NZMS Diabetes Sport and Exercise Weekend
On August the 5th I took a direct flight from Bangkok to Auckland to attend the NZMS Diabetes Sport and Exercise Weekend held at the Millennium Institute on the North Shore. On Sunday it was my turn to speak and I thought I would share an abstract from my talk here, just in case you were interested:)
Now I'd like to share with you, some of the things I do to prepare and partake in multi-day endurance events and adventures in the backcountry as a diabetic, and how others may be able to get involved.
The single biggest factor I think it comes down to, which applies to most things in life really, is attitude and perception. We are what we tell ourselves, we cannot control all the obstacles we may come across but we can control the story we tell ourselves about them, and this is the most important story.
Diabetes is as ‘bad’ or as ‘hard’ as we choose to make it. Yes we are married to it but diabetes itself does not have to define who we are. It is certainly only one part of my life and I think this shift in attitude is the most crucial for being able to take part and lead a life of confidence with this disease. Diabetes is not an excuse to eat badly, stay at home or miss out!
I have reflected on how one can develop a bolder ‘can still go anywhere and do anything’ type attitude, and embrace the unknown (something you must do a lot when adventure racing) when we live with a chronic illness. We do walk a fine line between wanting to be like everyone else and actually letting people know how serious the complications can be if we don't look after ourselves.
I think the answer is that we just have to make a start first because we will never know if we don’t try.
I acknowledge that because I was diagnosed with diabetes a lot older, I had already started, I was pushing my limits, challenging myself in the outdoors without the disease or without knowing I had it already, so I had those experiences to draw from which has given me this innate sense of security/confidence in my own ability. Some situations I have been in while racing have been so extreme- running out of food while in the middle of a 48 hour trekking section in the fiordland mountains during godzone, that any time I return to civilisation and come across a challenge with my diabetes it is easy for me to say ‘I’ve got this’ because I have that bank of experience to draw from.
Training for and competing in these endurance events involve constant trial and error with the variable disciplines involved and the different duration, intensities, frequencies and locations of my sessions, means that it is always going to be an on-going process because there are so many external factors like the weather and terrain that you can’t control. Although, we have to make a start to be able to gain these learnings and experiences. Set the goal/enter the race, commit and then give yourself enough time to figure it out along the way. That is what adventure racing is about, just like life, being able and open to continually adjust and learn, and being able to ask yourself the question- what is motivating me? why am I doing this?
So there is the psychological side which I believe is so important and which I think can often get overlooked in the care and management of diabetes and then there is also all these little practical things we can do to help us be the best we can be when we are active, compete and live with diabetes. These are some things that work for me.
What I have done religiously from the start is to record everything I eat, do, inject and what my levels are. I use a little notepad I keep with me at all times and it seems to hold me responsible for what I am doing. I suppose most people would prefer an app, either works. I find this is really good to identify patterns and refer back to in different training phases to see how my body has responded and how I can learn and adapt.
Lesson 1: Diabetes has a fickle nature, any patterns you find are key!! However, you have to be constant with recording to generate some viable data.
When I look at these phases I can adjust my insulin to suit. I think having a dynamic insulin regime and again, being open to adjustments makes for a successful athlete. I find that I can really reduce my insulin a lot more during speed phases coming up to competitions (especially multisport races that are between 4-7 hours long) and my levels are much more stable when I am doing harder/shorter sessions. This is largely due to the increase in insulin sensitivity (the body can use less insulin for any given amount of glucose) which occurs during sessions which use the anaerobic energy system, an energy system which sustains short, fast bouts of exercise and which primarily uses glucose for fuel. The use of stored glycogen from the liver, muscle and the replenishment of this during recovery after the session is great for lowering blood glucose levels. This means that my insulin regime is really dynamic, for example my lantus injections range from (4-15 units), and if I am in a speed phase of training I don't find I need much novo-rapid before meals or not at all over a 24 hour period- normally I might take around 10 units a day.
Lesson 2: Be dynamic, don’t be afraid to change things if they are not working because only you know your body. It’s great to take advice and get guidance from specialists, but I believe it is good to get more confident doing it ourselves because we know our bodies best.
One thing I will say is that I am more on the cautious side with my insulin regime. I prefer to inject less and run abit higher to avoid lows when I am training and in general I have very few lows anyway (this is to do with diet as well which I will get to).
I often wonder why many diabetics (I know) avoid exercise for fear of going low or getting out of ‘control’. I would argue that alot of diabetics let this fear stop them from getting out and exploring more of the outdoors and pushing their limits. Maybe these kinds of activities are not for everyone but we are all aware (at least to some degree) of the important role that exercise plays in reducing the risk of many health complications. The only reason we will ever go low is if we inject too much insulin or take too much medication. So why not dial back the pump, pen and/or pills and see how you go. You might just surprise yourselves, we will never know if we don’t try. The reality is that exercise is a stress and stress produces adrenaline, and adrenaline is a hormone which stimulates the release of glucose from the liver and muscle. So we are going to go higher than the recommended ‘normal’ range and sometimes we might go too low.
Lesson 3: Afew little highs during exercise or throughout the day are not going to kill me. The some of parts make up a whole and with good averages, comes healthy HBA1C. I have learnt to not beat myself up trying to achieve perfect figures because it's just not realistic or healthy!
