Half-Marathon 2: All Sorts of Problems

I thought it would be nice to run on the cliffs in one of my favourite parts of the Country, with it’s spectacular scenery. But, before you read further, please go back to the menu and read the warning if you haven’t done so already.

Coming only 4 weeks after the previous half-marathon and being more hilly with 1200 feet of ascent felt a bit daunting. After my first half-marathon I had calf pain for a week after and was only able to train short distances for the week after that. It was clearly time to address my running style. Calf injuries have always been a weakness of mine. I must be doing something wrong. Could it be the chronic inflammation in the tendons that people are talking about nowadays? Well, possibly, but I have been keto for about a year so I would have expected some recovery. But then again 20 years of what I now know was bad management through no fault of my own except ignorance, and no real programme of rehab, well it could be. But I am sure there is an element of poor technique . A friend commented that I ran on the balls of the feet and this was I now know the problem. But at the time the fashion was bare foot running so I thought I was ok. The science of running had finally caught up with my style! Running on the balls feet is more natural than heel striking we are told. But on reflection, what is the point of powering off the relatively puny calfs when there are the glutes and psoas, not to mention the large thigh muscles? I knew I needed a new style. I was definitely not running efficiently. I needed to plant my feet, possibly balls first and then pull back with the buttocks and rotate my arms a bit. Apologies to any personal trainers out there! Any advice is welcome. I am a test-pilot only in type 1 diabetes but any help from experts in other fields is always welcome.

A week of silly walks later and I had a sort of style. More like running and less like the flamboyant goose-stepping military marching adopted by  armies of totalitarian regimes. It was tiring at first but much faster I reckon in the long run, but that still has to be proven. Certainly training runs of 6 miles were a couple of minutes quicker. But there was going to be no personal best this time. It was a hilly course and I was relatively under-trained. Not a good recipe for fast times. Plus this was my second half-marathon in a month. New territory for me, but I reckoned do-able.

Preparation was good. I had good sleep but an early start meant a breakfast on the hoof. A motorway service station obliged. Bacon, egg, sausage and mushrooms. 495 calories. My daughter, who was running with me, had almost exactly the same energy but as carbohydrate. Porridge, banana and donut. I will try that formula on one run in the future just to compare the effect.  I reckoned on burning up 600 calories an hour running for just over 2 hours. So about 700 calories deficit equals about 60 grams (2 oz) of fat. I reckoned my body could give that up.

Insulin

So, what to inject? I need about 10 units of  long-acting insulin twice a day. Occasionally less but only a couple of units or so. That is my reliable basal dose. Glucose at breakfast was 5.4mmol/l, with no sign of a dawn phenomenon. Very strange. In fact a fairly flat trace that morning. A different pattern to my last half-marathon. It would have been tempting to ignore the rapid-acting insulin but the sausage did look dodgy in respect to carbs. Also in my experience there would be the glucose raising effect of the adrenaline of the race. I would likely be getting above 7 mmol/l at some point in the next couple of hours from experience.  So, I decided to inject 2 units of rapid-acting insulin. This was an hour and a half before the run. I know that my insulin rapid is just not that. Not rapid at all. More like 3 hours so its effect would be peaking in the last part of the run. The action of insulin is predictable in each individual. Mine starts acting at 3 hours then reduces glucose by 6mmol/lit per hour for the next 3 hours. I know that 1 unit of insulin reduces my  glucose by 2.2 mmols/lit. (Richard Bernstein). So 2 units of insulin gives a 4.4 mmol/l reduction in glucose. ( plus a bit more for the long acting but negligible over an hour or so). The rate of reduction of 6mmols/l/hour means that those 2 units would produce a 4 mmol/lit reduction in blood glucose over the period of 40 minutes or so that I would expect to be running with rapid-acting insulin working.  Therefore, a glucose of 8mmol/l at one and a half hours running would get to about 3.6 by the end of the run.   I reckoned I would  go with that, factoring in the adrenaline and the protein in the bacon. It was all educated guesswork anyway. Give it a go! With no carbs to interfere, calculations were relatively easy.

What a lovely place for a run! I had been there before with the family doing all of the summer holiday stuff. And it was still a delight. A well managed beach and tidy town with good facilities. Race organisation was spot on and the marshals were friendly and helpful as they are on most runs. More of a Fun-Run atmosphere. It was overcast but not raining. A slightly cool chill. So, perfect for running. The first 2 miles had at least 3 bottlenecks where there were queues to get over gates. But otherwise great. I was running with my daughter who was fresh from the Brighton marathon. She stayed with me throughout but clearly could have done it with time for a leisurely lunch before I would have finished. It was good to have someone to keep the pace. She had a GPS watch so could monitor the miles and timings. A nice help in a run with few mile markers. But also crushingly demoralising when you find out your last mile was not well paced. But that is running for you. The terrain was varied, I liked it. Grass tracks, gravel, sand, mud and steps up a steep hill at 8 miles. I had nothing to offer on the hill. I had no muscle power at all at that stage,  so had to walk up.

Control.

It was a surprise to watch my glucose going down! At 4.2mmols/l and just 3 miles. That should have happened at 12 miles! I had to resort to glucose tablets, then Jelly Babies provided at the drink stations. Then at around 6 miles my sensor fell off! These glucose sensors are only meant to be good for a week, but with careful management I could get 3-4 weeks use. It is all about keeping them dry, jiggling them around a bit to stop the sensor site scarring up,  and regularly replacing adhesive. So it was a big error not to re-attach it with fresh adhesive tape. After that, it was back to good old fashioned ‘see how you feel and eat if needed’.  I had left the glucometer in the car.

It is surprising how psychological it all gets, when you are on guesswork with no back-up of glucose monitoring. Just being out of breath and light-headed through running made me wonder if it was really just the running causing that feeling, or if it was a hypo. But there is a subtle difference. Of course the usual signals like sweating and light headedness are useless in an event where these are normal sensations. With a hypo I  normally feel just plain exhausted and need to stop. Of course, a glucometer in the car is of little use. So it was back to winging it.  Having got half way, there was no issue of stopping. I finished feeling good but with a glucose of 10.6, not bad by old standards, but for keto, not good at all. Far too high. Too many jelly babies. But I did feel pretty good throughout the run, though. I had to stop on occasions on hilly bits but overall was pleased. The new running style was good. There were the usual slight post-run aches but I was able to walk normally the next day.

Learning.

This run was not as planned. It was the failure of the dawn phenomenon which caught me out.  But overall it was encouraging. Before I decided to choose a ketogenic diet, I would never have contemplated a second long run after a month. I don’t think I could have done it. Clearly I had used too much insulin at some point. Possibly I did more activity before the run because we needed to walk a fair way to get to the venue. It was disappointing to need carbs to rescue the situation. I am trying to do these runs  purely on keto after all. But it was only the second event.  Safety is always paramount. I carry glucose for that reason. It is difficult to finish a run when unconsious through a hypo. So a certain amount of flexibility is prudent and practical. After the run, the glucose settled back into the normal range in a slow but predictable way. I did not feel the need to eat until 4 hours after the run. It was all so easy with keto. A year in this type of diet is still a novelty. There is still a lot to learn clearly.

The next event will be a much flatter location in only 3 weeks time.

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