Baker IDI provides a comprehensive multidisciplinary approach for clients with type 1 diabetes.  Extreme sports such as triathlons pose additional challenges for managing blood glucose variability due to hormonal responses to exercise and additional nutritional requirements to maximise performance.

 AK has a passion for sport and has competed at a national level for swimming.  He enjoys new challenges and is highly motivated to achieve new goals.  We first teamed up with AK 10 months into training for an ironman event which includes 3 stages - swimming (3.8km), cycling (180km) and running (42km).

At presentation AK was experiencing large blood glucose level fluctuations of 4.0mmol/l to 15mmol/l, pre, during and post training sessions. He was either restricting carbohydrate or over consuming high glycemic index carbohydrate foods to prevent hypoglycaemia during training.  AK reported feeling lethargic during training sessions, recovered slowly post training and was emotionally drained with his daily training experience.

 The Credentialed diabetes educator and dietitian worked closely with AK to better understand his training regime determine his nutritional and fluid requirements and establish blood glucose patterns that were appropriate to optimise his training outcomes. Flexible insulin adjustment principles were taught and established using multiple daily injections and later transferred to continuous subcutaneous insulin infusion (CSII) therapy. These principles required fine tuning based on exercise demands and BGL trends pre, post and during training. Throughout this process continuous glucose monitoring system – (Dexcom G4) was utilised to gain greater insight to glucose trends.

AK found the transition to CSII allowed greater flexibility with exercise training times, adequate nutritional intake for energy expenditure and less glucose variability pre, during and post training sessions. AK also felt he had a sense of greater control over his diabetes management.

 In March 2015, AK completed full ironman in 9hrs and 30minutes achieving his goal of under 10hrs. A remarkable achievement by a motivated athlete living with type 1 diabetes.

This case study highlights the importance of working with the client and a multidisciplinary team to achieve client centered goals and individualised therapy to achieve desired outcomes.