Over the weekend I was in Transylvania, the home of Dracula, contrasting weather conditions, warm-welcoming people, beautiful women and most importantly the type 1 diabetes association called ASCOTID!
Ascotid were hosting a conference in marking their 10th anniversary of being active, called the Diabforum, which went on for 2 days: Friday 9th & Saturday 10th September – and I had the pleasure of being there to attend and speak too. On the Sunday Ascotid hosted the 2nd ever ASCOTID TRAIL RACE event, a half marathon (or 8km cross country) in the hilly woodlands outside Târgu Mures.
Although I wish to talk about the running and type 1 diabetes side of things in this post, I will first say what a fantastic job the organisation does in particularly supporting children and families living with type 1 diabetes across the region – which is even more important when you consider there is a lot less support available in Romania and Eastern Europe; patients receive roughly 1 test strip a day with their prescriptions. There isn’t much funding available in their healthcare system, and whilst fortunately insulin is made more available, patients still have to buy a lot of supplies for themselves – which isn’t easy when even a job as high profile as a Doctor only earns 500 Euros per month!
At the conference it was fantastic to meet up with my friends, Matyi and Cristina, who I know from the YLD programme, and we were also joined by fellow young leader Daniel, who drove with his family 7 hours from Budapest! One of the points I wanted to make to some of the professionals in the audience was quite simply if you invest more today in key elements such as greater test strip availability, to give patients with type 1 the opportunity to better know their blood sugar levels, then in the long term future they will save money as more patients would have better control with less risks of future complications.
Last year at the first ever trail race ASCOTID hosted it was a big honour to be there, to bring my Olympic Torch and help draw awareness to the event. The run itself though didn’t go to plan for me, I struggled in all honesty as my legs were suffering a bit, a few previous frustrating injuries were reoccurring and there was a lack of time to prepare. The race itself was very tough, hot conditions and woodland running! So I wanted to go out and improve this year in the trail race.
Above all else, diabetes is the main reason I was there and the main reason I run any way – it is always a race with type 1 diabetes in a sense. That is the main competitor.
Tactically you have to make the best decisions to gain the best blood glucose results during activity; it kind of makes running with diabetes an exciting hobby…
So my pre game plan was to ensure my basal (long acting) insulin was most effective for the run, which would be long, continuous burning of energy – lowering my blood glucose levels during the activity (as opposed to potentially spiking the levels with sudden bursts of sprints). On an average day in taking multiple daily injections, I split my background rate of insulin with two long acting injections of Levemir, 14 units for the morning and another 14 units roughly 12 hours later in the evening. In regards to the challenge, I would not remotely need so much basal insulin in my system, as with too much basal and aerobic exercise it would make a hypo inevitable!
I made the decision to inject my evening basal insulin a few hours later than normal, with 16 units instead of 14. To avoid going hypo in the night, I had carb-loaded quite well in eating a pizza for dinner! So I knew with the level of fat and carbohydrates in my meal I wasn’t going to crash.
By injecting more basal, it may seem mad before running the next day; however, my genius plan was to not take any morning dosage of basal insulin before the run – with the run scheduled for 10am. So I had a bit of insulin remaining in the system from the evening before during the run but not too much to send me hypo – albeit with some carbohydrate top-ups required during the run.
My blood sugar level when waking up was 9.8 mmol/l, which the morning after a big pizza isn’t too bad going, and I would certainly say a good level to start running on!
It is not what the level is but what the level is doing, which matters.
The heat was very strong during the run and it only got warmer! There wasn’t much time for me to prepare for the race beforehand, with many photographs taking place and such a warm welcome. That is perhaps difficult in preparing to run; however, enjoyable in terms of the event. We are there to entertain, raise awareness, bring positives to the cause. So it is worth lapping it up!
I was made an honorary citizen of Târgu Mures by the random knights that were there to start the event, and began the run with my Olmpic Torch and citizenship scroll in hand! There were two races taking place and in starting at the front it was difficult avoiding the fast 8km distance runners, whilst I tried to save energy at a half marathon pace. One guy did clatter into me!
At the entrance of the woodlands I managed to hand over my torch and scroll and run my race. From then on it was about pacing myself in the early stages, saving the energy in the tank and improving the pace as the race went on. That is how I like to run (albeit in road running) finishing strong the essential bit – with the additional aim to keep a good blood sugar!
In not presently being on modern technology, I did not have my blood testing meter whilst running, which is something I recommend you have! My experience was the crucial part and a supply of gels accompanied me on the the run, with also 5 checkpoint stops for runners which also included energy supplies.
The insulin plan proved effective and I took gel boosts at the first 3 of the 5 checkpoints. For the later checkpoints I didn’t feel I needed gels and perhaps there was even less basal insulin in the system, so I just opted for water – which was of course also essential with temperatures in the mid 30s!
Overall I was happy with the run, far away from home, in different conditions and the woods; a first competitive race for a long time. It wasn’t others I was racing against, it was my race and diabetes. Nobody overtook me when in the woods, I built the pace and caught runner after runner. The final hill was an absolute monster after peaking with a good stride. The rise in pace could have also created a slight rise in blood glucose with my burst of energy in the final 5km – I finished sprinting but most importantly I finished with a level of 10.2 mmol/ls!
That may have been the end of the running race but of course the diabetes race goes on… Having stopped running this meant I also no longer had basal insulin in my system, which would make my blood glucose float upwards like a hot air balloon! So, in being aware of this, I took a shot of 1 unit of Bolus (quick acting) insulin and also had my basal insulin (which would kick in more slowly). It was around midday by the time photographs were taken and stretches were out the way, so I also injured less basal then normal having just endured the exercise, taking 12 units down from 14. My schedule was only an hour out in terms of 12 hours between basal injections, having taken my insulin later the evening before, and I later took my evening basal just an hour and a half out of that bracket, at 10.30pm, again with a unit less of my normal dose (to help avoid night time hypos, when levels might crash post exercise).
Keeping a close check was important and the levels worked out very well, it was good planning all round so I was pleased! With the evening meal it was very much a protein based meal but for the carbohydrates I had, I injected a unit less than required in Bolus insulin too.
I went to bed at 8.3 mmol/ls and woke at 5.3 – so all in all good running and better ‘Dia-Sherlocking’ to figure the diabetes out!
I know the whole wording, the tweaking and the general process of monitoring the levels may sound confusing; if you do not live with type 1 diabetes this whole post is an absolute alien language for sure! But to simplify it, everybody is different, it is your own experiences in living with diabetes that teaches you the lessons such as when you tend to go hypo or hyper with your blood sugars in sports, or with meals, and there is always an answer. You gotta do the Dia-Sherlocking and figure it out sometimes but the experiences you have develop your understanding and you are the boss, you make the final decisions from insulin to carbohydrate intakes – live, learn and keep on running.