Saturday, 30 September 2017

DXAmsterdam - The Cost of Diabetes



In the interests of being bang up to date and cutting edge in my reviews and information here's a few words on my trip to Amsterdam with the Abbott Freestyle Libre team in June. Yes, only three months ago. I must slow down in my rushed reporting otherwise you'll be visiting this blog every month instead of twice a year!

Obligatory 'biased view' disclaimer out of the way first. I was one of nine bloggers from the UK and Ireland invited for the weekend in the city of canals and killer bikes. There we met over 20 bloggers from around Europe. Yes, they paid for my travel, food, a few of my drinks, though definitely not all and provided a pretty good, fun-filled weekend. On the flipside they did not demand any quick blogging, which is a good thing, or 'positive' reporting. All views and opinions are my own.

Now if I'd got to this quicker I'd be able to give a fresh and detailed review of the weekend. Instead what you get are the bits that have really stuck in my mind. In the interests of saving me repeating what has been written before I've given a few links at the bottom of this to other blogs. Please do click through as it's a great selection.

For me the weekend was a great chance to meet the other bloggers with different experiences and knowledge sharing a common dodgy pancreas. Some of this was entertaining and some were pretty upsetting and grounding.

Related to this I'm now going to focus on the thing that is still on my mind three months later.

On the Friday night we had a brief presentation from Matthijs Graner who runs http://www.eendiabetes.nl/. His presentation was around the idea of a simple thought leading to interesting projects. He told the story of how he had worked to build photographic calendars of young people with type 1 diabetes in the Netherlands. 

We were then asked by Matthijs to have a think about things we could do that could be useful in different countries. Chatting with Mike and a few others we started to think about the thing that had already come up a few times in conversation. Living with our diabetes thing 24/7 it's easy to become engrossed in our own experience and focus on the bad bits for us. It quickly became apparent that while the UK has challenges for funding and technological availability we also have all insulin provided free at the point of use. Along with this, people with type 1 diabetes have access to blood glucose testing strips. Sometimes their are local limitations on quantity but a good argument or change of can normally fix this.

For me I also have access to an insulin pump to deliver my insulin as I meet criteria for this. Along with this all cannulas, reservoirs and batteries for the pump are paid for. And when I need to replace this, although I will probably have to justify why I need one to improve my control, I do not expect it to be an issue getting it replaced. The make and model might be more limited but it’s a start.

In the UK the government collect money from general and salary taxation. That pays for the National Health Service. The basic concept of the NHS is that care is free at the point of need so that if you need medicine or treatment you do not have to pay up front before it is provided. Before people dive in here and say “Ah, but….” I’m trying to summarise the generality. Specifically for type 1 diabetes, insulin and test strips are paid for by everyone who pays taxes so that the person with type 1 diabetes does not pay when they order a refill of insulin, test strips or pump supplies if they have a pump. Local awkward GPs and CCGs may mean you are experiencing different but I’m speaking for the majority.

Outside of this I currently pay for the Freestyle Libre to provide me an up to the minute graph of where my blood sugars are. As an example, as I write this my number is 4.5. But I can see from the graph that this number is good as the line is relatively level and the direction of the indicating arrow is horizontal. This is a personal choice for me to make my life easier. If I chose not use it I’d be looking at a similar number on my Contour Next meter and wondering if I’m dropping and whether I need to read an impending hypo or the reality which is I’m fine for now. It's not cheap and definitely not an option for all but it's a choice I've been able to make to make my D-life easier.

We’ll come to the rest of the world in a moment. What about the rest of Europe? After we shared our idea around the room it quickly became apparent that each country provided a different model for paying for your diabetes. For some pretty much everything was paid for by the government and for others hardly anything was. In those countries where it was ‘paid for’ there may be additional health insurance to pay for because you have type 1.

Some models of provision were simply bizarre to me. An attendee from Turkey explained that her insulin pump was partly paid for by the government. She had to pay roughly half and then pay for all the consumables. And after 4 years when the warranty expires the pump has to be handed back and a new one purchased even if it’s working perfectly well. Totally mind-blowing.

Of particular concern to me was the testimony of Maria from Greece. The country’s financial strife was such a problem that test strips were now becoming something that had to be bought and she was part of a an active movement that was campaigning very hard so that people with type 1 diabetes had access to very basic levels of care and weren’t just neglected. Once again it struck home to me how fortunate I am to have the NHS.

These discussions showed to me that it’s easy to look at the green grass elsewhere and cherry pick what other countries do well and ignoring what they do badly. As I write this a life critical campaign called Insulin For All https://www.t1international.com/insulin4all/ is trying to ensure every person type 1 around the world has access to the basic liquid that is needed to keep them a live at an affordable price. For those reading from the UK it may surprise you that one of the countries where this problem is largest is the 13th richest country in the world with the common perception that it is one of the most developed. The USA. Yes there are people across the pond who are making choices every day over whether to pay for food or insulin. As a child of the NHS I find this truly shocking.

As I sat in Amsterdam hearing fantastically inspiring stories from people like Claire Lomas eating dinner with my new blogging friends at the back of my mind was a guilt and gratitude that still lingers to this day. I’m fortunate to have been born when and where I did which gives me access to high quality insulin deliverable in a safe manner in a way that I can afford. 100 years or 10,000 miles in another direction and my story would be completely different and possibly much shorter.

