John Grumitt, one of Diabetes UK’s Vice Presidents, who has Type 1 diabetes is no stranger to exertion. But how did he find taking on La Marmotte – an uphill cycling challenge in the French Alps?
Taking part in La Marmotte means setting off on a 174km (108 mile) bike ride taking in four of the biggest climbs: Glandon, Telegraph, Galibier and Alpe d’Huez.
For those 7,000 taking part, this means peddling up well over 5,180 vertical metres (16,994ft) before completing the journey around 10 hours later – 11 if you include stops for food and water.
I was diagnosed with Type 1 diabetes in January 1992 , and I was positively discouraged from various challenges that I had enjoyed: learning to fly, skiing and sailing, but it didn’t stop me. Over the years, my control had been very good. I thought of myself as one of the lucky ones.
Yes, of course I had various hypos (particularly after a day’s skiing), and a few errors over the years.My HbA1c had been steady for years at around 48–55mmol/mol (6.5–7.2%) and I didn’t seem to have any complications. However, I developed hypo unawareness a few years ago. Having been relatively well behaved, losing the warning signs damaged my confidence and created various unintended consequences. And so, to protect against the risk of hypo, I started running my blood glucose higher. But when an HbA1c reading came back as 88mmol/mol (10%) I was devastated, even though I knew something was up.
I was fortunate to be referred to Professor Amiel at King’s College London, a leading expert in the field. The first thing that came as a huge relief was that hypo unawareness does happen to some people. Despite it only affecting a relatively small number of people with Type 1 (around 10 per cent) I still felt relatively ‘normal’ . What’s not clear was whether I had created this by not addressing the falling blood glucose while riding my bike.
The challenge is that when riding a bike for a while, you get tired and if putting effort in – be that to go at a pace or climb a hill – you get sweaty. Part of the challenge of endurance cycling is mind over matter – you quickly learn to ignore some symptoms of fatigue. These might have included the warning signs of hypos, which, if I had ignored them, may have contributed to my hypo unawareness.
The problem is that with hindsight, we don’t know whether it would have happened anyway, or whether the endurance sport contributed or, indeed, caused it.
Getting ready
In preparation for the La Marmotte challenge, I received expert advice from the sports team under Ian Gallen at Wycombe Hospital. Although this meant some travel from Chiswick, getting expert advice on how the body responds to such challenges when you have Type 1 diabetes gave me confidence and avoided unnecessary complications. I was told how and when to adjust my insulin dose (to roughly 20 per cent of normal) during training and the challenge, and what, how much and when to eat before, during and after the event.
I had a great coach at my local gym who created a schedule that helped me to train without completely destroying my family and work commitments. We trained and monitored performance every step of the way. This, together with a long ride one morning at weekends over a long period of time built my endurance and strength.
Training for this took about three months’ intense work. It was only this short because I had a great coach and I had a base on which to build. To do a big challenge like this, from scratch, you might need six months to build up endurance and strength.
The right kit
As for the bike, you need a reasonable bit of kit, but there is also an expression: ‘all the gear and no idea’ and there was plenty of evidence of that. I had my bike serviced the week before to make sure that absolutely everything was in tip-top condition – I didn’t want a mechanical failure as I descended from a mountain top!
Stephanie Amiel, Head of Diabetes & Nutritional Sciences at King’s College London, and her team set me up with a pump and a continuous glucose monitor (CGM) which, due to my hypo unawareness, gave me valuable data so that I could make decisions. The graphs from the monitor allowed me to spot the blood glucose trends and to adjust my insulin accordingly.
The big day
Fuelled by a hearty low-GI breakfast of muesli, yogurt, a couple of bananas, toast, grapefruit juice and coffee about two hours before, we set off. The buzz of being in such a large group with mountains towering all around set the adrenalin running. I had a very clear idea of what to do: not to set off too fast, have a regular intake of water and carbs, and keep an eye on the blood glucose trends. Oh, and concentrate a bit on the cycling, too.
Typically, the food stations were at the top of the climbs. Each climb might take an hour or more of continuous hard work, during which you are pretty much on the edge. Your mind is saying, ’give up’ while you are also thinking, ‘I have set myself a challenge and I’m not giving up. This hill is not going to beat me’. It is a crazy place to put yourself, but it is remarkable what you can achieve if you are determined to make it happen.
A typical scene is 100 or so people, stopping for the first time for a couple of hours. A combined feeling of elation of what you have achieved so far, coupled with awareness and trepidation of what is to come. The feed station is a welcome break from the monotony of peddling.
For me, it is also a chance to swap stories with friends. For the fuel intake, everyone refills their water bottles (I typically have one full of water and to the other I add a powder-mixture of carbs and electrolytes (minerals such as potassium and sodium that you lose when sweating, but are essential, for example, to stop cramping.)
As for solids, usually there is a ‘menu’ of bananas, oranges, a sandwich or wrap, cake or flapjack. The hardcore elite athletes will stop momentarily. Lesser mortals stop a little longer to take in the event, the views and have a breather!
The climbs were tough, but my detailed preparation allowed me to keep peddling at a steady pace. After the toughest of all, Galibier (2,642m/8,667ft), we descended 40km (approx 24 miles) and 2,200m (7,217ft) before the final climb up to Alpe d’Huez.
After a really good day, I failed to take enough insulin with my food at the pit stop of Galibier and my blood glucose rocketed to more than 20mmol/l in under an hour. Ahead lay a 1,000m (3,280ft) climb and with my levels over 12mmol/l, I knew my power would be severely limited.
I took a corrective dose, made sure I had a glucose gel ready and set off. After about 3km (just under 2 miles) painful cramp set in, forcing me to walk for about 500m (1,640ft). I drank lots of water with electrolytes, but no sugar.
At this stage, as well as the super-fit racing up the hills, lots of mere mortals were finding things tough. Rapidly, my blood glucose fell towards normal and with it the feeling of fatigue and cramps seemed to go. Almost without realising, I had renewed energy and started enjoying the final climb. I checked my monitor, which read 6.1mmol/l. Elated, I pushed myself to the top and onto the finish in the ski resort.