Wednesday, 24 December 2014

Second Pump Lucky, CellNovo Fails, Roche Insight to the rescue?

Noticing again how long it has between blogs, I really should stop implying that I’m going to do this weekly, perhaps a commitment to publish somewhere else would be what it takes.  I can feel another entry adbout making promises I can’t keep and burning the candle at both ends coming on.  But that’s another time really. Suffice to say that this September to March period doesn’t get any easier year on year; I take my normal workload and add at least 50% and then try and maintain training as well.

This October was worse than usual, losing two Tuesdays to getting started on the Cellnovo pump, and of course that tends to then disrupt the entire week from any kid of travel point of view.  I also had a trip to Trinidad, a training course and two new team members to break in. November had trips to Reading, Edinburgh, Tunisia and the Orkneys and December had another training course, Aberdeen and then on my supposed week at home another trip to Addenbrookes and one to London. Overall, I’ve had 8 weeks in a row with travel and three of the last 13 weeks overall at home.  In amongst that I’ve had a failed pump, reverting back to MDI and restarting a new pump, so that’s two lots of basal testing to deal with and a set of completely screwed up repeat prescription.
That’s not to say “poor me”, it just is what it is, and I wouldn’t still be doing it if I wasn’t still enjoying it, but I am looking forward to ten days break at Christmas

So why two pumps? Well let’s just say the Cellnovo did not live up to it’s concept.  In fact it was downright unworkable.  The idea was good in principle, but in hindsight if I’d been given all of the information at the time of choosing I may have held off for what I eventually ended up with, the Roche Insight.

So the concept with the Cellnovo is to have two programmable, rechargeable pump bodies, controlled by a separate handset with integrated BG meter.  You then connect an insulin reservoir to the pump after having filled it with insulin from a 10ml vial.  The reservoir has a short piece of tubing (50-150mm being the versions I had), which then connects to a separate cannula. The pump body has a bit of one half of Velcro stuck to it and the other side is stuck to your skin and holds it in place.
So what was good about it was the size of it and the short length of tubing, and the rechargeable nature of the thing.  Assuming it was working, the not so good bits were
  •   A lot of stuff to carry about, spare pump, insulin reservoirs, syringes and needles, cannulas (with excessive packaging), bits of Velcro
  • The pump had pretty sharp corners, meaning that you had to be very careful with placement and it was not as comfortable as I imagined when sleeping.
  • The insulin reservoir has a hard wired timer in it, with a three day limit (which I had not known about beforehand). This timer gave a 12 hour warning, once, and then at 72 hours exactly, whatever you were doing, the pump stopped and there was no way to extend this however inconvenient it might be.  The real effect of this was a lot of wasted insulin in my case plus a need to plan changes early, wasting more insulin
  •  The handset was in regular contact with the cloud, every few minutes day and night which had two effects, the handset battery being little more than a day and in my case acting as potential source of ignition on petrochemicals plants.
The practice was worse than that, and I’m not the only one to find this. As a result of around 10-12 people who started on these around the same time as me, I think only two are still using it and Addenbrookes are not offering to more patients until the problems are ironed out.

My specific problems included:
  •   One complete failure of the handset. Simply decided not to unlock itself. Particularly annoying as this was just two weeks into use and I was also suffering an unknown pump failure at the time (from the beeping going on) and I was in the middle of a three hour drive.  I eventually unlocked it to then need to replace the pump with the spare one and a new insulin reservoir, wasting the one I’d changed earlier that day.
  •   One completely failed pump, just stopped working.  Would not communicate with the handset and developed a tendency to eject it’s insulin reservoir spontaneously.
  • I had repeat problems with insulin reservoir changes.  The concept being that the pump and reservoir were attached to each other, synched and then got on with it.  In reality, I was experiencing several failures in this system with pump and reservoir losing communication and/or just failing to synch to start with resulting in the need to refill a second brand new reservoir. 
Overall, as a result of these issues,  it was causing me more stress than reassurance.  Coming back to all my travel this autumn, I ended up carrying extra supplies just in case of failures and I basically lost all confidence in the pump though not knowing whether or not it was actually going to work at any time.  So when I was given the option of stopping it and moving onto the Roche Insight I jumped at it, even taking a three week break from pumping altogether.
You might think this was a rash decision, but not really.  Roche are a well proven name in the game of insulin pumps, and this was my second choice anyway.  The only thing that turned me off of it was the tubing, but there are several other features that I hadn’t known about beforehand that I see entirely as positives.

