Adrenaline vs Humidity

Our duty in living with type 1 diabetes is to do the best we can to manage our own blood glucose levels; not such an easy challenge when our bodies fail to produce a key hormone called insulin.

Everybody has a different body but if you live with diabetes the condition does not control itself; you are the one who is ultimately responsible for your own control. As a little boy, when being diagnosed, my biggest fear at the time was if it would stop me playing sports – I was football mad growing up! The response from medical professionals in my hospital at the time wasn’t entirely convincing – all a kid wants to hear is “YES YOU CAN.” A big reason I do what I do today, with the runs and endurance challenges, is so I can say to others who perhaps are like I once was, YES YOU CAN – you can achieve anything in this life.

As an ultra-marathoner, a guy who has accomplished a number of whacky challenges all around the world, I know that you can achieve anything – I know diabetes brings up it’s own challenges and there is a lot to take on and learn, and that it doesn’t always go to plan, but ultimately you can achieve anything whilst living with diabetes. Before my years of running crazy distances like a type 1 Forrest Gump began, I was a keen footballer – and in this post I wish to share two affects on blood sugars which I’ve often experienced over the years: what can happen to blood glucose levels in both adrenaline and humidity.

In playing football I often found that on a match-day my blood sugars would spike. When starting out as a player the advice I received from the Doctors were to take less insulin, to avoid the risk of hypo. It is fair to say that this risk was absolutely avoided, I would come off the pitch with blood sugars way up in their 20s (mmol/ls)! When you consider that the other players on the pitch, living without diabetes, had their blood sugars probably somewhere between 5-7mmol/ls – in terms of concentration and performance, you’re at a great disadvantage. Now first and foremost that did not stop Gary Mabbutt in the 80s and 90s from a professional career for Tottenham and England – so once again, anything is possible – but of course we would prefer to be at our best and more so, we would prefer to be healthy.

The reason for the spikes were due to the movements on the pitch, sprinting for a ball and then jogging, walking, sprinting – sudden bursts and changes of pace continuously for 90 minutes. This causes the body to react and the liver can release glucose into the bloodstream, therefore spiking the levels. This is also made worse by the adrenaline reaction, causing the same effect. In training sometimes I would find I could go lower in blood sugars but on a match-day it was the opposite.

When I played at a semi-professional standard I found this was even worse – that adrenaline on a match-day was really strong, it was my dream as a boy, I would psyche myself right up and my blood would be pumping. This tended to mean higher blood sugars. So the teenage me during my years before being the DiAthlete had to figure things out for myself – what was clear was that the only way to achieve this was by testing my blood sugar levels more regularly, even at half time.

I began to up my basal insulin, on Levemir injections. I would take a unit more than normal in the mornings. I even went up to 2 units. What I found was that it helped control my blood sugars during the game, at half time I was okay and at full time I would be at around 11 mmol/ls at the worst; however, my blood sugars would crash towards a hypo much more rapidly after a game. The crash would normally happen, but usually much later on, often in the evenings. With more basal insulin my blood sugars would crash much harder, within an hour. I personally felt that it still worked as I could keep better control during the game – so I combatted the post-game hypo by stuffing my face with sandwiches after the game and had a large dinner, usually a Sunday Roast, with a unit or two less bolus insulin in the evening.

On my travels I have found that in the warmer conditions, where there is a lot of humidity, my blood sugars tend to drop much faster when walking around. Even more so when running around! The challenges I’ve taken on in various places, running in Australia, the U.S and Ghana for examples, I’ve needed much less basal (background) insulin in my system!

Last October in Ghana whilst over there I joined the locals in Tema, just outside of Accra, in a game of football. It has been some time since I played a proper game of football to be fair and I threw myself in the deep-end by playing centre midfield. It has to be said, those guys can play! I was so impressed by the standard of football on the bumpy, dry pitch – it wasn’t easy for me to settle into but everything about the game was pass, pass, pass… such a high tempo.

It was very humid, as the sun-light faded. As the darkness grew though, the temperature did greatly decrease. I came off the pitch and my blood sugars were at 5mmol/ls  – I hadn’t upped my basal insulin either. Charging about in the warmer conditions, in a climate I wasn’t familiar with,  perhaps meant my blood sugars didn’t spike.

As a teenager, when I was a good standard as a footballer, I was in Goa, India. I went on a wander by myself one afternoon; whilst all the tourists would be based by the hotel and main strip to the beach, I decided to head in-land to the nearby village. It was a quiet area, not a big place in Goa for travellers – and the reactions from the locals resembled that. Many had never seen a white European before.

After being invited into a house, which the man, who didn’t speak any English but pointed enthusiastically at things to show me, had welcomed me into as I walked by, I found a field. Very dry or dead grass on the field, hard ground and very unbalanced. On the field were two football goals, carved out of wooden logs. Further down the field were a few children playing between some cricket stumps in barefoot. I decided to join them, I had a ball with me and kicked the ball over – they were shocked.

I started playing the game with them and then, one by one, adult local men started coming out onto the field, with trainers or football boots in hand. A man named Godfrey, who spoke English, was my main contact – he explained that the two local villages were having a game of football and did this every month apart from in the Rainy season.

“We have not beaten them in 4 years, but today we will – we have you!”

I may have told them that I played for Crystal Palace… (but it is possible they wouldn’t have known who they were anyway…)

It was an incredible game – a range of locals from both towns playing the beautiful game, all age groups. Up front for our village team we had a man they called ‘Chief’, he was the oldest player on the pitch at 70. We won the game 4-0 and I scored all 4 goals – this may have given me folk-legend status in Managoa. Everywhere I went after that I heard my name. In the hotel every person from the barman to the cleaner would call me “GAVINNNNNN”; walking down the road the Taxi driver’s would toot by shouting “GAVINNNN” out the window; ordering a meal in the restaurant, the waiter would offer “GAVINNNN” a discount – I always tipped as the cost of a good meal out there would translate into no more than about £3..

They arranged a second game whilst I was there and it was crazy – the whole village turned out to watch it from the hill by the pieced-together-pitch! I got cheered when I got the ball. We won 5-3 in a much tighter game – the other village had some younger players who were also a good standard. For the last goal I ran through and squared it across to Godfrey, who absolutely hammered it through the goal from 3 yards out (and there was no net) and then ran around as though India had just won the World Cup – the shirt came off any everything!

I recall my blood sugars were a higher level in the good zone at the end, 8 or 9 mmol/ls – I was happy with that. It is possible that the combination of adrenaline and humidity was keeping a good balance of my levels; the movements of my body would have created that adrenaline effect for my liver to release glucose and spike levels, yet, with it being warm and humid, I was working up a great sweat and decreasing blood glucose during the game too. The meals were very high carbohydrate, so I would have also had much more glucose stored in my liver from the higher carbohydrate meals – potentially spiking the levels even more – but ultimately I worked so hard the levels kept well. I did drop towards a hypo shortly after the game, working hard in the warmer climates would mean that the crash in levels would be much stronger through burning more energy. Out there though I was in my element for a recovery – I love a curry!

india

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Sugar Tax and Trailer Snacks

Having attended the IDF World Diabetes Congress 2015 in Vancouver last month, I heard firsthand from the International Diabetes Federation regarding the recently revealed statistics of the 2015 IDF Atlas – which, to be mild, suggest very bleak times concerning the prevention of diabetes prevalence around the world. The stats revealed that in the world to date there are approximately 415 million adults living with diabetes (as a whole) – a figure up from approx 380 million just 2 years ago. Writing this as someone living with type 1 diabetes, an estimated 90% of this figure is concerning type 2 diabetes prevalence.

The question is, what can be done? The estimations are that most definitely within 20 years there will be 600 million people living with diabetes, probably meaning that 95% will live with type 2 diabetes and this is largely down to the growth of poor health and lifestyles, which can be prevented. And that figure of 600 million is most likely to be met within half the estimated time period, with the current rate of worldwide prevalence.

Personally my work is very much related towards type 1 diabetes, I want the best for people living with type 1 diabetes and their families; I want every child, in particular, living with this condition to feel good about themselves, to understand their condition and go on to live full, healthy and successful lives as a result. I’m ‘The DiAthlete‘ – some form of type 1 outlaw that takes on crazy challenges and speaks his mind, but one thing I know is that by taking action you tend to get more done. And regarding this situation, action needs to be taken for the cause of diabetes as a whole, for all types, and furthermore for the world as a whole.

One talked about method in recent times has been the Sugar Tax resolution. Can putting a tax on added sugar substances help encourage healthier lifestyles for people?

In Mexico, negatively known as one of the most obese countries in the world with the highest death-rate from chronic diseases, largely related to consumption of sugary drinks, they opted to take on the soda giants by introducing a ‘soda tax’ on the levels of added sugars to drinks. After just one year there has been a dramatic drop in soda drink sales across the country and many Mexicans have been encouraged to also go back to their roots – with traditional Meso-american diets involving grains, fruits and vegetables.

Berkeley in California, where I recently visited in 2015, has also passed a sugar tax – and the area is very much a university campus base and appeals to young adults. Denmark introduced a fat-tax on all food products which contained more than 2.3% of saturated fat. And a voice in the UK, TV chef Jamie Oliver, has been right behind this development introducing it into his restaurants.

Does this mean though that the people in say Berkeley won’t go to the next Californian city, such as San Francisco 20 minutes on the Bart line, to grab a load of sodas for a cheaper price, or the people on the Danish borders won’t pop down to Germany to grab their pizzas? Education is surely the key area here.

There is another argument against the Sugar-Tax idea coming from within the diabetes world. From the perspective of a type 1, as we all know hypoglycaemia means low blood glucose levels; a threat more common to the lives of those with type 1 diabetes on a daily basis, meaning they require fast acting sugar to stabilise blood glucose levels. An effective way to do this is by having on-hand a sugary drink, with fast acting carbohydrates. A tax on added sugars could perhaps mean an additional cost to those who really do not deserve it, to those who need affordable and available supplies for the sake of their short term health – an untreated hypo can lead to a very dangerous situation, such as a diabetic coma. As a child, when less experienced in the condition, Lucozade came to my rescue many times – and as the Diathlete when facing the big endurance challenges, I’ve often relied on the energy drinks to keep a stable balance of blood sugars.

