When diabetes doesn’t go your way….for 4 months.

Since I arrived back in Sydney almost 6 months ago my diabetes control seems to be persistent in providing me with a challenge.

My CGM looks like the latest ride at an American theme park.

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When this occurs I like to use the rule of elimination. Testing and eliminating all the variables that could be causing my BGLs to be running high.

These generally include:

  • Changing my infusion set
  • Buying a new batch of insulin
  • Fasting basal testing
  • Very accurate carb counting
  • Reducing my fat intake
  • Getting into a routine
  • Looking at my hormones
  • Trying to reduce any stress, especially diabetes-related stress
  • Working out exercise related high BGLs
  • Working out optimal pre-bolus for meals

This really forces me to go back to basics with my diabetes management.

In this instance, after ticking off the above I still couldn’t find the cause of my BGLs running above range for over 50% of my days.

This wasn’t what I was used to….or so I thought.

I got to a stage where I was working closely with my dietician and nothing was working. I was so burnt out.

I kept saying to myself, there must be something causing these fluctuations, I was adamant I’d get to the bottom of it. This consumed my thoughts every minute of every day for almost 4 months.

Then one afternoon a couple of weeks ago, I came home from a vegan festival exhausted physically and mentally, lay on my bed and cried. Cried because I didn’t know the answers and therefore had no solution.

I spent the afternoon trying to nap, trying to forget the frustrations and stress related to my diabetes.

Last weekend, I saw my dietician again.

My blood glucose levels had improved, I was feeling a lot more positive and I gotten my latest HbA1c – 6.1%.
This was the best since being back in Sydney.

I felt I was heading in the right direction.

I also came to the realisation that having the CGM gave me insight into my BGLs over a 24-hour period, 7 days a week.

I had never seen my BGLs consistently, only through intermittent blood testing with my glucose monitor providing me a 1 second snapshot of my control interspersed throughout the day.

I admitted to myself that maybe my control was not as tight as I had previously thought.

Grateful to have the opportunity to changes things.

My plan of attack:

  • Do basal fasting testing again (for the millionth time)
  • Only eat 3 meals a day with accurate carb counting
  • Test Insulin: Carbohydrate ratios
  • Only use rice syrup to treat hypos (I have a habit of treating with way too many carbs)

Results:

  • Having minimal BGLs over 12
  • Seeing patterns with my basal – fixing these made a huge difference
  • Not having huge post hypo spikes
  • Much smaller rollercoaster

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What I learnt:

  • Diabetes is never going to be 100% perfect
  • A good HbA1c does not reflect what your BGLs are 24/7
  • Expectations are good, but sometimes I set them too high for myself
  • There will always be room for improvement and that is a good thing
  • Diabetes has shown me that even some of the toughest challenges can be overcome

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I’m looking at the past 4 months as an insightful experience and the coming 4 months as an opportunity to dramatically improve my BGLs leading up to the Boston Marathon and my first ultra-marathon.

Above and beyond.

 

 

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2016 JDRF Walk to Find a Cure

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The JDRF Walk to Find a Cure for Type 1 Diabetes is the one annual charity event I have consistently being involved in since my diagnosis.

I have done the walks in Sydney and NYC, raising funds towards research for technological advancements and a cure.

If you know me, I am more than sceptical that a cure will come in my life time, particularly with the knowledge that insulin is the most expensive liquid in the world and type 1 diabetics (and a considerable amount of type 2 diabetics) rely on this for survival.

With the influence pharmaceutical companies have over the US government, I don’t have a strong belief that the investment needed or the approval of a cure will come any time soon.

What I do believe in is the research that JDRF does towards developing an external artificial pancreas. There have been incredible advancements in the technology used to manage type 1 diabetes in recent years, from the insulin pump devices to continuous glucose monitors and now trials have begun on devices that almost simulate the functioning of a pancreas.

