An Old Story
There’s an old story about a guy who bet a friend $1000 he could eat a bicycle. The disbelieving friend took on what appeared to be a sucker bet.
Then the guy took a metal file, ground the bicycle into little bits, and ate it five grams at a time, over ten years.
Simple but Not Easy
When I was diagnosed with Type 1 diabetes in 1972, it would be another 8 years before the first commercially available glucose meters, so glucose monitoring generally meant a trip to the hospital to have them test my blood sugar; and since exercise drops blood sugar–sometimes dangerously — my doctor advised against exercise.
At the same time, I had been receiving material from the American Diabetes Association advising that a healthy, balanced diet and mild physical activity would help forestall long-term complications.
OK, so am I supposed to exercise or not?
I took the easy path, not the simple one. I avoided exercise for the next 32 years, until I needed a laser retinopathy treatment that left me with a blind spot in the center of my field of vision in my left eye.
The simpler path would have been to find out a safe way to exercise.
A Very Real Fear
The fear of low blood sugars is real and completely justified. People lose consciousness, have seizures (I have), suffer brain damage from prolonged lows, and not infrequently, die. We routinely see obituaries of fellow Type 1 diabetics who have been found “dead in bed” from overnight lows. And I remember a case that hit home a few years ago—a runner that many of my friends knew from Camp Sweeney. He went out for a long trail run, didn’t come back, and his remains were found many months later. The cause of death is believed to be low blood sugar.
I’ve been close enough to that to know it’s not a good way to go. Having such a low blood sugar you can’t wake up is terrifying. Your body “sweats out” so much that you lose potassium. Lose enough potassium and you’re at risk for heart arrhythmias. Meanwhile, your body is shunting all energy reserves to the brain in an effort to preserve life. You literally don’t have the energy to wake up. Your dreams can often be filled with an awareness that something bad is happening and you MUST wake up, but only after you solve some arcane puzzle, or find some lost item. (If you’ve ever read Connie Willis’s novel, Passage, Richard’s experience trying to save Joanna by entering a near-death state will give you some idea of what it feels like.)
If you don’t wake up, you can’t get any sugar to save your own life. Then it’s down to hoping someone you live with can inject glucagon or call 911 so that paramedics can start a D50 drip before you’re permanently incapacitated or die.
Like I said, terrifying.
THIS is why many Type 1s are afraid of exercise.
No Practical Alternatives
It took me 32 years to discover that taking the easy path was destroying my vision and circulation. Short of outright meeting him in person, having a laser taken to the insides of my eye was a real come-to-Jesus.
Not to mention that it was the most pain I’d ever experienced without physical contact with something.
So that very same day, I decided I was going to have to take the hard path that had been staring me in the face for 30-plus years. I needed to exercise even if it might kill me, because not exercising certainly would.
A Little Bit at a Time
I took little steps at first.
Then I KEPT taking little steps.
My objective in doing so was twofold: first, to ensure that I felt proud enough of whatever I did that day that I felt excited about doing more of it the next day. Second, to make sure if I screwed something up and my blood sugar dropped suddenly, that it didn’t drop much, or too fast, and that I had time to fix my mistakes.
I made a lot of little mistakes. Like setting my temporary basal rate too low or suspending insulin during workouts, only to see my blood sugar spike when I quit. Or eating so little before a workout that my blood sugar tanked 20 minutes into it, just when I was starting to reap the benefits.
Mistakes like that are a good thing. They’re critical data and feedback on how well your effort is proceeding, and give you a chance to fix things before little “hiccups” in the process get well off the rails.
A Learning Experience
Things I learned while making many, many little mistakes
- That it is better to have a diabetes “buddy” who knows what you’re going through, knows what works for them, and will let you “cheat off their paper.” (Thanks Carol, Julie, and Donna!)
- That mild to moderate cardio drops blood sugar — up to a point
- That weightlifting and high-intensity interval training can raise blood sugar
- That physical stress can raise blood sugar
- That exercise can increase your basal metabolic rate and improve insulin utilization, meaning you may need less, meaning fewer large doses that can lead to lows later
- That simply dosing down high blood sugars isn’t as easy at it looks — especially if you’re ill or under physical or psychological stress
- That things like “liver dumping” (sudden release of glycogen reserves during exercise) can “spike” blood sugars
- That sugars can spike after practically any kind of exercise due to something called the “catecholamine response”
You get the idea. Enough learning, and this stuff all starts to look like rocket science.
Which is why it comes down to this: try little things and take note of the results you get. Sweat the details. Become a data geek. And stop blaming yourself for bad blood sugars. You have at least 20, possibly 40 factors that can affect blood sugar, and the only ones you can control are diet, exercise, and insulin.
So tweak away, one little thing at a time.
Little Things Add Up
You might not think it mattered all that much that one of the first steps I took when I got physically active was to throw out my big plates and eat off of a saucer. But it worked. It re-framed the idea of dieting into a contest — to see just how much food I could fit onto a saucer. Then after a while, piling up food on a saucer just seemed — obscene. I doled out smaller portions that looked attractive, like something you’d get at a fancy restaurant. I also decided that if all I could eat was what would fit on that tiny plate, then it darn well better be worth it. So I started eating more grilled food, more roasted food, more protein and fewer carbs.
