It wasn't the distances that worried me because I felt I was physically able to deal with these. I had managed sugar levels well in training but, still, my biggest worry was managing them over such a long day. Elbaman, the Ironman on the island of Elba, Italy, which I had chosen was by no means a fast course with over 3000 metres of ascent on the bike. I had anticipated a time of 13-13.5 hours in good conditions and if everything went ahead as planned. But sometimes, even well-thought plans need adjusting because this day held some rather challenging surprises for all competitors:
Pre-race/before the start: The importance of a good glucose starting level
I anticipated the swim to take me 65-70 minutes so I needed to ensure that levels were high enough to keep me swimming for an hour without falling into a hypo but at the same time the level had not to be too high because it would make me feel unwell and lethargic.
I set myself up in our little transition tent where all women had a dedicated place with a chair and a little box for belongings. Needless to say I made sure I had medical kit in there for all eventualities I could think of. It was still one hour to go and I kept monitoring sugar levels very closely to detect any upward or downward trends. Luckily my levels remained very stable around 157-164mg/dl (8.7-9.1mmol/l). The last time I checked was just before transition closed: The result showed 163mg/dl (9mmol/l). Whilst I walked to the beach where the start was I took a few glucose tablets (fast glucose release) and a half a muesli bar (slower release), about 18gr carbs in total, which I calculated should get me through the 3.8km swim. I took three Mule gels (natural occurring energy gels) and squeezed them into the sleeves of my wetsuit as emergency in case I was going to go into a hypo.
The swim: Hypo or no hypo??
My awareness of hypos is extremely good and I can usually feel them coming on way before my CGM but in this situation I simply wasn't sure. I tried to remain calm and focused on just getting to the next buoy, then the next one and listening to my body if the signs of dizziness were getting considerably worse or if I was getting tunnel vision. To calm my nerves I decided to take on half a gel in case I was low. I was about 1km away from the swim finish and figured that even if I wasn't in a hypo and didn't need the extra carbs, I would then be able to check my levels again in transition and inject insulin if necessary. At last I finished the second lap, incredibly pleased I hadn't given up.
The bike: on Mother nature's whims
It didn't last for long when I passed a handful of guys who had all come off their bikes on the corners and bends of the windy coastal road which had turned dangerously slippery. The rain began to get heavier and heavier and as I rode on the road condition worsened and wind picked up too. Since my CGM had stopped working and I had made the decision not to bother trying to re-activate it (which involves a two-hour warm up period), it meant that I needed to check glucose levels more often than I had planned (about every 60-90 minutes). I felt fine again and my first reading 30min into the bike it showed 135mg/dl (7.4mmol/l). Perfect! I kept my basal rate at 60% and followed my usual nutrition strategy: A 2-4 pieces of liquorice/wine gums every 20min and about half a Mule bar (15-20gr carbs; natural energy bar)) every 40-50min depending on intensity on the bike. I would usually eat it spread over 10-15min). Just as I was feeling human again the bad weather had picked up properly and rain started pouring down; it didn't take long until I was totally drenched. I knew from several very wet training rides that checking glucose levels could be a real challenge in wet conditions and needless to say it turned into a little mission. I had to keep the meter in a plastic bag to protect it from the wet and I had to look out for shelter when I stopped to measure glucose because it rained so much. I couldn't get my fingers dry to do a finger prick. I had some tissues with me specifically for this purpose but after I used them a couple of times they were so wet that I could no longer use them. Luckily a helper at a feed station gave me some toilet tissue to take with me. My levels had been pretty good throughout the bike leg to this date so I was confident that despite the rain I was able to complete the course in just under 7.5 hours. Little did I know what Mother Nature still had in store for us: Torrential rain with thunder and lightning started. Roads turned into rivers with lots of debris washed onto the road. There was a very technical 7km descent which got so dangerous that people started to walk it down with their bikes. Luckily I had gone down the descent just before the torrential rain had started. However, I faced a new challenge: The display of my glucose meter had started to steam up from the inside due to the dampness inside the plastic bag. The result was still legible towards the beginning but with the continuously heavy rain it steamed up more and more so that I had no option but to ride the last two hours by feel. I had a very small spare glucose meter in my saddle bag as a back-up but didn't bother trying to get it out. The bag was drenched and I got so cold in the torrential rain that I tried to avoid stopping at all times. Eventually the rain stopped and with 40km to go the sun came out. I had managed to keep glucose levels fairly stable and couldn't have been more pleased to see the T2 sign! It turned out to be an epic 8:20 hours on the bike with 3200 metres of climbing in horrific weather conditions.
I jumped off my bike and ran towards our tent to check glucose levels with my meter I had in transition: 85mg/dl (4.7mmol/l).
The marathon: The big unknown
The first 26km of the marathon went really well. I felt great running off the bike. I tested glucose every hour and levels ranged from 73-112 (4-7.2mmol/l). I still kept my basal rate at 60% although I was very conscious that I had been running the pump on reduced insulin for nearly 12 hours when I began the run. My biggest worry about the marathon leg had been to develop ketones due to a lack of insulin. As I progressed on the run however my levels remained steady so I kept eating a little but just enough to not go into a hypo (usually half a Mule bar and a 1/3 of a Mule gel every 45-60min). Then, from kilometre 26 to 31, I totally hit a wall. With every step I took, my inner self got talking to me, telling me how awful everything was and that I couldn't do this anymore. I felt sick and dizzy again (this time I knew it was nothing to do with sugar levels). I hated every meter of the run. This was my low point number 3 after having been sick in the water and cycled through torrential rain. I couldn't face any more sweet food but knew I had to keep taking on sugar to keep my glucose levels up. I don't quite remember how I got over this but as with the swim I tried to just focus on getting to the next feed station , and the next turning point and so on. I am fairly sure it was the determination and to a certain extent my stubbornness to finish the race that kept me going. I had gone into a little run-walk but managed to run again for the last 12km and picked up speed. I stuck to the same nutrition and insulin strategy that I had used for completing half marathons. With about 45min away from the finish I ran my basal rate on 100% again to counteract any effects of rising levels in case my glucose levels would rise afterwards.
I finally crossed the finish line in 14:48 hours, came 2nd in my age group and 11th woman overall. The bad conditions had meant that my time (as everyone else's) had been much slower than expected but I didn't care. None of these numbers mattered to me: It was the 85mg/dl (4.7mmol/l) which my glucose meter showed immediately after crossing the finish line!