Last up comes a thank you to Abbott. I believe their intentions are to improve technology and the access to it. As a private company, yes they will need to ultimately make a profit, such is life. But all the people I have met from Abbott and the look in their eyes convinces me their personal aim is to improve the lives of people with all types of diabetes. They will get things wrong, such as the random expiry dates of sensors and massive supply issues when the Libre was first released but I hope they will learn from these and over time the cost of the sensors also drop to allow access to all irrespective of local funding. Disclaimer is nice and clear at the top so I'll allow you to judge my integrity but I know I'm OK.




As promised here are the links to other blogs and also another link to Insulin for All. For a good list of documents relating to insulin costs in have a look down Laura’s timeline on Twitter. https://twitter.com/Kidfears99

Every Day Ups and Downs
Thrive Diabetes
Adrian

Thanks as always for reading. See you in a few months!

Thursday, 25 May 2017

Am I The Only One?

This blog is for you. 

Are you a person with Type 1 diabetes of any age but most likely over 12?


Are you the only person you know well with diabetes?


Do you just want to be 'normal' like your friends?

Why can't you eat what you want when everyone else is gorging on chocolate?

Does blood testing scare you?


Why does it scare you? Is it the pain of the stab or the pain of seeing a number that proves you’re failing again? And does that number come with massive guilt?

Have you had appointments with doctors and nurses where you just get told to control your bloods better and to then lower or raise your blood sugars as if it is easy?

Does the idea of a check-up fill you with dread?


Does the standard "How is your control?" question at other medical appointments also hurt you like a knife when asked?


Does every other person with diabetes have either perfect control, or blindness and amputations? They must have, as those are the only two options offered.


Are there so many things to control and juggle that it’s overwhelming?


Is it all too complicated and hard to understand?


Do you have other medical things going on that mean diabetes isn't your only worry?


Do you sometimes eat food without injecting when you know you really should?


Do you get mad at people that should care about you always telling you what to do? 


Even if they don't say it, do you feel like they wonder why you’re not doing better?

Have you had diabetes for many years but still don’t understand some things that you think you should know? Does this make you feel Diabetes Stupid?


Do hypos scare you?


Does being high scare you?


Is it all just too much hard work to bother?

Now ask yourself a few more questions and think carefully about the answers.

You're not the only one!


I'll say it again. YOU ARE NOT THE ONLY ONE!

What does a blood glucose number actually mean?

  • It’s not a score, it’s a sign of what you need to do next. If it’s low, eat something, if it’s high, then maybe you need some fast acting insulin or some activity. Don't feel judged.
Why should I engage with my diabetes?
  • You know this already but it’s not going anywhere for a very long time. So maybe it’s time not to fight it; time to work with your diabetes instead of against it? It is part of you and you are special, so it is special too. It's not going away. Maybe it's time to woman-up or man-up and face it head on.
  • No it's not fair you've got to test, inject, and handle the highs and lows when your friends don't. And yes it does make you a bit different. But they've got their own hang-ups too. Trust me; everyone has something that they think makes it hard for them. At least your challenges come with sweets as medicine!
Whose hospital appointment is it?
  • It’s yours. It’s not the doctor’s. So prepare beforehand. If you’ve got questions or things that are worrying you a lot, write these down and take them with you. And don’t move from your seat until they have answered your questions. You live with diabetes 24/7/365. Make sure that your one 20 minute segment with a consultant every 3, 6 or 12 months is valuable.
  • If you are finding things hard; tell your doctor or nurse. If they know what you are really thinking then they can help you better to smooth things out.
Am you the only person who finds Type 1 Diabetes hard?
  • No. Definitely not. I do!
  • We're all out here. You are not the only person with the Type 1. You know this already. But you are also not the only one who finds it hard. Keep remembering this and change the way you think. You’re not failing, you’re finding it hard. And it can get better.
Have you got a plan for your diabetes?
  • Make a plan. Ask yourself what would you like to change? Then seek help to make that change. Go looking and the responses you get might surprise you. People want to help. Including people like me. And also people closer to your age who are living through the same challenges as you today.
  • Find information? Use the links at the bottom. Dip in, dip out, then dip back in when you have a better idea about what you want to do.
  • Speak to people like you. Yes, they exist. Is there a local diabetes group for young people? Have a look online. Ask your diabetes nurse. And if there isn't, ask them if there’s anyone else locally who they think you might get along with.
  • Ask the stupid questions. You might be surprised as others probably don’t know either. Diabetes IS complicated. No-one expects you to be an expert and know everything just because you've had it a month, a year, a decade, or your whole life. Please never be afraid to say "I don't understand".
  • Talk to your parents, carers, partners or family. They want the best for you. They really do. I was younger once and it’s only now as a parent I can understand how much my parents worried about me. Take a chance on telling them you find it hard. What is there to lose? Nothing. You’ll probably find you'll gain their respect. They are probably the people closest to you and the ones that ask you most frequently what your latest blood glucose number is or how much insulin you’ve taken. They do this because they worry about you. And they've heard the same doom laden promises of the future as you have. After you’ve read or watched this, talk to them. Tell them how you feel.

Now it's time for some cliché phrases


It’s your diabetes, no-one else's. You can own it and you can be the one in charge of it.

You are not alone. Open the door and you will find others facing the same struggles as you.



YOU 
CAN 
DO IT!



This photo isn’t to prove how I like jumping over fire. It’s to prove that nothing should hold you back and any limits are mostly set by you. Let's lift those limits as high as they can go.


Make a change by clicking through the links below and/or talking to people close to you about you and how you feel.


Thank you for reading this. Please share it and talk about it with the people around you. You might be very surprised at the positive response from others.


