# Exercise advice



## scanz

I am planning to go to the gym tomorrow (might make it Tuesday now..) for the first time since diagnosis and I have to say i'm a little worried about it. I've read lots of information about what to do and what not to do and one thing that particularly concerns me is that it's advised to adjust insulin doses before and after. The problem here, for me, is that i'm currently on fixed doses. Should I therefore increase my carb in-take with the meal before and after?

Things that i'm aware of and understand are;


Not to exercise within 1-2 hours after meal and injection
Test before; if below 7mmol/l eat a snack, if above 14mmol/l then don't exercise and test again in 30-60 minutes. If BG is decreasing then insulin is available and go ahead. If rising then don't exercise and take extra insulin and wait an hour or so. - _However, i'm on fixed doses at the moment and not done any 'correcting' or anything yet so won't be doing this.._
Test during; every 30 minutes. If BG levels are falling and very low then 'top up', if rising and too high then stop as there's a lack of insulin
Test after; every 1-2 hours
Take in water every 20-30 minutes to prevent dehydration, otherwise BG levels may begin to rise
BG levels may also lower both during and after more than you expect
Increase risk of hypo up to 24 hours after
For every 30 minutes of exercise after the initial 30 minutes, an additional 10g of carbs will be required with next two meals in order to restore the glycogen stores in liver and muscles

They're the points I can think of at the moment. If you think i'm unaware of anything and/or not quite understanding something correctly then please let me know. Would be great to hear some of your experiences and how exercise effects you. I realise I need to experience it myself to see what happens, but as I say, i'm a little worried about going at the moment.


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## Northerner

That sounds to me like you have a very good understanding of the possible pitfalls and how to deal with them scanz, so you've certainly done your homework well  Now will be the time to put it into practice and see how you personally respond to the exercise! You are on fixed doses, but you have a good idea of the carbs you need for the insulin you are taking, so in effect you are not that different from someone like me who carb counts. 

Insulin adjestments can be totally different from person to person - I have my normal dose before exercising, it is only afterwards that I need to reduce my doses as I would go high if I had a reduced dose before. For others it is completely the opposite - they need to reduce first. For me, a good session will affect me for up to 40 hours, not just 24. You may have an additional problem if you remain on your usual dose of basal insulin - my lantus requirements can drop quite markedly when I am exercising regularly, so keep an eye on your waking levels in particular and if they are dropping too low for comfort speak to your DSN.


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## Northerner

p.s. as your body gets accustomed to the exercise, you may find that you can do more without needing to top up with extra carbs - again, this is a personal thing that only regular testing will show you.

Can't remember if I've already recommended this but the Diabetic Athlete's Handbook is a great resource for learning how to exercise on insulin injections


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## scanz

Thanks, i'll wait and see how confident i'm feeling tomorrow on deciding whether I go tomorrow or Tuesday 

You'd not mentioned that book before and I don't think I saw it in the recommended books section, so thanks, got it ordered


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## FM001

Looks like you have it well covered already, exercise is crucial in diabetes and everyone should participate no matter how little they do.


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## Copepod

Scanz - on fixed doses, the best times to exercise are before evening meal, or, as you say, at least 1 - 2 hours after an injection; no need to wait 1 -2 hours after midday meal, with no injection.
You may have already found http://www.runsweet.com/ a good reseource for all sports, not juts running, although most is aimed at those on MDI or pumps.
As you're keen on activity, that's another reason for changing regimes to present to your diabetes team.


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## Northerner

Copepod said:


> Scanz - on fixed doses, the best times to exercise are before evening meal, or, as you say, at least 1 - 2 hours after an injection; no need to wait 1 -2 hours after midday meal, with no injection.
> You may have already found http://www.runsweet.com/ a good reseource for all sports, not juts running, although most is aimed at those on MDI or pumps.
> As you're keen on activity, that's another reason for changing regimes to present to your diabetes team.



