Half Marathon With Type 1 Diabetes Recap - The Problem Is Fear, Not Carbs

Last week I ran the Trieste Half Marathon, a panoramic and insanely fun race. It was a training race where I had the honor of pacing some friends. With no performance objectives in sight, I decided to exploit the day as a precious occasion to test some strategies to manage diabetes and improve them for the future. How did it go?

To cut a long story short, there have been several changes and several improvements and despite some ups (I was about to say “and downs”, but I had none of those!), I felt more in control of the entire situation. What is most important is that after many trials and errors and races gone worse than ideal I’ve found the culprit, the factor that got me into hyperglycaemia on every official race so far.

But let’s proceed with order.

Carb Loading

The first thing I’ve changed was the carb loading strategy. I usually tend to stay away from fibers in the twenty four hours leading to the start in order to reduce any risk of any surprises in the stomach, but since this was only a 21 KM run at a slow pace, there wasn’t going to be enough time for my body to go crazy. I thus decided to get my Saturday carbs mainly from bananas, apples and oranges.

That is pure Mastering Diabetes stuff. Green light foods (whole, carbohydrates rich and plant based) are simply exceptional for blood glucose stability and as a source of energy. If you’ve hesitated until now due to a fear of carbohydrates, I encourage you to read this and start changing your life just like I did.

Only at dinner I opted for plain white pasta, which I never never never eat. Refined carbohydrates are an absolute disaster for our metabolism when consumed often and in large quantities, but I had walked quite a lot to collect my race pack, had consumed quite a lot of energy throughout the day, hadn’t hit my target carbohydrates intake yet (10g of carbs x 65kg of body weight) and the pasta pack was offered by the organization, so I went for it. One pasta meal in years won’t kill me.

I went to bed with 132, took 70% of my basal insulin dose to compensate for the insulin sensitivity generated by upcoming half marathon, and except for a small increase in blood glucose at midnight which I corrected with a few units of rapid insulin, I woke up at 115. Perfect conditions to apply Plan A.

Execution Of Plan A, Kind Of

Plan A

The precondition for Plan A to happen was waking up with a perfect fasting blood glucose. The plan then included two small bananas (50 grams in total) and about four rice cakes (32 grams in total), amounting to circa 70 grams of carbohydrates handled by half of my usual dose of rapid insulin for such an amount. I also had coffee with it to help my digestion before the long commute.

Thirty minutes after my snack, my CGM indicated blood sugars at 132. Fine.

But there were a few logistical issues I hadn’t really taken into consideration. I had opened my eyes at 5 AM, had eaten my snack and had to be at the bus station by 6.30 to hop on one of the shuttle buses that would take all the runners to the start line by 7.30, drop my bag by 8.30 and then wait until the official race start, at 9.30. That was a full four and a half hours between my wake up and me running, and by the time we had reached the start area around 7.30, despite halving my dose I had still an excess of insulin in me, I was back at 110 and trending down. Interesting!

Plan A Fails: What Now?

I had brought along some extra rice cakes, so I ate three additional pieces: knowing that 20 grams of carbs elevate my blood glucose by 60 to 70 points, those should get me up to the desired 190. I also had my “emergency” white sugar tabs, which I didn’t take and put in my pockets in case of need while running.

However, I still wasn’t anywhere near my target range and that did not help keeping my nerves in check. I had to drop the bag at 8.30 and stay without food until the start at 9.30, and I really had the impression that by that time I’d be too low blood and tank after a few kilometers.

In other words, the carb intake I had planned wasn’t producing the desired effect, plan A was not working, and I was getting nervous about the race and the idea of possibly not reaching the finish line. So I did what in the moment felt the most logical thing to do: I ate more.

This is the exact moment where I committed my biggest mistake and learned my biggest lesson.

Here’s me, talking about it!

Big Mistake And Big Lesson

I did not trust my plan. I did not trust my meticulous study of myself over the weeks and months prior. I did not trust my calculations. I let fear take over. And when emotions take charge there can be consequences.

The moment I let the fear of going low overwhelm me, I partially lost my rationality and my tunnel vision led me to actions I’d otherwise not even consider doing. I ate all of the remaining rice cakes in the bag (around five of them), a quantity that far exceeded the dose of rapid insulin I had injected and that would surely excessively elevate the amount of sugar in my blood streams.

While in the moment that surely felt like the safest thing to do and somehow put my mind at ease (“I surely won’t go into hypoglycemia now!” were the words bumping inside my scull), I was perfectly aware of the consequences: I was in my 150s, I had already eaten according to plan and had I trusted my plan I would soon get all the way up to the desired 190s. The additional fear-induced portion would simply get me even higher, right in hyperglycemia territory. Simple as that.

The big mistake was letting fear take control, binge eat, wreck and self-sabotage my otherwise carefully planned strategy and, ultimately, my health. But every mistake carries a lesson, if we dare observing and analyzing what is going on.

The big lesson was that no matter how much time and effort I had dedicated to calculate my insulin and carb intake down to the unit and gram, how seriously I had committed to stick to my calculations, a few moments before the race start I let fears take ove and run the show.

I recognized the fil rouge, the subtle factor that had ruined my diabetes management in all of my previous races, in one way or the other: I cease to trust my rational mind, I end up eating more than necessary (or injecting less) due to a moment of concern or fear, and I suffer the hyperglycaemic disaster that follows.

Fear Fear Fear. Now I See You!

I now know my weak point. I know it by name and surname, I can point my finger to it and deal with it face to face.

My weak point is that the excitement of race day, the will to cross the finish line, the thousands of other emotions that come and go make me unable to apply to a race the logic that I test and refine during my trainings.

It took me several marathons, half marathons and long training runs to untangle this knot, but I feel relieved now because I have brought this previously unconscious pattern to the light and can deal with it face to face. It is not food, or insulin, nor any other of the more immediately visible variables that a diabetic could think of that screw me over. It is the management of emotions the root cause of my low time in range during races.

Last Sunday - just like all my previous marathons - eating a bit more before the race start gave me the illusion of safety in the moment, ****but what I was really doing was setting myself up for yet another run in hyperglycemia. Who knows what would’ve happened had I followed my plan: perhaps the rise would have been slow but not excessive and that the run itself would have helped me tame it - exactly the way I wanted it to be, and exactly how it had always been in training. Perhaps I would have had to interrupt my run due to a low. Either way, shooting my blood glucose high just for an illusory feeling of safety is not the right way to approach this issue. The long term health consequences of blood sugar elevation are too serious for me to keep going light this.

So yes indeed, another race ran in hyperglycaemia. But this time I am happy that it happened. Some journaling and reflection allowed me to spot the true root of my race issues. I thought I was in charge of my pre-race actions but it was Fear dominating me without me knowing it.

It might look like a partial failure, but in truth his half marathon has been a huge step forward for me in several ways.

Now I see the issue more clearly and call it out. I have exposed it to the brightness of light. Managing it in the future won’t be an easy task.

But I am committed to keep striving towards my healthiest version possible for the longest time possible. I am in it for the long run, I am ready to deal with all my future mistakes, and I know that the awareness that I develop throughout the process will turn me into a better athlete, diabetic and person.