A Type 1 diabetes triathlon day
Written by: Herbert Krabel
Date: Fri Jan 16 2009
We all know how involved a triathlon day can be. Imagine now suffering from Type 1 diabetes and thus having to add all kinds of activities to your event.
Team Type 1 has been fielding teams for the Race Across America (RAAM) for a few years now and more recently Team Type 1 also has been quite competitive on the road too. For 2009, Team Type 1 will have a triathlon team that will consist exclusively of competitors who have Type 1 diabetes. Currently there are 10 team members and their race schedule for 2009 includes the Avia Wildflower Triathlon, the Nautica New York City Triathlon, the Chicago Triathlon and the Longhorn Ironman 70.3 Austin.
Matt Vogel* the team manager of Team Type 1 triathlon describes one of his days in detail. Initially he thought this would be a simple exercise of outlining a few things that people with diabetes must do to prepare for a triathlon, but he surprised himself when he looked at the total thought, preparation, and trouble shooting that goes into managing diabetes while training and racing.
Wake up
1. Check blood glucose (BG): refer to chart below
a. <50 mg/dl: not good, eat lots of fast-acting carbs, may not be able to race
b. 50-80: not ideal, eat some fast-acting carbs
c. 80-150: things are great
d. 151-250: not ideal, take a little insulin
e. 251-320: not good, take some insulin, check for ketones
i. If ketones are present, do not race
ii. Ketones: acidic level in blood, a byproduct of using fat (not glucose) for energy.
f.> 321 dangerous: take insulin, check for ketones, do not race
2. Calculate grams of carbohydrate in breakfast
3. Give insulin based on the individual’s insulin to carbohydrate ratio
a. Example:
i. Bowl of oatmeal (30g) + glass of milk (15g) + a banana (30g) = 75g of carbohydrate
ii. Insulin to carb ratio (different for everyone) = 1 unit of insulin for 15 grams of carbohydrate
iii. Math: 75g divided by 15 equals 5 units
4. Wait 5-15 minutes for insulin to absorb
5. Eat breakfast
6. Get dressed and leave for race
Pre-race: Transition area setup
1. Triathlon stuff: Setup bike, helmet, sunglasses, cycling shoes, towel, running shoes, visor, race number, water bottles, gels, bars, and body glide.
2. Diabetes stuff: glucose meter, test strips, lancing device, backup glucose meter, and extra insulin all in an insulated pack (so it doesn’t overheat).
3. Emergency supplies: lots of fast-acting glucose tablets, glucagon kit (hormone shot that releases all the glucose in your liver, to be used when lose consciousness), and a note explaining I have diabetes, what to do and/or call in case of an emergency.
60 min before race start
1. Check BG, refer to chart above
a. Sometimes the excitement, anticipation, and stress of a race can cause BG’s to spike.
2. Consider any insulin that is still working in my system (typical duration of insulin action is 3-4 hours)
3. Use my insulin pump to decrease the basal flow of insulin delivery: 80% decrease
a. People with diabetes need less insulin during physical activity
b. The more active you are, the less insulin you need
4. Eat a bar with 30-45g of carbs
Pre:race: Swim warm-up
1. Put on wetsuit with insulin pump secured in jersey pocket.
2. Tuck gels up wetsuit sleeves, just in case BG gets low during the swim
3. Put on cap and goggles
4. Jump in the water and get warmed up
Race: Swim start
1. Focus on swimming
2. Continually monitor the way I feel
a. This is the only way to make sure I’m not having a low blood sugar reaction.
b. You can’t test your BG in the water, the electronic meter will short.
T1
1. Take off wetsuit
2. Dry fingers and do a BG test, refer to chart above
3. Put on cycling gear
4. Load pockets with extra gels, bars, glucose tabs, and BG meter
Bike
1. Focus on riding
2. Eat 15-30g of carbohydrates every 20-40 minutes to prevent low blood sugar
3. Continually monitor the way I feel
a. “Am I tired because my BG is low, or is it because I’m just tired?”
b. “Am I cramping because my BG is high, or is my body low on salt?”
