(In the Spring, I was a diabetic tiger. In the Summer I was a diabetic snail – running slow and steady with my house on my back)
With the cliffs above me blocking the way higher, I eyed up the only way onwards: a waist high stream a few metres across. The water was flowing fast before tumbling down a series of waterfalls dropping into the village I’d left half an hour before. Having scrambled up three hundred metres of imposingly steep grass and rocks I could verify that contrary to what my map told me, there was definitely no path and definitely no bridge. There was also no-way I could risk crossing the torrent without the possibility of plunging to a premature death far below. I cursed at yet another misadventure and turned round to retrace my steps. I slipped, and desperately hung on to my walking poles, digging them into the ground with my life flashing before my eyes. I averted my slide and broke one of my poles in the process. Walking up the 1700m to the next col had just got even harder. This episode was typical of the four days I spent running in the Italian Alps. Getting lost, losing vital equipment like maps and head torches, leaving clothes behind and scrambling down mountain sides with no paths and no idea whether a cliff would bar my descent further down. There was always a silver lining. In the case of my failed attempt to cross the torrent, I had spent an hour with a group of Chamois (a kind of mountain goat). I even came upon one asleep, and had to make some noise so that it could run away before I walked over it. It was definitely their natural habitat rather than mine – on my descent, I followed a group down the hill thinking that my grippy shoes and opposable thumbs would allow me to follow their descent route. Not so. This human can’t run down the little cliffs that they did. Being immersed in the group of Chamois, on their patch (and in a place few other humans were stupid enough to visit) was a pleasure and a privilege and was definitely worth the unplanned hour’s round trip up to my dead-end.
From diabetes diagnosis to running four marathons in four days I was diagnosed with type 1 diabetes almost a year ago to the day. I remember too well the uncertainty I felt then. Could I still run? Would I be able to live an independent life? I remember my first long run, stopping every 15 minutes to test my blood and suffering a loud-mouthed runner making sarcastic comments about me “sitting down for a rest” as I was pricking my finger. Well, that long run turned into another and another, culminating in me spending four days and four nights, alone in the Alps running up and down mountains. I managed to mix the chaotic approach of the English amateur – getting lost, losing equipment, forgetting things and having no real plan as to where I was going to run – with meticulous planning and blood sugar management over the past days, weeks and months that allowed me to safely run one hundred miles and 12,000 metres of ascent in a remote mountainous place over four days. The “run” I wasn’t running in the usual sense of the word. The terrain was so steep that running uphill is impossible. In fact my bag was so heavy (seven kilos when I left) that running along the flat seemed pretty difficult too. So the technique is to kind of power walk up the hills – this is still very aerobically challenging – to kind of run slowly along the rare flat bits, and to fly flat out down the descents. The mix of terrain – rocks, paths, tree roots, grass, mud and different inclines – is a much more complete and tiring workout that running along a road, but once the body is used to it, it is actually gentler than pounding along a pavement. I was suffering from a niggley injury before I arrived in Italy, but it was completely better after the run! I had no idea how far I would be able to go every day, so I didn’t make a plan. I just ran for eight to twelve hours a day with the view that I would stop whenever I got tired. Before I left I thought I’d be spending hours resting in the middle of the day, but I was surprised to find that I could keep going at my steady pace for whole days at a time. Everything I needed was on my back. Food, clothes, sleeping bag, roll mat and sleeping bag cover. I could refill my water bottles in the mountain streams. This gave me a wonderful freedom to roam freely and be spontaneous with route decisions. It didn’t matter if I was still out after dark – I could either run with my head torch or just lie down where I was and sleep. In the end I spent one night as a paying guest in a refuge, one night in an old hut next door to a refuge, one night in a “bivacco” – a kind of tiny hut high in the mountains and one night under the stars at 2500m. Apart from at the refuge I was the only human being within miles on each of these nights – it was wonderful to share the night with the stars, the mountains and the animals.
