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Running with Diabetes

My Way or The Lycian Way Ultramarathon 2010

October 31st, 2010

My Way or The Lycian Way Ultramarathon 2010

Date: 11-16 October 2010

The Lycian Way Ultramarathon proved to big a greater challenge than first anticipated. With a total distance of more than 200 km over six stages, I was prepared for some difficult days ahead of me. But the difficulty of the mountainous route with many steep climbs and descents combined with my apparent lack of navigational skills, made this race one of my greatest challenges to date.

The difficulty of the race became apparent from the very beginning where two tall mountain peaks had to be climbed/passed with a full backpack weighing more than 12 kg (without water). On top of that, the heat was intensive and large quantities of water had to be consumed in order to stay properly hydrated. Finally, my lack of navigational skills made did send me off the route more than once. The route was marked with red and white paint with varying visibility and distance between the markers. One more than one occasion I missed one of the markers and was sent off the route. Towards the end of the first stage I got lost and spent more than 45 minutes on backtracking. Not only was that a waste of energy and time, it also meant I ran out of water at a critical point on the first stage. As a consequence I came close to a state of dehydration, which in many ways is more devastating for your physical performance than hypoglycaemia. Hypos can be resolved immediately with carbohydrate, whereas normal body water levels can take several hours to restore.

To make things worse, my glucose monitor failed to operate under the extreme conditions. The sensor and transmitter was attached on my abdomen and therefore exposed to physical stress from my front bag. I tried to tighten my front bag in order to avoid contact with the transmitter unit, but level of body movement on the uneven race course made this impossible. On top of that, sweat weakened the adhesive tape on the sensor making it even more vulnerable to physical stress. Eventually, the senor and transmitter unit fell off my abdomen and I was now running without continuous blood glucose monitoring. I therefore had to rely on regular blood glucose testing and my own ability to detect glycemic excursions. The latter had worked for me many times before, so I was confident it would do so again. I therefore decided to stay in the race and keep on running.

The second stage was no easier than the first. I teamed up with two of the other runners in race hoping the three of us would be better at following the route markers. It did to some extent help and we didn’t waste too much time outside the race course despite a few wrong runs here and there. The route itself was as challenging ad the first stage and sun was burning above our heads with temperatures way above what is comfortable for a Danish runner. The loss of waster and electrolytes from sweating was higher than my intake and slowly pushing me towards dehydration. I managed to complete the stage, but I was clearly suffering from body water shortage on top of energy depletion and exhaustion. Appetite was not present and I didn’t eat anything immediately after the race. At dinner time, appetite was still not present but I simply forced myself to eat and drink as much as possible. Replenishment of body water and energy stores was critical and failure to do so would make it difficult to complete the remaining stages. I kept on drinking and eating as much as possible though the night and next morning I was back in the game.

The third stage began at sunrise as usual and temperatures began to rise shortly after. I was slowly beginning at adapt to the heat, so it didn’t affect me as much as in the beginning of the race. However, I still had to drink as much as possible in order to stay properly hydrated and maintain adequate levels of electrolytes. Running without a glucose sensor meant that I had to do frequent blood glucose measurements to make sure my levels were within range. Already at this stage in the race, my total insulin dose was reduced by more than 30% and I was still reducing both basal and bolus insulin doses. My insulin sensitivity was so high, that bolus insulin doses were fine-tuned using half-unit increments. With blood glucose under perfect control, navigation was my only concern. I had teamed up with one of the Turkish runners and together we managed to stay on the race course without any major detours. Running as a team and thereby constantly pacing each other also helped us staying among the fastest runners in the race.

The day of the fourth stage was special. Not only had I advanced to the top three in the race, it was also my birthday. I turned 31 and had to run some 38 km before I could celebrate my birthday with a roll of Mentos and a Snickers chocolate bar. The stage was relatively easy, with only a single mountain that had to be climbed in order to reach the checkpoint. After the race I could enjoy the sweets I had reserved for this day together with the birthday greeting that had ticked in on my BlackBerry while running. Although my Mentos and Snickers bar were delicious treats, I still felt I missed a proper birthday cake. But that changed in the evening in the base camp when the race director asked me to come to main tent for a birthday cake. It was truly a warm surprise and probably the best birthday cake I have ever had in my life. My 31ST birthday is one I will never forget. After the birthday celebration I went straight to bed. The extra calories from the cake fell on a dry spot, as I was beginning to feel the cost of fours days of consecutive running

