This is part of an email sent to 3-time Diabetic Ironman David Weingard, who was interested in learning more about competing on injections. I’d like to note a couple things before you continue reading. First, that my injection strategy has changed since the race – I’ve replaced the nighttime Humalin shot with a second shot of Lantus, which has eliminated any sort of BG spike or discontinuity altogether. This was in response to a 490 reading on race day – the highest of my life, nowhere near the highest of spikes during training. I do pride myself on excellent control and rarely have A1Cs results over 7.0, but it goes to show that you cannot control diabetes entirely. You can, however, learn from your mistakes and from each other. I hope you find this useful if you’re averse to pumping.
Leading up to and at the time of the race, I was using 12 units of Humalin N insulin at bedtime. Because this is a 9-hour insulin, I'm usually running on fumes prior to swimming, which I like. During training I'd eat a Clif Bar immediately before entering the water, and would nearly always end up around 135 after the first 2100 yards. Then another 30 carbs (banana, usually) would keep things steady for the second half. Generally I'd be happy with a 150 reading out of the water.
At this point I'd take my daytime injection, 4-6 units of Lantus. As I mentioned before, I could expect a spike within the first hour (low 200’s), but never as high as 490. On race day I was facing a critical decision with a 216 before the race. Taking insulin was out of the question, and eating too little might be a bad idea. I wanted to be confident that I wasn't going to be low in the water and figured it couldn't get *too* high, considering the rate at which one burns carbs swimming. So I ate the whole Clif Bar. Probably a mistake, but looking back I'd do it again. I put way too much work into this to drown or end up in the hospital. I was willing to take one sour reading.
So after the first lap I was 216 (we exited the water after mile 1.2) - not horrible, considering. So I kept eating just as I'd trained. I ate a Snickers. Out of the water after the second lap I was 244 and not very concerned. I took my Lantus on the way to the transition and figured within a few miles I'd be on my way down. (During training I'd attributed my spikes to the hour or so between my swim and preparing for my ride...obviously the transition there is a bit longer.) At the first turn-around (10 miles, perhaps) I was 366 and started to worry, although not too much. I'd faced high 200's before and had done just fine. "Be patient, I kept telling myself."
I nearly died on a mountain in New Zealand because I'd taken just 2 units of Humalog in the middle of an uphill climb. I had enough carbs with me to cover a dozen reactions, but somehow I ran out. It taught me how responsive my body is to short-acting insulin, one of the reasons I don't pump and also why I'd never ever ever EVER taken any during intensive training. You can imagine how hard the decision was for me to inject some 30 miles into the bike, when I checked in at 490. But I had no choice - 2 units did wonders. By mile 40 I was 156 and would remain steady throughout the rest of the day. I'd considered taking more Lantus, but figured that'd get me later on the run. I didn't want to be running uphill against insulin, fighting low BGs. I had enough to worry about. Good thing I let that be as it was.
During training I'd aim for a 135 reading once per hour or so on the bike and would consume about 35 carbs per 30 minutes. The run I'd test a little more, but rarely more than once per half hour. During this time I'd eat about 30 carbs each 20 minutes. This regimen was extremely predictable and rarely threw curveballs at me.
My numbers during the run were a little higher than I'd have trained at. But to be honest, I was so sick of eating (one feels pregnant by the end of an IM) that I was happy to see a 231 if it meant I could pass an aid station without eating. I was so focused on finishing and running strong that I didn't care if my BG was 130 rather than 230. It was just one day, after all. And I didn't want to confuse hypoglycemia with fatigue. Basically I tested at every aid station since I was walking them anyway. It worked out well that way. I guess it was a little much, but for me to reach peak performance I need to know I'm not low.
In conclusion, don't let my race-day control steer you away from injections. I assure you that was an exception to an otherwise sound routine. I've also eliminated the Humalin altogether and gone strictly to Lantus, which has helped even more (I'd wanted to do this earlier, but couldn't justify changing anything so close to the race). I've always hated the idea of pumping and considered it an extra burden. But don't take my word for it...Jay Handy has done IM on a pump and injections. He's another guy you want to talk to. |
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