Abbey Brau

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Craig: This is Beta Cell, a show about people living with type 1 diabetes. I'm Craig Stubing.

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Craig: Type 1 diabetes is hard to manage even in perfect circumstances. You're trying to balance so many factors to keep your blood sugars in range and many of those factors you can't even control so the deck is already stacked against you. It makes sense to want to minimize the different aspects in your life that puts your blood sugars up or down, but many people with type 1 diabetes, myself included, seem to chase the thrills that make our lives so much harder.

When I was able to do a half marathon, I signed up for a full marathon, then a 200-mile relay race than triathlon and I would do Spartan races and no point does the training for these become easy in terms of managing my blood sugars. As soon as I think I've figured things out, almost the very next day, everything completely changes. Raised days are no easier.

They vary from virtually perfect to the worst blood sugar days of my life and the entire time that I'm racing a very large part of my mind is always worried about my blood sugar. Abby had been a competitive swimmer high school, but after she was diagnosed with type 1 at 22 years old, it took a while to relearn how to swim, not to mention live life normally again. When the nonprofit beyond Taiwan was printing together a team of 20 people with type 1 diabetes to bike from New York to San Francisco in the summer of 2017 I'd be signed up. When that was over, she looked for something even harder.

Abbey: I with the swimming background and my new love cycling from vape beyond or just the fact that I picked up cycling more. I decided, Hey, why not check that ironman off the bucket list?

Craig: What do you think drives you to do these two really long really physically and mentally challenging events spike beyond and iron man. Those aren't things that a normal person signs up to do and especially in that someone with type 1.

Abbey: I think it's a couple of things. I did start doing endurance events until after I was diagnosed, so I can't even say. Well, I was really great and I guess I always did the long-distance events in swimming and I call in when you're in college the longest swim you can do as a mile in the pool. As I would build up those distances, I realized the longer the event was, the better I would do. It wasn't daunting to me to do the really long stuff. I didn't like the sprint stuff. I don't like getting out there and going theory fast for a short period of time. I'm like, I haven't got a medium speed but I can do it a long time.

My coach realized that and he had the time was the one who putting a bug in my ear, I guess to do endurance things. I actually didn't do my first off mortars so until probably a year after I graduated because I was diagnosed with type 1 I was like, I don't know how to work out with this. I don't even know how to like live my life with this. It took me probably a year before I got back in the water to start swimming again and the first thing I did, I will never forget it. My blood sugar was like, I was so nervous to go low, so nervous and I'm pretty sure my blood sugar was over 200 and they had like who was at the side of the pool and it was just like good, can do 50 it's for sure going to go low.

I was totally fine and now I swim an hour or two without anything, but I didn't know at the time. I started doing all these other cornerstones. I just built up one mile and three of them five minutes longer. I don't know. I just have a weird endurance thing I think. I just like that space. Once you complete one thing, you're like, that felt great. It hurt and the training concept, but you forget all of that when you're done with an event, you forget all the things you gave up during training and it's just this great feeling of accomplishment doing any hindrance with it's furnace. It's so much more about your mental, how you approach it than the actual physical thing. Then, of course, the physical part comes in that you do have to train for, you have to teach your body how to withstand exercise for a long period of time.

As long as that takes a long time to train for it's not like you're training for a month or two, you're thinking, okay, this is a three to nine months training period. That's another thing to wrap your head around. I don't know, I won't say it's come easy to me, but the mental approach I guess is easy in that when I look at an event like in ironman for 17 hours, I don't necessarily think that it's daunting. I just think, okay, that's going to take me all day. Can I teach my body how to move all day and then accomplish this great thing at the end and at the end be able to say, I did an ironman or I'd like to cross the country. The biking across the country is a little bit different too because it was more of a, every day you're working, you're doing something.

You have to just it's shorter rides each day so it doesn't take all day, but the day after day after day after day, but at the same time, if you just take it one day at a time, it's like, okay, here's a 60-mile ride today. Okay, here's an 80 mile. There were definitely up to a hundred but they're also 35-50 mile days. Taking that ride last summer, one day at a time was how I approached that and thinking, I don't know if I can make cross country, but I can bike this far today. Then I'll regroup and maybe do it again the next day and the next day.

Craig: There has to be points where you think about, Oh yes, I also have diabetes. This isn't a walk in the park.

Abbey: Yes, and I will say diabetes presents a very added challenge until like beyond most of the longest since events I've done it, we're swimming there long enough that you have to check your blood sugar. Well you're swimming and you can't, you have to trick water. We can't touch the boat. You can't get out of the water. That is a really big challenge and something that nobody else has to deal with. When you have to tread water for, I don't know, anywhere from two to five minutes just to check your blood sugar because Dexcom or another CGM doesn't work in the water.

