Categories: Diabetes
      Date: Apr 14, 2009
     Title: Triathlon Training with diabetes: Different athletes, different finishing times, but just as inspiring!!

I often get emails from diabetics athletes all over the world, be it congratulating me for my results as a former professional triathlete with diabetes or asking tips and advices on how to handle triathlon training and diabetes.

In the article below, I will briefly tell the story of two very unique diabetics’ athletes and how I helped each of them. This is important for the diabetic athlete out there get an idea that triathlon training as a diabetic, goes well beyond the medical books, it also takes a good feel for the sport and for each individual athlete and their lifestyle.

Cliff Scherb – Ironman Arizona 2008 – Finish Time 9h17 (3rd M25-29) – Qualified for the World Championships in Kona 2009

Cliff hired me in August 2008 to get him ready for Ironman Arizona 3 months later. He was already a very accomplished athlete, but he wanted to sort out some details in terms of how to go faster with diabetes. He had just switched his treatment from using injections of Lantus + Humalog to an insulin pump called Omnipod.

Cliff's biggest problem was the lack of insulin early into the race, and with his previous treatment (same that I personally use). Doing the way he was racing before, the insulin was even across the day, which results in a elevated blood glucose levels early in the ride from all the hormones that comes to play in an Ironman. He would fix that by eating less early on the bike, which of course wasn’t optimal to set him up for a good run since your ironman run is basically a combination of bike pacing, bike fitness, enough calories/liquids on the run and bike and run fitness.

The once on the run, Cliff was getting the problem on the other way around. His initial insulin levels, would just become too strong after 8h+ of exercise, so he was literally forcing food down his throat to keep his blood glucose levels at safe and optimal standards.

How did we fix this problem?

1) First solution was changing the ratio of calories on the bike/run, you can handle way more calories on the bike than on the run, for multiple reasons.

2) Then to avoid the high blood glucose levels at the start from the combination of more calories and hormonal changes, Cliff took 6 units of Humalog as soon as he started the ride

3) Once past the initial and most tricky part, he went into a steady state mode of insulin units (delivered via his pump) and blood glucose levels.

4) Then for the later stages of the run, instead of being forced to eat extra calories just to avoid a low BG level, he simply disconnected his insulin pump, finishing with a BG level of 137mg/dl

Cliff accomplished his goal and is now heading to the World Championships in 2009!

Kener Assis – Ironman Brazil 2006 – Finish time: 16h38

Kener is our average age group triathlete. He has a 9 to 5 job, a wife, a teenager daughter and has Diabetes type 2. I met him at an annual meeting of the diabetes and exercise community in Brazil back in 2005, at that occasion I did a public speech for doctors, educators and diabetics on being a professional triathlete with diabetes, he was watching the talk and a few weeks later he sent me an email “Vinnie, Can you coach me to Ironman Brazil in 6 months?”. I didn’t know at that time that he never did a triathlon before.

Although relatively fit with some 10k runs at around 1h and the eventual 3h rides on the weekends, he couldn’t swim across a 25m pool. So I knew that would take some work from both parts! Unlike Cliff, I had to work with Kenner in a different way, mostly on the basics instead of super specific details such as how to lower the BG level in the first hour on the bike and how to get that higher later into the run. With Kener, we focused on:

1) Swim: 6 months out, he literately couldn’t swim across a 25m pool so for the first few months it didn’t matter how many times he would get in the pool, there was only so much he could handle in terms of training with a proper technique and pacing, we used that period to develop his skills in other disciplines, then in February (IMB was late in May), I got him to swim a 400m straight, which he did in 16 minutes (a 4min/100m pace). After this we shifted the balanced approach to roughly a swim plan, since we had a cut off time of 2h10 to make. On race day, everything went smooth and he was out of the water in 1h47!

2) Logistics: In March I got him to race a sprint distance triathlon, just to make sure he would make a few mistakes that and we could fix those in time for the Ironman. He went there, got his finisher medal and brought home lessons that varied from how to get your fingertips dry and clean for a BG test, to what is the best way to carry his oral medication and insulin syringes on the run.

3) Nutrition, oral pills and insulin: We found out that only his oral pills were not enough to handle all the calories he would need to be consuming in training and on race day. So in the process, Kener was also using fast-acting insulin whenever he had to lower his BG levels. Although changing from oral pills only to injection insulin is an aggressive decision for a Type 2 diabetic to make, once he made it, it was way easier to get his levels under control and he was lasting longer and feeling better in training.

Come race day, he executed the plan smoothly! Finishing with a big smile on his face! 

Good job guys,  you both are great examples to diabetics all over the world!