Eva Kapp is a keen triathlete and type 1 diabetic. We asked her to write a guest post about her experience with managing type 1 diabetes and doing endurance sports.
I was diagnosed with type 1 diabetes at the age of five. Now at 33 and a keen sports person, I consider myself an old hand when it comes to living with type 1.
I had learnt to control my glucose levels from an early age and it had never stopped me from being active. I enjoy all types of sports from (trail) running, road cycling and skiing to mountain biking and surfing. I used to be a member of my school’s volleyball team and the local athletics club and even taught classes as an indoor cycling instructor during university.
I didn’t discover triathlon until the end of 2010 when a friend persuaded me to go on a Saturday morning bike ride with the local triathlon club. I didn’t own a road bike at the time, and could barely swim a length of front crawl. Luckily, I used to swim when I was younger and enjoyed the challenge of learning a new swim technique. I had never really considered doing a triathlon but soon got hooked and found myself surrounded by like-minded triathletes. Although I had no idea how to manage my diabetes with having to transition between swimming, cycling and running, I just thought: “Let’s give it a go and see how it goes!”
My First Triathlon Experience
In 2011, I bought my first second-hand road bike, borrowed a wetsuit and started training with my local triathlon club. Six months later, I did my first race, a sprint triathlon (400m open-water swim, 20km bike and 5km run), came fifth out of 27 in my age group and was chuffed to bits. I started training regularly and by the end of the 2011 season I had competed in my first Olympic distance triathlon (1.5km swim, 40km bike, 10km run) and clocked 5 hours 56 minutes on the 180km bike leg of the “Challenge Copenhagen” ironman relay. I hadn’t had any previous experience in managing diabetes for endurance-based sports, but it didn’t stop me at all to go onto doing longer races. From training and racing, I had proven to myself that I was able to manage glucose levels very well.
Type 1 Diabetes And Ironman – A Big No?
Always up for a challenge, I had set my sights on a half ironman triathlon in 2012 which involved a 1.9km open-water swim, a 90km bike ride and a half-marathon distance run (21.1km). Standing at the start line, I was extremely nervous about how my sugar levels would behave. Although I had practised the individual disciplines and knew I could do the distances, I had never raced or trained for five to six hours in one go. In the end, all the training and hard work paid off and I finished in 5 hours 22 minutes, coming sixth out of 42 in my age group. It was my first real endurance triathlon and because I managed to maintain such good sugar levels, it really encouraged me to take the next step: an Ironman-distance race which involved a 3.8km swim, an 180km bike ride and completing a marathon of 42.2km at the end.
It was a daunting prospect: Nobody had explicitly told me that I shouldn’t be doing an ironman, but equally, when I spoke to medical specialists they didn’t have any experience of type 1 diabetics doing this kind of thing, so I was pretty much left to myself to find out what it would take.
To prepare for my ironman, I went on a training camp in the Pyrenees (France), practiced sea swimming in the North Sea, and even mastered using a glucose meter while riding my bike. Working out my nutrition strategy and insulin requirements for the big race also took practice and planning as it was vital for me to strike the balance between eating enough carbohydrates – the food source most readily converted to glucose – and injecting the right amount of insulin to turn the glucose into fuel. I experienced a lot of trial and error during training with how much or little food and insulin I needed for the three disciplines. I tested a lot during training sessions and so-called B and C races which were merely to simulate the “big” race. This enabled me to work out how much food and insulin I needed for the duration and intensity I would be racing at and to discover patterns of glucose levels.
Diabetes And Nutrition Management Before, During And After Training/Racing
Nowadays I barely have breakfast before training and racing. I will stick with very few carbohydrates (around 6 grams only), but eat more protein in the form of eggs. This is to avoid having to inject huge amounts of bolus insulin before the race starts. My basal rate that I set in my insulin pump will usually run at around 50% from 1-1.5 hours prior to race start to about 30 minutes prior to finishing. Immediately after a race or long training session, I will run my basal rate at 130% as my body requires a lot more insulin afterwards.
As for the type of food, I learnt that I am best with solid foods: A combination of natural energy bars (for a slower release of sugar) and liquorice sugar candies (fast-acting sugar). I barely use energy gels and if I do, it will be only small amounts. I only ever eat as much as needed to get my glucose levels up and maintain them without having to inject bolus for it. I tend to take on 2-3 pieces of liquorice sweets (8-10 grams of carbs) every 20-30 minutes and/or half an energy/fruit bar (ca 14 grams of carbs) every 30-45 minutes on the bike during training or racing over two hours.
On the run, I tend to need less, often I just go totally by feel and will make use of the aid stations to grab a piece of banana.
I only drink water and non-carbohydrate electrolyte drinks as I find it easier counting carbohydrates with solid foods only. The danger of getting carried away drinking energy drinks is also not present.
From my experience of doing endurance sports, I have learnt that I don’t seem to need lots and lots of carbohydrates. I am well suited for endurance-based sports, as my body seems to be good at using fat for fuel compared to short, sharp sprint based sports where the body is reliant on carbohydrates as the only source of fuel.
Other Factors Affecting Training And Racing Performance
During training for triathlon races in the past, I have learnt that training intensity and rest periods have to be aligned with my insulin sensitivity, which is determined by my monthly menstrual cycle – a hugely important piece of information for planning my race and training.
With an average of 10-15 hours of training each week at the start of my Ironman training, peaking at 17-20 hours in the later phase, it wasn’t just physically tough on my body. It was also mentally challenging to having to manage sugar levels well. As a full-time Marketing Manager, I had to do most of my training in the early mornings before work and then after work. Longer bike or run sessions usually took place on the weekends often consisting of 5-6 hours on the bike, immediately followed with a 30-minute run, as a so-called brick session.
It was a real effort sometimes to manage glucose levels over such a long time and required lots of commitment. With increasing (physical and mental) fatigue, I often find there is a danger to get “lazy” and not wanting to think about also managing diabetes but to just get the session over and done with.
Ironman Race Day
During the ironman race, I learnt to ignore the physical pain, but the race became a mental game. My diabetes turned out not to be the biggest issue but the bad weather with torrential rain, thunderstorms and lightning. I crossed the finish line finishing second in my age group and eleventh woman overall. The first thing I felt was disbelief – not just that I’d finished it, but that I managed to maintain near-perfect sugar levels over such a long race. I finished in 14 hours 48 minutes – much slower than anticipated due to the inclement weather- with a glucose level of 85mg/dl. The lowest my levels ever dropped during the entire race was 73mg/dl; the highest was 187mg/dl.
Since then, I have completed several long endurance events and middle-distance triathlon races – always sticking with the same nutrition and glucose management strategy and it has never failed me.
I am absolutely convinced that having diabetes brings a huge advantage for endurance sports: I had to learn to read my body really well and recognise when it needs fuel because otherwise it can’t perform well. This is such great skill to have for this kind of sport when I need to make sure my body can go on for hours.
My diabetes is not a barrier or an excuse for me, but just another factor to take into account when planning and executing training. There were times I failed with managing glucose levels and I experienced a lot of trial and error, but this was vital for me to learn and develop a set of strategies which will work on race day so that my diabetes is not stopping me from enjoying sports. I can only encourage others to test it out and not to be afraid of errors. It isn’t always easy but incredibly rewarding when you get it right.
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