But yesterday’s walk for me was more about supporting the type 1 community and sharing my appreciation for what they have done for me.

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I met my friend Tim just before the walk commenced. We treated Tim’s hypo and got on the walk with many families and young kids.

Moments later I had my own hypo and treated it with a green juice and banana.

Walking the 5K with a fellow diabetic we covered all things diabetes – my favourite topic was discussing how diabetes gives you resilience and how that is beneficial in endurance sports.

Tim and I have lived with diabetes for a combined 33 years and we have a similar perspective on living with this chronic disease and our approach to self-management.

We both see diabetes as an empowering disease that has given us so many opportunities that we may otherwise not have eventuated.

Particularly when it comes to endurance sports – Tim is currently training for a half ironman.

Having diabetes has compelled us to be more focused on our nutrition, the importance of looking after our health and knowing our bodies inside and out.

Although training for any event can add some challenges to diabetes management, its these challenges that we actively pursue.

The resilience these challenges create, I believe gives us a psychological advantage on the race day.

We are physically and mentally prepared for more challenges with the risk of hypos, carrying additional medical supplies and monitoring our body very closely through checking our blood sugar level during each race.

This puts us in a mindset that when faced with a challenge or a struggle we know we can overcome it.

And that really helps when the pain starts to set in during a race.

So this year’s JDRF Walk to Find a Cure, was more about learning and sharing how type 1 diabetes is an empowering disease to achieve things that we otherwise might not have pursued in different circumstances.

Thank you Tim for the great conversation and thank you JDRF Australia for a great event.

See you next year.

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There is still time to donate to my page:

https://jdrf-walk-nsw-2016.everydayhero.com/au/amy

No Running for Six Weeks

 

After the Melbourne marathon I got my first serious injury that has me off my feet until mid-December, if all goes well.

In the 3 years I have been running I’ve been lucky enough to have no injury setbacks that lasted more than a few days.

I attribute this to a few things – good diabetes management, a diet high in anti-inflammatory foods and continuously learning to listen to my body, knowing when I can push hard and when I need to slow down.

During the Sydney marathon I experienced big blisters on the balls of my feet which caused a lot of tenderness and pain, subsequently getting inflamed again during Melbourne forcing me to change my running technique and gait to make it through the marathon.

When I got back to Sydney the arch of my left foot was in a lot of pain, more than just tired feet.

After a doctor’s appointment and an ultrasound there was no definitive diagnosis. I didn’t have any tendon tears in my foot, but there was a lot of swelling. It was unlikely I had a stress fracture, but most likely my bones were weak and “under-stress”.

No running for a minimum of six weeks. Okay, this was going to be tough.

The first thing that came to my mind was the delay in the start of my training for Boston and the UTA 50 – my next major two races.

I knew I had to do some form of exercise to keep my cardiovascular fitness up.

I was taking a couple of spin classes and doing some strength training focusing on the right side of my body to alleviate any pressure on my left foot.
I was determined not to be on crutches if I could avoid it.

I decided to try out swimming for the first time since I was 16. After being burnt out from years of swimming squad as a child I wasn’t particularly excited.

My first session in the pool was incredible. I felt relaxed, strong and fell right back into a rhythm I thought I would have lost. Exactly what I needed to help with my recovery.

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Whenever trying a new form of exercise or sport, I know there is going to be a bit of trial and error to get my basal doses right to keep my blood glucose levels in range.

Initially with swimming, I disconnected my pump prior to jumping in the pool and reconnect after a 1-hour+ session.

My BGLs were stable while swimming generally sitting around 5mmol/L.

Post-swim was not so great. My sugar levels would shoot up to above 15 within the hour, even after reconnecting my pump, increasing my basal and giving a small bolus of 1-2units.

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I knew something had to change to try and fix the post-swim highs that make me feel unwell for the next few hours while I couldn’t refuel with carbohydrates until I am back in range.

With a recommendation from a fellow diabetic athlete I kept my basal on and my pump on during my next swim.

