My First Triathlon with T1 Diabetes: Why I Signed-Up For An Olympic Distance Triathlon, My Biggest Concerns, Watch-Outs, and Doubts (Fine-Tuning My Race Strategy For 100% Time In Range)
My first Olympic Triathlon as a T1 Diabetic is just around the corner.
I am observing my blood sugars closely during my training sessions to fine-tune several aspect of my race strategy. Inevitably, some concerns and doubts are starting to emerge because each discipline (swim, bike, run) has its own nuances and each training its own contextual variables. And while I have a good grasp of how my body and metabolism react to the three sports individually, I have no idea what could happen when I stack them onto one another in a long, giant endurance sequence.
The goal, as always, is to race with 100% Time In Range.
Triathlon is a stress test for my T1 Management skills, and that is on purpose: the effort and the self-awareness required to manage this level of complexity are going to make me a much more resilient type 1 diabetic overall.
I am conscious that it is going to be difficult.
It is my first time ever in triathlon, and I have been doing specific training for only a bunch of weeks. I still am not 100% sure how my blood glucose behaves during intense efforts on the bike, or how to deal with open waters - especially in colder fall temperatures. But I have an “80% grasp” of the whole thing and there’s nothing to lose in setting very ambitious targets.
Setting an ambitious target is a great way to elevate myself.
That’s why I am embracing this challenge with curiosity, grit and confidence - and yes, a slight of healthy fear.
Journaling is my best friend in this process.
I take copious notes, always.
I write before and after each training session in order to understand the “hows” and “whys” behind my blood sugars. Then I use these notes to perfect my race strategy. I annotate everything:
My blood sugar before the workout
What I ate in my last meal
The type of carbs consumed before and during the workout (and whether I should get some fats or proteins to smoothen the release of glucose during exercise)
The amount of carbs consumed before and during the workout
How long before the workout it makes sense to eat
How long before the workout it makes sense get rapid insulin (if at all)
Whether or not I had insulin on board, how much, and its impact on training
How much I slept, and whether it was a good slumber
Whether I am stressed or not
Whether I am hydrated or not
How intense was the run or bike training (and how my blood sugar reacted)
How cold was the water (and how my blood sugar reacted)
How my blood sugars behaved after the workout
and on and on…
There are so many variables to triangulate that trying to keep everything in mind would make my head explode.
It would also pave the way towards costly blood sugar mistakes, such as a hypoglycemia that ruins a workout (or worse, the race itself).
At the end of the day, I approach each and every endurance effort with T1 Diabetes with the same principles:
Carb up without compromising time in range (i.e. avoid spikes)
Have a pre-race snack that allows me to start strong and maintain blood glucose in the 150s
Keep the carbs coming during exercise to maintain blood glucose in the 150s (and in any case not above 200)
Ideally never being in a situation when an insulin injection is required, because insulin on board usually causes a blood glucose “cliff”
Test EVEYTHING I can during training, so that when the race comes, I can put my diabetes on “autopilot”, focus on the effort and get to the finish line happily and safely.
Having this in mind, this past week of training brought some additional questions and concerns to the surface.
Everything was not so smooth: I had spikes during swim, bike and run sessions. I had spikes despite working out fasted in the morning or despite managing my insulin intake in a way I though was correct. My 7-day Time In Range is still 85% (acceptable), but this blood sugar volatility is definitely something to address, among many other fears that pop up in my mind as the big day approaches.
So here is a list of "T1 Diabetes & Triathlon" issues I am currently figuring out one week out from my first Olympic Triathlon, and how I am planning to manage them:
Should I give any insulin before the race? We'll start racing at 11.30, which means I’ll have plenty of time to eat, give insulin and let that insulin wear off. My plan is to get my last bolus between 6 and 7 AM and eat an oatmeal. Then within 30 minutes before the start I'll get a snack containing both carbs and fats (a cliff bar kind of thing), to stock up 60g of carbs and smoothen the release of glucose in the bloodstream. This should offset the risk of hyperglycemias and of any insulin on board dropping my blood sugars while I swim.
How will my blood sugars behave in open water? That being said, open water swims have taught me that when the water is cold, my blood sugar drops FAST. I have also observed that while I swim I never feel the drop or any symptom of hypoglycaemia as I do while running or biking. So, to keep it safe in case the sea temperature is particularly cold - very likely - I won’t hesitate to get some extra quick carbs in right before the start. I’ll also carry two gels in my wetsuit (in the forearms?).
How will I deal with lack of CGM readings during the swim? Since I can’t bring electronic devices in the water, I won’t get any CGM readings during the swim. It is is algo going to take some time for the CGM to connect to the reader in my bike box during the first transition. This means I’ll put a good old finger-prick in my transition bag to get a blood glucose reading right out of the water, while I wait for the CGM to connect.
Should I give any insulin during the race? Big question mark, because for me insulin+aerobic exercise=BG cliff. What if upon coming out of the water I have a huge hyperglycemia? Tough call. If it’s very high (in the 300s), then I’ll give one unit. For anything within the 200s, exercise typically does the trick. However, I still do not have a definitive answer on this point. I’ll need to run some more experiments in my training.
How to balancing different metabolic rates? I have noticed I ****burn glucose much faster while swimming and biking, compared to running. So it makes sense to get carbs before the swim (45-60 grams, in my case), and during the bike section (60-90 grams per hour, in my case). However, I have never put the three sports together, so I don't know how they are going to compound. I don’t really know if my body will be able to burn all that glucose in time to avoid hyperglycemias, but to avoid bonking I’ll surely keep the carbs coming during the bike section. When the run comes, I'll decide whether to add more carbs or not based on my blood sugar at T2...if I got enough on the bike, I might skip the carbs - it’s just a 10k after all.
How to keep the carbs coming without hyperglycemia? The point is to avoid hyperglycemias in the first place (the goal is 100% time in range, remember?). If I notice an upward trend while I train, I sometimes skip because I usually don’t need many carbs for a workout. Races are different: I must keep the energy up and steady for two to three hours of intense aerobic effort. I can’t bonk, so I need the carbs: 60 grams before the swim, around 90 grams per hour during the bike and around 45 during the run. Many things must be right for all those (fast acting) carbohydrates to not cause a huge spike. There is no magic wand here: I test EVERYTHING during training, take copious notes and assess the insulin ratios for any given scenarios. Then I put all that info together to come up with the best T1 Diabetes strategy possible for triathlon, trust the process and the attention I’ve put all along.
How to balance out "race-day" stress? Lastly, I must manage race-day stress. Adrenaline induced spikes that forced me to review my well-crafted plans in every previous race I did. Sometimes I got it right, others I went into hyperglycemia due to some stress induced mistakes: I overdid my pre-race snacks to discard any risk of lows (you can’t be at 50 if you’re at 300, right??), I miscalculated my insulin doses, I did not stick to my plan. Mental clarity in these situations is key. Some calming breath work is going to help.
I am going to test and try and fail until I come up with something close to an answer to the questions above.
I am sure I won’t solve all my doubts, but I am equally sure I will do my best to do just that.
My T1 Diabetes Management plan might not be 100% bulletproof, but there’s no reason not to aim for that 100%.
If I am for the stars and end up “just” landing on the moon, that’s still pretty good.
That’s how I approach life with diabetes - triathlon or not.