That is so exhausting and takes away from the energy you have to do the actual swim you're doing. I guess at that point that is frustrating I think to me because I'm like, well, I'm doing this swim and nobody else has to stop and tread water for this long. I'm like wasting so much energy doing this and that sucks. The thing, okay, I could have swam that 40 minutes faster kind of thing. That's frustrating.

Craig: Do you think it puts you at a disadvantage?

Abbey: It doesn't. Yes, a little bit. I guess a disadvantage in that it requires more effort to complete the swim. I haven't done anything long enough yet where I physically couldn't finish it, but that is taking away from the energy you have used to finish that event. It is frustrating to think that I have to do this extra step that other people don't have to do, but swims so far in training for it type 1 it's an extra challenge, but it never really bothered me. It was more like you plan for it, you prepare for it, you deal with it and it just is what it is. I didn't start doing these swims or any endurance events since I was diagnosed. So it’s kind of always been there.

It's not like I used to do it without and now I have this extra thing. I just deal with it. It is what it is. I will say in training for the Ironman, I encountered something this spring that I have never dealt with before and he was totally like you said, I had the mental game of these endurance events down this spring. I lost that in the middle of Ironman training. I think is totally directly related to type 1 because climbing to these distances in times doing sports, especially with running never having really spent a ton of time running. I was having wildly roller coaster blood sugars and I'd have two weeks where any answers as it did were just making me go high. Then I would be like, okay, maybe that's my new normal. Then I would be more comfortable with some insulin on blood when ran and then the next two weeks a routine.

What happened was it always happened in the run. I would run so often and go low to a point where I'd end up walking for half of it and I got so frustrated with that. You'd get up and you'd get ready to run and you take the time on your day and then you can't actually do the workout. When you go through a point I ended up having to dial back my insulin needs. It's like I figured out a solution and then it worked out again. I lost so many workouts in that process trying to figure out what my insulin needs were or what my food needs were too because my body was just not used to this and it was new territory for me.

This whole training was new for me. Missing those workouts, then I would just get in my own head and be like, when am I going to make that up? I don't have time to make it up because of work or because I'm doing these other workouts. If you're high and then you tank, or if you get really low and then you come back up, it's draining, I don't know what you guys- I just feel exhausted after that happens and mentally drained.

Craig: The mental too, but also physically. You can't really recover from- you're screwed.

Abbey: Oh my gosh, yes, it's exhausting.

Craig: Even if it does come back up, even if you have eight gels. Your blood sugar will be fine, but you've got no energy.

Abbey: Exactly. I remember this one day where I needed motivation to keep going so I decided to go to- drive to a running spot, I made a lot of effort to go ran along the river here.

I ran for two miles, and then just I just felt it—and it came on so quick—and then I just had to end it and then I ended up walking, it was low for another half hour or 40 minutes until I came back up and I did a little bit of an extra run, but like you said, I was just exhausted, I had no energy. I just went in my car and I just cry, totally.

Honestly, I was so frustrated and in such a dark place. Then my blood sugar was staying low, it was like hovering in the 60s and like, "Now I need to drive home." Then I just was eating anything I had and it wasn't coming back up.

Finally, I end up getting home and my blood sugar's fine, and it's like, "Well, I could go finish that run now." It was weekend and I didn't have plans, but I just I was so mentally drained and so in a dark place at that point, and so frustrated that I just curled up on the couch and took a nap. I remember thinking like, "I hate this, I hate being diabetic, I hate IRONMAN, I hate my IRONMAN training." I was training.

One of my best friends did it with me, and she's a really good athlete, she's not taken one. She's a very positive and supportive person, I just remember thinking, she doesn't know how good she has it, not having to deal with type 1, I remember I wanted to tell her and be like, "You're so lucky. You don't get it, you don't have to deal with this."

Then I go back thinking that because it's not really my thing to think like, "Feel bad for me, I have type 1. I'm doing these sports." Or feel- I'm like, "I want to make it a non-issue and just do these events despite it but not make it a big deal." That was the first time where I was very mad, that I had to deal with this disease and everybody else- well, not everybody else, but most- everyone else, I need training for an IRONMAN, didn't have to deal with that.

Being so frustrated and so mad, that was the first time too that I had ever remembered in any of my endurance event training before, going to such a dark place where I was like, "I don't want to do this anymore. I hate this, I can't, it's so hard." Drop the whole spring, I cried at home, I cried at the gym in spin class, and I cried at work, to my friend who would listen. That's never happened to me in training before.

I think it's all due to blood sugars, having to deal with dialing back my insulin, how I'm eating and the excessive training, it was very hard. The IRONMAN is hands down, the hardest thing I've ever trained for, it's wildly bad.

Craig: It seems like what got to you was the lack of control when here you are with a training plan, and you do know step a, step b, step c for six months of training.