This blog is also available in video form here. The words are the same, the medium is different





____________________




T1 Resources - This is your encyclopedia of Type 1 info with all links doubly checked by a healthcare professional and then someone with Type 1 like you.

JDRF - The worldwide charity with a single long-term goal - to get rid of your diabetes. That's sounds pretty perfect to me. The website has some great articles too.

Diabetes UK - The UK's largest diabetes charity that also looks at Type 2 but still has plenty of advice for Type 1s.


Thank you.

Wednesday, 28 September 2016

A Hypo That Hurt

Today I'm sharing my experience of a hypo (hypoglycemic attack) from a few months ago that has stuck in my head. 

For those with a fully functioning pancreas a hypo is caused on a very basic level by either having too much insulin on board, not enough food or a combination of them both. Hypo symptoms vary from person to person and a good summary can be seen at Diabetes UK here.

As someone who's lived with diabetes for a while there are a few hypos that stick in the brain. And those that do tend to be the big ones. The ones that require the help of other people mostly. Thankfully for me this isn't a frequent occurrence but one that's unsettling none the less. A few 'highlights' over the years include; being collapsed in bed while visiting my sister in Germany instead of meeting up for a lunchtime squash session, collapsing in my hallway when my (other) sister was visiting the house with me scrambling around on the floor trying to get some sweets, and my personal favourite which is laying on the landing after my toddler son's bathtime and while Mrs Tangerine is coming to the rescue and getting some food he decides to draw on my face with a pen.

You'll notice from the descriptions above the really big ones normally come with massive co-ordination issues and the need for assistance from others. But the descriptions are also very factual and fail to give a sense of how it feels to be there. And I know my words here are entirely one sided and fail massively to capture the emotions of those around me trying to bring me back into the world of the conscious. 

The one this summer was the first really bad one for a while and maybe that's part of the reason why it has hit me so hard. 

First up the mechanics of it. As with all good stories it started with an impromptu visit to the pub in the afternoon. I'd had very little to eat that day and, as I've found recently, the lager I was drinking sent my blood glucose (BG) levels climbing higher. As it climbed higher and higher, in my drink fuelled brain, I decided to correct this and correct again by giving myself more and more insulin. Sat here now typing the outcome was inevitable and I got what I deserved. But the people around me didn't deserve what they got. For most of them this was the first time they'd seen me dangerously low and I know it surprised them too.

After a few hours we decided to return to a friend's house to continue the party. As time passed I started to feel more and more drunk even though I'd stopped drinking. The decision to stop was mainly down to the BG nightmare I was having and even tipsy Dave knew more alcohol wouldn't help the situation.

To add to the fun my BG testing kit was at home and the battery on my Freestyle Libre had died. This meant I was flying solo although by this stage my judgement was getting more and more messed up.

At this point my memories go fuzzy but I do remember very clearly sat on the sofa with my wife knelt before me force feeding me chocolate Minstrels. This is where it gets nasty and I did well to avoid getting hit very hard. In my hypo-head my BG levels were perfectly normal and eating food without taking any insulin was dangerous. With all seriousness and no thinking I shouted at the person who loves me unconditionally and doing their best to make me well "By making me eat these you are killing me!" Even now it's hard to think about without feeling massive regret and guilt. How that must have felt for her I can only guess. Her actions at the time were the polar opposite to killing me and she didn't deserve this abuse from me.

After a few minutes I agreed to prove to her that I was fine and would test my blood glucose levels. I mentioned above that my co-ordination levels often disappear but this time I was able to walk/stagger perfectly well. As we live on the same street we marched together back home. Both of us convinced we would be proven correct but obviously this was only going to be correct for one of us. I say we both marched but the reality was that Laura guided me home hoping I would finally accept the reality.

The BG meter was quickly found, blood extracted and applied to the strip. The five seconds wait for the BG meter to deliver its judgement is normally a quick process but on this occasion the penny dropped in my head and reality hit before the timer had finished and I knew the number about to appear would be a low one, it felt like time stood still. A bit like the scene in The Matrix but with fewer bullets. It was a low number. 2.0 mmol/L (36mg/dl). I've had numbers this low before without any drama but for some unknown reason this was hitting me hard. Whether the consumed Minstrels had already had an effect and I had been even lower I'm not sure.

The meter was a definite lightbulb moment and my own self-preservation and awareness kicked in. I started to consume some quick acting carbs and at the same point attempted to apologise for the abuse I had unloaded in the previous 30 minutes. I knew I'd messed up big style here and no amount of saying sorry could remove what I'd said. Added to this were a handful of close friends who had been left in a state of wondering what had just happened, how and why. They all know about my diabetes but this was the first time I'd shared with them the hard parts that Laura has experienced occasionally before.

Massive credit to Laura as she is fantastic and says she understands it wasn't the real me saying those things but I know that being on the receiving end of the abuse isn’t easy and must hurt. A lot. Especially when she’s trying her best to keep me safe. And also credit to my friends who saw this and didn't judge me but were amazed when I returned to the house virtually back to normal and able to have civil conversations about the episode.

The classic question to a person with diabetes is what does a hypo feel like? Well to everyone it will feel slightly different and for me each hypo can hit me in different ways. In this instance although BG levels quickly returned to normal the impact of it has been long-lasting. The guilt of putting those who are closest to me through that is significant and I'm very keen to do the best I can to prevent this happening again. This has involved cutting down on the drinking and also not correcting any alcohol related highs while still in the pub. If I am high then waiting until we leave is an acceptable risk for me to prevent the much bigger danger of being dangerously low.