I think scanz is on multiple injections, just using doses given by DSN rather than two injections of mixed insulin (correct me if I'm wrong! )


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## scanz

Copepod said:


> Scanz - on fixed doses, the best times to exercise are before evening meal, or, as you say, at least 1 - 2 hours after an injection; no need to wait 1 -2 hours after midday meal, with no injection.
> You may have already found http://www.runsweet.com/ a good reseource for all sports, not juts running, although most is aimed at those on MDI or pumps.
> As you're keen on activity, that's another reason for changing regimes to present to your diabetes team.



I've had a look at a few pages on http://www.runsweet.com/ and have to say that whilst there were some useful points, at this stage I found it a bit technical and difficult for me to fully understand. 




Northerner said:


> I think scanz is on multiple injections, just using doses given by DSN rather than two injections of mixed insulin (correct me if I'm wrong! )


You are correct. I am on multiple injections, but with my DSN setting fixed doses and not adjusting just yet. This is what made me ask about perhaps having extra carbs with the meals before and after, seeing as i'm not going to decrease my dose of insulin.


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## scanz

Just to let you know I bottled it yesterday  I did go into town and get my brother's birthday present though 

However, I am currently getting my stuff ready for this afternoon. Wish me luck!


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## Northerner

scanz said:


> Just to let you know I bottled it yesterday  I did go into town and get my brother's birthday present though
> 
> However, I am currently getting my stuff ready for this afternoon. Wish me luck!



Good luck scanz! Don't forget your sugar and your testing kit!


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## Copepod

Have fun at the gym.


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## scanz

Well, that went well.

No, really, it did 

Only one thing is concerning me...

I took a BG level reading about 15/20 minutes before arriving at the gym and I was 6.4, so I had a cereal bar equivalent to 18g carbs (Special K Red Berry, yum ). After arriving at the gym and getting changed and etc. I tested again before starting and I was 8.5. So off I went, 2.5km on the bike, 1000m rowing, 10mins on the cross-trainer and then another 2.5km on the bike. That all took 40mins or so and when I tested I was 8.6. I then went and done 20 lengths in the pool and finally before I was about to leave the gym I tested again and was 9.9. Now an hour and half later, not eating anything and only drinking some water, i'm 11.3! I expected my BG level to drop, not get higher.

Any ideas? Only thing I can think of from what i've read is that it's due to a lack of insulin. I did have my lunch and pre-meal injection an hour earlier today, 12pm rather than 1pm. Could it be that? 

Other than the increasing BG level, it went well and I feel okay, at the moment anyway


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## Northerner

Ah! That happens to me too scanz. Sometimes after a long run my levels will rise rather than fall in the hour or two following. It may be due to the liver releasing extra glucose to help replenish the muscle glycogen, but with insufficient insulin to keep levels steady (I can only think it must be the liver - where else can the glucose be coming from?). I've read that some people have a small snack after exercising, with an appropriately small bolus, which stops the liver being over-eager and also supplies a little extra insulin to circulate. Again, this is another area for trial and error. A pump would make things simpler, I suspect, by being more flexible on dosing.

Well done though, you will have learned a great deal already about how your body copes with the various activities!


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## scanz

Thanks pal. Yeah, I learnt a lot today and had to do my first BG test on the street 

Learning now as well, I just done my 2 hours after-meal test and i'm at 5.6. Didn't expect to be that low after a pre-meal of 11.3 and eating spag bol, salad and a bowl of nuts. Will test again in 2 hours and before bed, but i'm expecting it to go up as I always seem to do in the evening. I think this is due to a combination of things; my basal and bolus doses wearing off and the fats i've eaten throughout the day being processed, i.e. the bowl of nuts will come into effect later on. - think i'm right here anyway? lol 

But overall it was good and can't wait to get back into it properly


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## Copepod

Good news that you had a good gym session and blood glucose results are good - I wouldn't worry about 1 reading outside 4 - 7mmol/l. Just one question - how did you travel from gym to home? 

The post meal drop is probably due to the increaded insulin sensitivity after exercise, which may last many hours after exercise, depending on intensity and yourself.