Now you got this thing that you've had for years, but now it's not cooperating and there isn't really a guidebook on how to do that, it's not like the training plan you get for the IRONMAN it says, "Your first run, you do this with your insulin. Your second run, you do this. Your third run, you do that and then you're fine." It's always changing. Yes, I guess is that lack of control, that lack of-

Abbey: Well, and a lot of consistency. Even- it does type 1, you can follow the textbook all you want, you can do everything right and using air quotes you can't see, it can still be totally- it just does it's own thing. You can eat the exact same thing and take the same amount of insulin for all your same workout, and because the sky was blue that day it decided you're going to go high and ruin your entire day, or you're going to go low.

Yes, it is the lack of control, even if you feel like you have as many of those variables under control as you can, you eat right, you do all the things you could, and then it's still not, I think that's very frustrating.

Craig: Was zero-point the spring where you thought, "I'm not going to do it." Did you ever get that point like, "I'm going to drop out, I can't do this."?

Abbey: I don't think I ever thought I was going to drop out, partly because it's an $800 race, and partly because I wanted to go to Boulder. But there was, definitely, a period of time where I thought, "I'm not going to make it, I'm not going to finish this by the cutoff times." That was after we went out in April to test ride and run the course, it was very hard.

My blood sugars were a hot mess the whole weekend, and really high at one point. I felt sick when I was riding, I remember being done, being like, "Oh my gosh." I never thought I couldn't do it, there's a 17 hour cutoff in the IRONMAN, that I always thought, "Just finish it. I don't care what the cutoff or I don't care if it takes me 17 hours." But I always thought for my training plan like, "Put it to trial, you can do it." That's always mine- anybody can train for anything, you just have to put in the time.

After that weekend I was like, "I don't know if I can bike fast enough and run fast enough to make these cut-offs. I don't know if I'll actually be able to do it." That was really hard to think about. I did get over that, it was just a really tough weekend and in the middle of me dealing with readjusting some insulin things, but yes, that happened and, again, that's never really happened to me training for anything.

That was another mental blow where you're like, "What am I doing? I can't believe I signed up for this. Let me sign up for this. Who told me I can do this?"

Craig: When you show up at the start line and you're eyeing that 2.4-mile swim, in the back of your mind you're like, "Okay, there's the bike ride, there's the run." How much are you thinking, "Can I physically do this."? And how much are you thinking, "God, I hope I can keep my blood sugar in range for the next 17 hours."?

Abbey: Way more blood sugar. I felt really good about my training, I was feeling really strong, I wasn't as worried about the cut off times and finishing as I had been a couple of months prior. I was much more worried about what levels my blood sugar were and I wanted them to really stay in range, just because I knew that that could totally make or break my day and it did.

All the issues I ran into or due to having higher or low blood sugar, and when you say staring down that swim, I had to leave my Dexcom receiver in transition and when I left it, because why would my blood sugar behave normally on IRONMAN day in the morning? I've been eating the same breakfast for months and doing the same routine, provided insulin quarterly but this day, they decided to hover around 100 and I think, at one point, I had a 97 with a slight arrow-down.

I know that that's a very nice number, but not when you're staring down a 2.4-mile swim and a 17 hour a day. I love my Dex, my blood sugar was 93 before the swim and I was like, "That's lower than I want it to be for an hour some swim." I killed another Clif Bar, but I was right off the bat, I was nervous about what my blood sugars would be.

Yes, the whole day it was constantly checking, worrying and thinking, "Are they going to go up? Or are they going to go down?" And "If I eat this or even eat that." Just because once they are off, they're not in your norm for work. I always feel like it's like I can't expect anything from them, and they're always going to do something I don't want them to do. The whole day it was about what my blood sugars were.

Despite the roller-coaster day, I started that race with a 93 and I ended that race at a 105. It looks like a really nice day if you look at it that way.

Craig: You cross the finish line, at what point do you think, "Holy crap, I just did that with type-1."?

Abbey: It's more of a footnote. It's more like, "Oh my gosh, you just did this thing."

Craig: You don't think it makes you more proud.

Abbey: Initially, it's just like, "I just did an IRONMAN." But then I think, it's when I start to talk about it, and share the experience of other people is when I get more proud of the check one, because that's when you are explaining the experience and what you went through, or when I talked about training and, honestly, the hardest part of training was that mental dark space I went to, which I feel like was caused by type-1.

The fact that I probably made it to the starting line, to be type-1 and make it to that starting line, to sign up for it, train for it and do that, because the training was so hard. Honestly, I think a lot of the challenges I had day off, were due to blood sugar.

Interviewee: shoes with the heat and with-- I got a flat tire which killed 25 minutes out of my day, so I wasn't moving for 25 minutes and my blood sugar's just shot right up. A lot of the challenges I faced were based-- Were starting with what my blood sugar was and it not being where I want it to be. I think that's when I started to get more proud of the fact that, not only did I do an Iron Man, I did it with type 1. I don't want it to be that, if you don't have type 1 training for an Iron Man isn't hard. It is, but I went through them the whole period of like, "You guys don't have to deal with this." The other people I know in training, so I think it is an accomplishment. I guess I don't necessarily say that out loud enough.

