I Survived My First Big Low and Kept Running
Editor’s Note: Dave Holmes was a member of Beyond Type Run‘s 2018 TCS New York City Marathon Team sponsored by Dexcom and Insulet, makers of the tubeless Omnipod Insulin Management System. Learn more about the 2019 Beyond Type Run team here.
One dumb mistake after my type 1 diagnosis almost made me hang up my running shoes. I nearly stopped exercising entirely, out of fear and ignorance. Also, I should probably be dead.
Let me back up a bit. Like many who are diagnosed with diabetes in adulthood, I was initially misdiagnosed with type 2. General physicians don’t always know what they’re doing when it comes to the ol’ pancreas, but that doesn’t stop them from giving their opinion, diagnosing you with authority, and putting you on medications that you may not need. After a routine check-up revealed a just-higher-than-normal A1c, I was put on metformin, told to alter my already-decent diet and advised to take up exercise. I then went home, where the doorknob to my office sags under the weight of too many medals from triathlons, bike races and 10k fun-runs.
This was November 2009, literally five days after I’d completed the New York City Marathon for the first time. It didn’t make sense, but you don’t argue with the doctor.
As you know if your story is anything like mine, nothing changed. I blew what I now recognize as my honeymoon period taking medication for a chronic condition I don’t have. I ate righter, I exercised more, I tested too many times and I watched my blood glucose (BG) creep up and up and up. I spent years this way. And then the honeymoon ended. I developed all the symptoms we can list off the tops of our heads: weight loss, constant urination, unquenchable thirst, blurry vision, the whole nine.
So once I gave up and decided to take myself to an endocrinologist, the diagnosis of type 1 came as a relief. Finally, I thought, something will work. And it did; he put me on Lantus and Novolog, and just like that, my blood glucose level was normal. It actually hurt a little at first; once your body gets used to high blood sugar levels, healthy feels unusual. I got my first Dexcom, and I watched each day as my meals turned into glucose, but stayed between the red line and the yellow, in that happy grey band of optimum health. (Mostly.)
I am cured, I thought. I am invincible.
I am an idiot.
About a week after I got that Dexcom, I decided I’d go for a nice Saturday afternoon run. I did this about 90 minutes after lunch, a chicken sandwich on a ciabatta roll for which I’d given myself 4 units. My BG had ticked steadily up to the 170s. I put on my favorite running shorts, the ones with all the pockets, and I put nothing in those pockets. No money, no glucose tablets, no identification. What would I need any of that for? I headed out the door.
It was a beautiful February afternoon in Los Angeles, just a hint of a chill in the air, like a New England autumn day. I was feeling healthy for the first time in years. I had Robyn in my Bluetooth headphones. I traced my favorite 4-mile route through my town. This is living, I thought.
And then, on my path back, about a mile and a quarter away from home, Robyn was interrupted by three rude beeps. I pulled my phone out.
Low blood glucose alert.
Fall rate alert.
I jabbed my passcode into the face of my phone and swiped through to the Dexcom app. My happy, healthy line of 170s BG levels had gone a little down, and then very down, and then verrrrry down, and then, in the previous five minutes, from 120 to 80. And dropping, two arrows’ worth.
More than a mile from home.
No tabs. No cash. No idea what to do.
I learned two important things in that moment: sprinting can stabilize falling blood glucose levels, and also I am capable of sprinting for more than a mile. I threw open the door to my house and ran right to the OneTouch test kit on my desk. I tested: 55. I staggered to my fridge, found the emergency Gatorade, and downed it. I tested again: 50. Again: 48. I remembered the 15/15 rule my diabetes educator had taught me: in case of hypoglycemia, take 15 grams of fast-acting glucose, wait 15 minutes, and test again. I waited six seconds: 45.
This was my first experience with a severe low, and I found the effects to be similar to a panic attack, which coincidentally I was also having. I was dizzy, I was dopey, I was clammy, my heart was racing. I did not enjoy it.
Because I am here today writing this, you are aware that I did not die. Sure enough, a few minutes and 20 test strips later, my blood glucose levels began to rise. And then they skyrocketed, because I had downed a few glucose tablets for good measure.
But I learned my lesson, which is that exercise and insulin make a powerful combination. I developed a healthy fear of lows, and honestly, an unhealthy fear of exercise. How could I be sure this wouldn’t happen again? How could I be sure it wouldn’t be worse?
That’s why I feel so lucky I met the Type One Run gang a few months later. We got together in Griffith Park, just a handful of us, and we went on the kind of long, winding run I used to love to do. To my amazement, we all survived it. That’s the key: running with other type 1s, people who live with the same condition I have, who have to figure out their nutrition and insulin, who exercise through it, and who are alive, is empowering. I can ask them simple questions—like should I adjust my basal rate for this run?, or I seem to be dropping a bit, would this be a good time for a gel?, or I have two down arrows on my Dexcom, am I going to die?—and they have the answers. (The answers, by the way, are yes, yes and no.) It has calmed me down considerably. I can ward off a high, and more importantly, ride out a low with none of the anxiety I had just a year ago.
So this year, I am taking on the TCS New York City Marathon for a second time, with Beyond Type Run. 21 diabadasses are running 26.2 miles through the five boroughs of New York City, to raise some money for Beyond Type 1, and to show the world that type 1s can do anything. It’s a lesson that’s fresh in my mind.
It’s being around other type 1s that reignited my love for running. Now a bunch of us are going to push ourselves to the limit, together, at the world’s biggest and best marathon. I can’t wait.
But this time I’m going to bring some tabs with me.
To learn more about the 2019 TCS New York City Marathon Beyond Type Run team click here.