Monday, 5 August 2013

Caught by the Grim Reaper

So, this time last year, give or take a month I toed the line for my first ultramarathon in an absolute downpour and ran 40 miles on a quagmire before DNF at 40 miles.

Three days ago in overcast conditions, threatening to get very hot later and nice and dry underfoot, I toed the line again to run the same course and to try and beat it this time.  The only difference was this time I was running with a camelback with hydration bladder whereas last time I used a waist pack with one handheld bottle as well; and one other thing around 8 weeks before the race I was diagnosed as Type 1 diabetic.

To be honest, yes it did interrupt training a bit leading up to the race, but no, I didn’t feel unprepared. I actually felt fairly well trained and well tapered and I had a plan.  The thing that was bothering me more was the blood sugar management but as with everything else plan, plan, plan and it should not be a problem.

I’ve spent the last 8 weeks trying to understand this condition and how it affects me, and then plan a strategy to deal with it, including training runs of 2 and 3 hours going into it, but your guess is as good as mine in terms of what was going to happen over the next 14 hours plus.  That wasn’t going to stop me trying though.

The plan needed to take into account two main issues:-
1) Exercise induced high insulin sensitivity – as you exercise your endocrine system makes several changes to improve the transport of circulating blood glucose to the active muscles.  One of these is to activate additional transport mechanisms such as the GLUT4 pathway, but the other is that you become much more sensitive to insulin i.e. you need much less to do the same job. Normally your pancreas does this automatically, but my pancreas comes in a syringe these days.
2) increased transport of glucose to your muscles is pretty much at its max when running in steady state at close to your aerobic threshold. Again as a T1, your body is no longer as effective as it used to be in maintaining homeostatis by dumping glucose from stored glycogen into your bloodstream.

That, and experimenting gives two main parts to the plan
1) reduced morning insulin doses – Basal (levemir) down from a normal 6 units to 3, breakfast bolus (novorapid) down from 2 units for the meal I ate to one.
2) during the race, monitor blood glucose every 6km (approx. 35-60 mins), trying to run slightly high at 5-9 vs the normal 4-8mmol/l
3) steady intake of carbs throughout the race
4) if blood sugars are drifting higher >12mmol/l twice, then consider taking a unit of rapid acting insulin next time I come back round to the tent

pre-race briefing with Rob Bryn (fell asleep on the course) and Jane Benson

The Tent Farm

So, with that in mind I got to the start line amongst the biggest entry for this race so far. With adrenaline and low dosages in the morning, my BG levels had drifted up a bit to 8.7, but I knew that would come down quickly enough. Quick couple of photos and we’re off. Familiar territory with the long drag down the hill past the lake on tarmac, before turning left up the first gentle hill on a bit of roughed up old tarmac (which I swear was a limestone trail last year) and then onto the first trail for real.  The field is of course now starting to string out so I can see a line of bobbing lycra and dayglo shirts and jackets in front of me.  As normal the first lap is going a bit faster than the plan by the time I stop to take the first test.  Lots of other runners checking that I’m Ok as they pass me, a few even know me from past events and online, but all routine so far.  5.7, well within the range, but keep eating regularly and keep the fluids going in as it’s starting to warm up.

At the bridge, courtesy of Kev Taylor, lap 1 feling good.

That was the pattern for the rest of the lap, on a mostly well remember course, but with a few alterations for this year, dib the timing chip at the right points and keep going.  Last year’s slippery mud hill of scrambling and sliding was an easy walk and the long grassy stretch afterwards was dry and firm underfoot before getting back onto the long tarmac drag with a great view of the castle and back down to the final field section and then through the woods.

Back to the start/finish straight to find mum and dad there waiting to take a few photos.  Quick visit to the tent to replenish supplies and take stock.  Fluid intake was lower than intended, carbs intake a bit lower than intended, but broadly in the right place.  Plan error number 1 – too much choice of stuff – even though it was clear in my mind beforehand what I was going to take, I’d packed extra and ended up giving myself too many choices.  Result – dithering at the tent after a quick first lap of 1hr 40.  

End of Lap 1

The only soggy bit of the course

Blood sugars still OK, testing at the tent each lap as well as every 6km, dib out again to start the next lap.  1hr 46 on the Garmin, so around 7 minutes taken at the tent.

At this point I was in Merrell Trail Gloves, with injinji socks and a few toes taped to prevent blisters and with an ankle KT taped against an old injury.  The Trail Gloves are great in dry conditions on light trails with small stones underfoot.  They don’t do well in mud as the tread is not particularly aggressive, but for the conditions today that was not a problem.  What was a problem was where someone had dumped a load of fist-sized lumps of rubble and limestone in all of the potholes along one section of the course about 2-3km long all ready to turn an ankle and also spikier than the rock plate on the Merrells could really handle.  But that in itself was not a problem as the plan was two laps in the Merrells and then switch to the Inov-8 X-Talon 190s, with the possibility of change back later, or a change into my Altra road shoes.  The latter was dismissed early; the Altras would just not take the trails here.

