Mastering Long-Distance Swimming With Type 1 Diabetes

This content material initially appeared on diaTribe. Republished with permission.

By Miriam E. Tucker

People with diabetes can’t entry glucose information within the water, which provides complexity to blood glucose administration in a sport like endurance swimming. A protracted distance-swimmer with T1D and his dietitian talk about the easiest way to gas with kind 1 diabetes; their recommendation would possibly shock you.

These days, it’s fairly widespread for individuals with kind 1 diabetes (T1D) to excel in land-based sports activities equivalent to soccer, biking, and operating. But would possibly long-distance endurance swimming be simply too robust with T1D? Not for New Zealander Paul Spurway.

Diagnosed with T1D at age 18 years, Spurway used train as a key element to managing his situation from the start. He was initially a long-distance runner till his knees put an finish to that in his late 30s. So, he switched to the swimming pool. He then related with a bunch of long-distance out of doors swimmers and determined to offer {that a} go, regardless of the additional glucose administration challenges.

“In the water you don’t have access to your glucose data. You can’t prick your finger. The challenge is making sure you’ve got enough fuel in the body, not only to keep the engine working but also to keep the sugars under control. It takes a lot of trial and error,” Spurway advised diaTribe.

So why does he do it? “I find it very rewarding mentally and physically,” he mentioned, “and with the right checks and controls in place, it’s something that can be very enjoyable.”

Soon after he switched from operating to swimming and whereas he was dwelling in London, Spurway’s diabetologist referred him to a multidisciplinary diabetes train clinic inside the National Health Service’s Imperial College Healthcare NHS Trust. There he met Siân Rilstone, a dietitian who makes a speciality of diabetes and sports activities diet.

Rilstone lately authored a paper, together with Spurway and two different clinicians, about Spurway’s expertise. In it, they element his dietary necessities, insulin changes, and different issues earlier than, throughout, and after his swims.

“Paul was our first endurance swimmer,” she advised diaTribe. “There is no published data about T1D and endurance swimming. A lot of our work with him was trying different things and making sure he had the technology so that he was safe and able to monitor his glucose levels.”

One key to any endurance sport, together with swimming, contradicts the recommendation usually given to individuals with T1D to restrict carb consumption. With endurance sports activities it’s essential to get plenty of carbs.

“Whether you have diabetes or not, you need to fuel, and carbohydrate is the preferred fuel source during exercise,” Rilstone defined. “Of course, it’s more difficult in T1D because if you’re eating large amounts of carbohydrate and you’re struggling to control your glucose, of course that’s going to affect your performance. On the other hand, if your glucose levels are fine but you don’t have enough available carbohydrate, then you’re going to be exhausted. So it’s a real balancing act.”

The quantity of carbs for individuals with T1D, nonetheless, could must be considerably lower than the 90g per hour beneficial for long-distance swimmers. It could also be nearer to 60g/hour, with individualized insulin changes made accordingly. These feedings are given to the swimmer from assist boats.

For one eight-mile UK swim, Spurway consumed both heat lime photographs or caffeine gel with Gatorade, heat ovaltine, or heat coke each 40 minutes all through. The first two feeds totaled 32 grams of carbs every, with fewer carbs (11-15g) in subsequent feedings. That morning he took his standard Lantus dose and breakfast bolus about three to 4 hours forward of the race in order that there was no extra insulin “on board” that would drop his blood sugar.

Training far prematurely is essential. “You obviously have to build your fitness, but you’ll also need to learn what to do with your insulin and carbohydrate,” Rilstone mentioned, “which means that testing is really important, and this is why continuous glucose monitoring (CGM) is a total godsend.”

CGMs aren’t at present funded in New Zealand’s well being service nor have been they for most individuals with diabetes below the United Kingdom’s NHS on the time Spurway was dwelling there. But, for a number of of his longer swims, Rilstone and the staff briefly fitted Spurway with an Abbott Freestyle Libre CGM. Someone on the boat would scan the system to get his glucose studying similtaneously he took the feedings.

Over the years, Spurway has accomplished dozens of long-distance swims in England and New Zealand. He additionally as soon as swam from France to Morocco by means of the Strait of Gibraltar, about 20 kilometers (12 miles). For practically all of those swims, he has “nailed” the blood sugars, protecting inside goal vary more often than not.

Next up, he’s planning to deal with the Lake Taupō swim of 40.2 kilometers (about 25 miles), New Zealand’s largest lake within the middle of New Zealand’s North Island. It is the caldera of the Taupō Volcano, a big supervolcano. For Spurway, it’s not about profitable a race.

“Some events are competitive,” he mentioned. “I’m not at the front of the pack. I’m sort of mid-pack. I do it for the achievement.”