The fifth stage was longest in the race with more than 48 km to be covered along a mostly flat route along the coast line. It seemed like the extra calories from the birthday cake had done everybody good and the speed in the front group was remarkable high, despite this being the fifth and the longest stage in the race. I managed to maintain my third place in the race after completing the stage. I even tried to ‘attack’ number one and two towards the end of stage, but they caught up with me again and eventually left me behind. Eventually, all completed the stage and we were transported to the last base camp. The atmosphere in the base camp was great and the spirit was high in the evening before the sixth and last stage. Even heavy rainfall during the night couldn’t kill the high spirit, because we were all so close to finish the race. The rain kept on falling most of the night and it returned in the morning when the last the stage began. Although the rain made the running on the rocks dangerously slippery, it helped my core body temperature within a comfortable range.


After running more than 200 km over six stages I finally crossed the finish line as the third fastest runner. I was a great moment and one of the best in my running career that now covered a total of 40 races (marathons and above). The feeling you have when you cross the finish line after so many days of consecutive running is difficult to describe. But it is worth all the trouble and it is reason why runners take on challenges like this again and again.

The very first edition of the Lycian Way Ultramarathon was indeed a challenge. I had to overcome dehydration and exhaustion in the beginning of the race, in addition to the loss of my glucose monitor. But thanks to my training and determination to complete this race, I succeeded to get back in the game and finis in top three. Diabetes management was the least of my concerns and even the loss of my glucose monitor didn’t compromise glycemic control during the race. I simply had to revert to the trusted system that I have used successfully in the past, combing regular blood glucose measurements, own ability to detect glycemic excursions while running and fine-tuning of insulin dosage.

Would I run along the Lycian Way Ultramarathon again? The answer is yes. I have already signed up for the 2011 edition of the race. Although it is a challenging and demanding event, the race itself is a remarkable experience and one that ranks among the best races I have participated in. Not only do you get the chance to run on a beautiful and historic route, you also get to experience and meet a different culture first hand. Ultramarathons are much more than just running and driving yourself to the point of complete exhaustion. It is an experience where get to learn new sides of yourself, while meeting new cultures and friends.

Two hours before departure

October 10th, 2010

I’m about to depart from my hotel and check-in at the base camp next to the start line. Tomorrow it all begins and the details of the race are yet to be announced. All I know is that the first two stages will be the most difficult, as the route will take us across several peaks more than 800 above sea level. I have completed Olympus Marathon twice which gives me some experience with running up and down mountains. But I have never tried something like this with a fully loaded backpack. It will be tough, but that’s just a part of the experience. The view is breathtaking. I might help me to steer my thoughts away from the exhaustion and pain I will experience.

Otherwise I’m more than ready for the Lycian Way Ultramarathon. My backpack holds 6 days worth of energy, food and essential equipment. On top of that I have added a few extra treats in terms of sweets for my birthday on Thursday. And my BlackBerry so I can stay in touch with the world while running to change diabetes.

I will try to keep blog and Facebook updated when possible.

Packing for Lycian Way Ultramarathon

October 5th, 2010

How do you pack for a six stage ultramarathon under self-sufficiency and fit it all into backpack that can store around 30 liters? That is easy. First you put all the food and equipments you can possibly think of into a pile. Then you divide the pile into two: one pile with essential food and equipment (need to have) and one pile with equipment that makes life convenient (nice to have). The list of essential food of equipment includes sleeping bag, head lamp, disinfectants, first aid kit, compass, salt tablets, emergency flare and energy (minimum 2000 kcal pr day). The latter is the most difficult and the most essential. Caloric content, palatability and variation must also be taken into consideration.

My list of food currently holds:

5 freeze-dried breakfasts
9 freeze-dried dinners
28 energy bars
8 packs of energy gels
24 packs of energy drink mixture (1 pack for 750 ml of water)

This corresponds to 3800 kcal pr day and will barely cover the energy required to run the daily stage. The rest will be covered from adipose energy stores and eventually lean body mass. But that’s a part of the game. Energy bars and drink will be my primary sources of energy while running. The energy drink mixtures contain essential electrolytes that are required for prolonged physical activity. The mixtures also contain whey protein, which according to the packing information should improve glucose uptake in healthy subjects via the ability of protein (amino acids) to stimulate insulin secretion. It will not have an effect on me since I’m lacking endogenous insulin production and secretion. I will just have to inject the insulin myself :-)

The pile with equipment that makes life convenient includes compression running socks (4 pairs), underwear (4 pairs), two running shirts (long and short sleeve), race jacket, sun glasses, sun hat, MP3 player (holds 2 GB of music), digital camera, extra batteries, tooth brush and coffee (freeze-dried).

