A Type 1 diabetes triathlon day

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.