So this debate could come down to the bigger picture – and that would be type 2 diabetes prevalence due to the fact 90% of those living with diabetes have type 2 and it is only going to grow. The more type 2 diabetes develops it perhaps also means, for those living with type 1 diabetes, a greater misconception of the condition grows with it. The sugar-tax could be a positive in that sense for both types – there are always two sides to look at things from.

In regards to living in the UK, yes, with diabetes we are very fortunate to have the NHS, a system which may have its faults, every system does, yet it is very effective in keeping us alive! It is a form of free healthcare in the sense of getting all the essentials you need to survive – insulin and blood testing strips above all else.

The UK itself, however, does have a greatly increasing cost of living, especially in London town! It is all well and good if you are one of the multi-millionaires in the capital, but if you are an Oliver Twist character like myself, then you might look at things such as the increase of travel expenses every January and think twice about the thought of paying any remote kind of extra taxes! Wages are certainly not going up as the prices of housing, clothing or even socialising are.

Yet on that cost of living subject, to go to the supermarket to buy the week’s food supplies, what is cheaper – a variety of fruits and tasty, imported vegetables, or microwave burgers? Or even in the fast-food world, which might be sometimes more convenient for workers, what is more affordable, Pret-e-Manger or McDonalds?

As I previously touched upon, I do feel education is a key factor that can long-term make a big difference – and this begins in the schools. If you can educate children into the importance of healthy eating and more so, provide better encouragement into active lifestyles with exercise, they will grow-up knowing this way of life. As they would grow up knowing to read, write and speak. They can then pass it on to the next generation and the next one…

Sport holds a massive power in encouraging the next generation, children look up to their idols. I feel the right motivation greatly lacks, not just in England where the Premier League has a £Billion-Pound£ valued game of football ‘stars’ on the field (!!!) which results in a boring 0-0 spectacule between Manchester United and Manchester City, but across the world. The main issue is the fact that a large part of the money, which spins it all, comes from what is effectively the enemy – the major companies whose business is branding out poor health. I went to an Ice Hockey game in Vancouver and it was absolutely impossible to follow the game because every 5 minutes they stopped for an advert! The banners and endorsements around the stadium were all advertising unhealthy substances. Every sport does the same, you’ll see the familiar brands of Coca Cola, Burger King etc etc everything ranging from fried chicken to greasy pizzas; you cannot go to watch a professional sports fixture without seeing it. Even the innocent Hot-Dog Van in the car-park isn’t helping, is it!

If you take a child to watch a game of sport, the professionals on the field better be outstanding to inspire that kid, otherwise all that will be achieved is an endorsement of poor health into their brains.

In fact I’ve spoken at a few schools and when I’ve asked what sports the children enjoy playing, I’ve regularly had answers referring to their Xbox consoles!

Is a sugar tax introduction a good or bad idea? I’m personally not entirely against it as it is a form of action being taken and has had results in some areas of the world too; however, there are pros and cons to be considered and what I feel is the best option, first and foremost, is to provide more education and encouragement on to the next generation, particularly with health information and practical exercise in schools. The school in Stirling which makes it’s students run a daily mile I believe is absolutely on to the right path!

And the ridiculous price-tags in sports such as football, as the January Transfer window takes place right now, as far as I am concerned all comes from the Devil’s money. Just look at the ridiculous prices of footballers – how can any of them be worth more than £50+ million?? You could get a good house for £200k and that surely would do more than the likes of Wayne Rooney! Professional sports seriously needs to consider their morals and what they are supposed to stand for – and the same can be said for the governments of this world. Actions need to be taken if the long term prevalence of type 2 diabetes and the misconceptions of type 1 diabetes are to be stopped. A sugar tax is a potential answer but it has to work hand in hand with education if it is to work.

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#TeamDiAthlete Interview with Ben Coker

Gillingham 1-1 Southend United, Ben Coker post match about his diabetes and playing the beautiful game:

Ben Coker was diagnosed with type 1 diabetes at the age of 15, where the symptoms came on following being knocked unconscious during a football match. His first question to the Doctors upon his diagnosis: “Can I still play football?!” I once asked the exact same thing! Today Ben examples the answer to that for all young aspiring athletes diagnosed with diabetes, he plays professional football for Southend United FC in League One of English Football.

On Saturday Southend United, who have made a good start to life in League One following a successful promotion campaign last season, travelled to table-topping Gillingham at Priestfield Stadium and were very unlucky not to come away with all 3 points in a battling 1-1 draw. I went along to the game after speaking to Ben in the week and caught up with him after the match for a #TeamDiAthlete interview on how he goes about controlling blood glucose levels as a professional football player.

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Me, Gavin (GG) / Ben Coker (BC):

GG: “Unlucky today Ben but not a bad point against the league-leaders! How did your blood sugars fare throughout today’s match?”

BC: “Yeah it was a close game! My levels were 6.2 (mmol/ls) before the game, at half time they were 9.0 and after the game 11.3 – so around those numbers was good for such an intense game!”  

GG: “You’re on an insulin pump now, how much of a difference do you feel its been going on a pump from injections of insulin as a footballer?”

BC: “I feel the pump has really benefitted me with my football! I feel my levels are more stable and I feel I am playing my best football at the minute, I’m feeling good!”

GG: “A lot of people have asked about this one, what exactly do you do with your insulin pump on a match day?!”

BC: “On a match day I have to increase my background (basal) insulin because of the excitement and adrenaline. So I check my blood sugar levels regularly on the lead up to the game. I take my pump off during the game and re apply it at half time and check my levels again!”

GG: “One thing I remember from my old playing days was a difference in levels from training days and match days. Have you found any differences in blood sugars from training and match days?”

BC: “Yeah my training days are easier to manage than match days because of the excitement of a match day. I don’t have to give myself as much insulin for training compared to for a game.”

GG: “Post game, how do you go about your control?”

BC: “My blood sugar levels tend to rise after a game so I increase my background insulin on my pump and I keep a close eye on it!”

GG: “Have you ever had any bad hypos or hyper levels during a game??”

BC: “Touch wood, I haven’t had any hypos during a game but I was really high during one game a couple of years ago and got really bad cramp – but luckily I haven’t had any bad problems when playing.”

GG: “You seem to have it sussed! So what would Ben Coker’s message to young people living with diabetes be?”

BC: “The message I would give young people with diabetes is to listen to the Doctors that look after you as they do know best. Don’t let diabetes hold you back in any way – think positively and look after yourself.”

GG: “A good message for all to hear. Finally, Southend’s manager is of course Phil Brown and I always remember back in his Hull City days he had this glowing tan – despite being in Hull. So does Phil wear fake tan..?”

BC: “One hundred percent the Gaffa does love his fake tan!!!”

 

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FOOTBALL AND TYPE 1 DIABETES BREAKDOWN

A full match of football lasts for 90 minutes (normal time) and that makes it aerobic in terms of exercise for it is on-going, yet, if you consider the movements in the game, it is also anaerobic in terms of sprinting for the ball one moment and jogging about the next. This is why, as displayed with Ben's blood glucose levels, levels increase during a match - that change of movements combined with adrenaline causes organs such as the liver to release naturally stored glucose into the bloodstream. Chris Pennell also touched upon this when I interviewed him about playing Rugby! 

Ben shared that he ups his background insulin before the game on the insulin pump. As someone who injects, I used to do something similar in my playing days, upping my basal rate of insulin. I used to take a unit or two more basal on game days, I'd still normally find that I had gone higher in levels but not ridiculously high - meaning I was able to concentrate. What I would also find is that post game if I had upped my basal I would come crashing down in levels within a few hours. So this was something I counteracted by stuffing my face with the club's Sandwiches before any of the other players! Ben mentioned he tends to go higher still after the match and ups his background insulin then - everybody is different, there are different insulins and of course the pump and injections are different, so the best thing you can do as shown in the interview is to TEST YOUR BLOOD SUGAR LEVELS! 

Another thing we spoke about is training - I would sometimes find that I could go hypo during training but this would hardly ever be the case for a match day. And Ben shared that he takes more insulin on a match day than he has to on training sessions. You don't have the same level of intensity during training and there might also be other physical exercises involved in training as opposed to that constant change of pace for 90 minutes of a match day. 

Ultimately Ben is playing first team professional football and doing well at Southend United - a fine example of how life with diabetes doesn't have to hinder you at any level! Whilst I am a Crystal Palace boy through and through, I always keep an eye out for how the Shrimpers are doing - I'm sure there are many of the diabetes crowd adopting Southend as a second team with Ben as an inspiration!    
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Challenges, Changes and Unity

Gav and Fred

I have very recently returned home to London from Ghana, where I decided to venture to after a WhatsApp catch up with my friend Fred Appiah-Twum (pictured with me in Lethal Weapon style), who was an IDF Young Leader in Diabetes for Ghana when in Melbourne in 2013. It was a case of ‘LETS DO IT!’ a search on Skyscanner for cheapest flights and we went from there… In venturing to West Africa, I knew it was going to be very different in diabetes care compared to what it is like in the United Kingdom and I wanted to find out more about how communities go about handling their diabetes, whilst connecting with groups and passing on encouragement and education from my experiences.

Education is a key area in diabetes management, which with DiAthlete progressing into a social enterprise, we aim to deliver in fun and practical methods – particularly for young people. The vision is to empower a positive generation of DiAthletes in the future instead of the negative feeling of ‘having to be a diabetic.’ To go to West Africa and produce educational programmes for local communities and raise awareness was something with the potential to be very positive.

