I had just talked briefly with Patricia Brownell‘s husband at her team’s tent. Once again—as seems usual for us—we missed seeing each other in real-life, despite having been internet acquaintances for a couple of years. She was the first triathlete with diabetes I had heard of, and her success was very encouraging as I was just getting into the sport. The first race I did I saw someone in a Team Type 1 tri-top, but I never got the chance to see if my diabetes radar was working correctly.
The knowledge that there are other people out there with diabetes who do athletic things was extra meaningful to me yesterday afternoon as I walked along with my medal around my neck. I’d just finished the hardest single thing I had ever done. The distances—a 1.2 mile swim in beautiful Lake Winnipesaukee, 56 mile bike ride, and 13.1 mile run—weren’t new to me. Nor were the occasional chop and currents in the crystalline lake enough to keep me from having my best pace over that distance during a race. And even though it was quite hilly, the steep rollers and the long climbs didn’t do me in on the bike or run. I kept my pace and effort in check, and all things considered, I even nailed my hydration and nutrition strategy. I was even feeling good on the run, which was quite relieving after a couple months of runner’s block.
You see, despite all of those things, yesterday’s race was all diabetes.
As each starting wave got into the water, the announcer read off interesting things about some of the participants. This guy lost 150 pounds and is doing his first Ironman. That woman was diagnosed a few months ago with breast cancer. He almost died during a training accident. She trained for Timberman in Kandahar while on active duty with the Army. They were all very inspiring stories that in many ways described the best parts of the “Ironman lifestyle.” I vaguely remember filling out this part of the online questionnaire when I registered months ago. My head was underwater as I swam out to the starting line, but Lisa said lots of people clapped when the announcer said this:
“Jeff Mather was diagnosed with type-1 diabetes in 1998, and in 2009 he taught himself how to swim. Now he’s doing his first Ironman 70.3.”
I’m kind of glad that I didn’t hear that. When I race, I like to think that I’m doing what everyone else is doing, and I often feel the most diabetes-free during an event. Obviously, I have to think about it, but none of my fellow competitors have to know that I’m in some way “challenged” as an athlete. I was deeply moved after the race to hear how people responded to knowing that people with diabetes can be real athletes, but before the race I think it might have gotten into my head a little if I’d heard it. Plus, as I was bargaining with myself on the bike about whether to finish or not, it might have enticed me to make a different decision so that I wouldn’t (in some unknowable way) let those people down, even if it might have been a very dangerous thing to do.
I swam well, but my BGs had risen steadily throughout the swim. Although they started in a really good place (135 mg/dL, or 7.5 mmol/L), I suspect I bolused too little insulin for my ClifBar breakfast. About 5 minutes into the ride, I tested and saw a “286″ (15.9) staring back at me. I bolused a tiny amount of insulin, ate a gel (20g of carbs), and decided to wait an hour until my next one. I almost always try to eat 20g every half-hour—and I can’t skip too many without the risk of hitting the wall, like any other athlete—but if I was that high, I could hold off. A little less than an hour later I was at 367 (20.5).
Exercising while having high blood sugar (hyperglycemia) is painful. Imagine having your whole body full of lactic acid and not being able to clear it out by slowing down. I can almost feel my muscle fibers rubbing against each other as they try to contract. Muscles I don’t think about while on the bike got in on the painful action yesterday: My back, shoulders, hips, arms . . . they all hurt, and I found it difficult to stay in my aerodynamic tuck. Not only was I having a painful time getting from here to there over the long, shallow grades and the short, steep rollers, I was doing it more slowly than I knew I could, thus prolonging the agony.
“Do you have a pump?” asked the guy who rolled up next to me and then proceeded to stay in the drafting zone. It was technically against the rules, but he wasn’t getting any advantage from me, and if he had a mechanical problem, I wasn’t going to begrudge helping him. Alas, I did not have a hand-activated air-pump. No. Sorry. “Really? I saw the tubing and I just thought, well, maybe. . . .” Oh, you mean an insulin pump! Yeah, I do. Sorry, I wasn’t expecting that. We chatted for a minute, the Omnipod user and I, before he took off to rock the bike while I plodded along at my more leisurely 19 mph.
