Race Day - Negba

This past weekend I had my first race.  Some of the guys from the group have raced before, one or two race regularly.  For me this was going to be a learning experience, as I am hoping to race more in the future.  The next race I plan to go to is the National Amateur championships.  So hopefully everything learned from this race would go towards a better performance at the Nationals.  The race itself for my category consisted of 5 laps of a 15KM course, totaling 75KM, around Kibbutz Negba. For maps and course profile you can see how it looked on strava.

The team before heading to the start line

The team had done some training on the course a couple of weeks earlier so I was familiar with the route.  Mostly it was flat, however there were two steep rises.  They were not major climbs however they would present a challenge staying with the peloton.  I was not going to with this race.  I did set myself some goals.

Negba Kibbutz

• Stay with the peloton as long as possible.
• Get comfortable riding in a big peloton
• If I could help out my teammate who had a chance of winning.
• Take water while racing
• Complete the race in a reasonable time
• Eat enough before and during the race that I finish with good numbers.
• Have fun

The tl;dr version is that I learned a lot.  Staying in the peleton is hard work.  If you miss the back you will not get back on.  At the end of the first lap I slowed too much to get water.  I could not get back to the peloton and I was left riding out 4 laps at a much slower pace.  I was not able to be much help to Alon, though he still managed to claim second place.  I got much better at taking water while moving quickly on later laps.  I felt that my time for finishing 75KM was pretty good. According to my Strava data I held 225 watts for 2 and a quarter hours, which I think is damn impressive.  I managed to get my eating right and didn't finish the race with blood glucose too high or too low (massive win for me).  I had a lot of fun.

Pictures from the race here.

For those who want more detail read on.

The night before the race Alon came over for dinner.  I had lowered my long term insulin to 22units and I took only 7 units of short term insulin for dinner.  We discussed tactics a little but mainly ate huge amounts of pasta.  A big worry for me usually because so much carbohydrate late in the evening makes me sleepy.  Considering I had to get up early (4:45am) the following morning feeling sleepy early on in the evening was not likely to be a problem.  After dinner I got my bike and kit ready for an early start in the morning.  I checked my sugar before bed and it was in 74mg/dl.  I started second guessing the amount of insulin I took.  I finished everything I had to do and checked once more - 92.  Ok it was heading in the right direction.  I decided to risk it and went to bed.

I woke up at a time that I have previously gone to bed on a Friday night.  Dressed, coffee, blood test 234, a bit higher than I would have liked.  5 units of insulin, to bring myself down and to cover the sandwich that I ate on the way there.

Alon was already attaching his bike to the rack when I got downstairs.  We finished loading up the car and got on our way.  Thankfully the roads were clear and we got to the car park at 5:55.  There were many people there already and a good contingent from our team.  I walked Leehee to the water tent that we had set up on the hill.  Aviv was organizing things, I introduced them and left them too it while I while I started to warm up.

We took a group photo and made our way to the start.  I realised as I was doing my final BG test and grabbing a snack that I still had my glucagon kit on me.  I quickly went to find our support car that would be following my group around, unsuccessfully, and just made it back in time for the start.  Final check before the start, 229, I stuff half an energy bar in to my mouth and waited with my teammates.  We got moving at a decent pace.  Generally I was feeling fine, a little anxious about being in a large peloton but I was up for it and I felt like I could hang with the pace.  I was getting used to the movement of the group and trying to get into a rhythm.  But my legs weren't feeling nearly as relaxed as I wanted.  My glutes and hamstrings were really tight and worse my heart rate was at 171bpm.  This was really bizarre because at this level I should have been struggling, but I felt ok and I was getting the power out of my legs.

some of the elite racers coming past the water tent.

The first lap was at quite a pace and I was happy that I stuck with the peloton.  I was pretty happy that considering my high heart rate which was starting to settle down and my tight legs I was still able to ride in the pack.  It was all a bit nervous, certainly that's how I felt and I figured others were this way as well.  There was a lot of jostling for position, I was finding myself near the front and within a few moments near the back.  I worked myself into the middle but I was on the right hand side coming towards the end of the lap where the team water point was.  I couldn't find away through so I let myself go back to the pack and round to the right hand side of the road to get water.  I collected the water from Aviv at pace but too slow to stay on the back of the pack, the next 50 meters continued to rise and I had to put in a big dig to catch them.  Unfortunately I could not.  The pack were getting away from me and I was fast approaching my limit. 

dropping off a bottle 

I chased hard, giving it everything.  I took a corner too wide and almost crashed out, thinking if I could just make it up the next rise I could go all out on the descent and catch up.  I could see them pulling away with every peddle stroke and towards the end of the down hill they were out of site and I knew I had no chance.  I saw some individuals in front of me and as I got closer I saw some green shirts.  They were members of X-Team from the 40+ and 50+ starts.  I caught and passed them and Shai came back up to my wheel and we decided to work together for the rest of the race.

