What did you do last week?

Marathoning is hard...You've got to get up really early, it's a really far distance (26.2 miles in fact), and boy, the effort it takes to complete one really blows the rest of you day. And that's just race day, let's not forget the weeks of work (yes, that means exercise) it took to get you there to race day.

That's just one view of marathoning, it's the glass half empty view. For me and the hundreds of thousands of others who tackle them each year, the glass half full take is incredibly more appealing. Through training for a marathon you learn discipline, you learn time management, and you learn the rewards of achieving goals, not through a magic pill infomercial that offers a 100% money back guarantee if you're not completely satisfied, but through good ol' fashioned exercise. Not to mention looking and feeling better.

For those of us with diabetes, there's an extra challenge. Marathoning with diabetes is tricky; you have to worry about fueling your body with enough 'carbs' so that you don't 'hit the wall' ( a term used to describe the feeling you get when your body is completely out of energy) in the marathon, but you also have to do this while maintaining your your blood glucose. They sound like the same thing, but to someone with diabetes they can feel like complete opposites. When I'm running marathons, I like to try and stay in the blood glucose (BG) target range of 120-180 mg/dl. That is higher then normal, but as my wife has said many many times, 'your running is not normal.'

Now I've been running marathons for some time now, but last week's http://cbs3.com/sports/local_story_323094612.html was one of my better ones. not only in my time to finish, but for blood glucose control. And the description of it is the subject for today's post. There's so much to talk about in marathoning, it can be hard to focus on just one aspect, but in an effort to keep things moving we'll just focus on that day in particular.

The race was set to go off at 8AM, which means I was up at about 4:45 AM (my dogs didn't even want to get up at that hour); my BG when I woke up was 187 mg/dl. For a marathon I'll eat at least three hours before the start because my insulin has an absorbtion rate of about three hours, meaning if I take my insulin for breakfast at 4:45 AM, the it would be out of my system three hours later. I also set an extended bolus of 0.08 for about an hour because I tend to get so excited at the thought of running my BGs tend to skyrocket if I don't take some extra insulin.

By 5:30 the breakfast is in, the dogs have gone out and been fed, the coffee was made and the wife was slowly moving around upstairs. By 6:00 we were in the car for the 45 minute drive to Phily.

OK - fast forward to the beginning of the race. I had dropped my basal rate to about 1/3 of it's normal rate at the same time the extended bolus was ending (between 6:00 and 6:30), and had kept track of my insulin on board through my insulin pump to see that by the time the race was going to start I would have about 0.3 of a unit left from the extended bolus I took. I figured I would need about 30 grams of carbs and grabbed a Gatorade bottle with 2.5 servings http://www.gatorade.com/formula_and_nutrition_info/ from my bag which equaled 35 carbs - perfect. My BG before having the Gatorade was 143 mg/dl - a perfect start.

My plan from the start was to stick to the pacer from the Clif Bar team http://www.clifbar.com/play/marathon.cfm?location=paceteam. Clif Bar promotes marathoning by having runners in the race that are experts at pacing, and if you're worried about your marathon pacing all you have to do is stick to them to run your specific time. They had an individual who was running a 3.10 marathon, and in order to qualify for the Boston Marathon again that's what I needed.

I chose to do something a little different this time around with my diabetes management, along with the usual H20, I started eating right from the very start instead of waiting an hour. I had a honey packet http://www.foodreference.com/html/art-honey-health.html (17 grams of carbs) at 20 minutes, and about 8 ounces of Gatorade (14 grams of carbs) at 40 minutes. I checked my BG at the one hour mark and was 136 mg/dl - perfect!

I kept on taking small amounts of carbs about every 20 minutes. I checked again around mile 14 and was at 127 mg/dl - this time I had two honey packets, and a Shot from Clif Bar (25 grams of carb) http://www.clifbar.com/eat/eat.cfm?location=shot&id=105.

I checked again for the last time during the race at around mile 20 -I was back up to 147 - holy mackerel! The last 6.2 miles were great. I had gone out reserved, and began to pick up up the pace on the last few miles miles up. I ended up 'dropping the hammer' (meaning I pushed it) for the last mile and ran it in about 6:20, which brought me to the finish line in about 3:06.23.

Back to the diabetes - I had turned my basal rate back up before the end of the last mile. And as soon as I crossed he line and got a a medal slung around my neck and a thermo sheet pulled around my shoulders I checked my BG - 114 mg/dl! I quickly took a big bolus and increased my basal by +50% for about an hour. This was because within the next 20 minutes I was going to begin wolfing down any food in sight, and since my basal had been about 1/3 of it's usual rate for the last three hours, I was going to need insulin to compensate.

So there you have it. I hope if you got anything from reading my post it's that goals are possible. I've run many marathons, but never one where I acheived both goals for time and BG control. It does not mean the others were failures, nor does it mean the others did not have enough effort put in them. Sometimes, these finalities are purely luck. It should not take away from the acheilvment of working hard with a goal, it just makes the goals all the more worth while. And after one goal is met, a new one is made. That's the mark of a good runner, and a good diabetic.