  • Use of pre-filled insulin cartridges (only 160U which is an issue for some, but not with my low doses) that can last 6 days before replacement, based on risk of denaturing.  Cartridges very easy to change with a simple endcap that is a push, twist, lock fit integrating the tubing.
  •  Alternating the cannula only and full cartridge change every three days. The cannula inserter is great as well, with a very clever mechanism to hide the introducer needle.
  • Handset battery is superb, lasting three days or more so far, and can be turned completely off.  
  •  Handset auto start on insertion of a BG test strip.
  •  Less obtrusive during exercise

Not so good
  • No rechargeable battery usage in the pump itself, uses AAA lithium or alkaline only.  Battery life good so far though
  • The tubing – 70cm so far, still getting used to that, and I’d be lying if I said it wasn’t intrusive, but putting the pump in an arm strap MP3-holder is reasonably unobtrusive and comfy to sleep in.
  • The size of it – it’s quite a bit bulkier than the Cellnovo which was matchbox sized, where the Insight is about the size of an old-fashioned pager.
  • Need to tailor the supplies, so far I only have supplies of cannulas with the tubing and cartridge connector. I need to tailor this to be a mix next time.
Overall though, it’s been a damned positive experience and BG control so far is good. My insulin usage is actually even lower than on the CellNovo as the Insight has a 0.01U/hr basal increment rather than 0.05U/hr.  Starting from the basal setting I’d got to on the Cellnovo just needed a few tweaks during the day time with the night test being done as I type.  I’ll write up the general procedure on another occasion as a blog on pump management (not that I’m the expert yet), and I’ll include the other thing I really like about pump usage, which is the BG management during exercise, which so far has been an absolute boon with a massive reduction needed in carbs to fund exercise just because I’m xx hours away from a bolus or haven’t dropped my basal 10 hours earlier.

So, Merry Christmas to all, and I’ll see you soon.

Sunday, 23 November 2014

Another Race, Another PB at the Grunty Fen Half Marathon

So, two main things to report this time (and I know it’s a long time since the last one)
  • My Mid-September half-marathon, with another PB and a lot of pain
  • My change to an insulin pump in mid October and the quite profound change on some training habits that it’s helped with.  This is going to wait for another time as I think it’s going to be  a bit longer than I thought.
Starting with the HM, it’s quite dim in my mind now, possibly in an attempt to blot out the pain ahead of the next race, and partly just due to time and business.   The race in question is the Grunty Fen Half Marathon ( nice and local to me, just 5 miles to the start. This one had long been on my list of target races and this seemed like a good enough excuse.

Thinking about the build up to it, if it had not been one on my list of 5 PB attempts for the year, trying to raise money for JDRF and Highfields Friends and Parents Association ( then perhaps I would have DNS’d for the first time ever in a race.  Six weeks earlier I’d run a 40-miler with a dodgy achilles tendon (coming in 13th) and had almost two weeks of no running afterwards, slthough my pace when I did start again was pretty good.  Luckily I was doing a job in Hull the week before – not lucky to be in Hull, but luckily my route to get there went straight past a very good sports injury specialist I know, who gave me a very good treatment and I went off again much happier.  A few short runs in the week leading up to it and I was OK to get to the start line, even if unprepared in terms of any speed training.
Now cast your mind back to September 2014, one of the hottest on record, and it didn’t let up for the day of the race and there was also a pretty stiff breeze from the west which would affect the course for about 4-5km in the second half of the race.  Maybe not ideal conditions for attempting my 1:39 race plan with a 1:43 PB, albeit one set on a mixed road/trail course without the need to test for BG every now and then.  

So, the day came anyway, I was entered, I might as well go for it and see what happens.  If I went down trying that’s no shame and a bad day at a race is better than a good day in the office anytime.  Normal race day preparations; cut basal dose right back to 0.5 units, no bolus for breakfast and rely on a few gels to keep it in the right place.  I’d planned the BG testing as well, and had trialled different distances for testing, coming down to 7km being OK without being too risky, so that would mean two tests during the race at a cost of probably 1-2mins at race pace.
BG before the start was obviously adrenaline affected as it had not come down at all post breakfast and was sat at 10.5. Anticipating a drop in the race, I took a gel which out it up to 12.2 immediately pre race. Nervously I got to the start in time to clap out the three wheelchair racers and lined up alongside my target start time. All too soon we were off.  A very quick run out and down the hill (15m high) to the bottom of the village and out onto the fen and the exposed flatlands of Cambridgeshire.  Talking advantage of the water stations I grabbed an early sponge and was rewarded with a cooling drench of water down my back.  About 2 or 3 miles in, the wheelchair racers came haring past at a rate of knots having already completed their first shorter lap of about 8km or so and out onto the longer second lap.

