My Strategy For My First Olympic Triathlon With Type 1 Diabetes

If you’re reading this article, yesterday I’ve completed my first Olympic Triathlon race.

That is:

• a 1500 meters swim

• a 40 KM bike ride

• a 10 KM run

one right after the other.

I am incredibly excited and slightly scared.

Excited because I love challenges that force me to grow, and I find endurance races to be an excellent gym for the body and the soul. Scared because Triathlon is a tricky sport in itself, and competing in it as a Type 1 Diabetic makes it even trickier. But, you know, that’s the fear that makes you trickle a bit and then pumps you.

The fear that puts a grin on your face - the “all right, bring it on” type of grin -, and with that grin I am ready to face whatever is in front of me.

The biggest challenge is going to be keeping excellent blood glucose levels throughout the race, balancing the constant intake of carbohydrates with the risks of spikes and lows.

Last week I outlined my biggest concerns related to the race, and today I am going to share how I planned for them.

My goal is to put diabetes management “on autopilot”. That means planning everything to the best of my abilities so that during the race I can be fully confident that blood sugars are going to behave. I am ready for something to NOT go according to plan, but that’s not something I can control - I can only control how meticulous and attentive I am in my prep.

So let me share how I am planning to tackle my race day concerns in order to maximize my chances of success:

Note to the reader: everything you're about to read (the amounts of carbohydrates, the insulin doses, the ratios, the eating schedule and meal timings, etc) is tailored on me. I crafted this T1 Diabetes Management Plan after several hours spent training, testing, observing, reporting, correcting, annotating, fixing. Only by. observing with attention can I know, for instance, that I need that amount of carbs at that specific moment of the race. Should you ever sign up for a Triathlon or other endurance events (which I highly recommend!!!), please go through the process of meticulous note taking about your diabetes during training. It’s really something you need to figure out on your own. I only share the principles and how they helped me come up with this plan, but there’s no “one size fits all”.

Open Water Swimming

Sea water is going to be cold, I’ll be without my CGM reader and without food: I must avoid hypoglycaemia.

I’ll start to swim at 11 AM, so here’s my plan:

• I am going to give my breakfast insulin between 7 and 7.30 AM, and eat my breakfast (50 grams of carbs coming from oats or rice) at around 8 AM

• I will calculate my dose based my C:I Ratio for that day, and inject HALF of the amount. My goal is to start the swim with my blood sugars slightly elevated

• Based on where my blood sugars is at one hour before the start, I’ll decide whether to eat some more (like a banana)

• I will prick my finger 15-30 mins before the start to see where I am at, and keep some running gels in the forearms of my wetsuit - just in case something happens in the middle of the sea

Once again, the goal is to avoid hypoglycaemia while swimming, so I’ll do everything that helps keep my blood sugars between 150 and 180. I am also considering halving my basal insulin the day before.

Slamming Down Carbs On The Bike

Out of the water (because yes, everything is going to be OK during the swim), time to hop on the bike.

SInce I won’t have CGM readings for a few minutes, I am going to prick my finger right before the bike ride to know exactly my blood glucose levels. If I am above 200, I know I can safely take 0.5 or 1 units of insulin (I’ve tested this strategy ON MYSELF during training. This is not a “one size fits all” solution…do your own testing!). If I am below 200, I’ll get a sip of my isotonic drink and start pedalling, knowing that I’ll have at least 75 minutes of intense pedaling ahead of me. I’ve noticed in training that when I run after a bike ride my legs are cooked, so I’ll fuel myself with about 45 grams of carbs per hour. I will carry:

• two bottles with around 45 grams of diluted isotonic powder

• 4-5 gels in my bike case (just in case I need extra sugars)

• my CGM reader in my pocket, to check my blood sugars every 15 minutes

Another reason to get carbs while I ride is that I’ve observed that my blood sugar tends to drop very rapidly in the last hour of a race - and I want to avoid a low halfway through the run.

Finishing in style

40 KM on the bike: Done. Time to lace ‘em up and run towards the finish line.

As soon as I get off the bike, I’ll prick my fingers again (my glucose monitor will be in my transition bag).

• If above 250, I’ll take one unit of insulin

• If around 200, I’ll take half a unit of insulin

• If around 200 but the CGM is on a down trend, I won’t take any insulin

It’s a 10k, so nothing huge. But It’s a 10k after a 40k bike ride and a 1.5k swim, and I’ll be burning carbs like a furnace. The fatigue is going to compound and escalate quickly too, so I’ll need extra fuel to perform well and cross the finish line full of energy.

Running is where I am most confident, because I’ve ran several marathons and know what my body needs when a long race is coming to an end. But I’ve never ran after a long bike ride, so I foresee an entirely different kind of fatigue, and I am ready for it.

My strategy is the same as always:

• Bring the CGM Reader in my running belt to check the readings every 10 minutes

• Slam down 30-45 grams of carbs per hour (adjusting the quantity depending on my blood sugars)

• In order to avoid huge spikes, I’ll take half of the gel after 10 minutes, half after 30 minutes and decide whether I need more based on my blood sugars behavior

• For a 10k I typically only need one gel, but I’ll carry three or four in my running belt - I always carry extra sugar on every run, even a 30 min easy recovery jog

• If my blood sugar skyrockets during the run, so be it. It’s all information that I can review later to perfect my nutrition strategy for upcoming races

• If my blood sugar drops during the run, I’ll have the extra gels I need to keep it up

Post Race Assessment

Whatever happens during the race, it’s going to be precious data for the future. And I mean precious like golden.

• I ate X carbs Y hours before the race, and my blood sugar did Z. Was that ok, not ok, did I need to correct? Why, and how can I make it better next time?

• I ate X carbs during the bike and my blood sugar did Y. Why did that happen? Could I keep up my energy or needed more?

• My blood sugar spiked halfway through the race. Why? What did I do? Was I stressed, excited, unrested?

• My blood sugar dropped halfway through the run. Why? What did I do wrong? Perhaps I should’ve decreased my long-acting insulin yesterday?

• …

Asking these questions is critical to figure out the whys and hows of blood sugars. Stuff is going to happen and not all of it will match my plan. That’s ok, that’s all experience, that’s all additional information.

That is why I am doing triathlon and endurance sports: to push my body and spirit to the edge, to push my T1 Diabetes Management skills to their limit and force myself to learn in uncomfortable situations.

Managing my diabetes while sitting on the couch all day would be too easy. But if I learn to manage it amidst the complexity of stressful situations, then I can say I am really growing.