The other thing about high blood sugar that you should know is that it’s a sneaky, lying bastard. When the human endocrine system is out of whack, it messes with other parts of your body, including your mind. For me, it amplifies feelings of frustration, helplessness, and despair. Fortunately, I’ve come to see these lies for what they are, and I was able to hold off the voices that told me it was okay to roll into an aid station and call it a day. While that was true—it would be okay—it wasn’t what I wanted to do. I wanted to do what I knew I could do. I wanted that finisher’s medal.
Around the 30th mile I made myself a bargain. I was going to try to make it back to transition, eating and dosing small amounts of insulin (like 0.2-0.3 units) the whole way. If I was over 400 mg/dL (22 mmol/L) when I got there, I was going to say that discretion is the better part of valor and not risk going into DKA on the run or hypoglycemia by trying to treat a super high BG with too much insulin during exercise. It kept me focused on something I could do. That’s about the time, as I was talking to myself out loud, that I invented a new mantra:
This is triathlon. It’s what you do. Sure it’s painful sometimes. You’re almost three hours in to something that’s going to take six or seven hours today, but you knew that. You knew it would be hard. You’ve been here before, and you’ve done this. This is what you do. Everybody knows that. People think you’re touched, and they might be right, but you like knowing that you can do this crazy thing. It’s why you do it. This is triathlon. It’s what you do.
Despite backing off the pace early into the ride, I was still passing people. Don’t get me wrong, I did get passed by a lot of men and women, but I made up a lot of time on the uphills, especially the steep ones. The steeper they were, the better for me, it seemed. And I made up time on the downhills, exceeding 50 mph (80 km/h) in aero at one point. And on the corners, where I knew what my bike could do and where the line was and where others around me were not willing to go. And I made it back to transition in just under three hours.
327. The 327 (18.2) reading was enough to get me back out of transition. I was standing in front of my freshly racked bike after walking from the dismount line to my spot. I wasn’t going for a time goal any more. If it took me three hours to walk the half-marathon, what was another couple of minutes of leisurely bike-to-run? I took a drink, I put on my shoes, visor, and race belt, and I tested. 327.
As I ran onto the course, I saw Lisa and stopped. “This is going to be s-l-o-w,” I shouted to her across the road. “That’s okay. I love you!” she shouted back.
A little less than an hour later I was running past her again, smiling and blowing kisses. I hadn’t expected it, but the first couple miles felt good. I planned to run/walk again, thinking I would run a mile and then walk two minutes. But the first mile was so easy that I decided to go for two. The course was hilly, but I was running strong up and down them. I swear I could feel the insulin moving blood sugar into my sore muscles, giving them a fresh bit of juice. Yes, the first loop of the run was very good, all things considered. The second lap was a carbon copy of the first, albeit slightly more painful.
I even talked to a few people as I passed them. One guy told a teammate he was passing that he thought he could break six hours. A few moments later I told him, “I did that on my first tri, too. It was the best feeling ever.” We shook hands, and he told me to go rip shit up. For the first time in a long time, I enjoyed running. I was doing better than I thought I would, and it felt like the good ole days. My legs knew what to do, and my mind was free to consider other things . . . like whether I wanted to high-five that life-size plastic bear that I saw near the end of the first loop. I did. Oh yes, I did!
I decided to give everything I had once I figured out the run was going to be a good one, and I didn’t have much left by the finish line. My best 70.3 time was 5:38:42 for the mostly flat Patriot Half back in June. When Andy Potts (the men’s overall winner) put the finisher’s medal around my neck I was trying hard not to puke all over him, and I wasn’t even thinking about my time. Only after we got home did I realize that I ran a 1:56 half-marathon to finish the whole triathlon in 5:39:49, good enough for 112th of 231 in my age group and a very lucky 777th overall. Five minutes after I finished, my BG was a perfect 104 (5.8).
I don’t know how to end this except to say that I’m very, very grateful for all of the camaraderie and encouragement that I’ve gotten from everyone along this journey. Some people I train and race with know I have diabetes, and many don’t. Even amongst those who do, they don’t make a big deal over it. They nod and say, “It sucks that diabetes robbed you of some minutes during your race, but I’m impressed with what you did regardless.” To riff off what one person said to a family member before the start, “Don’t look for me at the end of the swim. You’ll never pick me out. We’re all wearing black wetsuits.” Most of the time, the combination of diabetes and triathlon is like that; you’d never know. It’s just what I do.