Over the last few months we have been promoting the #thinkwinter campaign in association with Mountaineering Scotland and Glenmore Lodge. The aim being to get us all to think differently about how we prepare for a ride at any time of the year but especially during the winter months.
One of our posts attracted a comment from Willie Watt, a mountain bike leader, coach and a Type 1 Diabetic. What Willie has to consider before during and after a ride blew us away and made us appreciate that for people with chronic health conditions, preparing for a ride is a whole different ball game!
So we asked him to write a piece for us that we could share with you all. I know we now appreciate just a wee bit more, the minimal effort it takes us to go ride.....
DMBiNS did a really interesting post recently on Late Back Procedures where a couple of folk (me included) shared their own perspectives about balancing riding with a chronic health condition. In my case Type 1 Diabetes.
Hopefully this possibly reveals the growing capability of those with chronic conditions or disabilities to head out on the hills. This is important because mountain biking has been proven to offer many benefits in terms of health and well being, whilst it is also widely accepted that folk with chronic conditions can be twice as likely to suffer mental health issues. Empowering them to mountain bike therefore makes a lot of sense.
My whole family mountain bikes and with that I have got to know hundreds of folk who love to get out on the hills, but in all those years I’ve only ever met two other Type 1 diabetics who mountain bike. The fact that they are particularly accomplished shows what can be done, but the prevalence of Type 1 diabetes suggests that I should by now have met many more. Having coached at Discovery Junior Cycle Club in Dundee and Wolfpax Riders in Laggan for almost 8 years it is particularly telling that I have never coached a child with Type 1.
Empowerment must therefore be at the heart of encouraging other Type 1’s to ride and indeed those with other conditions or disabilities.
Type 1 diabetes is a complex condition which needs careful self management to avoid serious immediate and long term risks. In doing so Type 1 diabetics must balance their need for insulin, food, the extent of exercise and external factors like stress or indeed the weather (insulin is absorbed more quickly when it’s warmer).
There is a tendency which many diabetics will recognise for those around them to wrap them in cotton wool, because they fear the challenges which exercise can bring in terms of the immediate management of the condition. I do get that but exercise is good for everyone.
That fear is though grounded in a reality, but one which is fortunately improving. When I was first diagnosed in the early 90’s I vowed to beat the condition by cycling and promptly went out and bought a Marin Eldridge Grade which I still have. But back then, I like all diabetics were using ‘stone age’ technology which relied upon litmus paper blood tests, slow acting insulins, an awful amount of guesswork, its was in-flexible, you couldn’t get it right and my desire to stay fit and cycle did result in me attending A&E too often because I simply used up all the fuel in my body (because I had too much unpredictable primitive slow acting insulin in my system) and I passed out.
That though as I have said has changed remarkably in the 30 years since and the last decade in particular has seen a profound acceleration in medical technology and information to allow diabetics like me to engage with the outdoors safely.
Diabetics now have an armoury of fast acting insulins (making them much more predictable), insulin pumps, Continuous Glucose Monitoring Systems (so you always know how much sugar is in your blood stream), pumps which work with CGMS, and pumps which use CGMS and AI to control your sugar level. Over the past decade I have gradually been offered more and more of that technology and with that my confidence to explore has widened. To the extent that diabetics like myself are literal cyborgs at the cutting edge of wearable medical tech.
On reflection it has been profoundly liberating.
That said, I as a Type 1 Diabetic still need to manage the condition carefully, so what do I do?
Before I head out (perhaps the day before for certain things) I check that my pump has enough insulin and battery power, I check that my CGMS sensor is working, has enough battery power and has enough usable life remaining.
Sensors tend to need to undertake a lengthy warm up period and a calibration period so I tend to pre-plan their insertion to avoid mountain bike days.
I always tend to carry enough kit for a level of redundancy and if I am away for several days I will pack spares and consumables. Depending on plans I could take them in my back pack but it is much more likely that I will tend to pack these and leave them in the car or bunkhouse back at base if they are easy to access.
My backpack has all the things which you would normally find in a leader’s pack, but it also has a particular focus on my diabetes. I will tend to have a back up finger prick blood tester, a fast acting glucose solution called glucojuice, lots of Dextrose tablets and then lots of granola/Stoats or other food bars which will all be easily accessible in the pouches on the waist belt of my pack. These are used to maintain an even blood sugar during a ride, where I will top up my fuel supply using my CGMS read out either by taking fast or slow acting carbohydrates or a mixture of the two.
A key for me at least is to have a meal before the ride which is highly predictable and full of long acting carbohydrates, a breakfast of say Wheetabix is a good example. This provides a firm foundation for the day.