Shortly before the journey to Ghana I had visited Pembrokeshire in Wales and met the local type 1 diabetes community over there, with a talk and an educational programme. It went down very well and I met some wonderful people – namely young Jarvis who at 13 is perhaps at a difficult age in terms of diabetes management, yet I saw a very strong attitude in the lad – enhanced by his love for football and sport. I believe the world of sport is an area to benefit people with diabetes, a good and active lifestyle is ultimately the best way to 1. learn our bodies and diabetes and 2. improve long term control.

newspaper pembroke

The education programme was fun, everybody seemed to enjoy themselves whilst picking up good advice and tips in improving diabetes control during sports and exercise. I am working on developing these programmes for communities in the future! And having operated them in Miami, London and Belfast, I wanted to bring these experiences to Ghana too!

Pembroke1

I received a few tweets before my travels from @Diabully – which I found the views quite interesting. DiaBully was being critical of me for a twitter view shared of ‘beating diabetes.’  Well I actually shared a view of diabetes in my life, ‘diabetes is not my enemy it is my competitor and you should respect your competitors in order to beat them’ – as each day we have to balance blood glucose levels with decisions on insulin management, diet and exercise, in that sense we compete with diabetes for control. Viewing it as an enemy won’t help you in living life with it. In @DiaBully’s criticism of me a view was shared of working with your diabetes and not ‘beating’ it. I respect that – effectively we are talking about the same thing though. It was a good post made however and I recommend reading it – although I suggest to @DiaBully less of the ‘Bully’ concept as we are a community, a team in diabetes around the world and that is how we strengthen, by working together. Remarks made with ‘*smirk*’ just comes across as unpleasant – don’t rub people the wrong way as you can do a lot of good with the information you share.

In going to Ghana there was one person I wanted to connect with in advance, who continues great commitment and awareness to support developing areas of the world in type 1 diabetes care – Elizabeth Rowley and her organisation T1International. We caught up with a few calls to see how we could directly share awareness and Liz tipped me with how care was in Ghana from her connections and interviews.

Diabetes Youth Care is an organisation based in Ghana, operated by Dr Nana Ama Barnes, who Liz and T1International have worked with and I happened to have made contact with through my research of diabetes care in Ghana. In connecting with Dr Barnes, we had planned for some events in my visit to Ghana, to meet schools, hospitals and the Diabetes Youth Care group. DYC bring young patients living with diabetes (type 1 and type 2) together to support education and advice whilst socialising. In meeting them, as I will share, I was really impressed by their unity.

Arriving in Ghana it was a completely new experience for me – I had never been to Africa before. In advance I had to get a visa and all vaccines arranged. Whilst I had thought I had got myself a good deal on Skyscanner for the cost of flights, that was swung out the window in regards to £70 for a yellow fever vaccine, £70 for a visa (for arrival in 3 days but it arrived in AMT ((African Man Time))  in 7 days) and all else… fortunately, for me, a good friend of mine’s trip to Kenya was cancelled and he had in date Malaria tablets which he wasn’t going to use, so that saved about £80… despite the many costs I knew we could start something positive on this journey. Not only in Ghana, but in receiving supportive messages from the likes of Adejumo from Nigeria and Yemurai in Zimbabwe, who I know through being a Young Leader, perhaps this was just something small and in one part of Africa, but maybe in future we can grow something. They call for change in many areas of diabetes care around the continent. 

It was great to catch Fred and I stayed with his family when in Accra – who were all wonderful people and his mother, Vida, cooked excellent food and absolutely spoiled me! After a day to explore – where I also met Dr Nana Ama Barnes in person to discuss our plans – a day later was the first mission. The empowerment factor – we had planned a 25km route, so just over half marathon, from Tema to Labadi Beach on the other side of Accra. My objective was to keep control of blood glucose levels through the run – putting what I preach into practise – and along the way we had a few diabetes community members meet us.

In meeting some of the DYC group members on the run, we had to plan for the run timings to be in the afternoon, to meet the guys outside work and school hours. This meant the challenge was somewhat more challenging – running in the full extent of the West African heat at its warmest point of the day. I had to make a decision on my insulin for the run. Now my tactic which works for me in long distance running is to greatly lower my basal insulin injection in the morning – operating on a split dosage, morning and evening with Levemir insulin. The decrease of my basal means I have less insulin working in the background when I am performing aerobic exercise for long spells. Marathon running is on-going, at a constant pace, so blood glucose levels decrease during the exercise by burning energy at a consistent rate.  

In general for being in Africa, where the weather is a lot warmer than Britain and of course very humid, I decided to lower my basal insulin a little more from average any way, as in the heat you sweat more and blood glucose levels will decrease when moving about just walking, if too much basal insulin. Instead of 14 units of morning Levemir insulin, I began by taking 13 to see how it went.

The evening before the run Fred turned around and said he wanted to give it a crack and run as much of it as he could. It was very brave of him considering he had no preparation for it!

With the run taking place in the afternoon, it meant a big call on insulin. To reduce my basal insulin would mean throughout the course of the day, when not exercising, my levels might soar hyper. I decided to reduce but not to the extent I would have done so if I was starting the run in the morning – I injected 6 units of Levemir, so around 55% of my normal split morning rate was reduced. I injected two units more bolus (quick acting) insulin with my breakfast.

This turned out to be a bad move – I found myself  on a mild hypo just before the run! The key to success for the run for my blood glucose control was consuming carbohydrates for the rate of exercise and humid conditions. Fortunately, following the mHealth Grand Tour the month before cycling across Europe, I was stocked up with a load of energy gels that were left over. We were in good store for carbohydrates – important for both myself and of course Fred.

We endured the run  with a support Taxi – the Taxi driver had our glucose supplies in his car and he would pull over and meet us every couple of kms. It was probably the warmest day I experienced whilst being over there – to make matters easier. We have a saying back home, ‘Sod’s Law.’ Fred battled on and we kept a nice and tame pace, I could tell he was struggling but he kept pushing as far as he could with great determination. He achieved a good 10km in harsh conditions! Then Fred was in the support car and turned photographer!  On my own running along the long road out of Accra to the beach I was getting some funny looks – I was the only white guy and I was running in ridiculous heat! This provided an opportunity to raise awareness – and Fred excelled at that part, explaining the details of what diabetes is to onlookers.

Accra BG

I cracked right on… the pace improved and improved, I felt strong in my strides – which surprised me as only the week before I had endured a tough Survivor Challenge which physically demanded every bit of my body – and of course not long before that was the cycling tour of 1500km in 9 days, including the Alps!

The further I went the quicker I went… I do always bide by the rule of finish stronger than you start – but this was ridiculous!

Ghana Run 1

Every 5km or so I would check my blood glucose and take on a gel if needed. At one point I ate a loaf of bread which Fred’s family make at home – I had crashed from 9mmol/ls to 4.1 – bordering the hypo zone. Carbs, carbs, carbs! Although the long, long road which went on for the majority of the route was mentally challenging – I picked energy up from  engaging with the community really, people waving at me, kids running parts behind me, cars tooting… it seemed to be creating a carnival atmosphere. I got to the beach to run the final 5 k a bit early, so Fred and I stopped for lunch and we soon met Issaka and Israel from DYC. Issaka was a bit shy to begin with but then opened right up and asked many questions on type 1 diabetes – before running the final bit beside me! Israel has type 2 diabetes, diagnosed in his 20s despite being a fit and active basketball player. You see type 2 diabetes isn’t all about poor health or obesity, it can develop for multiple reasons and is common in ethnic genetics.

Issaka did a great job in running with me – he has bundles of energy too! And we got the job done at the Afia Afrikan Village.

Ghana Run 3

We held a talk at Legon Secondary School and I was amazed by the level of interest by the students – who did not have diabetes but really wanted to learn about it, find out the symptoms and ways of living with it. Whilst there was a stern interest from the students to hear from me as a ultra marathon runner living with diabetes – what I really enjoyed was how they wanted to also engage with the subject of diabetes. This gave a platform to both Fred and Israel who were with me to thrive in passing on education and awareness. I believe that real change for the positive future of healthcare comes from within the cause itself , particularly in developing regions. In encouraging a platform for advocates from within, who have been there, experienced it and have stories to share, to rise up and make a difference, I think that is where development can excel from. I saw that in Fred and Israel.

Ghana School Talk

Over the weekend we travelled to Cape Coast, Fred and I supplying a DiAthlete Education Programme with Diabetes Youth Care at the Hospital. In knowing I was doing this programme with a large group of young adults and children living with diabetes, initially before going I requested from a diabetes associated pharma company to receive a few testing meters and testing strips for blood glucose management. The reason for my request was because I am aware that in Ghana and most of Africa, whilst there may be supportive organisations around such as Insulin For Life and Life For a Child, within the countries themselves for many to receive crucial supplies such as insulin and blood testing meters / strips, people have to pay good money to get a hold of these supplies. In the UK we have the NHS (National Health Service) a system which may have faults in areas but ultimately is the best service in the world – tax payers across the nation effectively supply a free healthcare system. With type 1 diabetes this means we do not go without essentials such as insulin! Imagine having to buy it every couple of weeks?

I wished to approach a company that have blood testing supplies as to do a diabetes education programme without  patients having to use their own blood testing strips they paid for, producing education where needed in a practical way without cost.

Bayer were the company in this instance and I write this in a productive way for them as suppliers to an area in need of more support. Bayer rejected my request with the reasoning explained on a phone call that in West Africa they test their blood sugar levels in mg/dl, not mmol/ls like their devices in the UK. They were mistaken in this instance, in Ghana and I believe most of West Africa they test their blood sugars in mmol/ls. My suggestion is to better research your market if supplying out there for a small benefit and respect to those living out there with diabetes. I tested each group member with my own blood testing strips and meter – which took up a lot of time for the programme and now means I need an emergency supply of testing strips provided from the NHS , which isn’t entirely fair on them.

