Diabetes in the long run. My personal experience of what it's like to be a type 1 diabetic runner and triathlete.
Thought for the Day
Wednesday, April 25, 2007
Boston and the Boston Marathon
Leading up to the marathon, all of the talk for those of us planning to go to Boston was about the weather. The forecasts gradually got worse and worse as the day approached, until flood warnings were out for the eastern seaboard and we were looking at the worst weather in the 110 year history of the Boston Marathon.
Storms. Rain. Freezing rain. 25 mph headwinds with gusts up to 50 mph.
I took a red eye flight to Boston on Friday night, arriving Saturday morning with very little sleep. Then I walked around the marathon expo with friends most of the day Saturday.
By the time I got checked into my hotel and got a shower, it was time for me to go to a dinner held by one of the founders of a company called AgaMatrix. The main product of AgaMatrix is a blood glucose meter. The dinner was a benefit for the Juvenile Diabetes Research Fund, and I was one of several diabetic runners participating in the Boston Marathon who were invited as guests of honor.
The dinner was a great experience. The guests of honor all talked a little bit about their experiences and what it meant for us to be there. Some of the stories were very emotional and I got pretty choked up when I had to say something about diabetes and running, and how much I appreciated the JDRF and their work to find a cure. I met a lot of great, interesting people at the dinner, diabetics and researchers and engineers working on medical technology.
But I spent almost the whole time at the dinner on my feet, and I didn't get back to the hotel until almost 11, and I was exhausted.
The next day, Sunday morning before the Boston Marathon, which is run on Monday, I woke up with the calf of my right leg knotted up in a painful cramp. I iced it, soaked it in the Jacuzzi, and massaged it, and I was sure I could run on it for a while, but I could still feel a knot in it.
So I was looking at running the race in a freezing rain storm, under-trained, with a sore right knee, right calf, and left hamstring.
One of the suggestions the Boston Athletic Association made to help people get through the terrible weather that was predicted was that runners should try to run with someone they knew, so runners could keep an eye on each other for signs of hypothermia.
I called Ben Clements, a diabetic who I had met at the AgaMatrix/JDRF dinner. Ben was a "charity runner" raising money for the Joslin Diabetes Center, so he hadn't had to run a qualifying time. Boston was going to be his first marathon, and from his description of the running he had been doing, I thought I could probably run his pace.
If we ran together, we could look out for each other. I knew if I tried to run with my friends from Arizona, I would soon be burned out. And Ben and I were both familiar with the issues of being diabetic.
Sunday was cold, windy, and rainy all day. There was even some snow, I think, coming down through the rain for a couple of minutes.
I had dinner with friends from Arizona, Jennifer and Lowell, at an Italian restaurant at the train station near the hotel. Jennifer always has the same thing before a marathon, spaghetti noodles with just butter, because she has a sensitive stomach. Lowell had spaghetti and meatballs. I can eat anything*, so I ordered the lasagna.
*Famous Last Words
I've never seen lasagna like I was served. It was like a bowl of tomato sauce with some cheese, tiny meatballs, and lasagna noodles, burnt at the edges. I think they ran out of lasagne, and just made something up.
It wasn't great, but it wasn't that bad, and I ate most of it. Later that night I realized that it raised my blood sugar much more than I expected, but I compensated with more insulin.
I woke up a little after 4 the next morning with a low blood sugar, 59. I ate a cereal bar and started to get ready to catch the shuttle at 6 AM to get to the train into Boston to get on a bus to the start around 6:30 or 7 AM.
Boarding the buses from Boston to the start in Hopkinton, it was raining, but not pouring down as badly as we had all worried. It stayed that way for the whole ride and after we got off the buses in the "Athlete's Village" to wait for the start.
My blood sugar was 192 on the bus, which is high, (normal is 80 to 110) but not terrible for starting a marathon.
The rain stopped during the walk toward the start with Ben. I tried to check my blood sugar again, but twice got error messages because the meter was too cold. Ben let me test with his meter and my blood sugar was 170. It looked good, a little bit high, but coming into a good range.