Number 193, "flying" off the start, elbows out in the bunch.  The guy to my left in the blue took off and I then passed hom later, blowing at the side of the road.

The first lap was relatively straightforward with not much in terms of into the wind stuff and I was pretty much on plan for pace, finding a few people to run along with for a while here and there, taking advantage of the water and sponges as I went.  First BG stop was OK, slightly higher than planned, but expecting a drop again, I took another gel.  This was also about the point at which I hit the hill (all 20m or so of it) to head back into the top end of the village again. Second time around it was going to be tough in that heat.
Second, longer lap, almost took advantage of the drinking and running club’s beer stand but though the better of it. Again, as with the first lap, the early part of this second lap was no real issue apart from the heat, with a few sections into the wind making the negative split pace plan start to look challenging. 

Another random photo JDRF vest on full display

It wasn’t until after the second BG test (again sitting around 9 or so, another gel taken) that we turned into the wind for a long stretch.  This is where it got really tough, and where I started to see the early rabbits limping along by the side of the road.  This was also where the early gains I’d made vs current PB started to get wiped out and saw me end that long into wind stretch just about on PB pace, but nowhere ahead of it.
The hill made it’s second appearance about 3km from the end and luckily this time I had a decent pacemaker to follow up it, a bloke I’d been trailing by a few metres for most of the second lap.  Now I normally have a good finish, being prepared to suffer to take a few extra seconds off my time.  This was no exception, I must have passed at least 20 people in that last few km, including the guy I’d trailled up most fo the hill.  I put in a quick spurt about ¾ of the way up, just to se if I could break his morale.  I heard him jump on the back of my heels, so put in another spurt, and another until a backwards glance showed him at least 30 yards back.  Coming into the final km I started trading places with a much younger, and evidently very fit female runner, alternately passing and then being repassed by each other until she finally made a break I couldn’t answer, but at least it spurred me on. 

Final time 1:42:58, overall position 160th of 529, so top 30% overall and 32nd of 63 in my age group.  But most important of all – a PB.  Time without BG testing, would have been nearer the 1:40 mark.

Pace profile below shows just how much that 4km into the wind took it out of me. I'd split this into sections with target paces for each.  You can see by the HR that I'm not taking it easy, average HR of 165 for over 90 mins is about as much as I can manage.

Avg Pace
Avg HR
Max HR

Photo of “team Highfield” a bunch of other folks also running for the school

BG at the end was up to 10.8 with the adrenaline, and spiked up to 13.8 half an hour later and then 15.5 at +60 minutes.  I resisted the urge to compensate, waiting for the inevitable fall.  Post race lunch had 15g carbs, and as I was still high at 9.0 I gave a correction there and almost overdid it, coming down to 4.3 2 hours after lunch, which really goes to show the delayed hypo potential is pretty real.

Friday, 19 September 2014

FAQs - How to low carb and still do endurance

So someone asked me about ten days ago

"Hi Dave,

I would be really interested to hear how you exercise on so few carbs, I would really like to be more active, but exercise usually equals hypos! and therefore more food, now would be a good time to mention my average daily carb intake on a non exercise day is around the 230 mark (I like my carbs). I eat pretty healthily, I cook all my dinners etc, but I really struggle to find filling low carb or no carb foods and meals, any tips you have would be really appreciated.

Thank you"

Today I finally got some time to put my thoughts down while sat on a train. Time offline can be useful after all.  Here's my answer.

As pointed out above, insulin and exercise are not the best of bedfellows (within reason). What you need to understand is what insulin does and what the non-pancreatically deranged body does in response to exercise. Essentially (and yes I'm simplifying here) insulin does three things that are relevant here
1) transport glucose to muscles
2) lay down excess glucose as fat (also prevents/limits its use)
3) suppress glycogen (prevention of liver secretion of stored glucose)

 What the normal body does in response to exercise is to significantly reduce the amount of circulating insulin. This is not a problem in terms of glucose transport into cells as you become more insulin sensitive and also there is a Glut-4 receptor which becomes more active and provides a glucose transport function.