On testing blood sugar levels it was clear to see the majority of those living with type 1 diabetes had high blood glucose levels. Issaka managed an impressive 8.9, the two with type 2 had good levels and the ‘type 3s’ family members of course were in good range. A big problem is the insulin in my opinion. Mixtard, which Novo are the main supplier of, is the main insulin available. It is most affordable – with Lantus in second, which from my understanding is because Sanofi lowered the direct costs. I would love to see more of that from the Pharmas. Whilst access to insulin is the most crucial aspect of survival with diabetes, the problem with Mixtard insulin, from my own experiences on mixed insulin as a child, is it absolutely limits your flexibility and range of control. If you are injecting just once or twice a day, with that insulin supposedly lasting for the whole day, then everything has to be taken into account upon that injection and daily routine – from what time you eat to what you eat, what you can do in the day regarding exercise and what happens during the night.

Ghana Blood SUgars

On mixed insulins it becomes a lot harder for control, no question. It becomes even more important to have lower carbohydrate meals and to test your blood sugars more regularly. PROBLEM! In Asia and Africa the diets are more consistent of high carb meals, a lot of rice dishes for example. There is an unpredictability in a mixed insulin and so testing blood sugars is particularly important – and yet people can only really afford to have enough supplies to test blood sugars once per day (at best). To be perfectly honest when I went around the room with the blood testing meter and finger-pricker (with changed needles for each member) a lot of people were quite shy about the concept of being pricked. As though they had not done it much themselves. And they hadn’t – some might only be able to test blood sugars once every few days. The facilities need to improve. Maybe my very brief experience can help open an eye or two?

Having met the Diabetes Youth Care group in Cape Coast what I can say is this – these are fantastic people. All willing to learn, all willing to work together in a community and support each other – type 1 and 2 – to share their experiences. Fred once again thrived in the opportunity to educate too. Dr Nana Ama Barnes is a credit to any healthcare professional, if the healthcare pros in the UK had half the level of her commitment our care would improve greatly too. And she does this with a lack of resources and funding, on her own personal time.

Diathlete GH

Shortly after my trip I shared small view of what I witnessed and where support lacked on my social network and was hounded by a lady in a power position in terms of diabetes care in Ghana. I mentioned at the beginning positive change can come from within – by giving the likes of Fred Appiah-Twum a platform to reach out from and the people living with diabetes likewise. Although I am for national organisations to operate for they can reach large networks across entire countries in diabetes care, they have to be run professionally and with all communities. What was displayed to me by a Mrs Elizabeth was the complete opposite, signs of clear problems from within. One person cannot make all the decisions alone and run things independently on a national scale, I know what is right and what I publicly received, with an alarming photo shared on insulin and blood testing supplies in a warehouse ‘awaiting to be picked up by my host’ when I had met many people short on supplies, summed up what is wrong. 

Elizabeth Denyoh message on FacebookAs Nigerian young leader Adejumo replied: How comes there are lots of supplies of essential commodities if that picture is what am thinking and yet Gavin could meet those who don’t even have access to them?’

Here are some of the public quotations in an attack against me by Mrs Elizabeth of the National Diabetes Association I found very alarming:

Please remove this post immediately as you did not come to Ghana through the proper Chanel’s, and did not do your home work, no child and I repeat no child in Ghana needs blood glucose meters for diabetes.’ (many children I met can test just once a day – at best)

‘It’s sad how people are so selfish and use the name of diabetics to enrich themselves.’ (I am so selfish I paid around £600 of my money to go over and meet diabetes communities, selling my own Dexcom to support funds.)

(An attack on Dr Barnes:) ‘Stop lying to people about our status in Ghana, you know very well there are supplies for children with diabetes in abound acne, but due to your selfish gains have refused to pass through proper channels to operate.’

There was many more insults and remarks made – does this sound like someone who should be in a high position for diabetes care across a nation?

I look at the likes of Adejumo and I see a real leader from within, he has created Nigeria DOC and regularly interacts with people in Nigeria on diabetes care – giving them an opportunity to share their views and be heard. I saw how well Fred thrived in Ghana, spreading awareness and education on the opportunities in this tour. We need to continue the opportunities and hearing the voices of the people from within – Africa is developing and the next generation of diabetes is with it too!

freddo

 

 

 

 

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#TeamDiAthlete Interview with Chris Pennell

Professional Rugby and Type 1 Diabetes

Chris Pennell has lived with type 1 diabetes for nearly 10 years and it doesn’t stop him from playing professional Rugby Union in the English Aviva Premiership for the first team of Worcester Warriors – where he has also had the ultimate honour of being capped by his country’s national team, England. Take that diabetes…

Worcester Warriors Home Kit launch Sixways Stadium Thursday, 04-AUG-2011 CREDIT: Ian Smith Tel: +44 (0) 70 5013 5323 e-mail: photos@issport.co.uk

I caught up with Chris recently for a #TeamDiAthlete interview with the legend:

Gavin (GG):   “After being diagnosed with type 1 diabetes, were there any fears you initially had?

Chris (CP): “Yes, I had some fears.  Mainly revolving around the impact my diagnosis would have on my sporting ambitions. These were soon squashed with a quick google search and chat with the club doctor. Once we’d spoken things through, it became clear it was going to be a challenge but absolutely didn’t have to stop me from doing what I love.

GG: “Does having diabetes affect you in any way when playing Rugby?

CP: “It does affect me when playing.  If my control isn’t good, it has a physical impact for sure.  I’m getting much better during matches now and hopefully I can show that with some good performances this season.

GG: “So how do you prepare for a game in terms of blood glucose management? Do you have a particular breakfast before a match, make any insulin alterations and what is your preferred blood sugar level to be before a game gets underway?

CP: “My prep for  game doesn’t vary too much from most of the other players.  I like to eat similar things on game days so there’s no surprises to deal with!  Going into the warm up I tend to be around 6-7 in old money.  I actually then inject before kick off as the adrenaline from the match makes me shoot up quickly.  2 units of bolus insulin before the game and 1 at half time keeps me between 7-10 for the match.

GG: “Wow, that’s interesting – I used to counteract the highs back when playing football by taking a unit or 2 more basal insulin instead of bolus on a match-day, which meant I would stop levels going too hyper during a game but I would crash quite soon after a match. It seems those two rapid injections of bolus insulin keep you in good control during games! So what normally happens to your blood sugar levels after a game?

CP: “Post game, I get some food quite quickly.  As I’ve got insulin in my system already and with my body wanting to replenish, its really key to have carbs going in.  I will keep a closer eye on my blood glucose than usual, just to avoid any hypos.

GG: “Amen – it’s always important to keep a close check on levels throughout exercise days! Last year you made your England debut against New Zealand, what did it mean to you to represent your country against the world’s top ranked team?

CP: “It was a very proud moment to take the field against New Zealand last summer, despite it being a short time! It’s made me hungry for more opportunity’s at that level again to prove myself and all going well, they’ll come.

GG: “I’m sure they will! And finally, from all your experiences as a professional athlete living with type 1 diabetes, what would your message be to others living with diabetes?

CP: “I would probably say your diabetes is very personal to you. Getting to know your diabetes through lots of testing is key and it really doesn’t have to stop you in life.  The one thing through sport I have discovered is how much easier it is to control when you lead an active lifestyle.

chris

Sports and Diabetes Breakdown:

If you take the example of Chris the main positive is clear for all to see – he is a professional athlete at the top level, has represented his country and his diabetes has not prevented that! If anything, it has motivated him even more. And personally I know this from my crazy experiences, every extreme challenge I have faced from running the length of the country with 30 marathons in a row to recently cycling over 100 miles a day for 9 days from Brussels to Geneva, what was once a negative for me in being diagnosed with type 1 diabetes as a child is now an added fuel for me to prove what I am about. With the right attitude about it, anything is possible for us all!

Diabetes can have very different affects on blood glucose levels during sports and exercise. This is because there are very different forms of exercise. Chris is a rugby player and this means he is constantly on the move, which is aerobic; however, he is constantly on the move during a game at different rates of pace in his movements. When he receives the ball, Chris won’t be standing still, or slowly jogging about, he will be bursting into speed to run at the opposition and make ground for his team. Off the ball, or when his opponents are in possession, sometimes he might be holding the line and on his toes shifting across the pitch in position, and then he might have to suddenly burst into a defensive sprint to stop an opposing runner in his tracks. So with a sport like Rugby, there are large elements of anaerobic exercise continuously through the game with the sudden bursts of sprints and changes of movement. This, along with what Chris mentioned in the interview – the adrenaline of playing the game – causes a reaction from the body and the key organs such as the liver releases naturally stored glucose into the bloodstream.

When you have a meal there are more or less always levels of glucose coming from the meal, largely in carbohydrates. Insulin, which with diabetes we have to inject or wear an insulin pump for to manage in our bodies, works to control the levels of glucose in our bloodstreams: too much glucose in our bloodstream and we go hyperglycaemic (high blood glucose levels) – which effectively was what led to our diagnosis as our bodies stopped producing insulin to control the glucose levels in our blood – and too little glucose in the bloodstream results in hypoglycaemia (low blood glucose levels). The body naturally balances this with insulin hormones, yet, for us we do not produce it and therefore have to manage it ourselves. What insulin does is stores levels of glucose from our blood into cells, which are in the key organs. When we create that ‘adrenaline effect’ with the anaerobic movements such as the sudden sprints and bursts of energy, the body often reacts by releasing those stored glucose from organs such as the liver into the bloodstream – meaning that during the exercise of a game like Rugby, despite burning energy, our blood glucose levels can actually spike upwards and increase. This is why Chris injects insulin before a game and at half time, to stop his levels from going too hyper during a game and from affecting his concentration.

However, sports like Rugby and Football are also on-going – so do also count as aerobic exercise for that reason. Whilst it is likely for blood glucose levels to increase during a game, the chances are for a major crash in levels post game as large amounts of energy have been burned! So the aim after a game is to prevent a hypo from happening – as you saw Chris mentioned, he eats soon after the match and – most importantly – keeps a close check on his levels following the game.