But I don't carry a lot of test strips during a marathon. I put a few in a little plastic bag, I had just used three to get one test done. I only had three left. For most marathons that would have been more than enough.
Ben and I started out taking it easy. There was no use trying to go fast anyway, with the huge crowd we were swimming in.
My legs were hurting from the very first step. Maybe the cold amplified the aches a little bit. The few things that hadn't already been hurting were bothering me. I was in pain, sore feet, sore calf, sore knees, sore hamstring.
If it wasn't Boston... I would have run anyway.
Ben and I were far enough toward the back that there were a lot of slow runners around us. I told Ben not to try to waste energy trying to dodge through the crowd, but to move up when there was an opening. Still it's also draining to be stuck behind someone going too slow for you. That can be tiring, too.
Somewhere around mile three, going from Hopkinton into Ashland, we came up behind a large, slower group of runners, and Ben said, "Catch you on the other side." He went to the left, I went to the right, and we lost each other in the crowd. I kept looking for him for a couple of miles, but I had to give up on it.
I saw his Team Joslin team captain, Jay Hewitt, another diabetic runner (and Ironman) near mile six, leaving Ashland into Framingham. Jay was running up from the back, and would finish in a much faster time than Ben and I had planned. Jay said that he had seen Ben and he was doing fine.
Here are the splits for the first 10K:
I've often thought that there is an opportunity for someone to do a photo essay for Runners World that shows a neglected side of marathon running. Any time you bring together thousands of people trying to get the maximum practical amount of fluid into their bodies, many of them are going to end up with some excess to get rid of.
There were many opportunities in this marathon, as in so many others, to take a snapshot of dozens of runners relieving their bladders with little or no cover. It started in the Athlete's Village and continued on through most of the course. Anywhere there were a few trees or bushes nearby, no matter how sparse, there were men standing facing away from the course, and women squatting facing toward the course.
I began to feel the need myself, and would have welcomed an open spot, but I just didn't feel that desperate. I wasn't in a terrible hurry. Near mile 7 though, leaving Framingham and heading toward Natick, there was a Wendy's, and a couple of Wendy's employees were out on the curb cheering and telling runners they were welcome to use the restrooms.
I ran into the restaurant, around to the men's room, and toward the one urinal next to the occupied stall. A woman's voice came from the stall, saying, "Sorry, I just couldn't wait." That seemed very civilized and lady-like knowing what was going on outside. I said, "I don't mind you using that one if you don't mind me using this one." And we both tinkled as quietly as possible.
I continued on at a comfortable, but not pathetic pace, but something was starting to bother me in my gut. After the ten mile mark, I was pretty sure I shouldn't have eaten the lasagna. I stopped by a porta-john, second in line, but ran on when it didn't seem like whoever was inside was going to give it up very soon.
It was still cold, and there were occasional gusts of wind, but I was warming up. I took my jacket off and tied it around my waist.
I was running and walking for a couple of miles, walking mainly to control the storm going on in my lower digestive tract, then running when the urges subsided. I was now on the lookout for an unoccupied porta-john.
Around mile 11 I started to hear the screaming of the famous crowds at Wellesley. I know the crowd was probably a tenth the size of what it is in better weather, but it was exhilarating anyway. It gave me goosebumps, or maybe I was just cold.
Anyway, I put my jacket back on and kept it on for the rest of the run.
Here are the splits for the second 10K:
At around fifteen miles, I finally found a porta-john just as a guy was leaving it. I hope the runners that followed me at a couple of those places appreciated how I cleaned them up. I'm not prissy, but I really had to clean a couple of them with toilet paper and hand sanitizer before I could sit down.
Kudos to the race organization for having every porta-john I saw, and I saw more than my share, well stocked with paper and sanitizer. It's those little things that can make the difference between a miserable time and a really miserable time in a marathon.
The next few miles were more of the same. I ran when I could. Then I walked when I had to in order to keep from having an accident, and looked for another toilet. Every stop, I was hoping that I had finally flushed my system of whatever was bothering it. But within a few minutes, the problem was back.