To my own surprise I didn’t drop low during this swim even with my full basal rate on and to my joy my post-swim spikes generally maxed out at 10mmol/L if they got that high at all.

This not only helped with my control and management but also my sanity. Swimming was now even more enjoyable.

As I have started to change my attitude towards the challenges in my life in recent years, especially with diabetes and running, I reflected on what my current injury is teaching me.

I truly believe everything happens for a specific reason and there is always a positive lesson to be learnt. More on this in an upcoming blog post!

Why I am happy to not be running for six weeks:

  • Running takes a big toll on my body.

Running consistently for 3 years takes a toll on your body, and I don’t seem to notice this until I stop.

Hitting the pavement day in and day out gets your body used to running when sore and tired, it strengthens you mentally and increases your pain tolerance for race day.
At the same time when I am forced to rest or take a break after my initial frustration I am really grateful to give my body a break and it has a positive impact on my performance.

  • I learnt to love swimming.

This is a big one for me. Especially as it is extremely low impact, yet challenging at the same time. I needed to expand my enjoyment for sports and exercise outside of running and I am happy I found swimming again.

And a few friends have made some not so subtle hints I should try a triathlon… we will see J

  • I can focus on my diabetes management without the pressure of a training plan.

Sometimes trying to manage my diabetes with all the variables from exercise can really test my patience.

I’ll have unexpected hypos and hypers. Trying to figure out the right amount of insulin to give post-exercise – sometimes a little less, sometimes a little more.

Making sure I always take hypo supplies with me on my runs.

So much planning and intensive monitoring while ensuring I get in the scheduled runs and workouts.

A short break from a committed training plans allows me to be more flexible with my work outs and focus on my diabetes management more – time to squeeze in some basal and I:C ratio testing!

Last but not least November is diabetes awareness month! Here is my diabetes footprint:

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Marathon #3

Less than a month after the Sydney marathon I was on a plane for a quick visit to Melbourne for yet another marathon.

My body was still sore and tired with little recovery over the past few weeks, but I knew the mental challenge would be the biggest of them all. Knowing I had to run another 42.2km, and always keeping in the back of my mind the potential of another PR.

Melbourne’s notorious weather was keeping me on my toes for race day with predictions of rain, wind and humidity. Sooner rather than later I’d find out that my preference for wind over rain was one I’d only ask for once.

The course is Melbourne is really flat, so I thought that would help run a faster pace than Sydney.

As I did my usual ritual of setting out all my race day gear the night before on my friend Laura’s living room, I felt strong, confident and a little bit nervous for Sunday morning.

On my way to the marathon just before 6am, my Uber driver asked me where I was going in sports clothes at 6am.

“I am running in the Melbourne marathon”. He confusingly asked what a marathon was. When I explained a running race of 42.2km I giggled at his mind-boggled response: “Do you get to take breaks along the way?”.

I was really hoping I wouldn’t need any breaks.

As I approached the start line, I said a quick hello to my friend Priscilla running her first marathon and snapped an all smiles photo.

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I crept closer to the start line, I like starting with the men, then they can overtake me. Fellow type 1 athlete, Alex Kozeniauskas came up and said hi, we wished each other luck and he was aiming for a 3 hr marathon…just a few steps ahead of me.

My BGL was on 14 when I started, not bad with all the adrenaline running through my system.

I mistakeningly gave a bolus of 0.2 units through my pump at about the 2km mark as my BGL was heading up.

My first 5K I felt strong and fast even though a little windy. I was running a 4:20 km pace and thought the 3:20 marathon was in sight if I could hold it.

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Then I hit the 10km mark and my body decided it didn’t want to run a marathon any more. My BGL had triple arrows down showing on my CGM and my feet where starting to hurt after I destroyed them pretty badly in Sydney.

I ate 45g of carbs through a Clif Bar and some sugar covered Apricot slices and half a banana at one of the drink stations.