On the other hand, if you look at what I do, for example recently running half marathon in Accra, Ghana, this does not involve sudden changes of pace and energy. Running long distance I keep to the same pace more or less for a long period of time – and this is very aerobic in exercise and gradually lowers my blood glucose levels DURING activity. So the key for me is to have less insulin, particularly in the background with my basal insulin, during my runs and consume more carbohydrates to help keep blood sugars up from going hypo. Quite the opposite from what Chris has to do when playing Rugby.

Accra BG

Ultimately here’s the thing: we can do it! Whatever the challenge, we can work our bodies out, we can understand our diabetes – it might not always go to plan but if it doesn’t that is a good thing, you ask the question why’ and learn from it! By testing your blood sugars before, during (where possible – such as at half time for Chris) and after exercise and sport, you gain that understanding for yourself! Keep positive, keep testing and never let diabetes stop you in any walk of life.

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DiAthlete Ghana Tour Preview

ACCRA & CAPE COAST
12th – 20th October 2015

Ghana

Date

Event Location
12th October Travel Date, arrive in Accra London – Lisbon – Accra
13th October Explore Day! The Diathlete will go on a wander.. Accra
14th October 25km Accra Coastal Run: Tema to Afia African Village Greater Accra
15th October School & Hospital visits with Diabetes Youth Care Accra
16th October Travel date to Cape Coast Cape Coast

17th October

Diathlete Program – sports day with DYC Cape Coast
18th October Hospital visit and Diathlete Talk with DYC Cape Coast
19th October Travel date to Accra & interview with Fred Appiah Twum Accra
20th October Travel date, depart to London

Accra – Lisbon – London

Over the past year I have been able to host a few ‘pilot’ educational programmes involving sports activity for young people and families living with type 1 diabetes. My aim from here is to provide a more fun way through practical sessions of educating young people and adolescents in diabetes management – and from all my experiences provide key info directly for when it comes to sports and the various affects different sports can have on diabetes control. I think that here in the Western world we somewhat lack this resource of education in many areas and it is something I am working on to support communities next year and in the future… to go to West Africa, where they struggle to get crucial supplies such as insulin and blood testing meters, and give them something which the Western World hasn’t yet maintained, I think that is a promising step forward to the world of diabetes – we are all in this together and nowhere should be left behind.

What I hope will come from this tour of Ghana is a connection between the people I meet in each diabetes community and myself – and I am confident I will find this as I know we can all relate in diabetes, that’s why I have a good relationship with Fred Appiah Twum, who represented Ghana as an IDF Young Leader when we were in Melbourne in 2013. Through this connection I wish to raise awareness across my network about what life with diabetes is like in West Africa – how they struggle to get the key supplies, the healthcare available to them and steps forward they are taking. By working with Dr Nana Ama Barnes and the Diabetes Youth Care organisation, the aim is to empower the communities they work so hard with and to share the positive work they commit to.

Last night I had a ‘WhatsApp Chat’ with Diabetes Youth Care, who every week have these question sessions take place with young people who wish to ask about type 1 diabetes and find out more. Fred also joined on the chat, so they bombarded the pair of us with questions as Nana Ama hosted it. It was excellent – you could see how positive these kids were. I was asked all kinds from sports and marathons to going on dates!

Whilst I preach encouragement and positivity in living with diabetes, I always feel it is good to lead by example as well. So I will run the Accra coastline stretching 25km. I know with my track record 25km isn’t the toughest challenge I’ve faced but you have to consider the climate, it is going to be much warmer and more humid than what I am used to – so key decisions will need to be made on insulin.

Cape Coast involves travelling by bus… so that will be an interesting experience. Once there I look forward to putting on what I understand will be the first sports and diabetes education programme in West Africa, ever. So that is a big plus to the diabetes world. I like to get people testing their blood sugars to understand what is happening to their diabetes in different types of aerobic and anaerobic exercises – now in Ghana they have to pay for their own test strips. I did not want to make them use their own for the programme, but unfortunately I did not receive support from test strip companies to simply provide me with a few boxes (for some free endorsements in return). Fortunately NHS in England are good at treating their own patients, so let’s just say I ‘lost’ my provided test strips and needed an emergency supply this week and if it works out I happen to find my old test strips, and then have spare test strips to take to Ghana, well it is not breaking the law to share is it…

T1International ran by Elizabeth Rowley have also been supportive of this project, as they do fantastic work in raising awareness of developing areas of the world in diabetes care. Liz did a great interview with Nana Ama last year on the work of Diabetes Youth Care. All in all I’m excited. It will be a different experience for me and I look forward to catching up again with Fred, meeting Dr Nana Ama and the DYC group and hopefully will help make a positive influence directly whilst raising awareness.

Here is Fred’s T1International Statement Photo:

Fred Ghana

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Bear Grylls Survivor Race

On Sunday I endured the Bear Grylls Ultimate Survivor Race at Trent Park in Hertfordshire, North London. A while ago I saw that JDRF UK were looking for a few supporters to participate in the event and in considering it, I felt it seemed interesting. There were two options, to do the Saturday where there were the options of enduring either a 5km challenge or a 10km challenge filled with extreme physical obstacles – or else to do the ‘Ultimate’ as it was called for the Sunday, a 30km race with over 100 endurance obstacles.

Needless to say I opted to dive into the deep end and swim with the sharks.

Of course I know Bear Grylls is associated with surviving in nature, with being physically fit and is linked to the armed forces. So that’s what I had to go by as otherwise there was absolutely no clue as to what the challenge actually entailed – just a note on the website saying ‘only the fittest will survive.’

bgsr

Whilst I have a record now of proving my fitness and achieving in crazy endurance feats, I wasn’t coming into this prepared. I haven’t for a challenge for some time. Whilst survival for Bear Grylls might be wildlife and adventure, my survival also entails getting an income – so I was working. Following mHealth, where my body was put under a lot of strain considering the depth of the challenge of day after day endurance – something even the experienced cyclists were not finding comfortable – not to mentioned the feat of climbing the cols of the Alps, my left leg particularly was in a bad way. I had no chance or time to really get much training in for this ‘ultimate survivor’ challenge. My best form of training was to rest as much as possible – which I didn’t get too much of either!

I was the only person JDRF had to represent them in entering the 30k ultimate race. To be honest coming to the event was lonely. I came alone, didn’t know anyone or have anything remotely diabetes related in sight. It was just me and my JDRF top. I had travelled up by train in the morning, feeling rather tired. The evening before I had returned from two days in west Wales, where I had been putting on an education program and doing a talk to the local type 1 community in Pembrokeshire. Even though this may have seemingly been an inconvenient way to prepare for an extreme endurance event, in being knackered from mHealth and unable to train much anyway, it was probably the best preparation for me – seeing that in a small way I could help positively influence people as I could in Wales, it was a piece of motivation that perhaps was very much needed! Sometimes I have to question myself, what am I doing? With every event and opportunity to meet others with diabetes around me, that inspires me.

Before embarking into the woodlands to begin the race, we had a brief-briefing and warm up session in a mass group. During the warm up we had to do a few squats. You know you’re in trouble when you feel the pain in your legs before even starting – my left leg strapped up was clearly weak still from mHealth, where the hamstrings had become very tight around the tendon area.

One aspect I had to be accurate on in my survival was my diabetes. Bear Grylls does not have to contend with that! I knew I could not carry my bag through the race with me, it wasn’t the right bag for it. I also did not want to wear my Diathlete jacket as it was a surprisingly warm October day. So there were no available pockets. I opted to leave my blood sugar meter in the bag, which was in the bag room – something not highly recommended. Ideally I would have warn a running belt to keep it in but I was in a rush in the morning, leaving early to travel, so I didn’t have that either! My decision making was key and my Diathlete experience and self knowledge of my body the most vital. I took just 2 units of basal insulin on my split morning dose of Levemir insulin, down from my usual average of 14 morning units. I had to consider the endurance and physical activity; I knew 3 units could well be too much to run on. I had smartly put on my cycling shorts from the mHealth tour underneath my running shorts – this meant I could store glucose gels for energy by tucking them in my tight lycra shorts against my legs. I carried 5 gels that way with 28.8gs of carbs in them each. That was my survival plan – as I knew blood sugar levels would decrease!

We set off though with a load of smoke and I found myself early on maintaining a comfortable pace and within the top pack – the running part is my part though! A few obstacles early on emerged, having to hop over some boundaries placed on the route, which gradually raised higher into walls to spring over. It was a case of so far so good in my mind. I clearly seemed stronger than most in my strides despite my battered legs and when it came to the early hurdles, despite the tightness I had enough flexibility and more so technique to leap, climb and hop over what I had to…

One of the first main obstacles was a giant roped frame to get over, which I also handled pretty well and took confidence from. In fact I was like Spider-Man there! I focused my mind, climbed two squares of rope at a time and found myself progressing up the netting much quicker than most others. It was an encouraging start but of course with much, much more to come! Once the challenge starts however, it starts, I got into it, regardless of whatever I was feeling beforehand, the challenge was on and it was my test to rise to it. That’s what life is all about!

The most challenging parts for me, which slowed me right down, were the upper-body elements. I’m not a tonk guy and I don’t belong to a gym – all my training, when I get the opportunity nowadays, is natural. In most cases this is the most effective way – none of that vein approach in front of the mirrors of the gymnasium, sharing spaces and trying to make impressions in front of others – the Diathlete has always trained himself by himself, out in the local woods or on the local roads, taking on nearby hills and using the best of nature available to build strength from. It was hard to keep myself up on the monkey-bars, swinging from one bar to another. It took determination and when I was tired, initiative. That’s what survival is Bear… so when I had to, instead of falling to the floor I climbed above the monkey bars, facing my slight fear of heights, and crawled along the top – not breaking the rules of falling to the floor!