Freedom My trip wasn’t all laughs. I spent most of it wet, I didn’t shower for four days and I couldn’t eat enough food. On the fourth day, I had a painful stitch for most of the day. But the sense of freedom from being fit, strong and self-dependent was electrifying. Upon crossing a col at 3300m altitude after the Chamois fiasco, I staggered down to a refuge with my weary legs and my stitch. They had long finished serving lunch, so I bought two large slices of tart (and had 0.5u of insulin for what I estimated to be 80g of sugar) and nursed an espresso. I had already climbed 2000m and run 25km that day, but the tarts refreshed me, and the crowds of tourists making their way up the path were surprised to see a dishevelled, smelly Englishman whooping with delight as he flew down the rocky mountainside. I arrived in Cogne – the largest town I visited in my trip – at 5pm. I spent an hour there recharging my phone and buying supplies and eating fruit before starting my trip up the mountain to the bivacco where I was staying. Almost everybody else was settling down for a relaxed evening in town, but I was leaving to start a one thousand metre climb to my bed. The clouds which had been my constant, oppressive companions for the trip finally parted, and I was treated to spectacular views of Grand Paradiso as I marched up the hill in the light of the setting sun. I spent two hours climbing to the Bivacco before enjoying the simple pleasures of resting my legs, eating my pizza and chocolate, drinking water from the frozen lake above me and watching the sun set from my own little house. After four days I had found my own little paradise.
Upon arriving in Aosta in time for lunch on the fifth and final day, I found a spot for a celebratory slap up lunch. Given that all restaurants in Italy serve fantastic food, my main selection criteria was for outside seating with a free table downwind of the other diners. I spend a happy hour and a half eating wonderful Aostan food and reflecting on my trip, whilst the overpowering pong of my still damp feet was wafted away on the breeze. My jaunt in the mountains was unexceptional by the standards of many trail runners in that area, but I count myself lucky to have had such a great adventure. Not many people will ever experience anything like that, healthy pancreas or no. My journey here started a year ago, when my diagnosis led to my taking up long distance running. It’s been a good year! Diabetes management The “good” thing about going on a trip like this is that diabetes isn’t “the risk”. There are many other risks – getting stuck up a mountain in bad weather or falling on steep terrain for example. Diabetes is just one risk that has to be managed. I did the following: I carried loads of test strips (over one hundred) and did a blood test about once an hour whilst running. With my current dose of lantus (7 units in the morning), I have an idea about how much I need to eat to keep blood sugar constant. (About 50g of carb an hour whilst working hard going uphill and about 20g an hour whilst going downhill – whilst being tough on the legs going downhill is much easier aerobically and so the blood sugar doesn’t drop as much.) I had been carb-loading like crazy before the trip, but I’m pretty sure my stores of muscle and liver glycogen were completely depleted by the end of the first day. So I needed to eat more carbs to keep blood sugar constant after that. I don’t take fast acting insulin before exercise so that meant breakfast and lunch were non-existent. In their place I had a constant stream of snacks over the day. I carried the most calorific food I could, which included nuts, sausage, and freeze-dried meals. Fat has nine calories per gram whereas protein and carbohydrate only have four, so fatty foods were a good way of topping up energy levels. I started off eating a lot of jelly babies, but after a couple of days relied more on chocolate and cereal bars which delivered not only vital sugar but also additional calories in the form of fat. Eating enough was a real struggle and despite not suffering from stiffness or sore muscles, I just don’t think I could eat enough carbs to restore my muscle and liver glycogen sufficiently to be full of energy day-after-day. I also doubt I was eating enough protein to rebuild all my fatigued muscle fibres.
Importantly, the huge amount of experience I’ve gained exercising over the past year made managing my diabetes possible. After I left the popular Trail Du Mont Blanc after the first couple of hours, I didn’t see another human being on the trail until the third day. So there was no option but to maintain healthy blood sugars and avoid bad hypos. It was critical that I kept a large enough store of carbs to keep me topped up for any unexpected delays or excursions – of which there were plenty. So I made sure I always had a whole packet of jelly babies as contingency, and I stocked up on chocolate and cereal bars once a day when I dropped down into the valleys. Diabetes mis-management It wasn’t all plain sailing. After running for forty minutes straight up a steep mountainside on the second day, I had the sudden realisation that I’d left my head torch behind. In the pouring rain, I soaked all my possessions whilst taking them out of my bag to search of the torch. I also did a blood test, but my hands were so wet that the blood must have diluted considerably. How does one test blood sugar in the pouring rain?! I didn’t know how to interpret the reading of 2.3 – I felt fine – so I ate four jelly babies to be on the safe side and retraced my steps to get the damn torch! My glucose meter ran out of battery at the end of the first day. I didn’t have spares and was facing a major problem, although luckily the refuge nearby sold AAA batteries so I could avert disaster. Lesson learnt. The only other piece of diabetes muppetry I achieved was with my lances. My meter has an integrated spiker which has a cassette of six needles which I can rotate to pierce my skin and create the drop of blood. I wasn’t sure if my spare cassette was useable or not, so rather than risk having to use a penknife to draw blood for the remaining four days of my trip, I opted to use the same needle for the entire time. Forty blood tests with one needle gets pretty painful as the needle blunts and is probably not the most hygienic thing to do either!