On top of that I need to bring my diabetes medication and test materials. This includes:

4 pre-filled pens with insulin analogues (two rapid-acting and two long-acting)
50 pen needles (5 mm)
1 emergency hypo kit in case of severe hypoglycemia
4 hypo gels
2 packs of glucose tablets
2 blood glucose meters
150 test strips
2 lancets
1 continuous glucose monitoring system with extra sensors
24 alcohol swabs for disinfection before injection

Does it sound like mission impossible? All of the above can easily fit in my backpack. There is even some extra space in the top of my backpack. Since I will be celebrating my birthday on the 5th stage I will probably bring something sweet for my post-race meals. I have a few ideas in mind!

Back to buisness

October 2nd, 2010

In 2009 I managed to complete a total of 12 marathon races all over the world. Initially, my primary objective for 2009 was to complete Marathon des Sables, an endurance race in Sahara under self-sufficiency covering more than 200 km. Following MDS my next objective was to complete a total of 30 marathons before my 30th birthday. This meant that I had to complete seven marathons in roughly six months. Not only did I also meet my secondary objective in terms of running. I also managed to complete an additional three races. And then lightening struck…

On November 27th, I paid a sports physician a visit. I’ve had problems with my right knee for a while and now the pain was so intense that running was impossible. He examined my knee with ultrasound and gave me two options. Complete rest for a period of at least three months duration or knee surgery. The latter would in theory fix the problem right away, but it would also require a three month recovery period with the risk of complications.

I decided to rest! Three months with no running. Some might say it sounds like an easy task, but it was NOT. I felt like a lion in a cage and was desperately trying to find alternatives to running so I could maintain a reasonable baseline physical condition. I was not successful and time went slowly by with little improvement in my knee. In terms of diabetes control, I could clearly notice a significant decline in insulin sensitivity, as the enhancing effect from daily exercise was absent.

After more than three months without running I slowly began to feel an improvement. My knee was still far form fully recovered, but I could begin to run short distances up to 8 km without pain. It felt good to back, but it would take some time before I could run a marathon again.

Then I received an irresistible offer that I couldn’t refuse. In October 2010, the very first edition of the Lycian Way Ultramarathon would take place in Turkey on historical grounds. It would be a race similar to Marathon des Sables, just without the desert and sand dunes. Nevertheless, it would be quite a challenge as the race covers up to 240 km under self-sufficient on a demanding route with high temperatures. I accepted the offer and began preparing for the race on the following day.

Since my baseline physical condition was far from my pre-injury level, I had to get back in shape and take on some serious long-distance running. But I had to move slow and prevent any worsening og my knee, which was still recovering. To get thing going I signed up for Milan City Marathon in Italy with less than four weeks of effective training. It worked surprisingly well and I completed my first marathon race in 2010 in 3:11. I was clearly back in business, but it was not a smooth ride and I did struggle a little towards the end.

My next challenge took place in Mainz, where I finished as the fastest Novo Nordisk runner last year. I was planning to defend my title this year, but competition was more intense this year and I was still rebuilding my physical condition. Despite rain and sub-optimal race conditions, I managed to cross the finish line ahead of my competitors/colleagues and defended my title. But there was a cost associated with my performance in Mainz. Some two weeks later I ran Copenhagen Marathon and did experience problems with my knee again. Nevertheless, I finished in a reasonable time and took a few days of rest to allow my knee to recover. It helped.

In the end of June I went to Greece to run Olympus Marathon once again. The marathon takes place on Mount Olympus and the route will take you from sea level to the top of the mountain and down again. It is one of the toughest races I have ever participated in, only matched by the 91 km stage during Marathon des Sables 2009. But it is also one of my favorite races and despite excessive risk of new injuries (or worsening the existing) I was looking forward to the challenge and the view from the top. Running uphill went fine, but on the decent my right knee gave me some problems and I had to distribute all the brake force and workload on my left knee. I did slow me down a little, but I managed to improve my finish time with ten minutes and ended as number 86 in the overall ranking.

Following Olympus Marathon I did experience some problems with my knee, so I gave it some rest for a while and kept my daily exercise on a minimum level before I began to prepare for my next challenge in the streets of San Francisco. Although the race course in San Francisco was far from flat, it was nothing compared to Mount Olympus and I finished in a reasonable time without any joint or knee related problems.

