My First Triathlon With T1 Diabetes: 5 Critical Mistakes That Screwed An Excellent Diabetes Management Plan (I Messed Up, But I Learned A Lot!)
Last Saturday I successfully completed my first Olympic distance triathlon as a Type 1 Diabetic, and what a wonderful experience that was!
The sun was shining, the temperature was warm just enough to enjoy every part of the race but not so much to turn the whole thing into a lap in the oven. I was excited and confident because I had put in the work required - both in my endurance training and in crafting a diabetes management strategy that would keep me energetic, stable and happy. I had done everything in my control to make the day a success for the diabetic and the endurance junkie in me, the plan was there.
And as it happens with every perfect plan, something has to go wrong!
My First Triathlon With T1 Diabetes was a partial success. I performed well, and I've been in range 92% of the time on that Weeknd...except for the four hours that included the pre race, the race and the post race.
I made 5 critical mistakes that swamped my diabetes race strategy, and learned some powerful lessons.
Let me explain them, one by one:
You can easily guess when the race happened. 🤣
Each of numbers in the image is explained in the points below.
Mistake 1: Rushing Through Breakfast
Good morning, you're racing in just about three hours...you need to fuel!
So screamed the voice in my head as I woke up at 5:34AM.
I knew I wanted to get my breakfast insulin in early, in order to avoid starting the swim with any insulin on board. I knew that the dawn phenomenon was ready to kick up my blood sugars as soon as I opened my eyes. And I knew I had to give my bolus, hydrate, wait some minutes and then eat my oatmeal and banana - that would guarantee I'd avoid a spike.
And what did I do?
I woke up, hydrated, gave the bolus amount I had calculated for the amount of carbs I was going to eat and...slammed all those carbs down in a split second, a mere five minutes after blinking my eyes opened. I was excited, anxious and notmindful. I did not followed my plan.
The blood glucose spike that ensued from this first mistake generated a snowball effect that screwed the rest of the day.
Mistake #2: “Fear” Bolus
And as soon as I saw the spike I gave more insulin - which was not planned.
I started to see the arrows pointing upwards on my CGM, and my blood sugars climbing their way up to 230s..."what the heck!". I had to correct, or I would be high all day long, I thought. So I stacked additional insulin on the one I had injected just one hour earlier.
And I soon suffered the consequence of insulin stacking: a blood sugar drop. Which led to mistake number three.
Mistake #3: “Fear” Snack
With all that insulin on board (part of which I had not planned to inject) my blood sugar was now at 109, trending down.
I only had 30 minutes before I would jump into the water, and the last thing I wanted was to go low in the middle of the sea. With cold water and intense effort I never feel hypoglycemias while swimming, and I started to panic a bit. Knowing that in case of high blood sugars I would have my insulin in transition zones, and that I'd rather be high than low in open waters, I decided to eat extra carbs right before the start to be safe in the water.
So I slammed down two extra bananas and one gel. Spike ensued, and the snowball effect was avalanching me towards my next mistake.
Mistake #4: No Insulin In T1
Exactly: my insulin was not in my transition bag, it remained on the backseat of my car.
This was not a nutrition mistake like the others, but the typical stupid screw up you do when you're stressed out. Insulin was part of my diabetes race strategy: based on my calculations, I had decided that if I was above 200 I could give one unit in order to keep the carbs coming without being in hyperglycemia. I had 200 grams of carbs to eat, but I had no insulin! Let me repeat, no insulin...it remained in the car!!
I did not panic. I knew I was going to race with elevated blood sugars, so I had a decision to make.
Decision: “Prioritize The Athlete, Not The Diabetic”
Without carbs, I'd bonk or perform very poorly.
I decided that I would not stop eating carbs. I would stick to my nutrition plan in transition one (from swim to bike) and at least for the 40k bike section of the race, and decide what to do during the run based on my blood sugar in the second transition (from bike to run).
So I ate my 100 grams of carbs while racing my bike.
Mistake #5: No Insulin In T2
I knew I had screwed up, and at this point the goal was damage limitation.
The bike section went well, I pedaled faster than ever and was burning glucose fast. However, my blood sugars was still at 250 while lacing up my shoes for the last part, the 10k run. Still no insulin (remember, it's in the car). At this point I decided to not eat the gel I had planned for the run - I could handle a 10k without extra fuel.
I ran fast, and hydrated every time I had the occasion.
Drinking water would speed up the insulin after the race, and it would counteract the dehydration generated by the hyperglycemia. I finished strong and with a big smile.
The endurance athlete was happy, the diabetic less so, but it was still a net positive.
Post Race Decision: Insulin? Refuel?
I took the medal, grabbed a bottle of water and immediately went to the car to grab my insulin.
I needed to eat rapidly, and I needed carbs to help my body recover. But I was way above 200: how could I even think eating carbs?! Well, I had to, and I actually did. I just took a few measures to tame my spike while eating a giant bowl of pasta and three apples:
I injected 150% of the insulin I had planned after the race (15 units instead of 10, 5 extra ones to correct the hyperglycemia),
I immediately grabbed a bowl of pasta, but I did not eat the entire thing right there, instead...
...I ate it over the course of 30 minutes: one spoon here, one there, with patience.
Why? Because while my blood glucose was rapidly coming down (3 hours of intense aerobic exercise + a ton of insulin), I was accompanying it to the 100s by giving a small amount of carbs every 5 minutes.
That way, I brought my blood sugars to the normal range, refilled my body and avoided an hypoglycemia.
Conclusion: Lessons
It was my first triathlon, and I kind of burned my hand. But I am still happy, because I learned so many lessons that I will use to perfect my strategy for my next triathlon race: Ironman 70.3 Venice, in may 2024.
Here's what I've learned :
Don't Let Fear Dominate: Fear led me to eat more, inject more, eat more and screw my blood sugars way before the race even started.
Have A Plan And Trust It: Had I just followed my plan, I would've probably been in range most of the time. I knew what to do and what to expect because I had tested everything during training.
Adapt As Needed: If something goes wrong (and now I know that it can definitively happen), just adapt the plan as best as you can. I had no insulin, but there were countermeasures I could take to avoid a complete disaster. I adapted, and I came out of it alive.
Don't Despair & Stay Lucid: I could've despaired when I figured that I had forgot my insulin. Instead, I accepted my mistake and just went on: what is the best thing I can do right now? One decision after another - observing and taking action. Lucidly.
Sacrifice: Be ready to sacrifice something from the original plan. In this case I sacrificed part of my race nutrition, going for the run without the gel that would've given me the energy for the last sprint. I wanted to avoid a huge hyperglycemia, and something had to go. I sacrificed something, and I was ok with it. I adapted.
This experience has taught me a lot.
It feels like I've taken a crash course in T1 Diabetes management, a "five years in one" kind of thing. But that's why I do it: I get uncomfortable and put myself in condition to truly learn. I stress test my abilities and fill my gaps.
Get uncomfortable, it always works.
Let's tackle that Ironman 70.3!