There are other factors to bring into the equation too. As part of UK driving licensing rules people with type 1 diabetes need to get their licence renewed every three years. And one of the questions asked is if you have had two instances of a hypo requiring the assistance from another person in the last 12 months. For me it's over 12 months until I need to renew but if I did then this would count towards my two strikes total. As a side issue this would be harsh as I wouldn't have been driving that night as I'd drunk too much alcohol anyway. I guess saying that I only have disabling hypos when drunk wouldn't make me exempt from the analysis?

This post for me is a massive conflict as I hate to say that diabetes holds me back in any way. And as shown in the last one about a day on a bike this is definitely the case. The impact of this hypo wasn't in the short-term, it's been the ongoing worry, analysis and regret of it and the feeling that others will judge me because of what they saw and did on that night.

Thank you for reading and please do let me know about what hypos feel like to you.

Thursday, 14 July 2016

Coast 2 Coast In a Day - A 150 Mile Sportive With Diabetes and Pies - A Short Novel


** Pre-warning - I've tried many ways to make this post shorter and less demanding to read. After several failed attempts I'm throwing the challenge over to you the reader to complete it without needing food, gels or water along the way. Sorry. **

I’m writing for a mixture of readers this time so I hope I can get a good balance between cycling, diabetes and cycling with diabetes. To help those just here for one bit or the other I’ll put the diabetes specific stuff in italics. 

The Sign-Up Discussion

It was a short conversation on Twitbook and email in June 2015 that was to have a massive impact on my next 13 months. I’m paraphrasing a little but the feelings on both sides are still spot on….
James: I’ve reserved you a place on my annual Coast 2 Coast in a Day cycling sportive.
Dave: Whoa! W-w-w-when did I say I could do this? I don’t have a suitable bike. And the whole idea is just crazy!
James: You have a good base of fitness and the right attitude.
Dave: What about the bike?
James: Roddy has a bike shop; he’ll point you in the right direction. See you in June 2016!

And that was sort of it. I’d accidentally entered a cycle event that would entail cycling 150 miles, 4500m in ascent (and descent) including some of the steepest roads in the country, across three National Parks and it was all meant to be completed in under 17 hours. For those more used to clipping your shoes into your bike pedals and spending a day in the saddle this might sound like a grand day out. I was filled with a mixture of dread and determination. My starting point was that it was highly unlikely I’d pull out now because I can be a bit stubborn when pushed but I also knew it would be hard work.

Time for a little background on why James had signed me up. James is part of the team running Open Adventure who organise endurance events of many forms and his annual C2C In a Day challenge is one of them. James also has type 1 diabetes and you may have seen him running with me when I was trying out the Medtronic 640G. By throwing these two things together James was keen to prove that Type 1 shouldn’t be a barrier to anything and offered 25 places free of charge to anyone with Type 1 Diabetes who wanted to challenge themselves. Along the way a chunk of these found injuries or urgent hair salon appointments that prevented them making the start line. This meant on the day there was 11 of us at the starting gate - only 9 made the photo call though. (Here's the link for 2017)


The Training

So as is the norm for ‘last minute Dave’ rather than start the training properly last summer, I looked at the calendar, saw that the event was months away and waited until just before Christmas to start putting the miles in.

Somewhere between getting signed up and February, James also approached me to be involved in a small film he’d commissioned with Summit Fever Media. It was to highlight the challenge that the C2C can bring to people of varying abilities and knowledge. I met with Ellie and Matt a few times before they kindly suggested that as I was going to try Hardknott Pass out a few months before the event they could come along and capture my enjoyment on film. So I caught the fantastic coastal railway up to Ravensglass and cycled to the bottom of Hardknott where they fitted me with a mic and drove (no cycling for them, oh no!) to the top to watch me climb majestically to the summit. Here’s what actually happened….



My diabetes plan for training involved me trying a variety insulin, food and testing strategies. A problem I was frequently coming across was massive spikes in blood glucose levels immediately after I finished a training run. This was especially the case after rides where I had finished at high intensity levels. I took another look at my notes from the Animas Sports Weekend and slowly built a plan based around a pre-finish bolus and temp basal reduction several hours later. One by one the problems started to get solved. The big concern for me was still not really knowing how to handle food on the day.

In the training as I was carrying food and clothing to feed me and keep me warm and dry for the longest training runs (up to 120 miles) I had multiple bags on the go. Initially I’d presumed this would be normal on the day but on perusing the photos from last year I spotted most had very little with them. At most it was a bag for the top tube and a saddle bag. So this was the way I went with the idea of having very full jersey and jacket pockets.

Also as part of the T1s Go Cycling group there was quite a bit of support going on between the team. Plenty of suggestions there on managing blood glucose and energy levels on the longer rides we were all doing. Through that we also managed to source some matching cycling jerseys through Animas. This was a late request and they were really helpful in getting it approved. Thanks also to Scimiter Sports for helping with the design and supplying the jerseys at a very late stage. The jerseys definitely made it much easier to spot members of the team on the route and feel that I wasn’t the only one juggling a feckless pancreas at the same time.

Accommodation and Registration

So despite my claims in the video above, I did keep going and found myself packing my transport for 150 miles and my bed for the night into the boot of our car before the very accommodating Laura drove me the one and a half hours up to a village in the far west of Cumbria on a Friday night.