Managing to drop to 6.8mmol/L and then stabilising at 8.

Diabetes ran pretty smooth for the rest of the race. Creeping up towards the end when I had slowed down to a snail pace.

My feet and body on the other hand, didn’t want to move, let alone move fast, and the strong winds were definitely not helping me both physically and mentally.

I really didn’t want to DNF, a little bit for my ego and also to try and push through one of the most challenging mental barriers I’d faced in a race to date.

I knew my friend Laura was going to be cheering me on at the 30km mark so that got me through a painful 20 or so kms.

As she was cheering me on, all I could muster saying was “I am dying”. At the time I didn’t feel it was a dramatic representation of the thoughts going on in my head.

As I got closer to the finish line yet slower each km, I knew I was going to finish the race. The last 2kms I gave it my all and ran into the stadium at a nice 5 min km pace to cross the finish line with a huge smile and being so grateful to have completed my third, yet toughest marathon. With an added bonus of another diabetic friend Adam cheering for me at the finish line.

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What I learnt from the Melbourne marathon:

  • Some things on race day are out of your control.

The weather conditions were the toughest I have run in, 40km head winds were a lot worse than the torrential I experienced in the Brooklyn Half Marathon 2 years prior. Weather plays a big role in your performance on the day, whether it be positive or negative and you’ve just got to go with it.

  • Your race goal can change at any time during the race.

When I hit the 10km mark I knew I wasn’t going to run a 3:20 marathon. The wind played a big role, but mostly my body just wasn’t ready to run fast for that long. I had to tell myself a few times that this was okay and changing my goal to completing the marathon helped me to keep going. Motivating yourself is key in any race.

  • Everything happens for a reason.

I needed to experience a less than ideal race. I know I will eventually have a DNF and I have learnt even after months and months of training I have to be okay with that. It’s part of any runners life experience. Running Melbourne in my slowest marathon time taught me that it was okay

  • Diabetes can sometimes be the smallest struggle.

And this is a win. When your diabetes is under control it doesn’t mean you are going to have your best race but it definitely helps. Diabetes is literally a constant thought on any diabetics mind and can cause anxiety, stress and impact performance. When you are running with ideal blood sugar levels it allows you to focus on other elements of your race with some ease of mind.

 

 

From Sydney to Boston

My training for the Sydney marathon really kicked off when I landed back home in May, after running up and down mountains in Latin America for 8 months.

I was hoping the “altitude training” would pay off with only 4 months until the one marathon where I had the chance to qualify for the Boston Marathon in April 2017.

For Boston I had to run at least 3:35 in Sydney, with no guarantee that time would be fast enough to get me there. The faster you ran above the qualifying time, the higher your chance of getting accepted.
Getting into the Boston Marathon is like getting the golden ticket in a Willy Wonka chocolate – a runner’s dream.

I wasn’t as disciplined as I was for the NY marathon, in the sense I didn’t follow a specific marathon training plan but decided to do a self-made routine of long runs, sporadic sprint training, strength training, high intensity interval training and some much needed yoga. My approach was, run a lot, get a little bit stronger and a little bit faster.

I had a few races in between Sydney – the Nike Women’s Half marathon, the Sydney Harbour 10K, the Sydney City2Surf 14K and a final 35K trail race 2 weeks out from the marathon – I PR’d in all of these but the races push you to your limits and can tire you out. So that was more than enough for me.

My BGLs were relatively well behaved until I started my new job a month after returning home, and switched my routine from morning runs to post-work evening runs. I started having high BGLs in the morning after breakfast that would continue throughout the day.

I was trying to get my BGLs in check and refuel from my intense training schedule at the same time. Let’s just say, my fuelling strategy was not up to scratch. I was restricting my usual carbohydrate intake. Only when I returned to my morning run routine did my BGLs improve dramatically and increase my insulin sensitivity.

