Back to Sports Corner Running a Triathlon with Type 1 Diabetes

An Interview with Brian Foster, Triathlete, Type 1 Diabetes, Insulin Pump User

Brian running, courtesy of Action Sports
A triathlon is an athletic event made up of three different contests. It is the combination of swimming, cycling, and running, in that order. The winner successfully performs each event plus masters the transition time between events which includes changing clothes, shoes, or any other gear needed for each event.

Event Swim Bicycle Run Notes
Super Sprint 375 m 10 km 2.5 km Distances vary, but this is a standard Super Sprint course
Sprint 750 m 20 km 5 km A 500 m swim is also common. The Sprint Distance is the fastest growing triathlon race distance in the United States
Olympic 1.5 km 40 km 10 km Also known as "international distance", "standard course", or "short course"
Half-Ironman 1.2 mi (1.9 km) 56 mi (90 km) 13.1 mi (21.09 km) Also called a "70.3", or "medium distance"
ITU-Long Distance 3.8 to 4.0 km 120 km 30 km The ITU accepts a 5% margin of error in the distance of the cycle and run courses
Ironman 2.4 mi (3.8 km) 112 mi (180 km) 26.2 mi (42.195 km) marathon Also known as "iron distance" or "long distance"
From Triathlon at Wikipedia

Imagine dealing with a grueling event like a triathlon and having Type 1 diabetes. Brian Foster has taken on that challenge. Below is an interview with Brian on how he competes in triathlons while having Type 1 diabetes.

What is your best event in the triathlon?
I've been lucky enough to compete in all three events (swimming, biking, and running) individually before starting triathlons. I competed in open water swims while I was an ocean lifeguard, and I got to do a little bit of cycling while in graduate school. I like all three events very much, but my absolute favorite has to be (and always will be) the running portion; I started running in high school and have been running ever since.

Does your diabetes cause problems with training or events? What a great question! I guess the short answer is 'Yes, diabetes can sometimes cause problems with training or events'. For example, in this particular triathlon it rained almost the entire time!!! I had spent countless hours in training working to find the perfect spot on my handlebars for one of my new ultra meters only to have the meter short out even before we got started because of the rain (and not just one meter - I had a total of six breaks because of the rain.) What bad luck!!!! But these things are a part of diabetes, they are a part of athletics, and more importantly they are a part of life.

I believe the larger answer to your question though (and I think the much more important one), is 'what doesn't cause problems with training or events?' Think about how many things could have gone wrong in the triathlon - sore muscles, stomach cramps, a flat tire, falling off of the bicycle (and yes, I saw all of those things happen to others) - a problem with diabetes is just one of the many things I learned to deal with if I wanted to be successful at this sport, or any sport for that matter. The same goes for you.

I think athletics is one of the most rewarding and frustrating things you can do. It's something that takes so much time and effort, and even if you do all of the right things you still might not get the results you want. It's really rare in athletics where you wake up and have everything go 'perfectly.' But I don't race to try and have that perfect race; I race because it is a challenge that I want to try an overcome - flat tires, shorted out BG meters and all.

Walk me through what you go through on the day of the triathlon? Because of the diabetes, I began some of my preparation the day before. Since it was such a really big race I inserted two sets the day before (one as a back up - the set had been rubbed off once or twice in training with the wetsuit). I packed up everything so I wasn't searching for it the morning of the event; one bag for my racing stuff and one bag with extra meters, sets, batteries, insulin syringes and treatments. You can never be too prepared! The day before I also went over the course maps and visualized certain parts of the race (like how I planed to check my BG right after I get back from the swim before the bike starts). I tried to get to bed early but it was hard to sleep because I was so excited!

I got up several hours before the start of the triathlon. My insulin on board setting is for three hours, so took my breakfast bolus at least 4 hours before the event so I'd be finished with the insulin. I took a slightly lower carbohydrate to insulin ratio because I've found the adrenaline can tend to make my BG way up. I got to the event about two hours before the start. At many of these larger races you have to rack your bike and many of your race items the day before, so the only thing you have to bring that morning is, well… you (and of course my trusty diabetes supplies). The remainder of the time before the race I spent simply going over parts of the race in your mind. About an hour and a half before the event I turned my basal rate down to a racing rate - for me it's about 1/3 of my normal rate. I continued to keep an eye on my IOB setting to make sure the insulin from my meal was completely gone. For this race we had to walk to the start which was far away from where my BG kit was, so I tested about fifteen minutes before the race to make sure I was at a safe number. I kept the pump on during the swim by my thigh; it stayed put because the wetsuit was so tight. After the gun went off we headed out!

Have you ever had to stop during a triathlon due to high or low BG?
I never have had to stop, but I believe that is because I check my BG frequently and have a plan for testing that I follow. I have had some low BGs during an event, but once I slow down and get some glucose in me, I'm ready to continue.

If that day ever comes where I do have to stop - I'll stop. There's nothing gutsy about trying to go on if it's a risk. There's a difference between finishing it out because it has gotten tough, and trying to continue by risking your health. Racing is very important to me but I'm not willing to sacrifice a lifetime of wonderful experiences in races for one finish. When I coached beginning marathoners for Team D (a fundraising program of the American Diabetes Association) I told my runners that finishing was not the most important thing. The important thing is standing at the start believing that you can finish. What happens during the race is not always up to our control and should not affect our sense of accomplishment.

