Wednesday, 23 September 2015

River Ayr Way Race - Another big PB

 So who else managed to make a whole weekend out of one day’s race?

My weekend started on the Thursday when I headed up from the flatlands of North Cambridgeshire to the equally wild but much more hilly Kirkby Stephen in Cumbria where my parents live.  The keener eyed among you may have spotted the reference to Thursday there, correct.  I just didn’t fancy two long consecutive drives and of course it gave me the opportunity to hone my taper week and carb loading with a good old pub meal, followed by a pub quiz and then back to my folks’ for a nice single malt nightcap.  Friday morning dawned.

The rest of Friday was not particularly momentous and certainly involved a lot less booze and one important decision.  My parents decided to have a day out and come and watch the race, which meant that I needed to be at Glenbuck for about 8:15 rather than Dam Park for 7am, net result being an extra hour in bed.

Saturday dawned much more brightly than Friday, at least in my mind; it was much greyer out than I’d been expecting, with forecast high teens.  It looked more like 5-6 out there with a wind, low cloud and general greyness.

A couple of eggs on toast for breakfast, starting the race mentally and medically.  This is where I start managing blood glucose with intent.  The insulin pump gets turned down to 30% for the next 3 hours to Glenbuck, then again on arrival for the expected race duration plus 2 hours.  Breakfast bolus was down to the minimum.  All of this to pre-empt the experimentally determined massive BG drop in the first 5km if I don’t, brought on by the combination of increased insulin sensitivity and the switch on of additional glucose transport mechanisms like GLU4 when we exercise. Plus I’ve spent years training the fat metabolism, which you can’t utilise with excess insulin whanging around your system.
Still grey and nasty on the drive up to Glenbuck, with fog, low cloud, rain, not looking like a nice autumn day at all. Eventually find the carpark, final kit checks, decide to wear the day-glo buff as a beanie to start with, check carbs, water bottle, blood glucose again – high, but where I was expecting it, with a drop to follow soon.  Last minute nervous chatter, trips to the bushes, more chatter, photo calls and then 9am finally arrives in front of the sculpture.

And we’re off.  Having no experience of this race whatever, of this race, I settle down into the train with a couple of markers that appear  to be around my target pace, only they weren’t, they were much quicker than I ought to have been for a 40-miler.  Time for the race plan to kick in, 25 minute run/5 minute walk, absolutely stuck to.  That 5 minutes being used to check blood glucose, eat if necessary to maintain target, take in electrolytes and give the muscles something of a rest.  Long experience tells me that if I don’t enforce it I go out too hard for a sustainable pace over the 40 miles. 

Typically, by experiment I need about 20-25g carbs every 30 mins to maintain stable blood glucose, and was not planning to stop until the second drop box station, so had the pockets of the camelback full of dried bananas, and gels with other stuff in the two drop boxes at the farm and Annbank.  Hydration would be at the water stops, quick gulp every time, and carry a 750 ml bottle of concentrated electrolytes to sip as I went.  All was going well until about 8km in when I started to feel soggy down my left hand side only to find at the next slurp from the bottle, it had a 2” split right down one side.  Enforced strategy revision then; grab a 500ml bottle of water at each stop to keep me going until the drop boxes where I had more electrolyes waiting.


By this time my delusions of grandeur had disappeared and I was back to my 25/5 schedule and about 5:50-6:10/km, just where I should be.

Haugh farm appeared eventually after two minor routing errors, with my first drop box sitting happily waiting for me with a nice lunch of cheese filled bagel, double expresso gel and after dinner mint to go with what I had left in my pockets.  Only trouble was I forgot the electrolyte tabs in my hurry to keep moving.

For me the next section with a lot of road was quite tedious, and my feet were starting to ache a bit to be honest.  I’d expected hard ground, but the gravel path with the 1” stones was particularly hard on the feet.  Everything else was feeling good by this point though and pace was still going well, swapping places with two or three other runners every time I went through the run/walk cycle.  I made absolutely no attempt to run up those nasty little short sharp climbs with energy conservation in the latter stages being more important than pace. 