Leading up to race day I was feeling good, not as strong as I would have liked to be and a little tired (mostly mentally), but I had my eye on the goal and felt my training had me in a good position for a good result.

Race day started at 3am when I woke up after a very restless sleep with a BGL of 9mmol/L and ate a bowl of buckwheat groats, almond milk and some strawberries. Back to bed for 2 hours and back up at 5am with a BGL of 5mmol/L, dressed and a banana in hand I headed out the door.

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I was lucky enough to be in the front group of runners just behind the elites, so crossed the start line just after 7am with a BGL of 13mmol/L. I always want to start a race with a BGL of approx. 200. No pre-race snack was needed, but I had plenty in my waste belt, just in case.

I started out fast and feeling good. Weaving in and out of fellow runners and setting a good pace of approx. 7:25 per mile. I managed to keep this pace up until mile 20, even after stepping on a stone and bruising the bottom of my foot at the half way mark.

At mile 5, I gave 0.3 units of insulin to get my BGLs down a bit so I could refuel with a Clif bar and some apricot bites 30 minutes later. I kept my BGL between 8-10mmol/L most of the race. Not wanting to risk letting it go too low.

Just before mile 20 as I was coming up a small hill, I saw my Dad cheering me on “GO AMES, you can run a 3:20”.

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This gave me just the energy boost I needed as my legs started to tire and my mind struggled to filter out the pain.

It was great having the support of my Dad, who got up early just to get to the side line in enough time to cheer me on.

The last 7 miles were tough. My BGLs were okay, so I didn’t plan on eating any more food unless they started to drop, even though I had only consumed approx. 70g of carbs the whole marathon. Recommended fuelling is 20g of carbs every 20mins.

I was getting thirstier at each water station and drinking more to try and stay hydrated enough to take me to the finish line.

I hadn’t hit the wall but my legs definitely didn’t want to move any faster and the ball of my foot was hurting from that damn stone.

I knew if I could keep my pace I would be closer to a 3:20 finish.

For the last 5 miles I focused on getting to the next mile, perhaps repeating “Boston” in my head over and over. I tried to stay in a positive mindset and push through the pain.

The last mile I used all the adrenaline in my body to speed up and cross the finish line in 3:25:56 – 14 minutes faster than NY and 9 minutes faster than the official Boston qualifying time.

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And most importantly my BGL was nicely sitting at 11mmol/L.

2 weeks later I got an email from Boston that I had been accepted. An achievement I believe I only reached because of my type 1 diabetes that gave me the resilience, determination and belief that I could do it.

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To finish, here are my top 3 tips for a marathon:

  1. Trial (and error) everything in training – this is essential so you are prepared for any situation on race day. Not only do you need to trial your pace and refuelling strategy like any other marathoner. As diabetics we need to trial food or gels that will sustain us but won’t spike our BGLs, we need to trial running and testing our BGLs multiple times – having good BGLs is key for good performance.

We also need to trial our approach if we have a low – do we stop and walk for 5 mins or can we continue running and treating at the same time?

How much insulin do we need to give if our BGLs are running high – for me 0.2 units through my insulin pump is more than enough to bring me back in range from a 13mmol/L reading.

  1. Have a plan for race day – know what you are going to carry on you and how you are going to carry it. I always wear a waist band and take with me a backup insulin pen (in case my pump fails), my BG meter (even though I wear my CGM), hypo supplies and refuelling supplies – a mix of Clif energy bars and apricot slices.

 

  1. Make sure you have something to identify you as a type 1 diabetic – where it be a medicalert bracelet or card or a tattoo (only if you like permanent identification like me). This is really important in the case you have a hypo or another marathon related incident like heat exhaustion or dehydration – you want the medical team to know you have type 1 diabetes so they can be aware and treat you correctly.

 

My final tip – Don’t let diabetes stop you from doing anything you want.

Now let the Boston training begin. See you in April, 2017.