Race Report – Women Run The Cities: 3 Challenges

In 2023, I participated in ten races. Eight running races and two triathlons. On Saturday, May 18th, I participated in my first race of 2024. The race is called Women Run The Cities and it’s put on by Twin Cities In Motion. I ran the 10-mile race. Before the race started, I met up with four friends to run an additional 4 miles as our training plan called for 14 miles. I’m generally good at following “the rules” aka the training plan.

I thought it was my first race since being on letrozole, but upon reflection, realized I did two races in November 2023, less than a month after being on the aromatase inhibitor. As a result, for this race, I for sure had zero estrogen in this body of mine. The consequence of that total lack of estrogen, meant the increase in joint, muscle and ligament pain was in full swing. I felt it during this race. It was not pleasant. In fact, in combination with my other issues, it was near debilitating. 

Upon waking on race day, the temperature was already 65 degrees Fahrenheit. As we ran, the temp went up to 86 degrees Fahrenheit. Plus the humidity was inching up. Lots of the route, along the Mississippi River, was in the beautiful shade because of the majestic trees we have in the Twin Cities, also known as Minneapolis and St Paul, Minnesota. However, there were long stretches in full sunshine, which reflected off the pavement and up into and onto our bodies. 

Needless to say, the race was one of my slowest 10-mile races. In the past, I’ve finished most of my 10-mile races in under 2 hours. Going into the race, I was hoping to meet that time mark. For the record, I’m a 12+ minute miler. No such luck coming in under 2 hours. It took me 2 hours and 7 minutes. I was profoundly grateful that I didn’t pass out a few times and that I was able to finish with a smile. I do love the medal. 

The time it took me was largely due to a few factors, not all my fault. There are three factors I want to highlight in the hopes it might shed insight into what it’s like for an athlete with two life threatening, incurable chronic illnesses to navigate. My hope is that these few details will shed some light for others. Both to understand what I’m up against and inspire others to keep at it.

As a reminder, I live with type 1 diabetes, 43 years so far, which means I am constantly making decisions about the insulin in my insulin pump, what to eat or not eat, and how much insulin is “on-board” in my body as my body produces absolutely zero insulin on its own. 

I also live with breast cancer, as I was diagnosed in October 2023 with this third round of breast cancer. As a result, I take an aromatase inhibitor, letrozole, which hibernates every bit of estrogen in my body. 

Race Challenges on May 18th:

1. Degrading insulin resulting in skyrocketing blood sugars
2. Heat and humidity resulting in heat exhaustion
3. Severe body aches resulting in nearly crippling pain

Let’s dive into each of these three race day challenges that arose for me. 

Challenge 1: Degrading insulin resulting in skyrocketing blood sugars

I made a decision the day before the race to not change my insulin pump. Meaning that despite having already worn the pump for three days – the usual maximum limit for the insulin in the pump to not degrade and become ineffective – I made this decision for two reasons: 

Reason #1 to not change pump: had more than 60 units in the pump and on average I only use about 28 units in a 24 hour period. There is currently an insulin shortage happening in the United States. In fact, I have not gotten a shipment of insulin from my provider since January 6, 2024. I usually get 5 bottles of insulin every 3 months. It’s a bit scary to think about running out of insulin. I’ve gotten cautious. 

Reason #2 to not change pump: I suspected that if I did change the pump, I would have to AGAIN change the pump after the race because of the high temperatures. Needing to use two pump sets (every time I do a pump change, every three days usually, it requires a fully new pump set.) The pump sets are NOT CHEAP. 

My blood sugars all day Friday day and Friday night were 100% in range, which means that the insulin had not degraded. I knew it was a risk to not have fresh insulin in the pump, but given my blood sugars, I felt like it was a calculated risk and one worth taking.

Sadly, my calculated risk was a BAD risk to have taken. Within about 10 minutes of the race starting, which happened after running 4 miles as warm-up, my blood sugar skyrocketed up to 375 mg/DL. For those unfamiliar, that is a VERY HIGH blood sugar. 