Annbank arrived a lot earlier than expected and I was definitely psychologically lifted when I was told that it was only about 8 miles to go as my left hip and knee (mainly ITB) were starting to play up, but with less than 14km to go, there was no way I was stopping.  Restock and off again, but this time unable to keep to 25run/5 walk, it was down to closer to parity, with more walking creeping in and the pace drifting the wrong way.  Mental calculation telling me that the 6hr 30 mark was gone, but 6hr 45 was still a possible, and sub-7 was an absolute cert unless I had a complete meltdown. 

This is where the race becomes mental for me, not physical, forcing the now protesting knee to keep running for an extra 45-30-now 15 seconds at a time until I’d got to 2min on/2 mins off.  One last routing error at the bypass had me sandwiched between two runners I’d passed around the 40-45km mark, and that’s where it stayed to the end with the 300 yards of the stadium separating one from the other over a distance of 62.9km for me in 6hr 51 mins.

still running, just about

I was absolutely chuffed at that given the knee troubles and the routing errors, as it was over an hour quicker than my previous 40 miler PB and the RAW was a tougher course to me.

just 300 yards between us after nearly 40 miles

Assessing the damage two days later, calves OK, Achilles OK, quads knowing they’ve been in a race, shoulders tight, but unlike previous endeavours walking is not an issue, blister on my left big toes that I didn’t feel during the race. Last time I was struggling with stairs for a week afterwards, so something went right in the training and conditioning this year.  Only thing complaining is my big toe joints. 

For some reason my cannula for the insulin delivery was giving me grief all through the race as well, kept catching a nerve or something with sharp pains in the area if I twisted or moved wrongly.  I’d had a cuple of twinges the day before but decided not t change it.  It got so bad that I almost stopped and replaced it mid race with the spare in my bag, but oddly enough it stopped hurting later in the race.  When I looked at it in the shower, the cannula was full of blood and it was quite sore and bruised for a few days.

Only fly in the ointment was Sunday evening after driving home, I was pressing some apples and pears (juice now fermenting nicely) when I managed to drop a 5kg weight disc on my left big toe joint.

Performance
     Time / Pace /Avg HR / Max HR
1 /  25:51/ 5:10 / 156 / 170
2 /  28:00 / 5:36 / 157 / 167
3 /  28:52 / 5:46 / 157 / 166
4 /  30:16 / 6:03 / 153 / 162
5 /  31:47 / 6:22 / 150 / 164
6 /  31:54 / 6:23 / 147 / 161
7 /  37:52 / 7:35 / 143 / 160
8 /  31:51 / 6:22 / 146 / 157
9 /  35:34 / 7:07 / 148 / 160
10/ 34:43 / 6:57 / 143 / 154
11/ 37:14 / 7:27 / 140 / 156
12/ 38:08 / 7:38 / 134 / 150
13/ 19:40 / 6:47 / 144 / 152
Summary     6:51:44 / 62.9km / 6:33 / 147 / 170 / elev gain 460 / loss 725
Came in 24th of 47 finishers

Blood glucoses for those that were interested (using a 30% basal rate in the pump for three hours before, during the race and two hours after, with novorapid insulin)
Prebreafast 6.1, 35g carbs, 0.6 Unit bolus
Plus 2 hours 11.3 – much higher than normal, but I know it’s going to come down
Race minus 15min – 10.0, perfect, 10g carbs
Now 30min repeats, remember the 2/5 cycle
9.6 / 25g carbs
10.8, no carbs
7.8, 20g carbs
7.7, 20g carbs
7.1, 20g carbs
7.6, 20g carbs
6.2, 20g carbs
7.4, 30g carbs
7.4, 25g carbs
9.7, 10g carbs
7.0, 25g carbs
???, 20g carbs
???, 20g carbs
???is because stupidly, I’d not got enough battery in the BG meter to last race distance.  Bloody stupid and dangerous, and if it had happened earlier in the race would have meant pulling out.  Another good learning point, but luckily I had a good idea of how much I need to eat by now. 

Post race, meter recharged, 6.4 an hour later and a 40g snack with 0.5 units insulin (50% of normal, as I know by experience that several hours later my BG can drop rapidly).  Instead I let it go higher (but not intentionaly as high as the 13.7 this time, and adjust downwards), but still by bedtime I was needing to take a couple of snacks to stop dropping into hypo territory.