After a long stop near mile 17, after the start of the Newton hills, I decided to check my blood sugar. It wasn't that I felt anything. It was just that I was going so slow anyway, there was no point in trying to save time.
the test said 394. That's extremely high. I've had false highs from having energy gel on my hands before, so I washed my hands as well as I could at one of the aid station tables, and re-tested. This time I got 374.
I gave myself a fairly large bolus of insulin, not as much as I would have given if I wasn't in the middle of a marathon, but more than I've ever given myself during a race before.
Then I just started walking. My blood sugar was high enough to put me in danger zone of going into DKA, diabetic keto-acidosis, which is as bad as it sounds. I wanted to be sure I was out of that danger, that the insulin was in my system, before I started running again.
So I walked on for a few minutes before I started running again.
I can't be sure what happened with my blood sugar. Adrenalin can raise the blood sugar, and certainly being at Boston might have raised my blood sugar more than other races have. I was running slower than I planned, and downhill, so maybe I was just not burning calories at the usual rate. I had diarrhea, and that can be dehydrating, and dehydration causes the concentration of sugar in the blood to rise as the overall fluid level goes down.
After the next mile, which took a long time to cover, I had a couple more pit stops.
Here are the splits for the third 10K:
The next couple of miles were run/walked from porta-john to porta-john. I had wanted to dominate Heartbreak Hill, to show it who was boss. As it was, we pretty much left each other alone. The hill didn't bother me, but I didn't really challenge the hill.
I still had hopes every time I stepped out of one of those big green plastic booths that I was going to be able to come on like Superman, or at least run the rest of the race. I was fairly sure, near the top of Heartbreak, that my system was finally all cleared out. I ran about a hundred yards, then quickly ducked into another unoccupied toilet. But when I got out of that one, I was really done.
I used my last test strip and saw my blood sugar was 89, which is kind of low, especially if it's indicating a downward trend. And that was my last test strip. I had an energy gel and ran on.
And I kept running, albeit at close to an 11 minute per mile pace, to the finish.
I enjoyed this part of the race. I was back with a lot of charity runners and locals. Lots of family members and neighborhood friends ran out onto the course to cover a few blocks with Boston locals and students from Harvard and Boston College. Everyone, though tired, cold, and exhausted, seemed to be having a great time.
Maybe the crowds have been bigger in other years. But maybe the year I ran it, the crowds were whittled down to the true believers. I know they gave me a lot of energy and emotion in the last few miles.
I was also running with a lot of charity runners. Many had inspirational things written on their shirts about why they were running, and who they were running for.
Going up a little hill, I saw a guy barely moving, leaning into the hill and trying to run. Across the back of his shirt he had written, "For my BRO, Kicking back at Cancer!" It must have caught me at a weak moment. It brought tears to my eyes. I tapped him on the shoulder as I passed and said, "Way to go."
I saw him later in the hotel I was staying at. He was coming down the stairs sideways, very slowly, but he had a big smile on his face.
With two miles to go, I felt like my blood sugar was getting low, and I had another energy gel.
Here are the splits to the end of the race:
I went to the medical tent after the finish, and my blood sugar was 77 there.
It was not at all the race I wanted to run, I could call it a disaster, but I'm still glad I did it.
I just have to get back to Boston some day. I know I can do better.
Storms. Rain. Freezing rain. 25 mph headwinds with gusts up to 50 mph.
I took a red eye flight to Boston on Friday night, arriving Saturday morning with very little sleep. Then I walked around the marathon expo with friends most of the day Saturday.
By the time I got checked into my hotel and got a shower, it was time for me to go to a dinner held by one of the founders of a company called AgaMatrix. The main product of AgaMatrix is a blood glucose meter. The dinner was a benefit for the Juvenile Diabetes Research Fund, and I was one of several diabetic runners participating in the Boston Marathon who were invited as guests of honor.