I was now at a much more comfortable pace, switching between leading, on the flat and downhill, and following on the rises.  My heart rate had come down into the mid 160s and my legs were loosening up.  I could now think about feeding.  I was worried that my sugar might be dropping after the second lap and I had a gel and some energy chews.  I was trying to eat something small but regularly.  Alternating between energy gels, bars, dates and chews.  I mistakenly did not record exactly what I ate but made sure to eat something small when I could.  I drank at least a bottle a lap.  My first two bottles had electrolyte and the rest were just water.

As the race went on we got passed by the Elite riders and they flew passed us at quite a pace.  The last lap I was feeling really good.  I was glad when it start to rain briefly that we weren't in a big group.  The roads were very slippery and it caused many accidents around the course.  We came up to a big group from X-Team, they were not riding so quickly so Shai and I went past them.  I rode up the rise following the turn off the main road, able to stand up on my peddles and power up the hill.  I took the down hill carefully and when I saw that I was riding away from Shai I slowed up and let him come to my wheel.  Eventually though he couldn't hold my pace and I rode away.  Finally on the last hill, I pushed myself.  I stood up on the peddles and gave it what I could.

Final lap, final hill.

I have never been so motivated coming passed my wife and the rest of the X-Team crew in the water tent loudly cheering me on giving me the power to speed up the final rise and on to the finish.  I was about 15 minutes behind the peloton.  Not as good as I was hoping but still happy that I finished and certainly good that I did not get lapped.

pushing hard to finish strong

The most encouraging part was that I finished the race with a blood glucose of 146mg/dl.  This is better than I had expected.  Not too high or too low.  I had something to eat to keep my sugars from dropping and went to the awards ceremony.  Out team did quite well.  Alon came second in our race, the 30-39 category.  We also got second in mens 60+, womens 30-39, and second and third in women's 50+.

Alon in second place 30+

Avi in second place 60+

Vered in second place womens 30+

Following the ceremony the team got together and had brunch.  It was a great day, everyone had a good time.  There were a couple of scrapes but we all survived the race well.

Team brunch

I look forward to the next one.

Do not get frustrated

Having diabetes is frustrating. It just is. While other people are tucking into their food I am sat fiddling with testing equipment, needles and pens. Even worse when I am keeping my logs, I have to type into my phone what I am eating.  Worse still when out with friends it looks rude to be sat there typing on my phone while at dinner, I am not on twitter this is a medical necessity ... mostly.  When we go out to restaurants for dinner I have to ask the waiter what carbohydrates come on the plate.  When we go to friends I look impatient because 5 minutes before the meal starts I am asking them whats for dinner, so that I can get my calculation correct.  And that's just the day to day management.

Then there are the highs the lows and the swings between the two. They are both horrible in different ways. Highs make me feel terrible in a lethargic and fuzzy headed way.  They are not so scary in themselves but I know what long term bad control does to people.  I have seen a lot of complications of diabetes and it is not pretty.  Blindness, kidney dysfunction and worst of all loss of limbs is a horrible prospect.  Especially when I wake up high and I know I have been high all night, that is when I start to remember what I have seen.  It is scary.  The hypos are more scary at the time, they can also have a prolonged effect even after I have recovered my blood glucose levels I am still affected by it later.  The worst is early morning or in the middle of the night.  I wake up, a neat reaction to low blood sugar, so I can deal with it before it gets too bad.  But the interrupted sleep usually messes up my next day.  The additional problem with hypos is other people, some know what to do, some don't, some panic some don't.  My wife knows what to do, she will get up in the middle of the night and get something from the kitchen if need be.  She will also stop me from doing something stupid.  I had a hypo while were out the other day and she stopped me from carrying on and made me sit down and drink a coke.  It must be frustrating for her too.

This reminds me of something that happened to me a few months ago. We were returning from London on a British Airways flight. It was towards the end of the flight and people were being told to return to their seats to prepare for landing.  I started to get that feeling.  Slightly fuzzy head, and tingling in my lips and tongue.  "Uh oh" I said to my wife as I started fiddling around with my BG monitor.  The reading was in the 40s (mg/dl - thats around 2.5mmol/L).  I stumbled my way to the back of the plane.  I said apologetically that I was diabetic and I needed to sort myself out. They were really quick on their feet, water, coke, something to nibble on.  I waited while I recovered and chatted to these two wonderful women.  They said they had had training in how to handle this situation and one of them had been a nurse earlier in her career so was familiar with my condition.  They handed me some more water and coke to take back to my seat just in case.  I was stunned, I mean it was so well handled, no panic, no calling doctors.  Just understanding the situation and handling it perfectly.