That's the potted science bit, and next comes the more empirical/experimental bit with myself as the hamster.

Essentially you need to separate aerobic vs anaerobic exercise as the body responds differently to those, the difference essentially being the release of the stress-based or counter regulatory hormones like adrenaline and cortisol, also glycogen which are in response to stress and serve to provide that liver dump of glucose. In steady-paced aerobic exercise those hormone are absent, or almost so. The difference for me is therefore type of exercise and circumstance. Weights/strength training including yoga for me is always anaerobic; races while having a strong aerobic component as well also have the stress response; interval training is also anaerobic. These can both be characterised as stable or increasing blood sugar.

Aerobic exercise by comparison is where I can find the precipitous fall in BG if I'm not careful. This could be anything from an easy 10k to a 40 mile race (low stress with these).

Here insulin is really not your friend. You can deal with it in two ways 1) eat more carbs to compensate for the drop, or 2) reduce your insulin dosage or a combination.

Thinking about that, higher carbs diets therefore lead to higher insulin consumption which then lead to higher likelihood of problems during exercise due to residual insulin kicking around.

Things you can do

1) exercise in the morning, fasted, and even before a basal dose if you are MDI - no circulating bolus, limited basal, limited cause for BG to fall.
2) give yourself plenty of time between bolus and exercise. Novorapid is supposed to have a two-hour profile according to my consultant, but that's a load of bollock$ in my experience. Last night for example after a 1U dose for a lunch of left over Indian cauliflower, omelette and a pear, I was at 4.9 at 5:30pm, a 15g carb snack and 5km of running later I was down to 3.9. Another 10g snack and 5km later and I was down to 3.5.
I would therefore give yourself at least 2 hours before exercise, preferably 4+ and be prepared to eat. The only problem there is that this was 25g of carbs that were then preferentially used instead of fat burning.
3) reduce your insulin dose. Both Think Like a Pancreas and Pumping insulin have guides for bolus dose reduction factors, but in my case I have to be more radical than them as I have extreme insulin sensitivity with exercise (been doing it all my life and spent years on training for efficiency).

If you are going to be doing extended exercise then you can also reduce basal. At the extreme end of this for my last 40-mile race I took half a unit of levemir with breakfast of 45g carbs, saw an expected rise to around 12, then a drop back within 3 hours to nearer 7. No more insulin during the race with moderate carb intake over the next 8 hours and was relatively steady at between 5 and 7 most of the time.

So, how to do that endurance stuff on low - moderate carb. Adaptation of diet and training is the key, and it's not an overnight thing. I'd spent about two years prior to diagnosis extending my heart rate based training from cycling to running as well. This allows the creation of a massive aerobic base capable of efficient fuelling and fat burning, so that when you need it you have plenty in reserve at the top end. Reduce your intake of refined carbs. I've had one slice of bread in the entire week so far. Refined carbs are OK as part (but not all) of the fuel used in exercise but add very little nutritional value long term (think burning straw vs charcoal), so try and utilise low GI carbs where you take them. I use things like oats, veggies, fruits, seeds, beans and lentils high fibre stuff. Not too much protein as the excess is turned into glucose by the body. Don't be afraid of fats - monounsaturated fats are a great source of energy and keep you fuller longer, but you need to be aware of the calorie density. Olive oil, rapeseed oil, coconut oil are all good butter and cream are OK as well. Cheese, meat and oily fish are good, but be aware of the protein content as well.

If you really want to you can go ultra low carb, higher fat, moderate protein and try to get into nutritional ketosis (very different from DKA), at which some people have reported significant improvements in overall performance.  Some find that as I do, they need to throw in some carbs during exercise, others don’t.  For me personally I’d like to have a bash at the ketosis bit, but with my work and travel patterns this becomes quite difficult.

Take today, a quick trip to my office in London, breakfast was a two-egg mushroom omelette, no carbs, no bolus.  Lunch will be around 30g carbs with one of the M&S packaged low GI superfood salads and a few handfuls of nuts.  Dinner will be no more than 30, maybe 45g carbs.

Other good low carb breakfasts, a cup of coffee and 2-3 handfuls of nuts keeps me full until lunch, or a mix of waitrose frozen berries, sheep or goat yogurt, sprinkled with chopped nuts or flaked coconut for 15g carbs.