I still have a long way to go because there is still so much I don’t know about managing diabetes while adventure racing. I have to navigate this adrenaline spike/glucose spike which occurs at the start of a race, the mixture of nerves, excitement and the sudden demand for oxygen to working muscles does present a situation that needs consideration. I have always struggled with that explosive speed off the start line, I’m usually fine after 30 minutes to an hour in and I wonder if my diabetes has anything to do with this. There are numerous theories and I am fiddling around with injecting some fast acting on or very near the start line of faster 4 hour races so I can avoid running so high during my races. I still have many questions around glucose utilisation and uptake in the muscles. I probably should go back and study!
This brings me to my next point; testing. It seems obvious that testing more is safer and best practise for the best results, however it can be quite hard during these sorts of events.
I test before I start every training session to get a baseline and only once during training if it is over 3 hours-,also depending on what I have eaten/injected and at what time before the session and what type of training I am doing i.e if it is higher intensity bursts I might bring something with me. I don't usually eat anything unless my session is over 2-3 hours in duration but I always take something just in case. This is because I have usually made sure I have eaten and digested enough before I start the session.
During shorter race up to 6-7 hours I don’t usually test during the event because it’s practically really difficult-i.e when kayaking, stopping would also lose valuable seconds. In transition areas would be ok but this is also the time you want to minimise. It’s not ideal and this is where the CGM technology will make competing and living with diabetes much easier. I personally believe that continuous glucose monitors are the way forward for adventurous people. They are such a great tool to use to be able to monitor exactly what is happening with our levels and make quick adjustments at exactly the right times. It is my hope that they will become more affordable and accessible in the very near future and I will be able to run one. To test often during adventure/multisport races we need this technology.
Generally my levels are usually quite up-down while racing and I can be up in the 20's usually, although his doesn't seem to affect me all that much when I am going, I find that it makes the recovery alot longer and the lag effect. Expedition races with the lack of sleep really mess with your hormones and I find this causes a lot of volatility with sugar levels once I stop.
In the longer adventure races I take my smallest testing kit with me at all times and I try to test every 4 hours, although again it’s hard in the rafts and on the bikes. I carry my novo-rapid pen and I work out exactly how much insulin I will need to carry on what leg and work out which box to place my lantus in so I don’t have to carry it but sometimes I do with timings of different legs.
In the last few godzones I opted to really increase my lantus, and inject minimal novo-rapid because I didn’t want to risk timing the novo-rapid wrong, there is an element of uncertainty (you don’t know where you are going to be on the course until you are there because there are so many variables) and having a hypo out there is not ideal. Hypo's take abit to bounce back from. Keeping it simple with only lantus reduces the faff time.
An interesting phenomena I have found is that paddling can drop my blood sugars really fast because it uses smaller muscles which have less capacity to store glucose and therefore they draw glucose out of the blood faster. It is also the nature of the food which is ingested during the race, the weight restrictions on our gear boxes are so tight it is impossible to bring lots of fresh produce so finding foods which are lightweight but also not packed with sugar is difficult. Which brings me to my next point about food....
One of the biggest factors along with exercise that I find to have a profound effect on my blood glucose control is what I choose to eat. I have always eaten a large amount of fresh produce but since being diagnosed with diabetes, my diet consists mostly of whole foods (very little packaged/processed food, not much fruit and no refined sugar or wheat). I love it. Eating more nutrient-dense foods in their natural form, is more sustaining, they even out my blood glucose levels and I find that I don’t ride the blood glucose rollercoaster. I don’t have to inject as much insulin because I’m not having to correct the highs. It is a win/win I find because I spend less time worrying about my diabetes and more time actually living.
I find that my exercise cannot always compensate for a highly processed, sugary diet/meal /training/racing snack. I avoid all the traditional high GI race foods and use/make/find alternatives like mashed kumara in transition areas; bananas, bliss balls variations and homemade smoothies-chia, berry, maca, protein, peanut butter, seed crackers/cheese, smashed avo and tuna, miso, kale chips, corn chips, coconut chips, mixed nuts, almond meal and buckwheat muffins, bread and pancake alternatives, yoghurt. Yes they do cost more in time to make but I go better for it.
Lesson 4; You can never be too well prepared with diabetes. Eat well and consistently when out on adventures or racing.
The combination of eating well and exercising regularly has a profoundly positive effect on my diabetes and it is something I am extremely passionate about sharing because I feel that it is a much healthier than just injecting lots!
Diabetes really was the push I needed to pursue this passion of mine which is to empower people to take responsibility for their health to truly live their best lives they can. I strongly believe that if we can look after ourselves better, by making the time to eat well- sourcing local, fresh whole foods and by moving (exercising regularly), then we can be so much happier and productive in life. It costs our government and most importantly us, a lot less! I feel that we need to start with the kids and teach them how to garden and give them an appreciation of where food comes from, what they are putting in their mouths and how this affects the planet we live on.
This is what drove me to apply to be the International Diabetes Federation Young Leader in Diabetes for N.Z in April 2015. Since returning from young leader training after the congress in Canada in 2015. I have set up a local support group in Wanaka, mentored teenagers, been guest speaker at numerous events and I have organised events to fundraise money to help some of our local kids cover some costs of the consumable and technology they use.
On the 14th of November 2015 World Diabetes Day I rode my mountain bike non-stop to the height of Everest (8848m) of vertical ascent up the 7km treble cone gravel ski field road, which was 9.3 laps in about 20hours of riding. My aim was to raise more awareness of diabetes.. I had local support from friends, family and generated abit of media too which was great!
I was lucky enough to get to use a freestyle libre which was so informative!
Go big or go home was my motto and with this in mind I set about planning Jerry's tour.....watch this space !!