4. If something feels off, I’ll pull over and check my BG.
T2
1. Take off helmet and cycling shoes.
2. Dry and clean fingers, do a BG test, refer to chart above.
3. Put on running shoes, race belt, visor.
4. Load pockets with more gels and glucose tabs.
Run
1. Focus on running.
2. Eat 15-30g of carbohydrates every 20-40 minutes to prevent low blood sugar
3. Continually monitor the way I feel
4. If something feels off, I’ll stop and check my BG
Finish
1. Sprint and cross the finish line with a big smile
2. Dry and clean fingers, do a BG test, refer to chart above.
3. Return insulin pump basal rate to normal.
4. Measure the carbohydrates in my recovery drink.
5. Calculate the needed amount of insulin and reduce by 20-50%
a. With the increased level of activity, my body will be ultra-sensitive to insulin.
Post Race
1. Check BG’s every 1-2 hours.
2. Be aware of low blood sugars, due to the day’s increased activity
3. Eat normally to refuel body
4. Count the carbs and take a reduced amount of insulin for those carbs
5. Be extra careful while sleeping
a. Extremely low BG’s can occur in the middle of the night.
b. Go to bed with a higher than normal BG (~175 mg/dl for me).
c. Set an alarm to check once or twice in the middle of the night.
d. Keep a supply of rapid acting carbs within reach of your bed.
* Matt Vogel is not a health care professional and is simply sharing his experience. Please check with your health care team before making any changes to your diabetes or health management.
Team Type 1 has been fielding teams for the Race Across America (RAAM) for a few years now and more recently Team Type 1 also has been quite competitive on the road too. For 2009, Team Type 1 will have a triathlon team that will consist exclusively of competitors who have Type 1 diabetes. Currently there are 10 team members and their race schedule for 2009 includes the Avia Wildflower Triathlon, the Nautica New York City Triathlon, the Chicago Triathlon and the Longhorn Ironman 70.3 Austin.
Matt Vogel* the team manager of Team Type 1 triathlon describes one of his days in detail. Initially he thought this would be a simple exercise of outlining a few things that people with diabetes must do to prepare for a triathlon, but he surprised himself when he looked at the total thought, preparation, and trouble shooting that goes into managing diabetes while training and racing.
Wake up
1. Check blood glucose (BG): refer to chart below
a. <50 mg/dl: not good, eat lots of fast-acting carbs, may not be able to race
b. 50-80: not ideal, eat some fast-acting carbs
c. 80-150: things are great
d. 151-250: not ideal, take a little insulin
e. 251-320: not good, take some insulin, check for ketones
i. If ketones are present, do not race
ii. Ketones: acidic level in blood, a byproduct of using fat (not glucose) for energy.
f.> 321 dangerous: take insulin, check for ketones, do not race
2. Calculate grams of carbohydrate in breakfast
3. Give insulin based on the individual’s insulin to carbohydrate ratio
a. Example:
i. Bowl of oatmeal (30g) + glass of milk (15g) + a banana (30g) = 75g of carbohydrate
ii. Insulin to carb ratio (different for everyone) = 1 unit of insulin for 15 grams of carbohydrate
iii. Math: 75g divided by 15 equals 5 units
4. Wait 5-15 minutes for insulin to absorb
5. Eat breakfast
6. Get dressed and leave for race
Pre-race: Transition area setup
1. Triathlon stuff: Setup bike, helmet, sunglasses, cycling shoes, towel, running shoes, visor, race number, water bottles, gels, bars, and body glide.
2. Diabetes stuff: glucose meter, test strips, lancing device, backup glucose meter, and extra insulin all in an insulated pack (so it doesn’t overheat).
3. Emergency supplies: lots of fast-acting glucose tablets, glucagon kit (hormone shot that releases all the glucose in your liver, to be used when lose consciousness), and a note explaining I have diabetes, what to do and/or call in case of an emergency.
60 min before race start
1. Check BG, refer to chart above
a. Sometimes the excitement, anticipation, and stress of a race can cause BG’s to spike.
2. Consider any insulin that is still working in my system (typical duration of insulin action is 3-4 hours)
3. Use my insulin pump to decrease the basal flow of insulin delivery: 80% decrease
a. People with diabetes need less insulin during physical activity
b. The more active you are, the less insulin you need
4. Eat a bar with 30-45g of carbs
Pre:race: Swim warm-up
1. Put on wetsuit with insulin pump secured in jersey pocket.
2. Tuck gels up wetsuit sleeves, just in case BG gets low during the swim
3. Put on cap and goggles
4. Jump in the water and get warmed up
Race: Swim start
1. Focus on swimming
2. Continually monitor the way I feel
a. This is the only way to make sure I’m not having a low blood sugar reaction.
b. You can’t test your BG in the water, the electronic meter will short.
