Epic adventures test the limits of human endurance — especially when you figure type 1 diabetes into the mix. Regardless of the size of the challenge, what matters more than anything is what you do when things go wrong.
Because they will.
Part 1: Framing the Adventure
Whether you’re planning a cross-state run or bike ride or a marathon swim around an island, there are a few things that are certain:
- When you finish it, you’ll have bragging rights no one can take away.
- You will learn something about just how far the human body and human spirit can be stretched and still rebound.
- You’ll screw something up.
This is OK. It is part of your story. People like stories in which the presumed hero ALMOST doesn’t finish the race, or faces some seemingly insurmountable obstacle at the worst possible moment. It’s part of what’s called the Hero’s Journey, which is part of your Story Arc.
Which is a fine way of describing a dramatic narrative.
Living it is another matter. To BE that hero who actually finishes takes preparation, and not just preparation for success.
Part 2: Planning for what should happen – high probability, low risk
One of the most important things you can do when preparing for an epic adventure is to be as fully reliant on yourself and your core team (not the folks who sign on for the romance and flake out when “winning” involves being awake at 3 AM and outside in the freezing cold) as possible.
Self-sufficiency is king
- Carry your own food and water on a 200 mile run and don’t depend on making it to Pruski’s Truck Stop before it closes 10 minutes after your planned arrival.
- Know your pace, your estimated rate of progress, and have an ability to update others and verify you’re still on track.
- If it’s relevant, bring your own shelter, sleeping, and toilet arrangements.
- Bring your own shade, navigation tools, and dry clothing for when (not if) you get caught in the rain.
- Bring spare shoelaces and extra clean socks.
The list goes on WAY longer than this.
The point is, nothing sucks like needing something you don’t have, so make sure you have it.
Practice, practice, practice
The best way to be certain of what you’ll need on an epic adventure is to train in conditions as close to those you’ll encounter on the event as possible.
If you’re going to run the Marathon des Sables (150 mile run across the Sahara Desert), train in hot weather. Learn how to keep the sun out of your face, how to recognize when you’re “cooking” (whether or not you’re sunburned), how to vent heat in temperatures above body temp (yes, this is possible, and it doesn’t involve evaporation!), and how to pace yourself during the days and nights. Learn how often you should switch from a run to a walk. Discover when, what, how, and how much to eat as you move. Plan your breaks, and stick to your timetable.
From this, you will learn many things: what kind of food to pack, why you need a stopwatch on a week-long run, and why world-record-setting super-ultramarathoners seldom run faster than a 17 minute mile.
Whatever you learn during training, put it into practice.
Then lather, rinse, and repeat. the more you encounter a particular set of circumstances, the likelier it is that you’ll encounter something similar during the event, and the likelier you’ll be prepared.
Part 3: Planning for what MIGHT happen
Contingency planning and gaming out alternate scenarios before the event — planning your cutoffs, go/no-go decisions points and criteria, etc., are critical to the success of any big adventure.
If it were ordinary, you’d be able to study how somebody else did it, copy his or her plan, and… you wouldn’t be the first to do it.
The problem is, iffy situations breed bad decisions, and bad decisions cascade.
For instance, running low on fuel or water has led the best of runners in races like Badwater (130 miles across Death Valley in August) to do questionable things that consume even more of their precious water, don’t bring about success, and usually involve another runner noticing you’re half naked and talking to imaginary gophers (I am NOT making this up… but it wasn’t me, I promise). Medical crews get called out, and you don’t finish anyway.
There was an article recently in the Washington Post about what mountaineers should do when they get lost. Basically, the answer was to stop, sit, and think.
Yes, we know you’re cold, you’re full of adrenalin because you got separated from your backpack when you slipped and nearly bought it falling down that ravine.
But if you decide to start walking — to look for shelter, forage for food, seek help, etc., you’re just making it worse.
Imagine yourself in that situation, and think back to what you wish you had done that morning that would have saved your butt.
- Charge up your rescue GPS locator beacon.
- BRING your GPS locator beacon.
- TURN ON your GPS locator beacon.