I’d contemplated booking a room for the night in a local hostelry but decided on camping for a few reasons. Firstly I knew I’d be up and awake at around 4am so it’s far easier to get off an airbed than out of a comfy hotel bed at that time of day. Also the cost of £15 was much less than a hotel room would be, so more money to spend on a comfy bed at the other end where I knew I would sleep well. On arrival at Seascale Primary School we unpacked the car and I sad my goodbyes to Laura. It was quite grounding at that point to know that the next time I’d see her I would have already conquered two significant climbs and would be well on the way to crossing the country.

After that I carried my camping stuff around to the school field at the back where I found plenty of tents all popped up and ready.


Once I’d managed to peg my pop-up tent down and set up my bed for the night I rode down through the village to the registration at the Sports Hall towards the bottom of the hill. Here I received my number, information pack, timing dongle that was attached to my wrist, neck tube and a Cliff bar. I also picked up a couple of labels to go on my bags and camping stuff that would be transferred to Whitby for me by the organisers.

After getting my stuff I biked back up the hill to the school. On the way I passed a food hub that had been arranged that was supplying a variety of hot and cold food for people wanting to eat. I chose to use the Purple Lunch Box parked in the school yard where I had a tasty bacon butty for about £2.60. There was also pasta, other dishes and deserts available.

Here I also deposited my bike in the school hall along with around 200 others for the evening. They were looked after until around 12pm when the doors were locked shut until they were reopened in the morning at about 4am


Outside were some water containers for filling up water bottles and some portable toilets.

At the same location was the first group of bike mechanics for the weekend who were available to make any last minute tweaks or emergency fixes. Although I didn't use them I believe time was free but parts were chargeable.

In the school playground was a map of the British Isles and I stood there for a few minutes wondering what I had agreed to do! What I did know though was that tomorrow I would be going mainly eastwards.



Next step for me was to wonder back down into the village where I waited for my brother who was driving up from Cornwall. Unfortunately a severe accident on the M5 had slowed down his progress but it gave me chance to watch a fantastic sunset over the coast.



After Pete had arrived with my father we had a photo against the map of the route and the reality of what had been something to worry about later was starting to hit home. That looks a blooming long way on a map!


A quick second tent erection of the day and I went with Pete back to the Purple Lunch Box where he had some food and we chatted with Louise and Kate who were nervously excited too.

From a diabetes point of view I was having mixed success. The day up until leaving home had been fairly level and then on the drive over (I wasn’t driving; thank you Mrs Tangerine) my levels started to drop. A temp basal of 0% and a few sweets lifted me up but gave an indication of the fun the next few hours would bring. The excitement, nerves and bacon bun, where I might have misjudged the carbs, lifted me up to 20.6 mmol/L (360mg/dl) before I went to sleep…. (to be continued)

As I predicted getting to sleep was a challenge and it felt like Christmas Eve with added nerves. I’d agreed to meet up with the Type 1 Cycling team at 05:15 near the start. Because of this I set my alarm for 4am as I wanted plenty of time in the morning to stay relaxed.



The Day Had Arrived

During the night the crash from a insulin correction for the 20.6 blood test saw me drop to hypo levels of 2.9 (52) on waking. This wasn't the perfect start I had planned. Hey ho. Some quick acting glucose taken on board followed by another bacon bun (as below) meant I started the ride at 7.0. I could see from the Freestyle Libre I was wearing I was slowly rising but I was happy with that. One of the reasons for the 4am alarm was also so that I could start my temporary basal on my insulin pump of 50% (that means the amount of my usual background insulin) approximately 90 minutes before I started pedalling. Through training I found an early reduction helped to avoid an initial drop at the start of exercise and also meant I wasn’t constantly eating to counteract the background insulin through the day. This level of temp basal had served me best after trying 0%, 25% and 75% in training rides with mixed success. But if you're going to try this practice first and find what works for you. YDMV.

Breakfast was provided by the Purple Lunch Box who were still on site and it was bacon bun time again but this time with a coffee to get me awake. A quick wash and brush of teeth and then I went back to get dressed into the lycra and filled my jersey pockets with supplies for the day. In retrospect I went with far too many gels but a mixture of nerves and uncertainty meant I was going to play it very safe.

Once dressed the tent was packed away. Although it was about 4.30am there was a mixture of activity on site. Some tents had already been packed and gone, some were half down, some were still up but people emerging and others were exactly as they were when I arrived the night before. Some people can obviously sleep a lot better than me, or need less time to cycle 150 miles.



A quick “Good morning” to my brother and I arranged to meet him down at the start after I’d had my photo taken with the rest of the defunct pancreas group.

Next job was to collect my bike from where I’d put it the night before and deposit my bag and camping gear next to the wagons that would transport them all across to Whitby for collection at the other end. I made two mistakes here. One more important than the other. First small mistake - the small power pack I’d bought to give extra life to my phone and Garmin 810 was packed away rather than into my bike bag. In the end it wasn’t needed as both managed to survive the full journey to Whitby without extra charging. Second mistake was a biggie. I’d read the top tips about insect repellent and packed it in my bag from home but at this point I forgot about it completely. On the ride I didn’t notice it but the week after I was scratching like crazy. If you’re reading this in prep for doing the event; don't be like Dave - spray!

The downhill coast down to the start was a mixture of big nerves and big excitement. I was down there for the group photo and the keen starters had already left by the time I arrived just before 5.15am. Even though there was just shy of 900 riders to get through the start in the space of three hours it didn’t feel rushed or chaotic at all.