T1
1. Take off wetsuit
2. Dry fingers and do a BG test, refer to chart above
3. Put on cycling gear
4. Load pockets with extra gels, bars, glucose tabs, and BG meter
Bike
1. Focus on riding
2. Eat 15-30g of carbohydrates every 20-40 minutes to prevent low blood sugar
3. Continually monitor the way I feel
a. “Am I tired because my BG is low, or is it because I’m just tired?”
b. “Am I cramping because my BG is high, or is my body low on salt?”
4. If something feels off, I’ll pull over and check my BG.
T2
1. Take off helmet and cycling shoes.
2. Dry and clean fingers, do a BG test, refer to chart above.
3. Put on running shoes, race belt, visor.
4. Load pockets with more gels and glucose tabs.
Run
1. Focus on running.
2. Eat 15-30g of carbohydrates every 20-40 minutes to prevent low blood sugar
3. Continually monitor the way I feel
4. If something feels off, I’ll stop and check my BG
Finish
1. Sprint and cross the finish line with a big smile
2. Dry and clean fingers, do a BG test, refer to chart above.
3. Return insulin pump basal rate to normal.
4. Measure the carbohydrates in my recovery drink.
5. Calculate the needed amount of insulin and reduce by 20-50%
a. With the increased level of activity, my body will be ultra-sensitive to insulin.
Post Race
1. Check BG’s every 1-2 hours.
2. Be aware of low blood sugars, due to the day’s increased activity
3. Eat normally to refuel body
4. Count the carbs and take a reduced amount of insulin for those carbs
5. Be extra careful while sleeping
a. Extremely low BG’s can occur in the middle of the night.
b. Go to bed with a higher than normal BG (~175 mg/dl for me).
c. Set an alarm to check once or twice in the middle of the night.
d. Keep a supply of rapid acting carbs within reach of your bed.
* Matt Vogel is not a health care professional and is simply sharing his experience. Please check with your health care team before making any changes to your diabetes or health management.
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Comments
Race Day for a Type 1
Larry from Maryland
Reviewed by: Larry N, Oct 21 2009 9:50PM
Excellent information. I will be doing my first tri in May 2010. I've already begun preparing, mentally and physically. Your race day itinerary is what I expected. I'll have to figure out my own race day carb needs. You are right, every body is different. I've been Type 1 since 1984.
seems about right
Reviewed by: R. Glantz, Jun 22 2009 8:19AM
I enjoyed reading this article - the most frustrating part about racing/training with type 1 for me is the pre meals and BGs - they can make or break your race day! I am just getting into triathlon - just competed in my first race yesterday and was a little surprised at how my blood sugars differed from a regular training due to the excitement and adrenalin levels I was experiencing - I cannot swim with my pump, so I leave it at transition during the swim, will put it on during T1, check my BG and head out on the bike, then will check BG again during T2 - slower transition times suck, but it's completely necessary as anyone with type 1 knows - while exercising, your BGs can drop very rapidly - because of this, I also carry lots of gels in a bento box on my bike and in my jersey pockets while running - if I feel off during any of this, I check out what my pump says as it wirelessly communicates with a CGM (continuous glucose monitor), notice the trends (is it going up or down and how rapidly) and will typically eat 2 gels or pkgs of blocks during the bike and another one during the run.... and afterwards, I also have to check my BG every hour or two as it jumps all over the place!
Good Post
CGM & IM Swim
Reviewed by: Matt Beebe, Mar 16 2009 4:27AM
Good post, tri is easy as a diabetic, just requires a tiny bit more logistical planning. Has anyone done a tri with the Minimed Realtime system (continuous glucous monitoring system)? I just started and love it, BUT, think using it during a tri might be an issue due to the swim leg (like short the monitor?). I've already done IMFL and many halves w/just the pump (picking it up on my bike at T1).
EXACT
Reviewed by: James C Pryor, Jan 26 2009 3:28PM
I have been doing tri's since 1989 wearing a pump. Except for the carb ratios, you have perfectly described what I have been doing! Now with a Minimed Pump with the Sensor feature, it is a little easier. But every time I finish a race, I know I win my specialty, "whatever" year old Type I diabetic. Now with more of us in the mix, I am going to have some competition! That's wonderful! (BTW, no well controlled Type I could do an Ironman by "how I felt".)
Type 1
Reviewed by: Celeste, Jan 26 2009 9:28AM
Thank you! As a parent of Type 1, this is all part of the day. It is always helpful to remember that there are others out there having the same kind of day!