- DON’T put it in your backpack. Put it in a pants pocket where it’s protected from falling out by the bend at your hips, and hopefully, a zipper or something.
Now, extend that thinking to everything that MIGHT go wrong. Plan for it to go wrong, and go back and repeat the process for what happens NEXT in your disaster scenario.
Have a backup plan
I was on a 30-mile run recently where my blood sugar dropped precipitously and I needed to stop to get something to eat. Fortunately, my training run was in a civilized area, and while I had emergency glucose gels, I was very close to a convenience store and still rational enough to buy a bottle of orange juice.
As I sat down on a park bench not far from the convenience store to wait for my sugar to rise, I decided to text my wife and let her know I was stopping for a bout 15 minutes. I got out my cell phone, and the battery was at 15%.
I had brought a spare battery precisely for this purpose. I put it in the phone and restarted the phone.
The NEW battery was at 8% (the battery was failing, and the previous night’s charging was unsuccessful).
I had forgotten to bring my GPS locator beacon, thinking that it was superfluous on a local run.
I had no choice but to wait until my sugar was back up and continue at a slow pace along the planned route.
What had I done wrong? I didn’t bring my GPS locator beacon.
What had I done right? I had multiple fallbacks, allowing for two of them to fail, and the third one — leaving a copy of my route and timetable with my wife — succeeded.
Leslie met me along the route with chocolate milk, and as the sun was setting, I decided to call it quits for the day since I was only 4 miles from home.
But that day was a success.
Your backup plan should include critical backup supplies
Having backups doesn’t mean you need two of everything, but it does mean that you can’t carry just ONE of something that’s critical.
It’s about avoiding the consequences of cascading failure.
If you’re out in the middle of nowhere and drop an insulin bottle down a storm drain, you should have another one stored somewhere safe. As a backup for THAT backup, have an Rx written in advance to be filled AT A PHARMACY (not mail order).
It does NOT mean figuring that if you lose your insulin you’ll just stop at a Walgreens or CVS when you hit the next town.
The next town may not be for 100 miles or more (for instance, if you’re running from El Paso to Pecos, TX, there are exactly 3 towns and one state park in 250 miles). The pharmacy at the 24-hour drugstore may not be 24-hour. The drugstore may be closed.
It means that if your CGM (continuous glucose monitor) sensor sweats off, you not only have spare CGM sensors (and possibly a spare transmitter if sweating off the sensor involves losing the entire assembly attached to your body), but you have spare alcohol swabs to sanitize the site, spare adhesive wipes (such as Skin-Tac) to ensure the new site won’t sweat off again, and possibly waterproof dressings so that any ice you have melting in that cooling bandana around your neck won’t wet down your CGM and infuser sites next time.
Think of it this way: if you lost something, how would you adapt?
- If you can get by with whatever else you have, then you don’t need spares.
- If your improvisations involve compromises in health, safety, or some other critical factor, you MUST have a spare or call it quits.
- If you simply have no other alternatives once the item’s lost or damaged, it’s time to quit.
If you don’t want to quit, bring backups.
Sometimes what you need is close to what you have, but not in the way you originally anticipated the need.
On a 223-mile run from Austin to Corpus Christi in October 2017, I got into the irritating habit of losing sensor and infuser sites to moisture.
Part of the problem was that I was sweating them off. But part of the problem was that I was wearing an ice bandana to keep me cool in the hot daytime temperatures (around 90-95 degrees F). When the ice melted, it soaked my shirt and got under my sites.
I tried several things, none of which I had planned on doing:
- I tucked my running shirt into my pants.
- I switched to a body-conforming Tesla running shirt.
- I dried the site, applied alcohol wipes and Skin-Tac, re-adhered the infuser and sensor, and covered them with waterproof NexCare transparent dressings so they’d stay dry(er), stuck to my body, and I could see if they were coming off.
- My wife Leslie applied a Kerlix self-adhesive dressing from our first aid kit like a cummerbund, covering both the infuser and sensor sites and would catch them if the waterproof dressing came off.
- She also switched to putting the ice in plastic baggies before tucking it into the bandana.