Dinners and lunches tend to be the most difficult with my job as it can come down to a sandwich or something with rice, pasta, potatoes etc, but you can simply leave those aside.  Dinner for example, my wife makes stir fry, I just have a big bowl of the veg and protein, no rice or noodles.

One thing that really stands out here though is the lack of education given to diabetics in both the value of exercise in managing the condition, but also inb successful methodologies.  I'm lucky in that I understood much about physiology and sporting performance before diagnosis, so I just needed to relearn my bodily responses to exercise.  Most diabetics are just given insulin and told to get on with it.

I also had the chance, while on the return journey to listen to the podcast below (downloaded to a tablet, so no phone connection charges).  It's an interview with Dr Phil Maffetone who's trained severl top class athletes and who's methods certainly warrant listening to.  I've reashed several PBs and massively improved both performance and enjoyment of running by following his methods.

What else?  HM was last week, report will follow. 

Friday, 5 September 2014

Inov-8 X-Talon 190 vs Trailroc 255 and post Grim restart

So why am I comparing an out and out off-road fell running shoe with a trail running shoe you may ask?  Well, I’m not is the answer, at least not really.   I’m not going to hide it, I’m an Inov-8 convert, currently I have 4 pairs of their shoes all of which fill a niche in my needs and all of which do what they aim to do well.  I’m not a complete shoe snob, I have two pairs of the same ALtra shoe (one not yet worn) and a pair of Merrells, both of which I’m happy to wear in the right place.  I also have a dead pair of New Balance zero drop, but they are now relegated to the indoor rower until they finally fall apart. 

But back to the topic at hand. Six weeks before Grimsthorpe, I was happily intending to run the whole race in the X-Talons, but as you know I went and screwed up my achilles.  Now the X-Talon 190s are not really the ideal shoe for Grimsthorpe in the dry as it’s fairly light trails and about 50% tarmac, but I thought my alternatives were a bit too lightweight.  The X-Talon excels in the soft and squishy stuff and on the downhills on slippery wet rocks as I found at the Yomp Mountain Challenge (twice), so is a bit OTT for a dry-ish Grim. 
In comes the Trailroc to fill that gap between the F-lite 195 (which is great on the road) and the X-Talon 190. 

So where is it similar and where is it different? Let’s start with the last, the basic framework of the shoe; the F-lite and the X-Talon are essentially the same show but with a different sole, built on the same natural fit, which some have said is a bit narrow across the toebox.  In my view however the flexibility of the upper and the lightness of the shoe completely overcome that and the whole package is light and flexible. 
The Trailroc by contrast, although supposedly built on the same precision last seems much wider across the ball of the foot.  Looking at the pictures, I’m not convinced that it is, maybe that’s an artefact of the Trailroc being a much more structured shoe overall.  If you look at the comparison photos, you can see that where the X-Talon is the pared down  speedster – The Range Rover Evoque perhaps, the Trailroc is the Land Rover Defender – definitely an uprated V8, but still a defender.  It’s clearly built for the long haul, with rubberised bits around the toe to deal with stubbing your feet on those loose rocks and catching edges of things, whereas the X-Talon is designed for plunging into a peat bog and shedding water.

Taking a look at both side and top view it’s obviously a well-made well thought out shoe.  I couldn’t find any evidence of a single manufacturing defect (unlike others where I’ve had to trim a sockless liner to prevent blisters) and looking at mine after a 40 mile race they stand up very well.  Colours as usual are the typical lurid combinations and the ink and orange I have is by far the most sober of the bunch. 
Turn it over though and here’s the interesting bit, looking at the sole it’s got some big beefy lugs, so obviously going to offer plenty of grip on both loose gravel and light mud, but interestingly the lugs are not too big for dry hard trails and even sections of tarmac either on the approach or transition between trails.  The other really interesting thing to note here is the colours and sections on the sole.  Now that’s not just to make the boring part of the shoe look a bit more interesting, but it’s three different compounds of rubber to give a harder wearing compound where the sole takes the most beating (as opposed to my soul which takes a beating on pretty much every run if I do it right).  That’s always been one drawback of the X-talon in that it has a very soft compound to give it the grip, but at a cost of high wear on road and hard trail.