August was spent on serious endurance running (slow pace and long distances) with a backpack in which more weight was added to mimic the conditions I would be facing in Turkey. No marathon races were planned in that period, so I could focus all my training towards building physiological and mental endurance. At one point I got bored with the endurance running and wanted to run in a higher pace, so I decided to sign up for a marathon in the forest around Hvalsø on a relatively hilly race course (according to Danish standards). It went surprisingly well and I finished as number four in the overall ranking. My performance and results also confirmed that I was in good shape and ready for my next major challenge.

In less than a week I’ll embark on my 40th marathon race. The Lycian Way Ultramarathon will place in Turkey from 11th – 16th October and cover up to 240 km divided over six stages. All previous races have been completed without any problems related to my diabetes. It is fair to say that ‘running with diabetes’ has become a routine and does not oppose any limitation towards extreme physical activity. But the marathon in Turkey is something special and although I come to start well prepared and with a great deal of experience from previous races, it will indeed be quite a challenge.

During the six stages during the Lycian Way Ultramarathon much can go wrong and diabetes does not simplify things. It is essential that I can control my diabetes and adjust insulin doses according to a physiological background that changes as I gradually become more exhausted and depleted of energy. But I feel confident that I will be able to mange just fine. I have the right insulins that gives me the flexibility and predictability I need in order to maintain optimal blood glucose levels while running and during recovery. I also have the right pens that allow me to fine-tune and accurately deliver the insulin doses I need. Last but not least, I will be wearing a continuous glucose monitoring system that will remind my when action needs to be taken in case I forget.

I have done it before and I will do it once again. Failure is not an option!

For more information about Lycian Way Ultramarathon, please visit the official website here

World Diabetes Day Marathon 2009

November 14th, 2009

Date: 13.11.09

World Diabetes Day (WDD) is celebrated every year on November 14 and the campaign is led by the International Diabetes Federation (IDF) and its member associations. Every year millions of people around the world take part in this event to raise and increase diabetes awareness. WDD features a new theme every year and it is chosen by the IDF to address issues facing the global diabetes community. Diabetes Education and Prevention is the World Diabetes Day theme for the period 2009-2013. The campaign slogan for 2009 is “Understand Diabetes and Take Control”.

Diabetes imposes life-long demands on the 285 million people now living with diabetes and their families. Self-care is an essential step in diabetes care and it is therefore of great importance that people with diabetes receive high-quality education so they can learn to understand their diabetes and take control. The purpose of WDD is also raise awareness on the prevention of Type 2 diabetes through a healthy lifestyle and regular exercise.

In November 2008 I arranged the first Unofficial WDD Marathon highlight the beneficial effect of physical activity in the prevention of type 2 diabetes. Not to forget the positive effect on health for people living with type 1 diabetes as well. The race was a success and I managed to recruit 14 colleagues to take part in the race. This year we decided to do it again and the second Unofficial WDD Marathon was a reality.

The race took place on Friday November 13th to serve as a pre-event for WDD. Several colleagues from last year’s edition had signed up again and new ones joined. The race was a social marathon meaning that we had to run “united” to change diabetes. A total of 14 runners besides me showed up at the start line in Bagsværd despite cold and rainy weather.

The race started at 14:00 and after running for a few minutes the rain started. With more than 41 km in front of us I knew this race would be a cold and wet experience. Several stops were planned along the route so we could replenish our energy stores and rehydrates. The first stop was at the office in Sorgenfri where I work. The receptionist had prepared a buffet with energy bars, fruit and water. On top of that, we got cheers and motivational support which made it easier for us to continue the race under the harsh weather conditions.

Next stop was at Steno Diabetes Center where I come for my regular controls. Today there would be no HbA1C testing or consultation with my doctor. Instead another fuel station had been prepared for us and after a quick stop we continued towards Hvidøre, which used to be a diabetes hospital. Today it serves as a conference center and is well renowned for its kitchen. When we arrived, a tasty buffet with energy drink, coffee, nuts, fruits and freshly baked blueberry muffins were waiting for us. Both the hot coffee and muffins were needed at this point in the race since we were all soaked, cold and low on energy.

After a way too long break at Hvidøre we continued towards the city centre of Copenhagen. On the route we passed several of the city’s most famous tourist attractions, including the Little Mermaid and the royal palace. Despite the fact that we were all cold and wet, team spirit was high in the group.

When we finally made it to the City Hall of Copenhagen most of our GPS watches showed around 43 km. It was therefore well justified to call the race off and announce ourselves as WDD Marathon finishers. We had been running for about 4 hours and 35  minutes and were only around 5 minutes behind schedule. However, time was not of importance in the race. The most important aspect of WDD was to raise diabetes awareness and run united to change diabetes. And we did both.