The dinner was a great experience. The guests of honor all talked a little bit about their experiences and what it meant for us to be there. Some of the stories were very emotional and I got pretty choked up when I had to say something about diabetes and running, and how much I appreciated the JDRF and their work to find a cure. I met a lot of great, interesting people at the dinner, diabetics and researchers and engineers working on medical technology.
But I spent almost the whole time at the dinner on my feet, and I didn't get back to the hotel until almost 11, and I was exhausted.
The next day, Sunday morning before the Boston Marathon, which is run on Monday, I woke up with the calf of my right leg knotted up in a painful cramp. I iced it, soaked it in the Jacuzzi, and massaged it, and I was sure I could run on it for a while, but I could still feel a knot in it.
So I was looking at running the race in a freezing rain storm, under-trained, with a sore right knee, right calf, and left hamstring.
One of the suggestions the Boston Athletic Association made to help people get through the terrible weather that was predicted was that runners should try to run with someone they knew, so runners could keep an eye on each other for signs of hypothermia.
I called Ben Clements, a diabetic who I had met at the AgaMatrix/JDRF dinner. Ben was a "charity runner" raising money for the Joslin Diabetes Center, so he hadn't had to run a qualifying time. Boston was going to be his first marathon, and from his description of the running he had been doing, I thought I could probably run his pace.
If we ran together, we could look out for each other. I knew if I tried to run with my friends from Arizona, I would soon be burned out. And Ben and I were both familiar with the issues of being diabetic.
Sunday was cold, windy, and rainy all day. There was even some snow, I think, coming down through the rain for a couple of minutes.
I had dinner with friends from Arizona, Jennifer and Lowell, at an Italian restaurant at the train station near the hotel. Jennifer always has the same thing before a marathon, spaghetti noodles with just butter, because she has a sensitive stomach. Lowell had spaghetti and meatballs. I can eat anything*, so I ordered the lasagna.
*Famous Last Words
I've never seen lasagna like I was served. It was like a bowl of tomato sauce with some cheese, tiny meatballs, and lasagna noodles, burnt at the edges. I think they ran out of lasagne, and just made something up.
It wasn't great, but it wasn't that bad, and I ate most of it. Later that night I realized that it raised my blood sugar much more than I expected, but I compensated with more insulin.
I woke up a little after 4 the next morning with a low blood sugar, 59. I ate a cereal bar and started to get ready to catch the shuttle at 6 AM to get to the train into Boston to get on a bus to the start around 6:30 or 7 AM.
Boarding the buses from Boston to the start in Hopkinton, it was raining, but not pouring down as badly as we had all worried. It stayed that way for the whole ride and after we got off the buses in the "Athlete's Village" to wait for the start.
My blood sugar was 192 on the bus, which is high, (normal is 80 to 110) but not terrible for starting a marathon.
The rain stopped during the walk toward the start with Ben. I tried to check my blood sugar again, but twice got error messages because the meter was too cold. Ben let me test with his meter and my blood sugar was 170. It looked good, a little bit high, but coming into a good range.
But I don't carry a lot of test strips during a marathon. I put a few in a little plastic bag, I had just used three to get one test done. I only had three left. For most marathons that would have been more than enough.
Ben and I started out taking it easy. There was no use trying to go fast anyway, with the huge crowd we were swimming in.
My legs were hurting from the very first step. Maybe the cold amplified the aches a little bit. The few things that hadn't already been hurting were bothering me. I was in pain, sore feet, sore calf, sore knees, sore hamstring.
If it wasn't Boston... I would have run anyway.
Ben and I were far enough toward the back that there were a lot of slow runners around us. I told Ben not to try to waste energy trying to dodge through the crowd, but to move up when there was an opening. Still it's also draining to be stuck behind someone going too slow for you. That can be tiring, too.
Somewhere around mile three, going from Hopkinton into Ashland, we came up behind a large, slower group of runners, and Ben said, "Catch you on the other side." He went to the left, I went to the right, and we lost each other in the crowd. I kept looking for him for a couple of miles, but I had to give up on it.