There were all forms of physical hurdles to get around. Carrying water cans, carrying 40kg sandbags in backpacks, bear-crawling under nets, leaping 8ft walls, aerial style climbing high up on ropes and balancing on straight ropes which were attached to trees.. it went on and on. There were also ‘ultimate challenges’ to overcome at the end of each 10km section. The first was rifle shooting which was quite fun really! I used my initiative about this too, to get a bit of a breather. The Marine explained the challenge of which I had 5 bullets to shoot 3 targets from range to pass the challenge. Fail and it would result in a time penalty. So I took my time, got my breath back and leant my arm low against the wooden deck we had in front of us. By keeping my left hand low down I could keep it against the wood and therefore keep it all straight. By keeping my hand straight I could therefore keep my aim straight. And by doing that I could hit my target. I also had to keep the gun straight, which was possible by keeping it locked against my right shoulder – and then the easier task to take aim, keeping my eye-line at a reasonable distance from the target-hole so the view was clear and pulling the trigger! Bang, reload, bang, reload, bang… step aside James Bond, all three targets obliterated!

Another ultimate challenge was lighting fire to burn down a bit of string placed above the destined location. We had hay around the area, a piece of cotton and two small pieces of metal to light sparks from. Using initiative again, the challenge was to stack up enough hay with the cotton wall, then rub the metal together to eventually create sparks. The sparks would light the cotton wall, if fluffed out, which would spread to the hay. The hay would then rise the flames to burn the rope in half. It was a good feeling to light my own fire!

The only challenge I failed was the memory test – which was ridiculous! They shouted out a code for a ‘helicopter’ at the start and after 10km of endurance obstacles, then another 10km, we had to remember what it was. I failed both times that one and so had x2 time penalties against me! Luckily I remembered my bag code though as the wristband burned off when I created fire! That’s more survivor worthy…

Come the third lap, the final 10km section, you do feel the endurance catch up with you. Stamina-wise I was fine, but body parts feel the aches and pains. It was clear to see everyone on their third stage was feeling it – some had started much earlier than I had, so when running I spoke to some of them and could see the guys on the third stage suffering with cramps. Despite this I feel I definitely was the strongest finisher of the day. I didn’t set the fastest overall time but my objective was to finish as someone with type 1 diabetes – beating my main competitor, diabetes… For the finish, I had so much energy, that is my trait: to endure, endure and endure and then release absolutely everything at the end. Show no fear, show no weakness – make it seem that I am stronger at the finish than the start. It comes down to heart.

After completing the final obstacle I knew it would be the home stretch for the last 1.5km. Whilst other participants were struggling along there came out the Diathlete determination and I love that! My legs were kicking into their stride, perhaps a little early but I had the tank. Other runners saw me fly by and patted my back, edging me on as I ran by. It was one final hill and then onto the road for the home straight. Mentally that is where I am at my best. The stewards applauded as they pointed me into the right direction… I overtook the hobbling walkers before powering onto the road section with the FINISH line ahead. There stood a Royal Marine who also applauded my effort of sprinting, jogging in my direction, before barking: “FASTER!!!” repeatedly as he sprinted alongside me.

It did cross my mind that type 1 diabetics are not allowed in the Royal Marines. So when it came to sprinting with the Marine, I found the energy to follow his orders and go faster, even out sprinting him! As I crossed the finish I received a warm reception from the spectators and I punched the air in my trademark fashion of passion! I let that emotion out and then there was the dark side… there was absolutely nobody there to see it really – nobody with diabetes at least. That question again: what am I doing it for? Needless to say I was in pain; I still feel the pain now a few days later – everywhere! Going home felt a bit empty to be honest. I had achieved and that was it. My blood sugars were 7.5 mmol/ls to start, 9.2 mmol/ls to finish, so I beaten type 1 diabetes well and truly on the day – I usually do in challenges. In terms of fundraising, I’d probably raised enough to pay for a few sandwiches at a JDRF event in future… Mentally you go from the hero powering past the finish line (in front of people who have no idea you have type 1 diabetes) to, within minutes, the muddy zero, who people avoid sitting next to on the train home. If you really want to know what it is like to be me, that is it. Back to work the next day. There is a positive to finish on however and that comes from you – the person reading. You see if my endurance feats do reach you, particularly if you yourself live with type 1 diabetes, then you know where I am coming from, you know that anything is possible, and therefore I have done my duty.

diathletebeargrylls

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mHealth Grand Tour

A few weeks ago I finished the epic of the mHealth Grand Tour, cycling through all 3 stages of the Brussels to Geneva challenge. It was also part of a medical experiment with mobile health data in sports and type 1 diabetes management – measuring our weight, blood sugar control, heart rate and diet throughout the 9 day process. Each route registered over 100 challenging miles and the further we went the more enduring it became, with the Alps in the final stage!

mhh1

I came into it as a guy that perhaps has a sporty reputation in diabetes, with my accomplishments mainly in ultra running, which was why I was invited to participate in this feat; yet, a guy nonetheless with no real experience of cycling – especially not to this level! So it was always going to be an uphill task, quite literally on most days, and showing up in my running wear and Del Boy hat probably summed up my levels of experience in comparison to the other riders. Some had bicycles they had brought with them worth well in the four figures, I had ‘borrowed’ a £150 bike from my mate down the road – Adam if you read this I took your bike and will drop it back soon…

In the initial meet up in Brussels where we had our briefing and all the gadgets ploughed on us it was a terrible wake up call for me. I’m very laid back in general. Too laid back sometimes. I had agreed to the challenge around 3 weeks before doing it – IDF Europe wanted to get one of their European young leaders participating and sent an email round to the sporty types, which I was interested in. Although as an Englishman, I consider myself more of the British Empire than a European 😉 . From there Team GSMA accepted my application and there it was, I was on the Tour! Brussels, Paris, Geneva… it all seemed too appealing not to go for. The matter of 1500km in 9 days of riding didn’t alarm me greatly until that moment in Brussels!

We had phones, heart rate straps and watches, apps regarding our food and measurements, blood testing devices that could connect to the phones… it was all amazing stuff but all a bit too much for a laid back guy that comfortably tends to be happy injecting and finger pricking. To add to the fact I had to cycle for over 100 miles each day was a lot to take in! I hadn’t cycled that distance in a day ever before! And seeing the others guys with their Team Novo Nordisk jerseys or full on cycling wear and previous tour tops on display, I couldn’t help but feel a little out of place. I once participated in a ‘road safety’ course on cycling as a school boy, I was the only child deemed ‘unsafe’ to ride on the roads!

There were in total over 100 riders participating in various stages of the tour, with 24 of those living with type 1 diabetes. Of that amount at least 11 with diabetes took on the ‘epic’ or riding all 3 stages. This was a super inspiring thing to be a part of!

The first stage was the ‘easy’ part according to many of the cyclists doing the full whack. Easy? As mentioned, I had never cycled 100 miles in a day – let alone over 300 miles in 3 days! What they meant of course was that compared to the final stage of taking on the Alps, this first section was easy… (it wasn’t!) I was out there for long hours, battling to keep with the time cut off of 7.30pm – some days going slightly over. The key for me, in taking usually 10 hours on the bike, was to leave early! If I could get out earlier than the others than I stood a chance of making dinner with them! I’m not the best morning person so had to push myself. In terms of diabetes we were well looked after by the support team – we had breaks every 40 – 50km roughly, with supplies on hand. I’d like to also add that the whole organising team did an absolutely fantastic job, from the chefs to the physios. Adam Denton, the lead organiser, was brilliant – he said to me he has a personal mission to transform me into a cyclist after seeing me in the early days struggling behind with my feet everywhere, running trainers on, baggy shorts blowing in the wind… I wasn’t a fan of lycra! He achieved that to a great extent, as good as he possibly could anyway.

My insulin strategy was obviously the key factor. My experience in going the distance was important, as an ultra runner, enduring mile after mile and long hours is something I know how to dig deep and do. I decided to go for two injections as normal with my basal, Levemir, insulin, yet of course reduce it. I felt my insulin plan of 3 units in the morning and 12 units at the evening worked well to start on the first stage – supported by a Dexcom CGM there were many advantages there! But as the challenge went on I did not realise we had a portable fridge to keep our insulins in – so I opted to carry it with me. It became more and more noticeable that my basal insulin was’t really doing its job. In the night times more so, after exercise, I would absolutely rocket high! This meant I averaged 4 hours sleep a night, as my watch reflected. Tired, bad blood glucose levels and of course the endurance – it was extremely challenging. Yet, I never lost the desire to keep pushing on and giving what I could. And that’s the main thing in life!

mHealth6

The experience of the Alps was very challenging for me and also very rewarding. An experience I’ll never forget. The cols were hard, I’d never done a col before! Climbing the mountains on the bike is so testing, the road winds and winds and only gets harder and harder as the gradients increase. You get to a point where you are just hoping for the top of the mountain and only find another winding road which appears even longer than the last. Mentally that is tough! An inspiration I found was a man named Jean-Louis, a French cyclist from Metz in his mid 50s who had only managed one day of the tour 2 years ago. Jean-Louis had type 1 diabetes, diagnosed in 1969 as a 10 year old! I was often at the back of the pack with him and so I took in a lot of inspiration from being around him. He is a crazy man! People say I am crazy, and I am, but he is another level of it! Jean-Louis would take his time. More laid back than me! He was a better cyclist than me, no question, I’m not a cyclist! Yet, he was of course a fair bit older and had trouble with his eye sight too – so he would just take his time, no rush, no panic, and keep on plugging away. When it came to lunch, whilst most would be looking to get in, get food and get out – no matter their pace – he would sit there eat, eat, eat some more, talk, eat and get going when he was up for it… I’d usually be just ahead of him until the last quarter or so when he’d catch me up, singing away. Then we’d push on together – usually with my borrowed bike joining in his singing with its squeaking… How that thing got up any col is beyond me!

Luckily now and then Orange Ian from Orange Healthcare would have a spare Orange bike in his Orange van. He’d do me a great favour and lend me the bike at every opportunity he could. The struggle with that was I was never on the same bike which suited my body, so sometimes it would be high up, other times low down… I was all over the gaff, yet, much more safe in terms of breaking!

mHealth4

The feeling of reaching the tops of the mountain cols was incredible. It was so mentally hard to keep pushing on but you know that is your only option. And when you finally get to the top and see the sign telling you you’ve done it, you feel emotional. And then it is all followed up by one of the best adrenaline buzzes ever – speeding down the mountains on the bike! Seriously, they should keep the ski-slopes open in the summer and use them for cyclists!