Craig: The Iron Man you train alone, essentially, or at least the only person with type 1. Which is very different from a year ago when you did Bike Beyond with a whole bunch of people with type 1. Do you think doing Bike Beyond, in a way help prepare you for these other endurance events?

Abbey: You learn so much when you spend a summer with 20 other people with type 1 diabetes, who are active and they want to pursue these crazy events. Or you're all biking 400 miles together or whatever. We had trail runners and other endurance triathletes on the team, just people who have that mindset. From a type 1 athletes standpoint, all of the knowledge and things that I try and do, I've learned from other type 1s. My endocrinologist, he's great in the CDE. She's a lovely human, but they don't have type 1, and they're not running marathons. They don't get it from a type 1 perspective, and they're not going through the training, so it's like, I learned so much from people who have--

Just spending time with other people's type 1, you learn different tricks of the trade essentially. You learn different ways to treat highs and different ways to treat lows, then also knowing that I've grown my network of type 1s and type 1 athletes. If I do have a question, I have people at my fingertips to reach out to be like, "This happened today. What do you think I should do?" Or honestly, even just venting. It's so much better to vent, cry, complain and do something when you're dealing with a blood sugar issue to someone with type 1, than it is to my friends who don't get it, or don't have to deal with that. Even if they're still just listening and they can't-- They don't have a solution for you, you know on the other end they're like, "That sucks, I've been there."

Craig: You're doing one of these endurance events like this Iron Man, and you get a flat tire, you stop, your blood sugar goes high, you change your basal rate, your blood sugar starts to go low. How do you mentally deal with that during the race? How do you deal with these highs and lows and not get burned out?

Abbey: I don't know. You don't really-- You do. You just have to get over it. I think it's just, you need to know going into it that-- My whole thing was, "I want to finish this race, so deal with it." It's like, okay, take a second to be frustrated or mad, then reel it in and be like, "What do I need to do to fix this? Do I need to get insulin? Do I need to eat something?" Just slow down, but keep moving yourself forward, so I would just bike really slow or walk, and-- I don't know. Yes, when you think about your options, it's either, get over it, fix it and keep moving yourself forward so you can finish this race you came here to do. Or sit and wallow in it, miss the cut-offs and don't complete the event, and it's like, "What do you want? You're here to do it." I think, it was my first time and I was like, "I have to cross the finish line. I have to do it." I just got myself mentally through it and you-- That's all you can really do.

Craig: It's a good metaphor for life with type 1, not even just endurance events, but just keep moving forward. Like, what's your other option? Like you said, sit and wallow or just keep going.

Abbey: Yes, very true, but when you don't have a 17-hour time limit on you, you can wallow a little bit more. [laughs]

Craig: Do you think that doing the training for this Iron Man has changed how you look at living with type 1 diabetes?

Abbey: Yes, I think it's made me appreciate-- I think going through that training and that dark space that I mentally have never been through before, it's made me appreciate the fact that I can go through this training and live with type 1. It makes you see the challenges that you live with more, just be proud of your every day. You don't have to go out and do an Iron Man to be proud of just honestly living with type 1, because there is a lot of challenges. A lot of those things came up because I was training, but a lot of those things happen anyways, even if I'm not training for something.

You have highs and you have lows, right? I think just realizing that it's always a challenge, but how about this, the fact that I was like, "I'm ruining my training plan, halfway through and I'm not going to ever finish this." Then I did it anyways. I think that to remind yourself that, if you're at a low point, whether you're training or you're just low because diabetes is frustrating in general when you're not training for anything. Just knowing that even though it doesn't seem like it in the moment, you'll get through it and you will be successful in whatever you're doing, or there's a light at the end of the tunnel, even if you can't see it at the moment.

I think it's just that fact too, that I went through that really dark period and I came out the other end to complete it. It's just a great reminder that even if it's the hardest thing you've ever done, you'll get through it and you'll succeed, I think. You can, if you just keep going forward.

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Craig: Hey, this was produced, recorded and edited by me, Craig Stubing, and our theme music is by Purple Glitter. Be sure to subscribe to Beta Cell wherever you listen to podcasts, to get all of our shows downloaded onto your listening device as soon as they're available. While you're there, how about giving us review on the Apple Podcast app or on iTunes on your computer, scroll down the reviews and write your own, it really helps other people find the show. If you love Beta Cell, you can support us on Patreon. There you can get access to our exclusive support-only podcast Out of Range, after dark. Go to patreon.com/betacell.

I'm Craig Stubing and this is Beta Cell.

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