great things for diabetes in our local area and she spoke, along with daughter Tori, 14, who lives with type 1 diabetes too. And Paul Farrelly came along, who lives with type 1 diabetes and once cycled from Portsmouth to Istanbul in 30 days – and also once capsized a rowing boat in front of Sir Steve Redgrave, with me in the back…
Training and Preparations
It has taken a lot of planning and organising. As previously mentioned, still with one or two possibilities to confirm too. It is a bit like Transfer Deadline Day, as I try and make some last minute deals happen, only without the bizarrely, unnecessary dramatic impact of Sky Sports News ‘HQ’…
Whilst going over to the USA I figured it is great to go and do a challenge for a week, but here is the thing, I have never been the the USA on my own before – I want to see it all!
My message to others is to never let diabetes stop you from living life to the full. Therefore, instead of just going to New York City and then around Long Island, I decided to push it on with a tour! Travel is sometimes a big concern, especially for parents with children who have type 1 diabetes – a big worry. So I would like to demonstrate that I live with diabetes and yet am very comfortable travelling around, even to the other side of the world! And I am gaining new experiences, meeting new people, enjoying life – whilst living with diabetes. The Diathlete Tour came about. It took some work, as the initiative is to support and inspire diabetes communities, raise awareness of Marjorie’s Fund and involve other people with diabetes as much as possible. I had a few contacts and have managed to establish a few more which I am grateful to a number of volunteers for! And so the final decision had been made to go to Minneapolis, Miami, San Diego and San Francisco for a series of events. It is an exciting schedule and I’ve never been to any of these places!
It has taken a lot of work to set this up. An example is my email inbox – over 100 emails this week so far alone. I’ve been up taking Skype calls past midnight, to even as late as 2am in the morning – the time zone difference not helping me. But it is all coming together!
In addition to that I have also put in serious time toward another major project that I hope comes to plan in the future. But you will have to wait a while to hear anything on that!
Through doing many events over the years and crazy challenges, I have gained some great skills to effectively make events such as this one successful – so I have confidence going forward. If there has been a problem though, it has been the fact that my time has been consumed up organising everything – and not training as well as I needed to.
I also have to try and earn something of a living whilst committing to these things. That is the difficult part. I do these things because it is in my heart, I want to do them, I want to support people with diabetes as much as I can. There is nothing more rewarding than being at events speaking your story to others affected by diabetes, particularly children with type 1, and being able to pass on some inspiration to them. But it means I can never commit to a full-time job, as I don’t know where I’ll be next week!
So over the summer period, aside from all the organising, I had to get some random work. I spent a week sleeping in a tent working at a festival. And it rains a lot in England. The showers were cold too… I then spent 6 weeks living in a boarding school to work as an activity leader with foreign students. It was an enjoyable job, to an extent, I met great people who I worked with and kids are always entertaining. But it was more or less 24/7 work given that I was living on campus. This all meant that my training time was shredded right down.
But you gotta do what you gotta do.
So in all honesty, I am not coming into this Manhattan Marathons challenge of running 7 marathons in 7 days in the shape of my life – by any means! I also suffered an injury whilst playing football working in the summer. My Achilles heel if you like is my left ankle. I sprained it whilst working. So I had to take time strengthening it back up. It caused me some bother during the 30/30 challenge on the first week, but fortunately the Edinburgh group arranged a masseuse to check me over when needed it the most and the exercises I learned, which recovered and saved my 30/30 challenge, I’ve again put into practice here. 5 years back I tore the ligaments, so it is my one weak area. Yet, with the right exercises, as proven in the past, I can strengthen it to succeed. And that is what I’ve looked to have done.
Although my training time has not been enough, one thing I do have in abundance which I am confident about helping me to succeed in this challenge is experience. 30/30 was 30 ultra marathons in a row! And I’ve been running big challenges since the age of 16. 7 years! I also think the experience of running in Adelaide last year is a good help, as it was very hot! I think there are similarities in the settings of Australia and the USA too, seeing as the USA is a new experience to me, the Australian experience can be a great factor in experience. Roads and street-settings are a similar layout.