Despite the challenge of doing a tour with next to no experience or real training to prepare for it, I felt proud to have gone the distance and have given it everything I could have. The real emotional part for me was seeing Jean Louis cross that final col – as I missed that on the last day. The last day of riding was by far my strongest cycling day, even though I suffered a flat tyre half way up the largest col of the tour, Mt Ramaz. I also lost my chain and narrowly avoided crashing coming down Ramaz but my pace was great that day – I wasn’t remotely at the back! Yet the problem occurred when I took a wrong turning. I found myself pedalling for miles on a straight road, knowing in my head there was one final col to climb but never turning up it. I couldn’t see a road sign which I knew was bad news! And then started to see Swiss flags with the French ones – I was approaching Geneva but the wrong way in! I called Adam and had to back track on myself, which was uphill but not remotely the climb I should have taken on. Adam had to put me in the van and take me to the top to be sure we’d be on time to come down the mountain and all be set for the police escorts to take us to the finishing ceremony. For me, that was crushing as we drove up – at the top I could see all the fellow cyclists, who I’d grown a great relationship with throughout the tour, struggling their way to the final peak. It took away that sense of passion and fulfilment for me, although I’d gone the distance and even got to the top of Ramaz – which the night before I was having heart to heart with James the physio about how much I wanted to do that one. I’d lost that come-on factor in not finishing the last mountain, even with the thrill of cycling down it to the finish. Seeing Jean-Louis, the last one to make it up there, get there was the best thing I saw. He broke down in tears and that emotion was what I missed myself but found so inspiring to watch. He’d earned it. He just kept going despite being behind, he’d refuse to come off the road or give in, step by step he’d get there every day.

mhh5

I had a moment where I broke down in tears earlier in the tour, at a dinner. I was the last in that day which entailed 4 big peaks and a 15% climb at the very end. It was a day where I found out about the loss of Super Gav, my little friend Gavin Quimby from Minneapolis. He had battled Leukodystrophy so bravely, with a smile on his face, another great inspiration to me at such a young age. I refused to quit that day despite being so far behind everyone and to make the top and finish was extremely emotional. Once I came in, everyone applauded my finish as they were all sat around the dinner table tucking in. I felt I’d gained respect that day which helped me for the rest of the challenge.

The question that has been asked at the end: will I continue cycling? Don’t get used to it! But I won’t rule it out 😉

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mHealth Grand Tour 2015 Preview

Next week on 2nd September I will be catching the Eurostar and heading over to Brussels, where the following day, as part of Team GSMA, I will be embarking on a journey to cycle from there to Geneva in the mHealth Grand Tour 2015.

Rochester

IDF Europe presented the opportunity for me to apply to join the tour around a month ago, an opportunity that really appealed to me – an adventure, a big challenge and a scenic journey – however, this has meant I have only had a few weeks to prepare. Whilst endurance feats are out there to my name, they come in the form of Ultra Running; cycling is a completely different kettle of fish! Different muscles, different tension – it’s going to be extremely challenging! And furthermore, this is no easy ride! The challenge consists of 1500km in distance, with 8 cycle days and 1 rest day on the itinerary. Over 100 miles per day!

A few weeks ago I happened to be in Brussels and so I took in the landscape of where the Tour would start from. To be perfectly honest, whilst the building-work was scenic and impressive, the place itself came across to me with a bit of a bad vibe; perhaps that will serve as a motivation to pedal harder and get as far out as possible on Day 1! I did manage to get a ‘practice ride’ whilst there, at around 2am in the morning on one of the Brussels equivalent to our London ‘Boris Bikes’ following a Litre of Beer!  

BRUSS

In adjusting to cycling, the most challenging part has been finding enough time to train really – on top of Diathlete at present, I also have a job. So fitting in training is a must but is also restricted more than I would currently like. But when I have been able to get out on the bike, I’ve regularly trained up and down the ‘Thames Cycle Path’.  I had a Hybrid bike at home, which my Thames routes have been endured on. For the challenge itself I have now got my hands on a Road Bike, which is most suitable to the conditions. There is a massive difference between the two in terms of gears and speed. 

At home I’ve aimed to get in as many stretches and exercises as possible. One area I’ve identified as a positive preparation is steps – using the right muscles is key and the power lifts of climbing up and down stairs represents similarities to the movement of the legs on pedals. So if you’re ever round my house you’ll find me repeatedly powering up and down the stairway at present!

There is one clear and main objective for me in enduring this very crazy challenge across Western Europe, the same for all my challenges, getting the better of type 1 diabetes. 

As an ultra runner when enduring feats such as last years ‘Manhattan Marathons’ for Marjorie’s Fund, 7 marathons in 7 days, or the 30/30 Challenge the year before covering 30 miles a day for 30 days, that aerobic, on-going, form of endurance tends to result in blood sugar levels gradually decreasing. The key area I’ve identified in my experiences as a type 1 who injects insulin, is the Basal insulin injection. My long acting ‘Basal’ needs to be reduced, greatly, otherwise blood sugar levels will crash too quickly. The other way of counteracting it is by loading up on more carbohydrates regularly throughout the challenge. Whilst carbs remain important throughout extreme endurance exercises, I’ve found getting the Basal correct is the most important area for the best control. When running 30/30 I adjusted my regime to injecting a x3 split daily dosage with as little as just 2 units in the mornings, 1 unit in the afternoon and a lowered evening dosage too down from my usual 14 evening units on average. 

lev

What I’ve noted from there was this upcoming cycle challenge does represent many similarities to those previous accomplishments. Being on the bike for long, long distances, maybe for 10 to 12 hours per day, will mean I need much less Basal insulin than my average day, as the level of all-day endurance effectively replaces a lot of the work the background insulin has to do. It is a different sport but it is still a strong aerobic exercise and the repeated days means that the evening dosages will also need to be lowered as the tour goes on. 

With one week to go I am in the process of getting my final preparations in. I have raided Decathlon for all my necessary, rather tight, cycle wear and am enduring a final patch of training. These are like the main Pre-Season friendlys before the big start, so my insulin has been planned in the method I plan to take the challenge on. I lowered my morning dosage down to just 3 units of Levemir. Instead of injecting an extra unit during activity, I waited until afterwards where I took a further 5 units (after blood testing) to prevent levels from shooting up, then took my evening dosage at a reduced rate too, with 9 more units. The key is testing those sugars! 

decath

One incident I did encounter was the heavy rain, which caused problems with my blood sugar meter. I was completely unable to test bloods as the meter was so wet. This is of course not beneficial when you’re trying to record levels to be aware of the best insulin regime for the challenge – not to mention it is good to know what you levels are during exercise!!! I had to go by my feelings and use all my experiences to help ensure my levels were in a safe margin. One move I use, which is effective but disgusting, is spitting. I have learned to tell whether blood sugars are higher or lower but the way my saliva feels. If it is sticky and hard to come out of the mouth, there’s too much glucose in it. If it feels weaker and fizzy, in a sense, there is a good chance that levels are lower. I do this when nobody is around and I have a drain available, as to spit in public is the worst thing you can do! The key factor there was that my insulin was correct and I continued to top up with small glucose boosts every hour through the ride – thankfully levels were a solid 6 mmol/l when I got in, so I know my stuff pretty well!

On the cycles I have been through terrible weather conditions, strong wind and rain, which maybe won’t be taking place across most of Europe, and have suffered many rather frustrating punctures! But at least I am able  to learn how to repair (kind of…) 

If I am honest there is of course an air of nerves about the task ahead, 100 miles (+) a day is a massive feat for any cyclist really. Nerves are a good thing though, I always played my best football when installed with an element of nerves, as I stepped up to higher levels on the pitch. With the runs, when starting out, people were so negative or fearful of my health that a part of me always sensed that, and whilst I had something to prove, it brought the best of me. Above all else though, I’m excited. 

From experience what I know is that once you get out there and get going, it 90% comes down to heart and determination. I don’t want to look myself in the mirror and feel I’ve let people down by not accomplishing the challenge, I want to look people in the eye and say I have type 1 diabetes and it did not stop me – so there’s plenty of motivation.

I will fundraise to support JDRF on this challenge too, in combining with the Bear Grylls Ultimate Survivor challenge I’ll face shortly afterwards.

ROCHESTER SM

 

Here is a glimpse at the task ahead:

Stage 1: Brussels to Paris

Start/Finish Description                                                  Km/m
Day 1
3rd Sept
Brussels /
Cambrai
From Brussels we head south to Cambrai.  There is something of a military theme to the day as we pass the 1815 Waterloo battle field before heading to the ‘Western Front’ at Mons, the location of the last fighting on the Western front on 11th November 1918. The cycling will include some of the famous pavé of Northern France as we pick up the 2015 Tour de France Stage 4 route into Cambrai.   At 150km it is a full days riding for the first day of the Tour! 150km
1,281m
Day 2
4th Sept
Cambrai /
Reims
Day 2 takes us into Reims, the heart of the champagne region of France.  There continues to be a military theme as we roughly follow the line of the Western Front past St Quentin and the River Aisne.  The cycling is mainly on quite rural roads through the open ‘rolling’ countryside of northern France.  The wind turbines highlight the potential risk of windy conditions but as we are heading east, hopefully the wind will be behind us as we head into the champagne vineyards around Reims! 162km
1,628m
Day 3
5th Sept
Reims /
Paris
The final day is the longest day of the Stage at 173km.  Leaving Reims we ride through the region’s vineyards roughly following La Marne river which meets La Seine in Paris.  There are no significant climbs but the day isn’t flat!  We make our way to Paris following quiet country roads and then into the city using a combination of quiet roads and cycle paths. 174km
1,946m
Rest Day
6th Sept
Paris We have a ‘rest day’ in Paris.  As part of the Tour we will also host a Diabetes outreach event in Paris on the 6th that riders are welcome to join.  Alternatively it is an opportunity to see some of the sites.