The Trailroc also has the meta-shank stiffening in the sole, which when you are more of a natural runner like me, could be a bit of an issue, but we’ll get to that.
Looking side by side (excuse the debris on the X-Talon, I told you it was a no-road shoe) you can see the slight difference in height and construction, and also if you look closely you can see the one vs two chevrons so a 6mm drop on the Trailroc vs 3mm.  Again, that’s going to affect the wear of the shoe.

So before we start talking about the experience, let’s summarise the shoe.  A theoretical 255g (mine weigh in at 280 for a UK 8.5, worn a few times) which is theoretically 65g/2.5oz heavier than the offroader, but still a pretty light shoe compared with some of those slow and steady LandCruisers of shoes out there.  As per most Inov-8’s I went a half size up from my usual and was happy with that choice.  The shoe fit perfectly in the width, with just enough space in the toe to accommodate a bit of downhill and a bit of swelling of the feet (I’ve never lost a toenail to running yet and don’t intend to).  The lace structure again has had a lot of attention paid to it, pulling the upper in right along it’s length and providing a very comfortable fit that is improved more by paying attention to how you pull the laces in rather than just yanking on the free end.  That plastic cradle on the outside gives great stability all round without being instrusive and the shoe just hugs the foot to help improve the feeling of ground contact.
I had plenty of toe wiggle room across the front and they felt light and airy once on.  On the run though you can immediately tell the difference between these and the two lighter, lower drop offerings.  With the 6mm drop and the heavier shoe, I was immediately running with a flatter foot, with the footstrike coming back to much more horizontal and a light heel touch rather than the ball/toes of the foot before the heel comes down.  That’s not necessarily a bad thing, remembering after all that I bought these shoes to take some strain off the achilles by altering my gait in just that way.   You can definitely feel the weight differential though, slight as it is, if you’re used to running in those lightweight shoes as I’ve been doing for three years.  Again that has some benefits, as after running in those for some miles, now that I’m back in the lightweight performers for a road HM, my pace is markedly faster at the same HR (also a function of fitness and the good base of an ultra, which is the subject of another article I think).

So, comfortable, but slightly heavy.  What about the rest of it? Grip – perfect for the light, dry hard trails and light mud in my experience so far, also nice and cool with that mesh upper if not quite as good at shedding any water.  The tongue is nice and padded as well to give enough protection from the laces on the longer runs.  Let’s face it, I did 40 miles in a pair of these so they are a decent comfy shoe and robust enough, and that soul is definitely hard wearing and certainly does the job it was well designed for.
Which brings me back to my earlier point, this is not really a comparison at all, but more of a contrast and one that shows that yet again the thought going into the design means that Inov-8 have hit the nail cleanly on the head with this shoe.  So far I’ve no real drawbacks with it and am looking to see how well it goes long term.

Now to the post Grimsthorpe.  Once I’d recovered enough to be able to walk again, I stuck to my word and took two weeks off from running, putting in the hours on achilles rehab, yoga, the bike and a bit of indoor rowing (where I managed to strain an intercostal instead).  That was definitely called for, but then left it a bit late for my HM, just 6-weeks after Grimsthorpe with 4 weeks to try and get some speed into the legs but not set the achilles back to where I started from.
So far it’s not going too badly.  With that lay off my legs seem to have found themselves an extra bit of pace without my asking. They just seem to want to go faster and I’m not stopping them.  Target pace for the HM is sub 4:50 per km and everything has been run at that pace or faster with one exception.  The bike has also had a decent bit of use and that’s where I’ve been doing the steady work. 
The pace plan, hydration plan and BG management plan is now all set and has been tried on a 12km at race pace session and refined a bit.  The overall plan is a negative split i.e. starting conservative and getting faster during the race, with an extended 7km between tests, so I only need to test twice during the race.  I’l llet you know how it works in about 10-15 days.

Wednesday, 6 August 2014

Grim Reaper 40 mile race 2014, a success of sorts

So, Thursday 31st July, kit bag by the door, running kit checked, nutrition checked, medical box checked, camelback checked, tent checked.  In reality it had all been checked at least 5 times already but I checked it again anyway, and still nothing wrong. 