The group photo was a great opportunity to meet people I’d chatted with online for the previous few months. a mixture of confidence, BG worries and technology on show but overall everyone seemed to be doing OK. During the day I got chance to chat with a couple of the team on the road and the was another priceless point of the event for me.


And of course Ellie and Matt were there to capture our nerves too!





Amongst the 11 was Jen aka Miss Jen Grieves. A big hats off to her and Ian though as they'd already cycled 5 miles from their hotel for the night before and this was just before Jen had some major insulin pump issues too.

Time to Go!

So after months of pretending it was too far away to worry about it was time to go. Me and my brother approached the start with a steady, but not overwhelming, flow of people. As is customary you look around to see what everyone else is riding, carrying and wearing. I felt OK as I didn’t spot any glaring errors on my kit list. I made a quick nip down to dip my bike in the sea before getting my SPORTident timing card started and we were off!



The first few miles were nice and steady and a case of trying to judge pace to keep plenty in reserve for the rest of the day without going too slow. 

On the way out we also spotted a few cycling the other way who’d stayed in hotels in surrounding villages and were now going to the start. As it’s a popular area for events there were a few other direction arrows in place in those early miles but thankfully some event staff were on the junction where the arrows pointed in opposite directions. They made sure we headed straight towards the infamous Hardknott Pass.

Also at this point we joined onto a couple of larger groups and riding alongside them added to the excitement. It also gave a chance to glance admiringly at other bikes on show. “That one costs about £8000” said my brother as another flew past. I was left wondering for a few minutes why the rider had neglected to ask for a roof, two more wheels and an engine for that price. Oh well, me and my more budget wheels would end up at the same place on the same day (hopefully) so no need to get that jealous. OK, I was but I had to carry on anyway!



Hardknott and Wrynose Are Coming

After 8 miles at Eskdale another set of marshals guided us onto the road leading to the Passes. From this point until the bottom of Wrynose Pass the road had been closed by the police for the event. This meant nothing could inhibit our relaxed (!) ride over the next few miles. The scenery continued to provide a stunning backdrop to the slowly building excited nerves in the riders.



Me and Pete stopped at the bottom for a photo with the phone box before cracking on. 



We’d agreed beforehand that for the big hills each has their own pace so no point trying to stay together. I also knew Pete was keen to make it to the top without walking whereas I was happy to jump off if needed.

Thankfully today was drier than my last attempt and I got much further up without stopping. To hear the support of others who’d opted to walk earlier than I did as I went past them on the early steep section was fantastic and the event spirit was certainly building. Eventually though the legs were starting to hurt and I decided to jump off for a couple of corners before I fell - I’d been there before! Whether I could have kept going at this point I’m not sure but with 135 miles to go I wasn’t going to prove a point to myself and suffer later because of it. 

As the gradient eased in the middle section I, like many others, jumped back on before the final steep tight corners gave me chance to walk again. It’s hard to judge numbers and earlier riders probably had a higher share of riders not walkers, but I’d estimate when I was on Hardknott around 75% had to get off at some point. Obviously any chance of me telling everyone that I’d made it all the way in the saddle were dashed by Ellie lurking with her camera to catch it on film. After the final steepest corner I jumped back on in plenty of time for the glory photo at the top.



Once at the top I reached my brother who was waiting and we took a few minutes to admire the view with pride at getting this far in one piece.



The descent down the eastern side of Hardknott is not one I’d really enjoyed in my training runs and again it was more nerves and constant braking that got me down safely rather than speed and excitement. The tight corners and steepness mean any speed gained has to be killed quickly to keep on two wheels. Thankfully the road was dry and once the last tight corner had passed there is a small fast paced section before a humpback bridge and then the turn left towards Wrynose Pass. Although with the same peak as Hardknott, because you’ve not descended fully from Hardknott, it’s not as far up. Still plenty of riders walking on this one and I joined them too for a section in the middle.

Descending from Wrynose was one highlight of the day for me although I nearly came a cropper towards the bottom. Unlike Hardknott the descent is steady and not really tight bends. This means the chance to build some speed was there and we took it. Many riders went slower but as I knew the road I was more confident. A scary moment came when a cyclist who was riding in a team passed me and then about ten seconds later slowed right down to stop with a teammate who was fixing a puncture on the side of the road. A quick shout of “WHOA!” from me followed by an “Oh, sorry” from him and calmness was restored.

The miles after this passed relatively easily although I did need to take some sweets and a gel to keep my blood glucose up as we went through Hawkshead. I’d been doing OK until now but the steady BG I’d maintained could have been partly stress led so a drop was understandable with the continuous cycling towards the ferry.

Don't Pay the Ferryman

The ferry across Lake Windermere is another special part of this event. It’s also the only part of the route where your time is stopped. As the time between ferries depends on when you arrive it’s only fair that this time is excluded. For us we arrived just as the ferry did from the other side and we got on along with our sisters who been waiting for us while, to use their words, “watching all the different shapes and sizes in lycra”. I've been across on the ferry many times but this is the only time I've seen in filled with cyclists and a few pedestrians only. And this time there was also no charge.



Kendal Feed Station

The ride up away from Windermere was an ascent followed by rolling roads down to the first feed station in Kendal. Here my wife was waiting along with my sisters. The feed stations have a fantastic reputation and rightly so. We obviously arrived at peak time in Kendal as the queue for food was quite large but moved fairly quickly. The choice here was similar to other stops with baguettes filled with ham, cheese, jam and peanut butter along with fruit and packs of sweets to stuff into jersey pockets. I had a sandwich, half a banana and took some sweets for later  The water stations were under some pressure though and we chose to avoid that queue until Hardraw where we guessed it would be a little quieter.  There was also a coffee cart with espressos for sale but I skipped that to speak with family before getting on the road again.

