Type 1 Keto

Half-marathon 2

I thought it would be nice to run on the cliffs in one of my favourite parts of the country, with its spectacular scenery.

Coming only four weeks after the previous half-marathon and being hillier 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 time to address my running style. Calf injuries have always been a weakness of mine. I must be doing something wrong. Could it be chronic inflammation in the tendons that people are talking about nowadays? Well, possibly, but I have been keto for about a year so that 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 barefoot running so I thought I was ok. The science of running had finally caught up with my style! Running on the balls of the feet is more natural than heel striking we are told. But on reflection, what is the point of powering off the relatively puny calves when there are the glutes and psoas, not to mention the large thigh muscles? I knew I needed a new style. I was not running efficiently. I needed to plant my feet, possibly balls first, and then pull back with the buttocks and move 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 appreciated.

 

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. Indeed, 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. This was not going to be a fast time. Plus, this was my second half-marathon in a month. It was new territory for me, but I reckoned do-able.

 

The preparation was excellent. I had a good sleep, but an early start meant 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 taken as carbohydrate rather than protein and fat. 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 ten units of long-acting insulin twice a day. Occasionally less but only a couple of units or so. That is my regular basal dose. Glucose at breakfast was 5.4mmol/l, with no sign of a dawn phenomenon or stress hormone spike. Very strange. A reasonably 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 mmol/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 decrease of 6mmols/l/hour means that those 2 units would produce a 4 mmol/lit reduction in blood glucose over 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 be 3.6mmol/l 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 excellent facilities. The race organisation was spot on, and the marshals were friendly and helpful as they are on most runs. It was more of a Fun-Run atmosphere. The weather was overcast but not raining with a slightly cool light wind. So, it was perfect for running. The first 2 miles had at least three 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 could have finished and had time for a leisurely lunch before I would have crossed the line. It was good to have someone to keep the pace. She had a GPS watch so she could monitor the miles and timings. A helpful device 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, and 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.  I 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, and 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 suitable 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 significant 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 becomes 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 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 lightheadedness are useless in an event where these are normal sensations. With a hypo, I usually 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 halfway, there was no issue of stopping. I finished feeling good but with glucose of 10.6mmol/l. 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 morning glucose rise that 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 do not think I could have done it. 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 challenging to finish a run when unconscious through a hypo. So, a certain amount of flexibility is prudent and practical. After the event, 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 three weeks.