I saw his Team Joslin team captain, Jay Hewitt, another diabetic runner (and Ironman) near mile six, leaving Ashland into Framingham. Jay was running up from the back, and would finish in a much faster time than Ben and I had planned. Jay said that he had seen Ben and he was doing fine.
Here are the splits for the first 10K:
mile| split | elapsed
| time | time
1 9:32 Downhill
2 9:17 18:49
3 9:03 27:53 Hopkinton/Ashland
5K 28:59
4 8:33 36:26
5 9:15 45:41 Levels out
6 9:16 54:57 Ashland/Framingham
10K 28:06 57:05
I've often thought that there is an opportunity for someone to do a photo essay for Runners World that shows a neglected side of marathon running. Any time you bring together thousands of people trying to get the maximum practical amount of fluid into their bodies, many of them are going to end up with some excess to get rid of.
There were many opportunities in this marathon, as in so many others, to take a snapshot of dozens of runners relieving their bladders with little or no cover. It started in the Athlete's Village and continued on through most of the course. Anywhere there were a few trees or bushes nearby, no matter how sparse, there were men standing facing away from the course, and women squatting facing toward the course.
I began to feel the need myself, and would have welcomed an open spot, but I just didn't feel that desperate. I wasn't in a terrible hurry. Near mile 7 though, leaving Framingham and heading toward Natick, there was a Wendy's, and a couple of Wendy's employees were out on the curb cheering and telling runners they were welcome to use the restrooms.
I ran into the restaurant, around to the men's room, and toward the one urinal next to the occupied stall. A woman's voice came from the stall, saying, "Sorry, I just couldn't wait." That seemed very civilized and lady-like knowing what was going on outside. I said, "I don't mind you using that one if you don't mind me using this one." And we both tinkled as quietly as possible.
I continued on at a comfortable, but not pathetic pace, but something was starting to bother me in my gut. After the ten mile mark, I was pretty sure I shouldn't have eaten the lasagna. I stopped by a porta-john, second in line, but ran on when it didn't seem like whoever was inside was going to give it up very soon.
It was still cold, and there were occasional gusts of wind, but I was warming up. I took my jacket off and tied it around my waist.
I was running and walking for a couple of miles, walking mainly to control the storm going on in my lower digestive tract, then running when the urges subsided. I was now on the lookout for an unoccupied porta-john.
Around mile 11 I started to hear the screaming of the famous crowds at Wellesley. I know the crowd was probably a tenth the size of what it is in better weather, but it was exhilarating anyway. It gave me goosebumps, or maybe I was just cold.
Anyway, I put my jacket back on and kept it on for the rest of the run.
Here are the splits for the second 10K:
mile| split | elapsed
| time | time
7 8:46 1:03:44 Framingham/Natick
8 11:22 1:15:06 Wendy's
9 9:06 1:24:13 Lake Cochituate
15K 30:44 1:27:49
10 9:09 1:33:23
11 9:38 1:43:01 porta-john
12 9:36 1:52:38 Natick/Wellesley
20K 30:23 1:57:26
At around fifteen miles, I finally found a porta-john just as a guy was leaving it. I hope the runners that followed me at a couple of those places appreciated how I cleaned them up. I'm not prissy, but I really had to clean a couple of them with toilet paper and hand sanitizer before I could sit down.
Kudos to the race organization for having every porta-john I saw, and I saw more than my share, well stocked with paper and sanitizer. It's those little things that can make the difference between a miserable time and a really miserable time in a marathon.
The next few miles were more of the same. I ran when I could. Then I walked when I had to in order to keep from having an accident, and looked for another toilet. Every stop, I was hoping that I had finally flushed my system of whatever was bothering it. But within a few minutes, the problem was back.
After a long stop near mile 17, after the start of the Newton hills, I decided to check my blood sugar. It wasn't that I felt anything. It was just that I was going so slow anyway, there was no point in trying to save time.
the test said 394. That's extremely high. I've had false highs from having energy gel on my hands before, so I washed my hands as well as I could at one of the aid station tables, and re-tested. This time I got 374.