To add to my frustrations in final preparations, over the weekend I came down with a flu bug! I have been as sick as a dog! This was absolutely the last thing I wanted, as it weakens everything, my immune system to my muscles. But rest assured I have been dosing up on all vitamins to recover, it is still there but I have seen improvements. Hopefully a good sleep tonight and I can feel better tomorrow and ready by Friday.
Of course the key element of all of this is to manage my diabetes successfully. This is the soul reason why I am doing the challenge of 7 back to back marathons, to show that I can do it whilst living with diabetes. That is the soul reason as to why I run full stop! And my message through doing this is not to say I have diabetes but I can run marathons if I want, it is a statement to say I have diabetes but it is possible for me, or anyone else living with diabetes, to achieve anything in life. Not only in sport, but down any path.
To run Marathons with diabetes it takes a lot of know-how indeed, it takes a lot of planning and I believe you’ve got to take some gambles too. As previously mentioned I have plenty of experience, which is why Diathlete has developed so well, and this means in the past I have taken the gambles already – and learned from them. This provides me with many ‘Dia’-tricks up my sleeve.
An example is when hypo. Now the prime aim is to prevent hypo levels from happening altogether, but with diabetes if you are burning so much energy, as you tend to do when running marathons, hypos can happen. The key is to never panic. Luckily for me I am as laid back as they come and do not do that anyway. If out of glucose supplies, from energy bars, gels to energy drinks, which on this challenge I hope never to be in that situation and to always carry what I need with me, then I even have a plan for that too. Simply by changing my running pace I am able to raise my blood sugar levels. I can put in sprints, then walk, then jog, then a burst of pace and sprint again… by mixing it up and altering the pace I am likely to trigger the ‘adrenaline effect’ – where my liver reacts to the sudden changes of endurance and releases glucose into my body, which, without insulin intakes to counteract it, rises my blood glucose levels. Therefore, temporarily, keeping me safe from hypoglycemia.
That trick alt to buy me time to get help or get to a shop and buy more supplies.
As said though – I plan to do my best to prevent off those hypos! And for me insulin management in consideration to the level of exercise is the crucial factor.
Personally I am on multiple daily injections (MDI) and currently take the insulins Levemir and Novorapid for my basal and bolus rates. For my Levemir, basal insulin, I have a split dosage. On an average day I inject 14 units in the morning, 14 in the evening – roughly 12 hours apart. I see my basal (background) rate as the key solution for control in exercise and especially when out all day running. Too much basal for the level of exercise means CRASH – hypo will happen. Too little could mean gradual hypers take place, or the slightest energy boost could zap my levels far too high.
Diabetes is all about balance and even more so when running extreme challenges. Through my experience, the tactic I am putting into play with this challenge is to inject just 3 units of Levemir in the morning before running. Now that seems very little in comparison to the 14 units on an average day, but both timing and calculations take place here. In the evening I am going to inject 11 units of levemir. This means that in total I have halved my daily average of 28 units down to 14 units for the day – which in consideration to the level of endurance, I predict to be a good cut down – if anything I may need to lower the background units some more.
Timing is key as if I inject the night time dosage too late, say 11pm, and I start running at 9am, there is a good chance that the evening basal dosage will very much still be in the system along with the morning 3 units – and therefore could mean too much insulin is working whilst I burn energy running at a consistent pace. This puts me at risk of falling hypo early on. I will aim to have 8-9pm evening injections and 8am morning ones – starting the runs for 9am.
I think within that first hour or two of running I certainly have the biggest hypo risk, given that the insulin is fresh settling into my system and potentially some of the evening insulin will be around anyway, so this is the point where I consume more glucose in forms of gels or drinks – to keep a balance. The breakfast meal needs to entail slow release carbohydrates to last throughout the morning.