Friday, 4 September 2015

Get Ready for a Rant

If you are in any way sensitive, don't like naughty language etc, then stop reading right now.

Background - I work in the oil and gas industry, including working offshore, occasionally as an auditor.  That involves me walking around the platform, accompanied by a person from the operating company, looking at stuff and asking questions. I also carry a digital camera as I take photos of stuff that I see, to use in feedback sessions at the end of the audit. Overall therefore, what I do is actually pretty low on the risk scale.

One of the things that I need to do is every four years, go through a training course on offshore escape and emergency training, involving basic fire fighting, escape from smoke filled buildings, escape from submerged and capsized helicopters etc.  I also need a medical. 

Pre diabetes this was every two years.  In their wisdom Oil and Gas UK have determined that as a T1 diabetic, I need to do this every year.   Rant number 1 - why the fuck, as a well controlled diabetic should I be subject to a full medical on an annual basis when I have two other significant engagements with the medical system in terms of annual reviews as a pump user and with my consultant.  Surely the most effective basis here would be for me to submit my HbA1c information, a letter from my quack and then determine on the basis of that, what my risk as a T1D is, and then decide if I need an annual medical. But what the fuck would I know, I only do it every day.

Get ready for rant number 2

This year, my now annual medical expired on 22nd August, I therefore arranged my appointment with my offshore doctor on 27th July, assuming that would be plenty of time. I arranged it early because, and get ready for yet more pointless bureaucracy, I need every single platform I may visit identified on my medical certificate and the company doctor of every operator needs to give consent for me to go there, and, before I go the medic on the platform needs to give his affirmation that he is happy for me to visit and can deal with potential complications.

You'd have thought with an HbA1C of 42, no history of hypo unawareness and no history of needing assistance to deal with hypos, and a consultant's letter detailing how well I manage the condition (yes, in diabetic terms I'm in the top 10%, sun shining out of my arse etc) I'd have no problem.

Well, 4 weeks down the line and looking to go offshore next week I can tell you, I'm mightily pissed off, to the extent that I'd be happy right now to tell the offshore medical community to go and do things to itself in anatomical terms that only the medical community is likely to understand.
 

Pulling directly from an e-mail sent to me (names redacted to avoid litigation)

Dear Dr XXXX,

 I have had discussions with [operator XXX].  There are some issues to overcome before a decision can be made as the battery operated insulin pump is often not certified as ‘intrinsically safe’

Does the auditing work he is undertaking involve going outdoors i.e. outwith the accommodation area

If his job would involve going out on deck can he forward evidence that the insulin pump is ‘intrinsically safe

 
My response

Essentially the problem is that your company doctor is conflating the medical clearance in terms of is my diabetes controlled and am I a health risk with process safety risks.  They are asking, wrongly in my view, questions about the pump and whether it is intrinsically safe etc which has absolutely no bearing on my ability to manage diabetes as a medical condition.

My view is that control of the ignition risk is an issue for the platform management through ISSOW and other risk control channels. In fact the pump is an IPX8 rated device, so suitable for Zone 2 environments and is powered by one AAA battery, which will not be changed outside the accommodation. We routinely use digital cameras outside the accommodation, with gas detectors, permit to work etc, which is exactly what I have done elsewhere in relation to the pump.

Since I started on the pump I have been to XXX LNG, YYY Tunisia and a handful of other North Sea installations, all under the conditions I describe above.  My view here is that the doctor is overstepping the bounds of both his responsibility and knowledge
 

My real response

What the fuck are you talking about? You are a doctor, not a process safety specialist. Your company employs me because I am a process safety specialist.  Do you have any fucking idea why you are asking that question, or what intrinsically safe actually means?  Do you have any idea of what goes on offshore and the equipment that people take outside the accommodation?  Do you really think, as a process safety specialist I would put myself and others at risk unnecessarily?

Wind your fucking neck in and stick to what you know about.  Am I medically fit to go offshore or not.  Leave questions about managing safety risks to those that know how to do it.

Can you detect that I'm slightly peeved?

End of Rant