On arriving at the trail, whilst setting up for the day ahead, I always significantly dial back the insulin delivery on my pump. This requires a degree of tuning until you find what’s right for you but there is a lot of information to help from websites like http://www.runsweet.com and your diabetic care team.
Crucially I am very openly diabetic. I do that for 2 reasons: 1. To prioritise my and other people’s safety, and 2. In and effort to encourage others to support diabetics they may know to take part. Both I think are really important for any diabetics, but the first is obvious. Alas, many diabetics are rather reluctant to reveal that they are diabetic. Those with other chronic conditions may be similar. Which in turn goes back to my second point, everyone has to play a part in encouraging folk to be open and to empower those around them despite the challenges they may face. At a practical level I am very open with the adults around me, regards my management and treatment of my condition during a ride. Equally I share my routes, I communicate and those around me do have late back protocols.
The later two points are important because technology is empowering and I know that I am much more relaxed than I have ever been before in terms of where I can explore on my own. Guides, leaders and coaches will quite rightly expect diabetics to have properly filled out their health declaration and most likely will follow that up with a chat to better understand practicalities and how the ride or session can be modified where necessary to suit. That said, diabetics like many with chronic conditions will not wish to be presumed to be a burden, but that in itself needs a balanced approach.
I feel that we do have a responsibility to think about unintended events to a much greater extent. Any one can be injured whilst riding, a lone diabetic who is injured would have additional vulnerabilities and those around them will have greater anxieties. At a practical level mobile phones or perhaps even better two way radios can provide added piece of mind as well as access to necessary support if required.
That though is the worst case, but avoiding such worst cases is ultimately what I and every other diabetic would wish to plan for. An important part of that is regularly checking blood sugars whilst out on the trail and taking corrective measures if necessary. My experience has shown me that it is important to check my sugar 30 minutes into a ride, because that is a point of transition between my normal insulin regime and before my dialled back regime really comes into effect. Again giving diabetics confidence and the time and space to do that will be important. Blood checks should be carried out at natural break points and experience has shown that taking on board a small amount of carbohydrates at regular intervals keeps me level.
The sophistication of the technology diabetics use means that we are encountering impacts on our management which we would not necessarily encountered a few years ago.
I recognise that I burn far less sugar going downhill than I do going up, which is perhaps obvious but when it gets to the final run of the day, you can experience a serious spike in sugar levels in the carpark. I tend to treat that with care though, because prolonged exercise also tends to deplete your body’s long term stores of energy - glucagon, which means a diabetic needs to carefully check their blood sugars for 24 hours after a long or energy sapping ride so a high can be followed by a low. I tend to bring my sugar down gently and refuel as necessary.
Equally life can throw you a curved ball. On a recent ride on my own at Laggan in the snow, my CGMS blood sensor and pump suddenly failed. Having spoken subsequently to my medical team they thought the cold weather could have been a factor, despite it being well tucked below layers. The technology is therefore potentially vulnerable so their protection from the cold, to sustain battery life or to avoid cannula lines from freezing and blocking or perhaps more obviously impacts or snags on cannula lines is important. Importantly when my CGMS and Pump read outs failed I chose to return to the Laggan Forest Trust Cafe, otherwise I would have been riding ‘blind’ in the cold on my own. Despite it being a brilliant day, taking the safe option for me was definitely the right thing to do, because I rely so much on the information they give me. Whilst the sensor and pump were replaced their replacement was not immediate, they must be sourced direct from the manufacturer via the NHS so that can take time. For me it took a little over three weeks before everything was resolved, which could have affected a longer stay and required me to use my back up protocols. Despite the equipment being provided by the NHS I have always made sure that my pump is covered by my home insurance.
Rides over multiple days, mean that I consider the medical consumables and food which I pack, but it also brings about the need to consider topping up my long term energy reserves between rides. Inevitably that relies upon eating long acting carbohydrates such as pasta, rice, potatoes etc. and having enough food on hand to eat what your body demands.
None of this is particularly rocket science, but the condition does dictate thought, analysis, careful management, pre-planning and packing. It is worth it though, it has broadened my horizons, it has led me to develop many friendships and skills and it directly improves the treatment of my diabetes, because when I mountain bike regularly I need less insulin, my weight is controlled better and my healthcare team tell me it must benefit my micro-vascular system. I am sure many other Type 1 diabetics could also benefit from taking part in mountain biking in a safe and supported manner. Hopefully this blog will empower some to do so and to encourage those around them to support them. For those interested in coaching or leading young diabetics here is a link to an article I wrote a few years ago http://www.youthcyclesport.co.uk/training-development/cycling-racing-and-coaching-for-young-diabetic-riders/