The evening meal likewise needs to be quite filling – for I will burn in region of 4000 calories per run! I need to get that back and keep my energy up!
My bolus insulin doesn’t need adjusting as much as people would think. I know many people adopt the tactic of lowering their bolus insulin right down to rise levels and then burn energy to bring them back down through the day. That can work, but for me I believe the key is in the basal insulin working in the background. Therefore, I aim to keep a check of my blood sugar levels and have target levels to be at.
In mmol/Ls the aim is to be between 7.0 – 12.0 to get things underway. So somewhere between 120 – 200 ml/dl. I think more towards 12 (or 200) is better. What needs to be in mind is that insulin can take a few hours to operate and bring the levels to where they will be after eating – as firstly comes the food into the system, which temporarily makes blood sugar levels rise, and then comes the insulin to bring it back to normal (if you’ve done your calculations correctly). So the calculations need to be on a basis that once these sugar levels come back down, when the insulin is working, it is coming back down in the planned range of between 7.0 – 12.0 mmol/Ls and not any lower than that. This may mean my starting blood sugar level could be a little higher, such as 13.0 or 14.0 mmol/Ls but on it’s way to 12.0 or slightly lower within the next hour. So in terms of injecting my quick acting Novorapid insulin, I probably want to adjust it, depending on the morning blood glucose level, to act with my breakfast meal and get to the level I want it to be. This may mean lowering it by injecting one unit less than what I would normally require for the meal.
Yeah I know, I’m pretty smart…
But know this: all this info did not come about from any medical professional – it came about from 15 years living with type 1 diabetes, 7 years of extreme challenges, sometimes getting it wrong and learning from that – it came from living with diabetes, taking a few risks to begin with and learning from it. And through that I have been very successful over the years!
In having the Dexcom G4 CGM I believe I have a great tool available here to help prevent hypos altogether, as I can keep a constant check whilst running.
The Schedule and How I feel ahead of the Journey…
I arrive in the Big Apple on Friday September 5th. On the 6th we have the opening event taking place and I can’t wait to be there and hear the talks from Dr Jason Baker, Lauren Antonucci, Zoe Heineman and then give the first talk of the tour myself too! My USA debut! This is a free event too and takes place at The Cure Thrift Shop, 111 E. 12th Street, New York from 7pm until 9pm. I look forward to catching up with the likes of Paul Madden and Justyna Wozniak at the event too!
The challenge of running around Long Island, NY, begins Sunday Sept 7th, going from the Cure Thrift Shop to Rockville. The following day and route is from Rockville to Babylon. And then Babylon to Medford, Medford to Stony Brook, Stony Brook to Huntington, Huntington to Queens and Queens to Manhattan – finishing back at the Cure Thrift Shop 111 E. 12th Street for around 6pm! So if about – come along and be at the finish New Yorkers!
On Sept 14th I am off the Minneapolis – looking forward to catching up with Scott Johnson over there and also speaking at a JDRF Minnekotas event on 15th.
Next is Miami where I’ll meet Jamie Perez and her son Tyler, who has type 1 diabetes. I’ll be arriving there on Sept 18th and a series of events includes a tour of the Diabetes Research Institute.
After Miami it is a long journey across America – to California. I hit San Diego on Sept 26th and speak to the Dexcom team on 29th.
After that I then head to San Francisco where I look forward to catching up with fellow IDF Young Leader, Lucas Fogarty, and also fellow type 1 Fabiana Couto. I arrive there Sept 30th.
I return to New York City on October 6th and head back home on the evening of 7th.
Despite this rather frustrating flu I’ve had, I feel sure I’ll recover in the next day or 2. And ahead of the journey I am excited to get things going, it is the trip of a life-time that I hope can help inspire many communities and raise awareness and some funds to support the fantastic work of Marjorie’s Fund!