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## scanz

Copepod said:


> Good news that you had a good gym session and blood glucose results are good - I wouldn't worry about 1 reading outside 4 - 7mmol/l. Just one question - how did you travel from gym to home?
> 
> The post meal drop is probably due to the increaded insulin sensitivity after exercise, which may last many hours after exercise, depending on intensity and yourself.


In total I walk about a mile to get from home to gym and vice versa, with a very short train/bus journey in-between. 

2 hours after my 2 hours after-meal test of 5.6 I had gone up to 9.3 and an hour later before going to bed I was up to 10.4. I didn't wake during the night, but just over an hour ago before breakfast I was 11.5. I know levels tend to be higher in the mornings, but after reading so much about expecting levels to drop and the risk of hypos i'm surprised at the higher readings.


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## Copepod

Asked about travel, as stress can raise blood sugar levels. I really wouldn't worry too much about levels so early into diagnosis - be easy on yourself, when your pancreas is randomly throwing out insulin (so-called honeymoon phase), which can counteract the usual reactions (in someone with long established type 1 diabetes) to exercise.


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## scanz

Thanks 

Thinking of going again tomorrow, really want to get back into going regularly. Will record BG levels and post on how I get on.


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## scanz

So I went to the gym for the second time today, again everything at the gym went well and enjoyed it. Here's how my BG levels went;

2 hours after lunch/just before leaving the house = 8.3
An hour later, just before starting exercise = 8.5
40 minutes later (i know, i know, meant to be 30... ) = 6.7

_Perhaps I should have taken some sort of carb top-up at this point, but I took a risk and didn't seeing as it was only just below 7_

40 minutes later = 7.2
1 hour and 30 minutes later/before dinner = 9.5
2 hours after dinner = 6.5

So it's a bit up and down, but I think they are fairly good? And did I make the right decision in not topping-up at the 6.7 point? And just to note that I didn't eat/drink anything except water between lunch and dinner.


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## scanz

Went for a run yesterday before lunch;

Tested at 12pm before heading off and was 8.3.
At 12:45pm when I returned I was 9.1.
Then at 1:20pm just before eating lunch I was 9.3.
2 hours after lunch I had gone up to 10.4.
Then before dinner at 6:45pm (having not eaten anything else since lunch) I was 11.2!

Why the constant rise?


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## scanz

Done the same run today, but in between lunch and dinner;

3:30pm, 2 hours after lunch = 9.7
4pm, just before heading off = 10.6
4:45pm I returned from the run = 5.9
5:30pm = 7.7
6:30pm, before dinner = 8.5

So better results than yesterday and I guess it's good i've not experienced a hypo yet because of exercising


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## Northerner

scanz said:


> Done the same run today, but in between lunch and dinner;
> 
> 3:30pm, 2 hours after lunch = 9.7
> 4pm, just before heading off = 10.6
> 4:45pm I returned from the run = 5.9
> 5:30pm = 7.7
> 6:30pm, before dinner = 8.5
> 
> So better results than yesterday and I guess it's good i've not experienced a hypo yet because of exercising



Hi scanz, I wonder if, on yesterday's run, your levels kept rising because you didn't have enough insulin circulating (presuming that if running before lunch then it would have been some time since your breakfast insulin?). Today, however, you began your run 2.5 hours after eating/injecting so would probably have had more insulin on board.

Pretty good numbers though! I find my numbers always climb after a morning run, but then I need to be cautious with my lunch insulin as I can drop much lower in the afternoon.


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## scanz

Northerner said:


> Hi scanz, I wonder if, on yesterday's run, your levels kept rising because you didn't have enough insulin circulating (presuming that if running before lunch then it would have been some time since your breakfast insulin?). Today, however, you began your run 2.5 hours after eating/injecting so would probably have had more insulin on board.
> 
> Pretty good numbers though! I find my numbers always climb after a morning run, but then I need to be cautious with my lunch insulin as I can drop much lower in the afternoon.


I think you're correct regarding yesterday's run and BG levels. I had breakfast at 7:30 and went for my run at 12, so my NovaRapid would have pretty much died off by then. I should have gone earlier 

EDIT: Just done my 2 hour post meal test and down at 5.9, so may have to keep an eye on that tonight.


