2020: Striking a Balance & Exercising with Type 1 Diabetes – A Year in Review

Striking a Balance

As much as we all probably want to wipe 2020 from our memory, I’m going to approach this blog optimistically with a suggestion that most of us have learned something about ourselves and our management of type 1 diabetes during the past year. Not many of us have maintained the same routine / work pattern / exercise levels / childcare arrangements / socialising levels etc. etc. over the year. This means we’ve all been challenged with adapting in some way, shape or form including adjusting how we manage our type 1 diabetes.

Whenever I feel like my type 1 diabetes is getting a bit more difficult to manage I tend to try to reduce the variables and get back in control. That could mean reducing carbs for a while or even reducing my exercise levels for a bit, just until I feel my blood glucose (BG) is more stable and in-range for a good amount of time. It’s important to note that “in-range” and “more stable” are very personal and individual to everyone that has type 1 diabetes. The reason I say that is due to one of my other beliefs:

“type 1 diabetes is a delicate balancing act between physical and mental health…”

It’s no good battling for 90%+ in-range blood glucose if it’s having a huge negative impact on my mental health! I’ve been there watching the CGM arrows and watching the numbers go up and down, making every effort to micro-manage my blood glucose, it wasn’t sustainable for me and it wasn’t pretty for those around me. What I gained from in-range BG I would lose in the form of anxiety and being unable to devote my time and concentration to other things such as family, friends and activities.

I feel very fortunate to have the DIY Artificial Pancreas setup “Android APS” to really help my management of my type 1 diabetes. Android APS acts as a hybrid closed-loop artificial pancreas system. For anyone who doesn’t know what closed-looping is, it basically involves a (compatible) Continuous Glucose Monitor (Dexcom G5 for me), a closed-loop compatible insulin pump (Dana RS for me) and a (compatible) smartphone running an app that is connected to both the insulin pump and CGM device.

My own conclusion to successfully managing type 1 diabetes… it’s about balance. So, how did I balance 2020?…….

2020 – A Good Start!

2020 began pretty well for me, I was successful in a job interview gaining a promotion at my place of work. Our twins had joined their big brother in their first year at school and some renovation work on our house was just about completed. I’d also successfully finished 2019 with my longest ultra-run to date, completing the 50 mile Lakes in a Day ultra-marathon. I wanted to maintain a good level of fitness in early 2020 so decided to fundraise for my local MIND charity by taking on Run Every Day (RED) January.

My usual training regime consists of up to a couple of shorter 5 – 10km runs during the week and a longer run between 10 – 20 miles during the weekend, sometimes supplemented or replaced by cycling my 34 mile round commute to work once or twice a week. With this in mind I thought that running around 5k every day in January would be fairly straightforward…… well…… it wasn’t. After the first week I felt tired and run down, I was working long hours setting off to work around 6am and often going out for a 5k run at 9pm in the dark with my head torch once I’d got home from work. The lack of any rest between runs was giving me little injury niggles and the long hours wasn’t giving me enough sleep to recharge.

To prevent injuries I reduced a couple of my 5k runs down to just 2 miles steady runs instead, then made my total month’s running up to 100 miles with an 8 mile run on 31^st January. The 100 miles was a target I’d set for myself at the beginning of the month. I did feel better towards the end of the month but decided that running every day just didn’t suit my lifestyle or the amount of spare time I had available. The good news was that I had completed RED January, maintained really good blood glucose levels across the whole month and didn’t have any low blood sugar hypos whilst out running at all. I raised a good amount for charity and was overall pleased with making it through the month without injury.

Priorities

The next couple of months seemed like a bit of a blur. I threw myself into work and outside of work tried to spend as much time as I could with my family, also getting back to enjoying playing football with my local team on Saturdays. My fitness levels were good but I didn’t really get out much in terms of running or cycling. Then……… Coronavirus….. and….. lockdown!

I work in the Adult Social Care sector and the new job was due to begin on 1^st April, what timing, just days after the first national lockdown was announced! The next couple of months were hectic for my team and I. I set up working from home, I was still doing parts of my old job, taking on bits of my new job and was also part of the Covid-19 relief effort, recruiting and brokering Covid-19 relief volunteers to support in lots of different ways. When you add home-schooling for three primary school aged children on top then exercise really went down the priority list.