Post-Kendal Climbs

Being relatively local i knew what was coming up but a lady helpfully shouted as we left “There’s a big hill ahead”. And she wasn’t wrong. The road out of Kendal towards the M6 is a long and steady gradient that climbs for about 3 miles before a drop then a rise again. Once the final summit of this section had been reached it’s a fantastic long downhill towards the M6 and then onwards to Sedbergh. Waiting just after the motorway were our parents and sisters again. This time they had cow bells to add a bit of Le Tour to the day. Apparently some riders passing smiled and cheered while others needed to enjoy their day a little more.

The route for the next section was nice and rolling. My BGs started to drop a little after Sedbergh and another stop with family enabled me a chance to take some of the sweets from the last feed station and get back up before cracking on again. This was one of the few times I felt my energy drop badly purely because of my BG levels.

Hardraw Feed Station

Hardraw feed station came next and this was my personal favourite with some fantastic carrot and coriander soup and wholemeal bread on offer along with baguettes, fruit, sweets etc. Along with the soup I had some melon. Oh that melon was glorious. Melon has never tasted sweeter or juicier! 



Also here I saw a friend from my street at home who’d got delayed a little with some teammate woes. It was strange in a field so big and spread out to bump into people from so close to home!

Head Down and Crack On

Time to move on now and break the back of the ride. For me this section was crucial in passing without pain and keeping me in a good mood until the I got to the next feed station and onto roads I’d not been on before.



Again the countryside was beautiful as we passed along gently rolling as we went near the majestic Castle Bolton perched on a hill before hitting the sweetly named Sissy Hill and Scarth Nick.

This was a nasty little beast that I’m sure is thrown in to stop anyone getting complacent about the challenges ahead. The next few miles run alongside the firing ranges for Catterick army garrison and the signs warning of tanks turning added to the randomness of the day. 

After this we caught a short shower and my rain jacket came out to protect me although it wasn’t quite as effective as the one I’d left at home. Hey ho, another lesson learnt.

Tunstall Feed Station

Soon after the rain stopped came the feed station at Tunstall Village Hall and another chance to refuel. I know we were starting to take longer at the stops but this was the first one where we sat down to rest the legs and chat with fellow riders while eating the now usual, but excellent, food options.




From a D point of view this is where I perhaps over ate for the first time. The sandwiches and biscuits were just too appealing for me. I didn’t bolus but soon after the stop when I started to ride again and saw on the Libre my BG rising I did a small corrective bolus before focussing on the riding again.

Where's the Ark?

Tunstall to Ingleby Greenhow will be most remembered by us for the rain. Those who finished earlier are known to have said “What rain?” but as we turned over the A1M the black clouds gathered and unleashed a mighty downpour. 



After a while we sheltered under some trees hoping it would pass but it didn’t and I agreed with Pete he should crack on to Ingleby Greenhow at his pace and I would do likewise. After about half an hour the rain eased and then stopped and the glorious surroundings resumed with highlights including a cricket match in full swing in what appeared to be the middle of nowhere. I've tried to find the cricket pitch since on Google Maps etc but it doesn't appear to exist!

Ingleby Greenhow Feed Station

The rolling roads continued including an almost lethal left hand bend half way down a hill until the Ingleby Greenhow stop arrived. Without doubt this had the loudest supporters of any stop with lots of people cheering me in. And it felt like it was just for me, which it obviously wasn't but it was good anyway! This was a fantastic lift and those people might not appreciate how helpful it was at that stage. Also here I met an old school friend who was helping at the feed station and that familiar face helped to lift me again. I’d heard before about the pork pies on offer here and they didn’t disappoint.

By this stage I knew my gels were well over stocked and I left them for anyone else to use as they wished leaving a few in my pocket just in case.

It was here also that I cancelled my temp basal so went back to my normal non-riding insulin levels. From this point onwards I managed any dips with carbs alone using sweets and the gels I had left.

The Last Big One - Possibly

For the months before veterans of the ride were keen to warn of the pain to follow after Ingleby Greenhow. The infamous Limber Hill gained legendary status. And this is where I misjudged my map-reading skills. Badly. After a few rolling up and downs came a pair of significant climbs. 



In my head they were big enough and the sight of Ellie and Matt lurking again like Gollum with a camera was enough to convince me I’d mastered the monster and from here on in it would be downhill!

Look. See. How happy do I look? The big one has been beaten! Or has it?



After this I got stuck at a junction waiting for a car to decide if it was safe to emerge and Pete who was about 50m in front already got a good run ahead. Tiredness and a total misjudgement of distances meant I got a bit demoralised as I mistakenly thought I’d been ditched in a race to the line. Though I was also still enjoying the ride so settled myself in and looked forward to seeing Laura and my mum and dad at the finish.

Extra Refreshments

Coming through the villages I approached the bottom of a descent and like a mirage ahead I saw my brother stood outside the Arncliffe Arms at Glaisdale with beer in his hand and one ready for me! Now I was at a conflict as I wanted to finish as quickly as possible but, wow, it tasted lovely. A few fellow riders came past looking confused as they cycled on; maybe they were worried they’d missed an additional food stop?