I never really thought of the Kerlix and NexCare dressings as being put to that use, but I was glad we’d brought them.
My buddy Roddy Riddle, who ran both the Marathon des Sables and the grueling 6633 Arctic Ultra (only 32 people have ever finished in 20 years) encountered a problem with preserving his insulin in super-hot desert and super cold Arctic conditions. Putting it into a freezer pack was for various reasons impractical — it wasn’t easy to access and it was just more stuff to carry in an event where ounces matter. He took to tucking his insulin inside his pants.
It made sense, really — insulin works best at body temperature anyway, and in the desert, his body was significantly cooler than his surroundings. In the Arctic, it was significantly warmer.
And it was creative thinking in a situation where even emergency aid would have taken hours to reach him.
On your event, you may not expect 140 degree temps, 70 below and 60 mph winds, rain, edema, tightening ligaments and tendons from hypothermia, chills and high blood sugars from stress, hallucinations from sleep deprivation, disorienting fog during your swim or run… but plan for them anyway.
Because the first two happened to Roddy, and the rest of them happened to me.
If the unexpected doesn’t happen to you, count yourself lucky.
Part 4: Planning for what SHOULDN’T happen
The difference between what might happen and what shouldn’t happen is subtle; but the essence of it is that something that MIGHT happen can be reasonably planned for.
Things that shouldn’t happen are so far down on the probability scale that it’s impractical to plan for them.
The problem is, if and when they DO happen, they are so high risk they may kill you.
Fallback planning, disaster version
A scenario I left out before: at the Honey Badger 100 mile Ultra Road Race in July 2017 just outside Wichita, KS, I and two other runners were run off the road around midnight by a local farmer (we spotted his truck the next morning and know exactly where he lives) who was either angry at runners or thought it would be a hoot to threaten their lives. The race director called the Highway Patrol, who stopped and questioned the farmer and told him that if he set out on the road again that night, he’d be arrested.
Before all that happened, I had the interesting experience of finding out in the moment what would happen if I dove headlong into a ditch on the side of the road.
Strangely, and perhaps because I’m disaster-planning-obsessed, I had been thinking that night (your head goes weird places after 70 miles on your feet) about what I would do if somebody ran me off the road.
I had a similar situation at my solo run of the Capital to Coast Relay (the Austin to Corpus run) — busy road, two lanes, rush hour, and no choice but to step into the ditch at unpredictable intervals.
What do you learn from thinking about jumping into a ditch?
- What kind of weeds are softest
- How to avoid fire ant beds
- How to avoid cockleburs
- How to avoid soaking your socks in the dew
- What weeds are flattest
Follow your planned route. Don’t improvise. Always, ALWAYS file a manifest, and agree with another person when they will come find you if you don’t return. Arrange check-ins, and if you don’t check in, make sure BOTH of you have a clear understanding of what emergency protocol kicks in and when.
It sounds stupid, but you should think about things like this when you can. It keeps you focused on your surroundings, on your situation, and it keeps your mind alert.
It is incredibly important to keep your mind alert.
Do you feel like your blood sugar is low? Treat. Test if possible. Always do this first if you’re in a bad situation, and not sure what to do. Then stop. Next, think. You may be on a windy mountain ledge and unable to test. Yes, the clock is ticking. But 10 minutes or 60g either way is not going to kill you, and not eating just might.
Catastrophic non-T1D events can dramatically affect the intensity and duration of your planned exertion, and thus the adequacy of insulin, food, and test supplies.
Don’t expect new, useful, constructive ideas if you are low.
Implement safety checks that others — not you — can enforce
When attempting something epic, your mind will fail.
You are used to thinking of yourself a strong, but losing your ability to think is a critical, life-endangering failure. In such situations, you MUST arrange in advance to have someone else do the thinking.
Ultramarathon swimmer Lynne Cox has a rule: that for an event to be “on”, everyone in the team needs to confirm that their go-no-go conditions are met. Typically, there’s a crew chief, a safety chief, and the athlete herself. On one particular marathon swim, she fell asleep in the water, waking up periodically in a sort of apnea when she tried to breathe and found herself face-down in the water.
