Lifted these quotes and race report off his Facebook page:
"At the 2010 Olympics I had a very public hypoglycemic episode in the 30k skiathlon race. I was later asked by a prominent diabetes blogger if "I had learned my lesson?" She had interviewed me before, was skeptical of my athletic ambition with type 1 diabetes, and was clearly implying that I should quit. I was pretty devastated about how the Olympics had gone but even in my depressed state I was able to counter her question by saying "the only lesson I have learned is that I need to figure out a way to manage my glucose better under pressure." That summer I started using the
Dexcom continuous glucose monitor and I began meditating daily. CGM technology had just become viable for my purposes and it added a wealth of data that I could use for insulin dosing. The meditation practice was to teach myself how to control stress hormones on race days. Adrenaline releases stored glucose into the blood stream and cortisol makes the body less sensitive to insulin. The combination makes insulin dosing much more difficult. In my meditation sessions I would focus on breathing in and out while letting all other thoughts drift to the side. At my first race of the 2011 season my glucose was rising as the start time crept up. I stopped warming up, found a quiet room, sat down and focused on my breath. My blood sugar dropped from 200 to 150 in 15 minutes (using Lifescan Onetouch). I went out and won the opening race of the season.
My IronMan race reminded me of the skeptical blogger. I have received several negative comments questioning why I would race this far and that I was being unsafe. My response is "that anything is possible with diabetes with proper planning and preparation. I don't believe in placing limitations on myself and I raced the IronMan for one reason. I wanted to."
Race report
"
Before Sunday's
IRONMAN Lake Placid the longest duration that I had raced was 5 hours and :45 minutes when I won the
Sea to Summit triathlon last summer. Planning to race for 9:30 hours was stressful because there were so many unknowns. In training I had experimented with suspending and reactivating my insulin at strategic times but I tended to trend high with my glucose too often with this approach. So, I went in another direction. I am fortunate to own two controllers (PDMs) for my insulin delivery which enables me to wear two pumps simultaneously. I wore the pumps on my chest (one on each pec) and programmed each of them to deliver .3 units per hour for the first two hours of my race (a total of .6 units per hour which is 60% of my standard basal dose). Then I had the pumps reduce delivery to .2 units per hour (.4 total) for the duration of the race. Wearing two pumps had two benefits. The first was that if a pump failed I had a backup already inserted and the second was that it allowed me to further reduce my insulin dose by simply tearing one off.
15 minutes before the start of the race my glucose was a steady 120 which was perfect. Because I would be unable to feed during the 2.4 mile swim I drank 16 ounces of Gatorade Endurance five minutes before the start. I had the the best swim of my short triathlon career and came out of the water in :59 minutes. I drank another 20 ounces in transition to my bike and was able to start monitoring my glucose again with my
Dexcom once I was in the saddle. My sugars were 140 but dropping quickly so I drank another bottle of gatorade. The second bottle was overkill and over the next hour of the ride my glucose shot up over 250. This left me unable to take on additional calories for a full hour which was unfortunate. Instead I took electrolyte tablets and pounded water whenever I went by an aid station. By mile 40 of the bike ride my insulin had caught back up with my carb intake and I started taking on fuel again. I ate 4
UnTapped coffee waffles, heaps of water and 2 more bottles of Gatorade before finishing the 112 mile bike course.
My glucose was 160 when I left the 2nd transition and started the marathon run (26.2 miles) There were aid stations every 1.5 miles and I dumped water over my head and drank a few dixie cups of Gatorade at each one. For the first 10 miles my glucose would rise predictably, level off and then begin to fall. But then I noticed that despite a recent feed my glucose did not rise, so I tore a pump off reducing my insulin dose to .2 units per hour. A few miles later, despite another feed I was still dropping with a glucose number of 90. At mile 15 I tore the 2nd pump off. Glucose hovered between 80-100 for the next several miles and I force fed myself at each aid station to keep the sugars up. Unfortunately at this point I was feeding the insulin that had already been delivered and not for energy. I started to get nauseous. I took my last feed at mile 22 which was an 8 ounce RedBull and a Clif Gel. This was not at all appetizing but it was the most concentrated and palatable sugar I had available to me.
I finished the IronMan in 9:50:18 which was good for 10th place overall in the Amateur division and 23rd Overall adding the Pros in. My Glucose was 87 at the finish line.
For my first attempt at the IronMan distance the race went well and my insulin dosing strategy wasn't that far off. Next time I will program a higher dose of insulin for the first few hours on the bike and suspend delivery for the entire marathon so that I hopefully won't have to force feed myself again.