Bottoms up and all that meant we hopped back on refreshed and ready for the coast into Whitby. Err, nup. As we turned under the railway bridge I could see a slope ahead going up to the right and Ellie lurking at the side of the road. This wasn’t a good sign. The fabled Limber Hill hadn't been conquered earlier and had now arrived. With a beer in my stomach and a pair of running/walking camera operators tracking me up the hill there was no way I could bail now. And I didn't. For me this was by far the biggest climbing achievement of the day.


Are We Nearly There Yet?

After this the rolling roads down to Whitby were fantastic. Slowly a group formed and going down the last lanes a group of about 12 started to own the road together. Finally with about 5 miles to go Whitby Abbey and the sea finally came into view. We were nearly there! My heart went out to a pair mending a puncture by the roadside but for me the end was in sight and, just like Starship, nothing was gonna stop us now!

Coming into Whitby the signposting was excellent as it had been the whole way and the finish line was a glorious sight along with Laura and my parents waiting. Getting to the end was emotional but it was a mixture of relief and pride that just made me smile. A lot. We’d done it! We’d biked from one side of the country to the other in a single day. Powered only by sandwiches, jelly sweets, soup and pork pies!






As I crossed the line and shook James’ hand my anger at him for creating a challenging route with more hills than any reasonable route planner would contemplate disappeared, to be replaced by thanks for convincing me I could do it.

One of James’ team spotted the team jersey and asked what my Libre reading was. I really had no idea what i would say but when I scanned and it read 4.2 I was a very happy man. And I got the nod of approval from him too!

Post Race 

Next stop was the White Horse and Griffin where my second alcoholic drink of the day awaited. The landlord had been given a warning of our arrival by Laura and made space for our two bikes. By the morning we found out he’d had to make space for another nine!

We then went hunting for fish and chips but by this stage there was only one chippy we could find open. It was doing a roaring trade and every other customer seemed to have a medal proudly on show. Strangely I wasn’t that hungry, possibly because I’d eaten so well during the day.

Bed that night was very welcoming after a long bath and I finally got chance to catch up on messages including those encouraging me to go faster when I was on the road. You can be sure I was going as fast as I could!

Following the day’s slight exertion I set a temp basal of 75% (or -25%) overnight on my Medtronic pump and that worked well with me waking at 8.2 in the morning. Overall it had been a good 24 hours for the BG levels. Though I’m not sure doing it every day is an achievable plan going forward. I did make a slight error the following night though by not temp basaling again and I dropped a little low through the night but managed to catch it with no damage done.

During the day my diabetes was obviously on my mind as usual but nothing to worry me too much. Below you'll see my Libre graph of the day and whilst it's far from perfect it didn't cause me too many concerns allowing me to focus on working out how to keep pedalling.



And as I'm sharing graphs, here is my Garmin data for the day; not fast, but steady.


A Round-Up

So if you’ve read this far you deserve a medal too.

A few thanks before I finish off.
  • First up James and the rest of the Open Cycling team. Words can’t say how well organised I found the event. Any event of this size is going to have new problems that pop up each year but I know they work hard to minimise these for the year after. On top of this he has repeated his offer of free places for people with Type 1 Diabetes who want to prove that we can do anything. Are you Type 1? Sign up!!!
  • Secondly the rest of the T1s Go Cycling team who kept spirits going and gave a real sense of ‘team’ even when we all went at our own pace. A lot of faces from Friday to Saturday evening were familiar so they must have done some miles themselves to make sure it went as smooth as possible.
  • The free images provided by Open Cycling are a fantastic freebie of the day and I've never come across that before in events.
  • Everyone who gave advice and tips before the big day. For a lot I’ve forgotten where I pick up the gems of information but I am grateful.
  • The team at Animas for the jersey sponsorship that meant I could easily spot the pancreas deficient on the journey.
  • My brother Pete. I know he could have gone faster during the day but the chance to ride together for the majority of the trip was fantastic.
  • My parents and sisters for their support on the way. It gave me a massive lift to see them when I did.
  • Ellie and Matt from Summit Fever Media who gave me a priceless momento of my day and the months before it in film. I feel very lucky to have that record forever.
  • And the biggest thanks goes to Laura for tolerating the stupid amount of time I spent training and then drove me up on Friday, met me in Kendal on the day and then was waiting at the far end to give me the thing I wanted most in the world; a big hug and knowing that she was proud of me.
And here is the video to record some of the above in moving images - for those interested in the parts above in italics keep watching after the credits at the end.



So I finish with what went well and what didn’t go as smoothly as it could have done but hindsight is a fantastic skill….

What I did well:

Insulin levels.
Practiced Hardknott a couple of times before the big day.
Cleat covers in pocket for walk up hills.
Booked camping at Seascale and White Horse and Griffin hotel at Whitby well in advance.
Temp basal overnight after the event.
Approached it as an endurance event rather than a race.
Used a Freestyle Libre to track my BGs without needing to stop and take blood out of my finger on the move; not easy!

What I did less well:

Didn't drink enough!
Over corrected stress led BG high on Friday night.
Too many gels in my pockets.
I didn't make sure any new clothing is fit for purpose. Especially waterproofs etc.
Went back to hotel before going looking for fish and chips.
Choosing a room on floor three of the hotel that had no lift!
Packed but didn't use insect repellent.
Needed to train even more!!

If you feel inspired (and entries are still available when I post this) you can find out more about the 2017 event and sign up here - http://www.opencycling.com/coast-to-coast-in-a-day/

If you've got Type 1 use this link for a free entry - http://www.opencycling.com/coast-to-coast-in-a-day/type1.php

I'll see you in Seascale on 24th June 2017!