She had a medical person to watch her health while the crew chief checked her time vs. her plan for the race and assessed how it would be affected by wind, weather, and marine conditions.
Just when she should have been watching Ms. Cox, her safety person was busy throwing up in the water, because the waves had made her seasick.
The crew chief was forced to make the call to discontinue her participation. (Read more in Lynne Cox’s book, The Open Water Swimming Manual.)
I had a similar moment during my Austin-to-Corpus run. I had taken too long on multiple breaks, and despite planning “wiggle” room, was running behind schedule near the middle of the third day, somewhere about 60 miles from Corpus Christi. As a team, my crew chief (my wife Leslie), our navigator Angie, my pacer Josh, and I all agreed we’d forego the last sleep break in hopes of making it to Corpus before the 7:30 cutoff on day 4. I managed fairly well until we reached Beeville, at which point I began flagging and was forced to take a 90 minute nap. In the previous 3 days I had gotten — including that 90 minutes — a total of 7 hours of sleep, as each day we realized we were taking too long to do things like eat, sit down, and check into the hotel at the end of the day.
I was so obsessed with making it to Corpus that I had literally been running in my sleep, and somewhere in the preceding hours had hallucinated a guardrail where there were nothing but fire ant mounds. Our crew had arranged “safety questions” they’d ask me that were easy to answer if I were still rational. About 40 miles outside of Corpus, I failed a safety question (“what year were you diagnosed with type 1?”) by answering “did you just say ‘devilish?'”
My wife made the call for me to sit down in a folding chair and take a nap we didn’t have time for.
I really wasn’t in a condition to question her.
About 20 minutes later, I was reasonably coherent and told her I’d walk 35 of the last 40 miles and asked if we could keep going if we could manage 3-3.5 miles an hour. I managed 4, and we made it to Corpus. But only because we ALL agreed whether to continue, and any single one of the crew had complete and unquestioned authority to stop my participation if it became a danger to my health or safety.
Part 5: Problem solving when Things Go Wrong
Know when to keep going
During the Honey Badger 100, my feet began to blister at about mile 45, and were thoroughly blistered by the one restroom stop at mile 50. I walked on blisters for the next 3 miles, feeling like I was treading on bubble wrap filled with sulfuric acid, until I reached the 14-hour cutoff at St. Leo’s church, just past the halfway point.
I should mention that Leslie does a fantastic job with strength tape and Neosporin. She prepped my feet so well that I was able to run another 50 miles on blisters and finish the race.
The one thing we didn’t plan for was the way in which the combination of exertion, sleep deprivation (it took me 32 hours and change to finish, with no sleep) and running on blisters caused my blood sugar to skyrocket.
The temptation when one’s blood sugar is going up in a race is to “run it down.” That’s great if you’ve just had a runner’s gel and you’re going a bit to slow to burn it off before the next aid station. It’s another thing entirely stress causes your body to dump glycogen into your bloodstream. The purpose of that glycogen is to provide energy stores to help you get through whatever is causing the stress. Your body expects you to slow down, rest, and replace the glycogen.
If you don’t, it just dumps more glycogen, which you can’t really use without insulin.
If you get insulin to bring your blood sugar down without eating anything, it re-stores the glycogen but doesn’t address the original reason (stress) it was dumped.
So you dump glycogen again.
This patter repeats, with your blood sugar “scalloping” up and down for a while, until you’re exhausted, it’s a real emergency, and you start breaking down muscle protein.
This is not good.
Leslie and I had to figure out in the middle of all this that the critical thing I needed to do was EAT. Even though my blood sugar had by now crept up from the low 200s at mile 64 to over 300 by mile 85, and 550 mg/dl by mile 95, I had to eat.
I did. I got just a tiny correction bolus of insulin, about 1/3 of what it would take to bring my sugar below 200. I ate about 25g of carbs, whole fat yogurt as I recall.