My whole body, specifically my kidneys, had to work overtime to work to get my blood sugar back in range. My vision got a little blurry. I felt a little nauseous. I was really thirsty. My athletic performance tanked. When blood sugar gets that high, movement actually contributes to even higher blood sugar. Despite that, I decided to take double the insulin I needed to lower my blood sugar into range, as I knew that this high blood sugar was happening because of degraded insulin.

After some time, lots of water, and zero nutrition (I didn’t want to raise my blood sugar any more than it was) my blood sugar did begin to come down. It never got below 200, despite the continuous additional insulin I was giving myself.

As I continued running, I knew this high blood sugar was impacting EVERYTHING. Including my judgment.  

Challenge 2: Heat and humidity resulting in heat exhaustion

I’m not that good at sweating. Meaning that when it gets really hot and humid, I struggle. I’ve suffered heat exhaustion quite a few times in my life. I get dizzy. I get disoriented. Race day was my first race of the season in the heat. 

Usually there are at least a few training runs in the heat before a race. To practice hydration and reacclimate to the heat. Not this year. It was cool and then it was HOT. Thankfully, I had done a good job on my electrolyte intake the two days before the race. I am currently using a combination of LMNT and Nuun. Both have no sugar and are mostly electrolytes. Thankfully, I had also done a good job of drinking lots of extra water the days before the race. That likely helped quite a bit. 

However, in combination with my high blood sugar, taking letrozole and the high temps and high humidity – I suffered. It showed up as not being able to talk much with my friend Tanya who made the decision to stay with me as we ran. I was thinking so much about my situation that I had very little awareness of Tanya and how she was doing. Plus, I kept getting dizzy. Twice I completely stopped moving because I was concerned I might fully pass out. Thankfully, my deep breathing and my body awareness kept me upright.  

Challenge 3: Severe body aches resulting in nearly crippling pain

This last challenge was a new one for me. I’ve worked hard to figure out the right hip, quad and hamstring pain that hit me hard at Grandma’s Marathon last summer. My physical therapist has helped me understand that the top of my right leg doesn’t naturally fit back into my hip socket. Somehow the muscles and ligaments all tip my femur slightly forward. Thus, there’s lots of muscle compensation happening, that causes lots of pain. The exercises she’s given me are incredibly helpful and for most long runs I have no more pain in this area. Success!

What happened at the WRTC race was that the middle of my back, both sides of my spine out to the sides of my body, cramped up. The cramping was excruciating. This was a new sort of pain. 

All the way to the end

I have a high pain tolerance. This last challenge is what nearly knocked me out of the race. None of my strategies seemed to help. I tried stretching, walking, and breathing more deeply. It just wouldn’t subside. 

The pain, in combination with the high blood sugar and the heat exhaustion, let’s just say, I’m a bit amazed that I didn’t drop out. You could say that I’m one stubborn athlete. I like races! I like being in and with the crowd of runners! I like legitimately winning that finishing medal.

I was profoundly grateful that Tanya stayed with me. She’s a faster runner than I am, and she could have gone ahead. She also has excellent intuition and she seemed to know there was a lot going on for me. 

As soon as we finished, I got more water and a few snacks. Then I gratefully sank to the ground where I layed completely flat on my back and did a few stretches. Almost immediately the pain in my back faded. 

Actions going forward

Turns out both my PT and my acupuncturist suspect that I had a diaphragm cramp, likely related to my breathing. I’ve not had this happen before, but I’m willing to learn. 

Next time, no matter what, I’m sticking to changing my insulin pump before the race! Running with a high over 200 mg/DL is NOT in my future race plans. Much less over 300 mg/DL.

I did have fun after the race! Hanging out with my Run Minnesota colleagues is always the best! When I got home, I immediately changed my pump and the fresh insulin got in my body and my blood sugars came right down. The race did wear me out. Thankfully, I had the afternoon to take a long refreshing nap! 

Thanks for reading. I hope you gained some insights.