The one place there was something wrong however was the achilles. About a week before the race I’d posted on facebook that I rated my finishing chances at 60:40, and it had survived a 98km bike ride the day after.  Another week of rehab and I was optimistically thinking 75:25.  This had the potential to become my bogey race after two DNFs in previous years, one in awful conditions of torrential rain for 12 hours before and then for 12 hours of the race (it has longer events than 40-mile as well) and then in very hot conditions, similar to this, but with training disrupted by my diabetes diagnosis.   This time though I was determined to finish.
The nutrition and insulin strategy had been discussed with the Diabetes Specialist Nurse at the hospital and based on recent performance we’d settled on 1 unit basal, a good breakfast with no bolus and keep an eye on it before and during the race, taking my half-unit pen with me just in case.  The risk with the pre-race strategy is that I’d drift too high with no bolus, the optimal point being around 8-10mmol/l to allow a drop in the first 5-10km and then hopefully a steady rate through the race, eating to the meter.   Of course there was always the possibility that adrenaline would kick the blood sugar higher as well, but to be honest this race has always been pretty low key for me.

So it’s an early start this one, a race start of 9:30 means 5am wake up, 6am departure and 7:30 arrival to get my tent set up, change into the race gear, get race head on (that starts 3 days before really), check and re-check bloods etc, but that early start means a quiet start.  No-one else up at that time of day, all mine.  
I arrived right on time and already found a big tent city, luckily room for my small one right at the front, part of the strategy to minimise the rest time and distance from control tent to my tent.  The basic format for this race is a 10-mile lap around a country estate on a mix of roads, hard packed trails and mud/field edges, electronic timing at a control tent and points on the course and returning to your tent each lap for as long as you want, but the clock keeps ticking.
In my case I had my prepared nutrition and hydration strategy, tuned to my race strategy.  Over 10 miles, I was banking on around 2 hours per lap, so 80g carbs plus a bit just in case.  That was in one of my boxes, elastic bands around each bundle of bars and gels.  The camelback would be filled with 2 litres of Nuun hydration solution, which at 500ml an hour (by long standing experiment) should last me 2 laps.  The plan was at least one or two hard, fast (for me) laps until the achilles could take no more with a very quick back to the tent, grab the next bundle and off again. After that run/walk or whatever would get me to the end.  Of course I also had plenty of carbs in reserve and a plan B and C if necessary, but mentally I was prepared for pain and lots of it. 
Pre-race the blood sugars went a bit like this
5am Waking 7.0 (high in rebound from a hypo the night before, why then of all times?)
Breakfast 45g carbs, no bolus, 1 U basal
+1 hr, driving 6am 9.7
07:30 – 12.2  - I’m getting a little twitchy here with the novorapid pen
08:30 – 7.3, not quite sur ehow that much of a drop happened on that little insulin
09:00 – 7.3 – a quick fig roll just in case
Race briefing over, assemble at the line, another wait for the cows to be moved, another quick test on the line 09:20 – 6.1 what happened to that fig roll? Half a 9-bar for luck.

Lap 1 – intention run it hard, but maybe not as hard as I did, completed in 1hr 32 including the return to the tent for supplies, a record for me at this event and not far off training pace for a 10-mile run.

5km laps were 26:47, 27:37 and 29:00 so slowing a bit but also reflecting easier terrain early in the lap. Drinking at the 5km tests and where I was walking the uphills and more difficult sections.  BG was pretty much behaving itself with 5km tests of 9.2, 7.2, 6.7.  A total of about 70g carbs taken during the lap, so that would be about 45g per hour, pretty much right on schedule.

Quick return to the tent, pick up the next bundle of food, and out, no need to refill camelback or bottles, time check and off I go.

Only problem was it was just starting to warm up now, but I still wanted another faster lap while the achilles was holding up.  On the first lap it had really not been painful but there was a bit of discomfort moving around between heel and lower calf, but nothing worth worrying at.  Second lap it really started to bite; not so much the achilles but more so casuing other issues.  If I kept myself landing fairly flat footed in the middle, the 6mm drop Inov-8 TrailRoc’s were aiding the achilles, keeping that eased, but then the gait was throwing more strain onto the hip flexors and quads as I began to discover.  Towards the end of the second lap the early pace was beginning to tell, and I was thinking about going onto a yomp style 1km run/1km walk for the next two laps. 

Lap 2 played out like this (5km splits and BG)
31:06 / 8.9
31:08 / 7.8
32:44 / 6.0
43:23  / 6.0 – this one included the lap 2-3 transition and a camelback refill, taking about 4 minutes, plus a bit of lap 3 walk/run.