All because of one little change.
Gradually, I learned about other little tweaks that worked well for me:
- Micro-bolusing and frequent testing: Maybe there’s another term for this, but the idea of getting little adjustments to insulin throughout the day keeps me aware of the possibility that my insulin-to-carb radio may be miss-set, my basal rate for that time of the day may be incorrect, or that I wasn’t as active that day as I thought. Over time, if I see a pattern, I can correct things. If I see no pattern, then maybe there’s nothing to learn there, and I move on.
- Micro-treating for almost-lows: When you’re low, adrenalin often kicks and tells you to eat more than you need to to correct things. It’s hard to think when you’re full of adrenalin. So a 5g peppermint when your blood sugar is 95 mg/dl with a slight downward trend and minimal insulin on board is going to be a lot easier to work with than eating half a birthday cake when your blood sugar is 43 mg/dl, straight down arrow, and your meal bolus has been on board for 45 minutes. As much as possible, pay attention to the data you have and try to avoid disasters instead of just getting better at handling disasters.
- Practicing a little exercise of each type and noting the effects on blood sugar: A Certified Diabetes Educator and the book Pumping Insulin book taught me about “exercise equivalents” to insulin. The idea is that if X minutes on the elliptical trainer drops your blood sugar the same amount as Y units of insulin, then it’s the equivalent of Y units of insulin, and up to a point, you can use them interchangeably. Another excellent resource on this topic is Sheri Colberg-Ochs’ book The Athlete’s Guide to Diabetes.
- Setting little goals for yourself that you know you can complete the same day you set them. It’s really important to set goals you know you can complete. Why kick your own butt? Who taught you that? I’m talking about walking a block farther than yesterday, or lifting an extra pound, or making it another 10 minutes on the treadmill at any speed. The single most important thing is to leave the task with a sense of accomplishment, looking forward to the next.
- Recalibrating whatever you did so that it IS a success. The only preconceived requirement is that you make an honest effort. Didn’t make it to 13.1 miles today because your sugar went low at mile 10? Fine. You made it 10 miles… maybe even a little faster than last time, and perhaps that’s why your sugar is low. You learned something about how your sugar drops right around mile 10, so you got a data nugget! Level up, player 1!
- Giving yourself a break. Sometimes you have a bad day. So do folks in the NFL, NBA, major league baseball, and the Olympics. On days like that, it’s important to ask yourself what you learned, and to show up tomorrow with a fresh attitude.
At my first half Ironman, I blew a tire, couldn’t change it myself, and missed the bike cutoff by 7.5 minutes. I was pulled off the course. It stung my pride like a wasp. But, it was still a worthwhile day. I met great new friends that I still stay in touch with. I also learned what I was actually capable of and where my effort was deficient.
I was determined to never again be one flat tire from finishing. Yes, there are bike mechanics roving the course, but they’re mostly there for the faster guys. They’re nowhere to be seen when you’re in the back half of the pack. I knew I had to be as self-sufficient as possible.
I tackled the problem in terms of:
- Flat prevention
- Flat repair
- Working on speed
- Working on breaks and transitions to buy myself more time to address unexpected problems
Flat prevention & repair
First, I installed Gatorskin tires. I’m not a weight weenie. I’d rather have the protection against a puncture than save a little weight on lighter tires. Plus, I did the math. I knew I would lose more time from a puncture than I would gain from slightly lighter tires.
Then, I took classes from my LBS on fixing flat tires fast. Before this, I knew what to do, and I could do it, but I was very slow. In addition to my extra tube and C02 cartridges, I started carrying a can of fix-a-flat. I practiced every step of using it. Yes, I’d have to immediately replace the tube after my race, but I could likely finish the race with a temporary fix-a-flat solution.
I learned several specific techniques so I knew what to do for everything from a blowout to a goathead thorn gash. On all my training rides thereafter, any time I saw someone with a tire problem, I stopped and volunteered to change it for them. I wanted all the practice I could get.
Increase average speed
I also identified ways to improve my average speed on the bike. I didn’t want to ride super-fast, so I had to find ways to streamline everything else on the bike: keeping an eye on my sugar, fueling, drinking.
- I did lots of century training rides and bricks. That gave me confidence in just relying on Dexcom alerts, so I could skip stopping to test during each segment unless something seemed off. It also gave me the data to figure out predictable fueling timing.
- I solved stopping or slowing to fuel or drink by sticking unwrapped dried pineapple in the leg pocket of my bike shorts and a Speedfil bottle on my bike. Again, lots of practice let me figure out how often I had to eat, and I knew exactly when I was planning to eat during each leg.
- I figured out during training what I could stand to eat and drink. For example, I tried a bunch of liquid nutrition products and hated all of them. So the only thing that went in my bottles was water or G2.