Are you using a continuous glucose sensor during training or competition?
I am! I am using a DexCom! I've been using it for training since I got it in (beginning of July), and used in the first triathlon at the ˝ ironman. While running with it I use a neoprene cell case I wear on my arm, and while I'm riding I developed a clip for my handlebars. At the race I used a waterproof bag to hold the DexCom during the swim in my wetsuit and it worked like a charm!

If yes, how has this helped your performance? It's been a fantastic tool; I've found the trending information to be so incredibly important when I go for a three hour bike or a two hour run. I can actually watch at the point when my BG begins to drop and then confirm it with the meter and treat it - it's the best! It has also helped incredibly after training to keep an eye on recovery. It's really a wonderful time for those of us who had diabetes for so long to see how far we've come- I really feel like we are on the verge of some very big improvements in how we manage our diabetes.

What is your best time?
This was actually my first 1/2 iron-man triathlon, most of my other triathlon experiences were Olympic distance triathlons or shorter (1500 meter swim, 50 kilometer bike, 10 kilometer run) - one of my most cherished accomplishments was competing in Triathlon Age Group Nationals in the Olympic distance. This triathlon though was completely different, being a 1.2 mile swim, 56 mile bike and 13.1 mile run. It took me 5 hours and 57 minutes to complete it. I was very happy with the swim and the run; the bike (because of the rain) was something I need to spend more time on if I hope to qualify for a spot at worlds next year.

How long have you had diabetes?
The end of October I'll be celebrating my 26th year of having diabetes! (I was diagnosed when I was seven) I'm going to celebrate with something special - what do you think about an ultra-marathon?

How do you train while using an insulin pump?
I always wear my pump while I exercise, whether it is swimming, biking, running, or anything else. The only time I do not do a basal decrease is when I'm doing some very short intense intervals which will actually make my BG go up instead of down - the rest of the time my basals are decreased.

How do you determine when to drink or eat carbs during an event?
I try to follow the same guidelines that someone without diabetes would - why should it matter? Now sometimes it might change a little if my blood glucose is a little higher then I would want it, but for the most part I follow what everyone else does. The Powerbar website has some great articles on nutrition and hydration - it's a site I use often because my weight can change drastically depending on my training. They even have an interactive part that lets you enter your personal data to calculate how many carbs to eat for certain activities.

How often do you check BGs during training compared to the day of the triathlon?
I check very frequently (8-10 times per day) every day; for a race it's probably more. I will check BGs right from the time I get up through the start of the event, and of course during the event. An important part that many people don't give enough priority to though is after the event (or after training). After long exercise bouts we can be insulin sensitive for several hours, sometimes even days (which is why checking after the exercise session / race is so important). I've always recovered better from training / races if I keep my blood glucose in control after it is all over. And if I recover better, it means I can go at it again even sooner. This is also why I've found the continuous glucose monitors to be so valuable. I use the CGS to be alerted to a low BG that I may not have been ready for or a high BG if I've eaten too many carbs for the insulin I've given.

What recommendations would you give a person with diabetes who wants to train for a triathlon?
One of the great things that's new in a triathlon is that they are becoming more diverse. It's no longer just a swimming, cycling, and running event. Many triathlons are incorporating other events like mountain biking, kayaking, or trail running instead of just having the original three. Some even incorporate orienteering into the event - so the race is not always won by the best athlete but by the person who can read the map the best!

Many of these large triathlons will also have more then one event at them. At the triathlon I just competed in they had a shorter triathlon and a kids triathlon on Saturday, and on the following day when they had my event they had an aqua-bike division (just swimming and biking) and a relay team (a team of three with each person doing one event each). So even at a 'triathlon' there are many different things you can do.

If you would like to compete in one of these I say 'Go for it!' but there are some considerations you should have:

  1. You should first get your doctor's ok - that is first and foremost. You may also want to talk to a registered dietician or a registered clinical exercise physiologist about some of the nutritional and training related needs - there would probably be too many to mention here.
  2. My only recommendation I will make for diabetes is not only 'check, check, check' but 'think, think, think.' My experiences of highs and lows are always ones that always seem to make sense if I spend some time after they occurred as to why they occurred. I believe it has made me a better troubleshooter and I believe I've had less problems because of it.
  3. In addition to the recommendations you might get with your diabetes, you'll also need to learn about a triathlon itself. The United States Triathlon Association (USAT) is one of the governing bodies associated with triathlons. And if you're looking for a supportive environment for training for a triathlon there's no better group then Team in Training - a group sponsored by the Leukemia & Lymphoma Society that helps you to train for a triathlon while you raise money for them.
  4. You should plan the event far enough in advance so that there is no risk of injury. It all depends on the size of the triathlon - some are held with a 1/4 mile swim, 10 mile bike and 2 mile run while others are consist of several hundred miles long (yes, several hundred miles!!!) Leave your self enough time to train for it.
  5. Focus less on competition, and more on finishing - you have your whole life to get competitive about them, but not if you fail to enjoy the work it took to get there.
  6. And Enjoy It!

Rick Philbin, MBA, M.Ed., ATC

September 2006

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Last Updated: Friday September 07, 2012 11:18:00
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