Miraculously, my blood sugar dropped. We are talking maybe… MAYBE 1 unit of Humalog here. Getting some food on board, though, seemed to signal my body that the crisis had lessened and that it could store energy from the good I’d eaten.
It took everything I had to believe that strategy would work. But I had no other choice. It was either do that or quit.
I don’t mind quitting. In fact, I self-DNF’d (did not finish) my first 140.6 due to water safety conditions.
But I don’t like quitting when I have my wits about me and there’s a problem to solve.
For me, I felt that what worked was that Leslie and I sat down during one of the planned breaks and reasoned out what factors were at play, what possible scenarios might play out, and what the cost of failure was for each of them. We decided that I needed to eat anyway (since I had not eaten for a while as my sugar had been climbing after supper), and the consequences of being wrong weren’t fatal.
I made it to the finish.
Know when to quit
Not all races end well. As I mentioned, at my first 140.6, it was an off-brand race with very little water safety crew. The day of the race, it was storming, with lightning, just before the start, and the race director decided that after the lighting abated the race would go on. High winds on a large lake created significant fetch on the water, resulting in 2-ft chop, at least a foot above what would be considered unsafe boating conditions. Nevertheless, the one motorboat headed out onto the water and stopped about 400 meters offshore as the kayaker, the only other safety crew, repeatedly capsized just meters off the beach.
The race started. I swam about 400 meters out — just beside the motorboat — and aspirated water. I raised my hand to signal for rescue. No one on the boat saw me, because it turned around and headed somewhere else.
I decided that I could swim the 400 meters back to the shore, and turned and swam against the other participants, along with a few dozen others, back to the shore. A steady stream of swimmers voluntarily DNF’d at the timing table, letting race officials know we had quit and had not drowned.
It’s hard to be rational in 2-ft chop, rain, and high winds. But it comes down to this: Get Out Of The Water Safely. That was the plan. It was simple as that. EVERY thought I had after the decision to quit was about how to do it safely, calmly, and rationally.
Key to problem solving in disaster and near-disaster scenarios is finding that little nugget of rationality to cling to and holding on.
When you’re low, that nugget is getting sugar in you — and how to operationalize that. It can be saying, “diabetic — need sugar”, or “I have to eat” or anything. But it needs to be SO INGRAINED it cannot fail. It must override instinct and habit. As with self-rescue from near-drowning, you must override instinct and replace habit with behavior that will keep you alive, so you can return and fight another day.
As crazy as it sounds, once you put your mind to doing something, it’s relatively easy to stay in that mind set, through suffering, setbacks, and painful learning experiences.
You’ve done some badass things. You know what I’m talking about — it’s not those believe-to-achieve mantras and harden-the-freak-up attitudes I’m talking about, but the sheer dogged persistence of getting in there and doing the hard thing repeatedly until it gets easier.
Sometimes, though, dogged persistence makes it hard to tell what decisions are smart and which ones will get you into trouble.
It’s difficult to override instinct and unproductive habits that get you into MORE trouble.
Expeditionary Thinking is all about playing out both in training and in planning the most probable-but-low-risk scenarios as well as the improbably-but-high-risk ones, planning for cascading failure, and deciding ahead of time where the risk cutoffs are. It means surrounding yourself with a competent crew (even if that’s just your phone-based safety check-in) who can do the thinking when you’re not able to. And it means planning a reasonable amount of redundancy into the equipment, gear, food, and supplies you take with you, so that you do not endanger your health or physical safety.
When it comes to doing epic things with type 1 in the mix, it means acknowledging that while you may not feel like diabetes is holding you back, it is constraining the conditions of your success. You MUST plan around it, you must include it in your disaster scenarios, and you must, while rational, consider the consequences of a poor decision and the consequences on your health.
You must realize that type 1 aggravates precisely the types of on-the-edge situations that make epic adventures so exciting.
But that doesn’t mean you can’t do those things — it just means you must be more careful than everyone else.
The call is on you to be HYPER planful, HYPER thoughtful, and HYPER realistic about your plans for a successful adventure… and an unsuccessful one.
Because with type 1, living to see another day is sometimes the most epic accomplishment of all.
Be safe out there!