Working on breaks and transitions
I practiced the water bottle handoff that’s unique to a full Ironman race, so I bought back a little time there.
I knew I would be testing my sugar and eating in transition, so I also came up with a very specific transition process designed to save as many minutes as possible:
- I stuck hi-vis duct tape on my transition bag and tied bright pink and orange ribbon around the handle so I could instantly spot my bag.
- Once I grabbed the bag, I skipped the tent. I didn’t want a spot in the transition tent—it’s elbow-to-elbow with people, especially near the entrance, and it just slows you down.
- And I knew I wasn’t going to change from my tris uit to run gear, because I needed to save every minute possible.
- I dumped my bag on the ground right outside the transition tent, out of traffic. I had practiced the most efficient sequence in advance so I immediately started working through each step. I had bagged and labeled things to minimize the need to actually think in the moment.
- I’m not a fan of clipless shoes, so I went straight from the bike to the run without a shoe change
The three most important lessons I learned since I started being physically active in 2004 are:
- Try little things before you try big things
- Gather data and learn all you can from failures
- Keep going
Progress Can Make You Confident—or Cocky
By 2013, I was finally confident enough, after running a number of marathons, to imagine myself doing something like an Ironman. Or at least a half. This was before Galveston, but I had dreams.
There was only one problem: I didn’t know how to swim.
I hired a swim coach who helped me for about 5 weeks. Hardly enough to turn me into Michael Phelps. But it was enough to show me, in a very compassionate way, that many of my assumptions were wrong, that I would make no progress until I admitted that, and that I would need to practice strange, unfamiliar things until I had mastery of the water.
I got a little antsy and signed up for a sprint triathlon. 300 meters in a pool shallow enough to stand in. I got maybe 200 meters before I freaked out about drowning, despite the fact that I could have walked the length of the pool. I flipped over on my back and backstroked the last 100 meters, which I’m sure was annoying to those who were trying to get past me. It took me sixteen minutes to cover a distance that these days I could cover in six.
That’s one of the few times I can remember when I tried to “eat the handlebars” instead of filing them down into little bits and eating a spoonful.
That’s why it’s important to keep your goals little enough to accomplish.
The Importance of the T1D Athlete Community
Back to the drawing board, I practiced constantly in a pool, got better, did better in some sprints, and then some dear, dear diabetic friends–principally Michelle and Robin, taught me how to swim in open water.
This time, I knew how much I didn’t know. My humility restored by the memory of that miserable 16-minute, 300-meter swim during the sprint tri, I broke down the task of open water swimming into little pieces:
- Slow down
- Look where you’re going
- Make it back to shore on your own
Each of these little steps required a good bit of humility and diligence.
Michelle and Robin were incredibly patient, and I owe them a huge debt of gratitude. They helped me for the joy of helping, as long as they could, because this is what true friends do. Eventually, though, their lives got too busy to do a lot of lake swims. Carol and Julie swam with me for a while, and I was joined by fellow T1D and T2D athletes Jeff, Glenn and Scott. Jeff is an excellent swimmer, fearless, and non-judgmental. He helped build my character. Glenn is tough as nails, and taught me a little of that toughness. And Scott… is like Buddha with fins. He and I have trained together for years now, and he is the one person, if we fell off a cruise ship, who would say “well, THIS is new for both of us” and then race me to shore 15 miles away.
When I did my first 200-mile run, a team of diabetic relay runners on the same course stopped to let some of their runners accompany me on the last 40 miles. That included Matt, who has since formed a diabetic trail runners group, and Angelica, who regularly runs 100-milers in Tyler, TX to raise awareness of Type 1 among kids (that’s her in the photo). Angelica also ran about 100 miles of Texas with me, second in distance only to Eric, a T1D who does Tough Mudders and accompanied me on the first 110 miles of my first run across Texas.
When I ran Iowa, 26 different Type 1 athletes met me and ran with me.
I owe all of these people EVERYTHING for teaching me to believe I could “eat the bicycle” and realize my fitness dreams despite Type 1. Their feats are an inspiration.
Perhaps some people could do this alone. I don’t know, and I don’t want to find out. It’s so much easier with T1D friends who can show you the way.
This is why there are over 300 Type 1 diabetic Ironman finishers. Do the math and you’ll see that that’s a higher percentage than the general population.
A Final Word
I have to admit that I’m torn about the nice things that people have said since I ran across Iowa, then Texas. Realistically, I can see that those were pretty badass feats. The newspapers and TV folks seemed to think so. When I look back, even I am kind of amazed.
But I feel sometimes that the message gets lost that I am just an ordinary guy, and ANYONE could do this by breaking it down into little pieces. I’m well over 50. I’m a late starter to fitness. I was significantly overweight to begin with. Maybe that makes the story newsworthy; I don’t know.
Don’t let living with Type 1 decide FOR you what you can and can’t do.
Decide. Deconstruct. Plan. Train. Fail. Train.
Repeat as needed for desired results.
A. Little. Bit. At. A. Time.
You’ll never win that bicycle bet if you don’t start.