Stage 2: Paris to Belfort

 

Start/Finish Description                                               Km/m
Day 4
7th Sept
Paris to Troyes We head east from Paris along the Marne river using quiet roads and cycle paths to avoid the worst of the traffic.  Once clear of Paris we head to Coulommiers (where the Brie cheese comes from) before going onto Provins, a fortified medieval town, which is a UNESCO world heritage site then heading onto Troyes which is described in the Lonely Planet guide as “one of the finest ensembles of half-timbered houses and Gothic churches in France”.  It is a long day but it is flat with most of the ascent gained over a number of small climbs, each less than 100m. 181km
1,525m
Day 5
8th Sept
Troyes to Langres Troyes to Langres is possibly the quietest days riding we have recced in France!  The area is very pretty with a mix of lakes, forests, open countryside and sleepy villages.  There are few claims to fame, Charles de Galle came from the area and the Viaduct at Chaumont is an impressive three story railway bridge with over 50 arches and spanning 600 metres.  Langres is an old fortified hill top town.  Again there are no significant individual climbs but over the day we gain 300m of ascent so the whole day is uphill. 163km
1,704m
Day 6
9th Sept
Langres to Belfort As Langres is a hill fort the day starts downhill.  This is the longest day of the tour at 189km and also has the first big climb of the Tour, the Col du Ballon d’Alsace which was the first offical climb of the Tour de France in 1905.  It has been included in the Tour de France no less than 20 times.  The offical climb from St Maurice is 619m over 9km with a maximum gradient of 8%.  Luckily from the summit this there is a 30km decent to Belfort to enjoy, making the distance less of a challenge. 189km
2,376m

Stage 3: Belfort to Geneva

Start/Finish Description                                                    Km/m
Day 7
10th Sept
Belfort / Yverdon L-B Heading south from Belfort, we cross the Jura mountains.  There is a fair amount of climbing but the highest point is for the day just over 1100m so not especially high. There is some cluture on the route too, La Chaux-de-Fonds is a World Heritage site and centre of the Swiss watch making industry. The town is referred to by Karl Marx in Das Kapital and was birth place of the architect Le Corbusier.  From here we head down into the spa town of Yverdon-Les-Bains. 167km
3,312m
Day 8
11th Sept
Yverdon L-B /
Morzine
Day 8 takes us through Montreaux and into the Alps. There are two options for the day.  The ‘easy’ option is to ride directly to the hotel in Morzine however, for the climbers there is the opportunity to add the Avoriaz climb onto the route when you arrive in Morzine. This adds 30 km (14km up) and 850m of climb to the day but Avoriaz has has been a stage finish of the Tour de France so has kudos and if you are Bernard Hinault it only takes 33 minutes to the top! 151km
3,492m
Day 9
12th Sept
Morzine /
Geneva
The final day is a proper day’s riding.  It starts with the famous col de Jeux Plane which, even from the ‘easier’ Morzine side, is 11km long with over 700m of ascent. The second col of the day is col de la Ramaz which is another big climb before our final climb of the Tour over Col de la Croisette which gives great views of Geneva and the lake.  From here it is all downhill to the hotel and dinner. 125km
3,381m
Fly Home
13th Sept
Geneva We have a celebratory dinner on the evening of the 12th and expect people to be heading home on the morning of the 13th.
Posted in Cycling, Diabetes Management, Diathlete | Tagged , , , , , , , , , , , | Leave a comment

DiAshes

Cricket and Type 1 Diabetes

The Ashes series is back! England Vs Australia in the cricket. Now perhaps the game of cricket isn’t the most popularly played sport in the entire world today, not even over here in England, however, it is a classic sport and when it comes to rivalries they don’t come bigger than England and Australia! Whilst the two nations battle it out over the next number of weeks, I’ll share information here on the various potential effects that type 1 diabetes can have on blood sugar levels during a game – or any sport that may be similar in exercise.

As I begin this blog I will reflect that I was there in Australia during the last Ashes series, even seeing a game at the Adelaide Oval – well for the few minutes it took for the last English wicket of the Second Test to be bowled out by Mitchell Johnson. England lost the ‘5 Test Match’ series 5-0 down under, it was a disaster from an England perspective. Every bar around had the cricket on all day long whilst over there – it is big game in Australia which unfortunately doesn’t quite get treated with the same passion over in England!

adelaide oval

On the cricket field there are various forms of activity and roles going on, with different styles of batters and bowlers – which could well mean there are alterations in the impact of blood glucose control.

For those unaware of how the sport is played, each team has 11 players to have a turn on the bat. This is called an ‘innings’ – tallying up the amount of points your team can get on the bat until 10 members of the team are ‘bowled out’ by the opposition. The batsmen are active in pairs, working together to score runs for points and running together to make the ‘crease’. The Ashes Test Series has two innings for a test, this means that both sides have two opportunities to score points on the bat, with a maximum time period of 5 days for one test. The Ashes, as mentioned above, goes on for 5 tests in total.

So what happens to the blood sugar levels in this endurance?

Joe Root is probably England’s key player if they are to go on with any chance of winning! He is better known for his skill on the bat. If Mr Root had type 1 diabetes the chances are his blood sugars would actually spike during the game. Cricket is a lot different to a sport such as football, where you are constantly on the move, but the affects could be similar as the pace constantly changes. Joe Root and whoever is partnering him will have to suddenly burst into a sprint to score runs, when / if Joe hits the ball far enough. Runs are scored by hitting the ball into the field, hopefully not caught by the opposing fielders, and exchanging places with your teammate batter, who will run from the ‘bowler’s crease’ to the batter’s crease in your direction. The more times you can exchange places, the more runs you can get! But be careful as the opponents will try to throw the ball at the wicket, which is what the batsmen defend, and get you out if not back in time.

That sudden burst is likely to increase blood sugar levels, as Joe would go from a movement of concentration into a sprint after hitting the ball, as he often does (shown in the first test!) which would raise his levels during activity. Now whilst sugar levels can spike in this kind of exercise, it should not be forgotten that it is still exercise – energy has been burned. So it is possible that if Joe Root is staying in for a long while – as he did in the first test (big smile) – he is burning lots of energy smashing the ball and running around, so his levels (if he had type 1 diabetes) could crash lower later in the day post exercise. This is something people with diabetes have to look out for and the best way to do that is by keeping a close check on blood sugar levels.

The swings of the ball on the bat is a lot more physical and whilst the various forms of movement can cause the body to release naturally stored glucose from the liver to spike levels, the energy of hitting the ball is actually often the opposite effect – lowering levels. This is something I have tested out in sports such as Tennis too, when playing a game it is constant changes of pace, spiking the levels during, but when serving a ball it is the opposite, blood sugar levels decrease. I also found this in Rugby when I played as a school boy – on the ball, sprinting around to progress up the pitch, levels can increase, yet the physicality of the game, with plenty of contact in tackles, drops levels significantly more. So with different sports come different alterations in affects.

In cricket the opening two batsmen are known as ‘openers’ and it is their job to try and frustrate the bowlers by staying in for as long as possible. They don’t go out to smash the balls into the boundaries – which scores 4 runs is going over the boundary line, 6 runs if smashed high over the boundary line and into (or out of) the stadium. The likes of Root might go for that but the openers will look to play it defensively and pick up runs every now and then. With that in mind, perhaps it is more of a case of stroking the ball and not as much running. This is more likely to cause a decrease in level. Alistair Cook is England’s main opener so that would be the likely outcome if he had type 1… well, actually his sugars would probably stay the same as he never seems to last very long before being bowled out!

For a bowler there is of course energy being burned up too. It is a sudden burst of energy in two areas, firstly the sprint to run up to the bowling crease and bowl the ball at the opposing wicket. Secondly, the power to be unleashed when bowling the ball. These are two forms of anaerobic exercises, which go from being still to suddenly powering energy. Again this means the likely outcome for a bowler would be an increase in blood sugar levels during activity. There are different forms of bowling though, a ‘fast bowler’ goes for all out power, so the mentioned affect could account for the fast bowler. Back in the 90s and early naughties the Aussies had Shane Warne, the most stereotypical Australian man who has ever lived! He was also the greatest ‘spin bowler’ ever – which means he wasn’t about powering out wickets, he was more tactical and would spin the ball from bouncing in a wider position to suddenly drawing in and taking the wicket of the batter. This meant more concentration was on his way of bowling more than the speed and this could be similar to the physical impact mentioned about batting or other sports, decreasing levels.

It is interesting to see how the different movements can have massive differences on the body when it comes to type 1 diabetes. The best way to understand your own body is to regularly keep close checks on your blood sugar levels, before, during and after exercise and activity – you can recognise a pattern in your blood sugars and make alterations in carbohydrate intakes or insulin. For an example when I run ultra marathons or long distance, I know I need less basal insulin in my system and alter it to a reduced amount, a different times – going from two split injections of basal a day into three split, at reduced amounts. Testing my sugars has been key to me figuring out the best methods for my activities. I also used to increase basal before football matches as I would find levels going too high during the game otherwise – then levels would crash more quickly after, so again by testing I knew to eat within half an hour of a game and take a unit or two less bolus insulin for the meals to help stop the hypo coming later.

The best way to understand sports control is to test, test, test your levels! We do need the resources for that, which in many locations aren’t cheap or easy to get! So there’s a key issue in the world and I hope to show that by having those resources we can achieve anything in any walk of life, particularly in sport!

And in terms of tests – England are now 1-0 up against Australia after winning the first Ashes Test in Cardiff. Why it took place in Cardiff when it is ENGLAND v Australia, I don’t know (we didn’t play them in New Zealand down there…) but now we’ve won, we’ll take that! 4 more Ashes Tests to go this summer – and plenty more blood sugar tests for us during our activity is the best advice!

Ashes-001

Posted in Diabetes Management, sports | Tagged , , , , , , , , , , , | 1 Comment