Total carbs about 40g in 1hr 46, so pretty low by any standards, but eating to the meter seemed to be working OK. At this stage a quick remark with Keith, the organiser cemented the walk/run strategy in my mind.

Lap three started to get really tough, hot, no cloud cover, humidity increasing all the time.  Added to that the pain in my quads was spreading to hip-flexors and ITB, but the walk 1km/run 1km was pretty much stuck to apart from increasing the walk on one field margin section of pretty hard going and uneven ground, only to have the next run on easier ground extended a bit as well.  To be honest this was now getting bloody painful, but I knew that having done the best part of three laps and having DNFd twice, it was going to take a lot to stop me completing that last lap.  It was hurting, but I was in a better mental place than ever and prepared to go through any pain and out the other side.  The thing that really sticks in your mind during these things is the other people, all going through the same personal trials as you but every one of them in this race full of smiles and chit chat as you pass each other, no matter who’s going faster or slower, makes no difference.

So Lap 3
36:36 / 6.3
39:32 / 7.2
49:03 / 5.6 – including a 6 minute transition, refilling camelback and a short rest this time
Around 50g carbs in 2hrs 05, so still around the 25g per hour mark, much lower than most people would predict.

Lap 4 has no other way to describe it than 10 miles of pain.  Quads on fire, hips on fire, brain on fire; I’d been drenching my Texas Longhorns baseball cap every lap at the control point and it was giving me about 15 minutes of cooling before it was dry again. Oddly enough although my head was roasting, I kept getting waves of cold throughout the race and waves of sickness as well, but that’s all part of the fun.  The run/walk was becoming fragile now and was erring towards 1250/750 and then later in the lap became run when I could and walk when it hurt too much.  The odd thing is that throughout these last two laps I was able to maintain the same running pace as always and a pretty decent pace as well at around 5:30/km or a 9-min mile, the only thing was I couldn’t keep it up and it was as if my legs were just switching off.  I also ran out of water in that last lap with about 4km/2.5 miles to go, which was not at all ideal.  I’d checked in before the start of this lap and was lying 19th, but I knew I was passing others. My walk was quicker than some people’s run and as always I was passing people I’d seen go past me on laps 1 and 2 and with a quick word established that they were also on the 40 miler.

5km laps and BG
39:46 / 7.8
34:53 / 6.8
44:50 / 8.7
06:02 / 3.7 – no idea where that came from, but this was a very short section following, mainly due to an odd course measure (I did a total of 65.7km vs 64)

Total 55g carbs in 2hr 8 mins, so staying at that 25g/h including a gel for that 3.7 outlier.
Eventual total time 7 h 50, finishing 13th of 107.  I’d passed 6 people on the last lap, or they’d pulled out with less than 10 miles to go.  Considering the achilles problems going into this I was chuffed to bits to finish where I did and ran over the finish line a very tired but happy man.

Then the recovery started, coffee, eggs, ½ bagel and PB and plenty of nuun hydration salts and water. Post race BGs

Straight After    7.4 – 22.5g carbs
+30min             10.7
+75 min            9.9
+105min           8.6
+3hr                 6.8
Dinner              7.2 – 45 g carbs, 1 U bolus (would normally be 3U)
+2hr                 6.4
Evening           6.7 – 3.5 unit basal (normal is 4.5, but adjusted for increased sensitivity post race)

Total for the race about 240g carbs, so around 30g per hour while racing, much lower than any text book would suggest. I think the reason for this is my years of low heart rate training which have effectively trained me to utilise my fat burning/fat reserves very effectively at these moderate pace for long durations.

And the next few days? Ouch!

I went down to see my sister in Hampshire for a few days and being bothered about potential insulin sensitivity and erratic blood sugars I asked the other half to drive. Only trouble was that sitting still for 2 hours had my lower limbs seize up completely so when we stopped at the halfway mark for lunch I had to take over.  The next two days were not fun with stairs being a particular problem, but just walking along my quads would occasionally fail to fire on demand, threatening to dump me unceremoniously on the floor.  I was also finding other things not working well, such as my shins which were in agony and both ankles.  I also found a very unexpected piece of chafing on my rear end.

Four days later though, a 2 hour bike ride at an average 18.5mph (28.5kmh) was tough on the legs, but the HR was solid throughout.

Mission very definitely accomplished.  Now for 2 weeks off running and then a 4-week campaign before my next event a fast road half marathon.

Plus a couple of piccies, tent farm, castle, assembled throng of loonies