I gave myself a fairly large bolus of insulin, not as much as I would have given if I wasn't in the middle of a marathon, but more than I've ever given myself during a race before.
Then I just started walking. My blood sugar was high enough to put me in danger zone of going into DKA, diabetic keto-acidosis, which is as bad as it sounds. I wanted to be sure I was out of that danger, that the insulin was in my system, before I started running again.
So I walked on for a few minutes before I started running again.
I can't be sure what happened with my blood sugar. Adrenalin can raise the blood sugar, and certainly being at Boston might have raised my blood sugar more than other races have. I was running slower than I planned, and downhill, so maybe I was just not burning calories at the usual rate. I had diarrhea, and that can be dehydrating, and dehydration causes the concentration of sugar in the blood to rise as the overall fluid level goes down.
After the next mile, which took a long time to cover, I had a couple more pit stops.
Here are the splits for the third 10K:
mile| split | elapsed
| time | time
13 9:30 2:02:09 Wellesley College
14 9:51 2:12:00
15 10:59 2:22:59 pit stop
25K 31:42 2:29:08
16 9:33 2:32:33 Wellesley/Newton
17 24:20 2:56:53 porta-john, blood tests
18 13:16 3:10:10 Woodland and Brae Burn Country Clubs
30K 55:40 3:24:48
The next couple of miles were run/walked from porta-john to porta-john. I had wanted to dominate Heartbreak Hill, to show it who was boss. As it was, we pretty much left each other alone. The hill didn't bother me, but I didn't really challenge the hill.
I still had hopes every time I stepped out of one of those big green plastic booths that I was going to be able to come on like Superman, or at least run the rest of the race. I was fairly sure, near the top of Heartbreak, that my system was finally all cleared out. I ran about a hundred yards, then quickly ducked into another unoccupied toilet. But when I got out of that one, I was really done.
I used my last test strip and saw my blood sugar was 89, which is kind of low, especially if it's indicating a downward trend. And that was my last test strip. I had an energy gel and ran on.
And I kept running, albeit at close to an 11 minute per mile pace, to the finish.
I enjoyed this part of the race. I was back with a lot of charity runners and locals. Lots of family members and neighborhood friends ran out onto the course to cover a few blocks with Boston locals and students from Harvard and Boston College. Everyone, though tired, cold, and exhausted, seemed to be having a great time.
Maybe the crowds have been bigger in other years. But maybe the year I ran it, the crowds were whittled down to the true believers. I know they gave me a lot of energy and emotion in the last few miles.
I was also running with a lot of charity runners. Many had inspirational things written on their shirts about why they were running, and who they were running for.
Going up a little hill, I saw a guy barely moving, leaning into the hill and trying to run. Across the back of his shirt he had written, "For my BRO, Kicking back at Cancer!" It must have caught me at a weak moment. It brought tears to my eyes. I tapped him on the shoulder as I passed and said, "Way to go."
I saw him later in the hotel I was staying at. He was coming down the stairs sideways, very slowly, but he had a big smile on his face.
With two miles to go, I felt like my blood sugar was getting low, and I had another energy gel.
Here are the splits to the end of the race:
mile| split | elapsed
| time | time
19 17:10 3:27:20 multiple stops
20 12:38 3:39:59
21 21:05 4:01:04 Crest of Heartbreak hill, pit stops, blood test
35K 47:58 4:11:46
22 10:44 4:11:48 ran to finish, downhill (more or less)
23 11:19 4:23:08 Newton/Brookline
24 11:32 4:35:01
25 11:24 4:46:25 Brookline/Boston, the giant CitGo sign
40K 35:54 4:47:40
26 11:49 4:58:14
26.2 5:52 5:04:07
I went to the medical tent after the finish, and my blood sugar was 77 there.
It was not at all the race I wanted to run, I could call it a disaster, but I'm still glad I did it.
I just have to get back to Boston some day. I know I can do better.
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Hello mate nice post
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