In hindsight, I’m not sure if my eventual troubles were caused long this stretch with any kind of twisting on one of those rocks.

End of second lap, a bit slower at 1hr 50, nicely to plan, now much closer to the target place, but still a bit quick.  Took more time at the tent this time though, planned sock change, foot check, shoe change, all OK. Unplanned toilet visit but I may as well do it here as on the course.  Hydration and nutrition better this lap.

About three km into the lap my left knee starts twinging.  As I’d had no hint of any knee trouble in any training I assumed it was just one of those slight niggles that runs itself off.  But in this case it didn’t.  As I went round the lap it started to get progressively worse and worse, affecting my run walk plan and getting seriously painful.  I’d gone from run 3km, walk 2-3 minutes to run 1km walk 300m and by the halfway point was down to around equal walk:run.  After that it took a serious downhill turn and as I hit the long stretch of tarmac back down the course I was down to around 200-300m running before the pain got too much and then walk the rest of the km.  The knee was now also starting to pull on other things with the left ITB now also starting to get painful as it started to take some of the load in compensation for the other bits of my leg that were not working properly.  Pace as expected was going well out of the window now, and I was thinking about whether I had enough time to finish the course walking the rest of it.  With about 5km of the lap to go though, the pain was just getting too much and mentally I had pulled out, but I was definitely going to complete the lap.  I even called home to tell them I’d see them later that day instead of Saturday morning as planned.

Walking in after lap 3, that's a grimace, not a smile

I walked the final km across the start/finish line half an hour slower than the second lap at 2 hours 30, well behind any original pacing plan.  Luckily I bumped into Gary Benson, there to crew for his wife Jane, eventual first lady in the 100mile race. Gary did a quick assessment of my leg and applied a KT taping on the ITB and I tried to set out again.  I got about 200m down the course before the pain in the knee stopped me again.

That was it, for the second year in a row I’d been beaten by the Grim Reaper. First time by the conditions, this time by injury.

Importantly though, I had not been beaten my diabetes.  My blood sugars were in good control for the 6 and a bit hours I was out there with only two readings lower than 5 and those being followed by readings well within the target range.

A ten minute chat with Gary helped in that he couldn’t point to anything in my training that might have been an issue, and that he thought that it was just one of those things, an injury picked up on the day.

For those that are interested, here’s the BG record throughout the race, as sent by e-mail to my specialist diabetic nurse/dietician at Addenbrookes.

Waking, 3 units Levemir, 1 unit Novorapid, a bit low but not outside my normal range on waking
After Bagel and eggs, coffee, OK to drive
pre race
16km lap 1
32km lap 2
48km, lap 3
post lap 3, after bagel with PB,
Ready to drive home again
back home, pre dinner, pasta and veg at 8pm, 55g carbs, 2 units Novorapid (would normally have 3)
2 hours post dinner, 1/2 bagel eaten to prevent an overnight low, should have only had one unit Novorapid at dinner.
4 units Levemir vs the usual 8.


And here’s the Garmin trace

Overall I took in about 310g carbs over the 6 hours plus another 40 or so directly afterwards, plus protein and fats from nuts with three hard boiled eggs straight afterwards.

The other thing to note, for any other T1s or insulin injecting T2s is that you will stay insulin sensitive for a while afterwards.  I took my usual basal dose on Saturday morning, but took only half or less of my bolus doses and still experienced a drop in blood sugars after some meals.  By Sunday I was still not quite back to normal and needed to snack twice to avoid low blood sugars.

Learning points from this?

1) I truly think that I need to moderate my ambitions here.  Both this year and last, I struggled to fit in the required training just because of the travel with work, and in this case my pre-diagnosis diabetic symptoms and then post diagnosis learning curve

2) my nutrition strategy needs tightening up

3) shoe choice?


Actions arising

1) find a 30-40 mile ultra next spring and complete it.  Get the monkey off my back. Think about the Grim Reaper 40 next year.

2) Nutrition – give myself less choice; one of the other competitors had planned in detail with each lap’s nutrition pre-defined.  I like the idea of that, defined nutrition, defined carbs, protein etc, but with a buffer included as well and enough post race recarb and protein.

3) Shoes – the Inov-8s were the best shoe for that terrain, they were a great shoe on the Yomp as well.  I like Inov-8s, need to look at more of their lighter trail shoes as well as my Trail gloves need replacing through wear anyway.

4) get the fluids going in earlier – I had a litre on the way home and my wee was still very dark.

In some ways quite disappointed with this, my second DNF on this course/this event, but in other ways quite excited knowing that it was injury that took me out, not blood sugar control. 


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