So, you’ve got type 1 diabetes and you’re going to run 250km in a remote desert location. Most people have no idea what the potentially dire, life-affirming, and exciting consequences of that choice might be.
Never mind them, though, this is about you.
And the spectacularly creative and personable thing about diabetes is that it’s yours, and as much as many elements are predictable, your own experience and manifestation of your D will have its own quirks that may be like nobody else’s. Read this with that in mind. There is no right answer for everybody and if your experience and knowledge of your own physiology clashes with what’s recounted or recommended here, please open up a discussion in the comments or contact me directly via my twitter feed @trailfiend.
There are many other issues to consider – especially in your training preparation, gear, nutrition, and preparedness planning. But these are some crucial self-management tips I really hope the other type 1s taking on the Big Red Run in the Simpson Desert next week (WOOHOO!!!) are thinking about.
Diabetic Desert Domination
1. 1. Don’t Panic
There’s a perfectly good reason that Douglas Adams nominated this simple mantra as the first rule for successful navigation of the universe: it works. If you register a high blood sugar on the run, don’t dose immediately to correct. Go through a mental checklist
– Was my hand/glucose strip/meter/lancet device contaminated by sports drink/gel remnants/sugar debris?
– Am I still high because of the insulin-blocking effect of adrenaline from the run (using a constant glucose meter to check my own response, this takes me high from about 15 minutes before the starter’s gun until the first half hour has passed)?
– Did I take in some much needed carbohydrate in the last 20-30 minutes?
These are all very realistic causes of elevated BGL readings, and if you correct on the run without checking these first then you risk a performance-torpedoing low blood sugar (hypo).
2. 2. Test twice.
You’ve quickly rinsed your hand with plain water – not the water with the flavourless maltodextrin in it, you have dried it by hanging it out in the air as you run rather than wiping a sweaty, Gu-covered t-shirt all over it, you have considered whether there are any other factors contributing to your high, and you have taken a 2nd reading after making sure your glucose meter isn’t glucose-contaminated.
– Sugars are actually in a functional range! Congratulations, crisis averted, well done on not panicking, the extra 90 seconds of self-control you exerted means you will have your day in the sun… literally.
– OR it’s still high, even after checking your CGMS and thinking about what could be going on AND taking account of your ultrarunning fuzzed thought processes.
3.3. Get amongst it.
This is a code to live by at all times but especially in remote locations when you are the best qualified guardian of your own wellbeing. Nobody else around you knows just how wild and playful your diabetes can be when you take it for a solid run, how it reacts to an intensification of effort, dehydration, suspended basal, a ten-minute shoe-fixing break, etc.
If you are staying high, YOU HAVE TO DEAL WITH IT, and do it CALMLY and SENSIBLY.
Is your pump primed, is your canula delivering, did you remember to take your Levemir this morning? If these mechanical kinds of question relating to the behind-the-scenes stuff have all been dealt with, and the front-of-house problems haven’t yet been resolved, then you need to act.
4. 4. You’re so sensitive.
That’s right, you hipster SNAG Silver Linings Playbook-watching girly man. Being active will increase your insulin sensitivity. Being active for several hours at decent intensity will really increase your insulin sensitivity. And until you have done it a couple of times, you will be amazed by the effect that running 40km every day for 3 or 4 days and then doing an 80km day will have on your sensitivity.
Being high for any prolonged period – even an hour – will really effect your performance later by dehydrating your system, and even just by making you feel sluggish and even nauseous. But, see point 1. Don’t panic!
If I am high on a long run and need to dose to sort it out, I will NEVER take more than half the dose I would need at rest, and I will usually take much less.
Example: My BGL has been 15 for an hour, I have no extra insulin on board, and I would normally take 2.7 units to bring this BGL back to 6.0. ½(2.7)=1.35. So, allowing for increased sensitivity from running multiday, and because I am planning to maintain a decent effort, I will take perhaps 0.8units of insulin. I will check in with myself in a half hour to see how my BGL and body are responding, and act accordingly.
5. 5. All options are on the table
This is not military diplomacy, but I do have a full arsenal. I can throw in drinks that taste like water but deliver a high dose of CHO quickly. I have gels with and without flavour. I have caffeine and I have practised with it enough to know what it does in my system. I have spare slow-acting insulin, I have multiple spare vials of rapid acting insulin kept in different locations throughout my pack in case unexpected impacts cause breakage. I have spare insulin pens and old school syringes. I have enough spare peripherals of all sorts including extra meters and batteries to last for a month, never mind a week. I can unplug my insulin pump on the run and swallow 3 gels in one go if need be. Even if sugars are low or high I can push on. I am hydrated because unlike most of the moving parts in this system, my kidneys are not disposable.
And if worst comes to absolute worst, I can always slow down and regroup.
As I have recommended here before – check out www.exT1D.com.au, join up and get informed. It is one of the best online tools you will ever find for becoming a more capably active endurance athlete (or any kind of athlete) with type 1. If you’re feeling technical and want to see some juicy papers online, check out www.runsweet.com. And I will always recommend www.missyfoy.com, www.certainintelligence.blogspot.com, and www.integrateddiabetes.com.