Between the first national lockdown in March and September I’d gained around 21 lb in weight (yes, a stone and a half!!), my activity levels had really reduced and being so busy working from home meant I wasn’t getting out to exercise as much as I’d like. I was going through much more insulin than I usually would although my HbA1c from my diabetes clinic returned at 44 mmol/mol (6.2%) and I was in-range upwards of 85% of the time. My Android APS artificial pancreas system was doing a great job, allowing me to concentrate on work and family whilst it did its bit to keep my blood glucose on track.

I needed something to focus on, some kind of event, the obvious choice was…… the Virtual London Marathon 2020!

Virtual London Marathon 2020

I like to give myself at least one endurance challenge every year but 2020 wasn’t any old year. My ballot entry for the London Marathon had already received its annual “unsuccessful, try again next year” knockback (not that it went ahead anyway). I had been successful in my ballot entry for the Ride London 100 mile cycle sportive but that event, like most, had been cancelled too. So when I spotted the Virtual London Marathon opportunity I thought “right, here we go”.

To be completely honest, the extra weight I’d put on and lack of exercise earlier in the year meant that I was nowhere near marathon distance ready by the time the event came around on the 4^th October. I managed a few 10k runs and a couple of longer runs prior to marathon day and just hoped I could make marathon distance.

In preparation I’d done a recce of my proposed 26.2 mile out-and-back route in the car and hidden water bottles and Clif Shot Bloks at 4 mile intervals along the route. No food or drink stations on this event, all self-supported. Also, no crowds cheering me on!

My usual type 1 diabetes-related preparation for endurance events was in place too:

• Android Smartphone with “Android APS” app installed
• Dana RS insulin pump (compatible with Android APS) running as a DIY Closed-loop Artificial Pancreas system
• Dexcom G5 continuous glucose monitor (CGM) system
• Garmin Fenix 6 Pro Sports Smartwatch (connected via Bluetooth to my phone) displaying my blood glucose levels
• Water bottles placed at every 4 miles of the route
• Clif Shot Bloks placed across the route

I was anxiously looking-forward to the marathon run on race day. It felt good to be part of something “collective”. There was over 37,000 participants running 26.2 miles on the day in lots of different ways, all over the world. Given the way that 2020 had gone so far just knowing we were in some way doing this “together”, even socially-distanced, was a great feeling.

I was tracking my run using the official London Marathon app that connected to my Aftershokz bone conduction headphones (highly recommended and brilliant to still hear ambient noise) and something very strange happened after I hit my first mile. Suddenly a round of applause and cheers erupted through the headphones from the “virtual crowd” along with “you’ve just completed your first mile”.

….. I burst into tears, overwhelmed by emotion!….

It was the first time I’d heard the cheering of crowds for months and I immediately missed that feeling of being cheered on during race events. I’d become so accustomed to social distancing and not seeing or hearing large crowds of people it was really emotional hearing the applause. The creators of the Virtual London Marathon app had done a great job interjecting at each mile with some applause, race facts, and messages from famous athletes and generally being really upbeat about taking part.

Physically, the run went pretty well until around 15 miles, every mile after that really was painful with the lack of training really showing. The final few miles were just about mental toughness and grinding out the miles on tired legs. I was way off my “usual” marathon pace by quite a distance but I was also way off what I’d consider my optimum marathon running weight and physique too.

My wife and our three children surprised me around a mile from the end which was my second highly emotional point of the event (yes, tears again). They cheered me on and I said “thanks, love you all, I’ll see you at home”, my virtual finish line. I eventually completed the 26.2 miles in an official time of 5 hrs 24 min 05 sec and in a good deal of pain. I really do need to train properly for these things!

Hugs and congratulations from my wife and the kids were very much welcomed.

I managed a few more runs between October and the end of 2020, including a virtual half marathon event, but let’s face it…. we’re missing events, socialising and seeing our family and friends. Fingers crossed for a less socially distanced 2021.

Big news for 2021!

Maybe it’s the lack of events that have taken place in 2020 or maybe I’m a glutton for punishment but I’ve signed up to take on two huge events in 2021:

• The Coast to Coast in a Day event organised by Open Cycling. 150 miles with 4,500m of ascent on the road bike.
• The 50 mile Lakes in a Day Ultra-marathon. Can I beat my previous time? Will the Lake District weather Gods be kind?

I really hope these events can go ahead safely.

Whatever 2021 throws at us, stay safe, look after each other and “stay balanced”!