So I do what I can to get it right, I am frustrated by what I have to do, and more frustrated when I get it wrong.  I am sure I calculate my insulin correctly then I check a few hours later and find I am really high, or low.  Then I have my recent Hba1c result 7.4%, not terrible but after the training that I had been doing and the loss of weight I thought maybe it would be and improvement.  This is the biggest frustration.  With all the other frustrations one would hope that it would lead to better results.  But when it doesn't it gets super frustrating.  The natural reaction is to say to yourself, its not worth it.  Why bother trying so hard when it makes no difference.  Why test? why exercise so much? why bother trying to calculate how much insulin, take less and just avoid the hypos.  Why not? because its worth it in the long run.  This disease takes practice and a lot of work.  You cannot expect to get it right every time, but you can learn to listen to your body, you can work at every aspect of what you do, and you can get better results.  Getting frustrated and giving up is the worst thing you can do.  If you want to scare yourself into getting it right ask your doctor to tell you about diabetic complications.

It may seem like it isn't but this is a simple problem.  It is.  It is a closed loop, you are closed loop.  Your results can be calculated, what goes in will come out in the result.  It is not as simple as the equation of insulin exercise and food.  That's the starting point, know how your body reacts to these 3 main components.  What changes that reaction; time of day; illness; stress.  You can understand how you end up with the results you do by keeping a log, keep as many details as you can, test often.  Get in tune with your body, accept that you will have bad days and bad results, but don't let it get you down.  Keep going, keep striving to get it right.  Live a long and healthy life.

Meeting my medical professionals

Today I had my meeting with a nurse, dietitian and a Doctor, all of whom specialize in diabetic treatment.  Because of my change in regime due to my training I came armed with a bunch of questions as well as the past week and a half of documented sugars levels, insulin and food intake.  I see the same people every 3-6 months and have a blood test a couple of weeks before I go.  The blood test is Hba1c and once a year I have a full panel to check my kidney function, cholesterol and a few other things.  The most recent Hba1c result was 7.4% up from 7.0% the previous test 6 months earlier.  I was a little disappointed.  With my change in regime I was really hoping for an improvement in my result.  Sadly no, I have got my weight down from 91Kg to 87Kg (fully clothed).  I am happy about that but I really want to get down towards 80Kg.  I am sure that will come with time.

Both the appointments with the Dietitian and Doctor were productive.  I have an additional appointment with the dietitian and someone who can advise me on sport in a couple of weeks.  I hope that will be useful too.  I had a number of questions that I needed answering plus we talked about how my training was affecting my blood sugar.  The most interesting thing was that I have been making a mistake with my long term insulin.  I have been told to keep that constant and only vary the amount I eat and the amount of short term insulin that I take before and after exercise.  Additionally we calculated that I should be eating about half what I eat every hour.  I eat about 30g of carbs in energy gels and bars, I need to try to eat 15g on every hour.  I should also eat some slow burn carbs before I ride and take a small amount of short term insulin.

Hopefully my next meeting I will learn more about the food and insulin intake that I need to do long rides without hitting the wall and without having hypos during and then having huge swings after.

I had some questions prepared for the appointments, I have listed the ones that I have already discussed above with the answers I was given:

I have hard bumps around my injection sites, they are more noticeable to the touch not that I have lost some weight.  Is it hard insulin, and can it be released slowly into my system.  Will they ever go away?

A: It is not hard insulin.  I didn't fully understand (a consequence of us both speaking to each other in our second language) but I believe what she told me was that it is fibrous tissue that forms at the injection site as a reaction to too many injections in the same place over too short period.  They do not go away. (sadly as I am losing weight they are becoming more noticeable)


Can I get a Continuous Blood Glucose monitor?

A: No currently I am not eligible on my current Kupat Cholim (health plan) - Maccabi Gold.  I am not at risk enough and they are very expensive.  I am free to buy them at my own cost but they are very expensive.  Dexcom Medtronic Abbot.

Should I eat late in the ride to stop excessive glycogen breakdown?

A: I should eat throughout the ride to try to keep constant levels of blood glucose and avoid large swings in either direction.

Where can I get a medic alert bracelet?

A: The Israel association of diabetes has information about them on their website.

If I have a chocolate chip cookie that weights 45g total (it is home made so I know its flour, sugar, butter and chocolate) how much insulin do I need to take for it?

A: About 50% carbohydrate to 20 to 22.5g when estimating how much sugar to take.  Bear in mind that the chocolate and butter are fats which slows the uptake of sugar.  This makes such a food item less suitable for recovering from hypos

Why is my Hba1c so high?

A: Not sure, possibly from the high swings after riding.