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## scanz

Since my 2 runs last weekend my right heel/ankle has really been hurting, can barely put any pressure on it at all. The fact I was back to work this week and walking around on it hasn't helped at all. It's feeling a little better today after resting yesterday, but there's still pain.

I'm also feeling pain, well perhaps more an acheness, down in my calves and knees. Is this sort of thing to be expected? I mean before I went to the gym and done the runs mentioned in here, it had been well over a month since I had done any form of proper exercise. I had hoped to go to the gym or go for a run this weekend and make it a regular thing again, but not been able to because of the pain. 

I'm just worried the same thing may occur each time I do one or the other and it will mean i'm unable to make it a regular thing.


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## lucy123

Hi Scanz,

I too am having an issue with my left heel from running. I am beginning to think though that the pain is actually being caused when I am playing tennis. i bought some very expensive tennis trainers and have noticed they seem to press hard on the back of my heel and the heel that hurts doesn't feel supported. I did think it was from running but am now thinking the tennis aggravates it and then it hurts when I run. It sort of throbs when I am not standing on it and kind of feels like a bruise/blister deep in the heel. 

Have you got a good pair of running shoes as they make all the difference.


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## scanz

Yeah I have some good running shoes. Walking around on it in flat formal shoes this week at work hasn't helped though 

I definitely done it when running, the pain started not too long after I got in from the run. Hope it goes away soon because I really wanted to get back into exercising regularly as soon as possible.


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## Northerner

scanz said:


> Since my 2 runs last weekend my right heel/ankle has really been hurting, can barely put any pressure on it at all. The fact I was back to work this week and walking around on it hasn't helped at all. It's feeling a little better today after resting yesterday, but there's still pain.
> 
> I'm also feeling pain, well perhaps more an acheness, down in my calves and knees. Is this sort of thing to be expected? I mean before I went to the gym and done the runs mentioned in here, it had been well over a month since I had done any form of proper exercise. I had hoped to go to the gym or go for a run this weekend and make it a regular thing again, but not been able to because of the pain.
> 
> I'm just worried the same thing may occur each time I do one or the other and it will mean i'm unable to make it a regular thing.



It's one of the frustrating things about exercising, particularly a fairly high impact sport like running. You have to build up gradually, and rest any injury properly or the problems will keep on building up. Last week I had a good 5 mile run, but afterwards my lower calf was hurting and I've had to rest it for 3 days. Went for a run again today, but after 3 miles it is sore again. I know why it is happening with me, it's because I broke my femur a few years ago and so my leg doesn't quite strike the ground like it used to. I'm now going to have to rest it again before I can go out running again 

I think that, particularly when you are starting out, there is a big danger that your enthusiasm can outweigh your body's capacity to absorb the shock. You need to build up strength and stamina, and these are slowly acquired at first.


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## scanz

Perhaps going for a run 2 days in a row was a bit too much and I probably went too quickly as well.


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## Northerner

scanz said:


> Perhaps going for a run 2 days in a row was a bit too much and I probably went too quickly as well.



Could well be - your muscles, bones, joints and tendons probably needed a bit of recovery time between runs. I'm not saying this applies to you, but I think a lot of the public are misled by films and tv programmes on how to train - often they will go from being a couch potato to pushing themselves to the absolute limit day in - day out, without any pause (think films like Rocky, or programmes like Biggest Loser). It's totally the wrong way to approach things, you need to let all the little micro-fractures and injuries heal. I found out the hard way about overtraining when my femur snapped at mile 23 of a marathon  I'd overtrained and the most likely explanation is that a 'hotspot' developed on my femur which didn't get a chance to heal. Eventually, the marathon was too much for it and although I got back running again it has affected me seriously ever since. 

So, good running shoes and a steady, incremental training schedule!


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## Copepod

This thread has some good links to online advice for getting more active, depending on your starting point and what you want to achieve http://www.diabetessupport.co.uk/boards/showthread.php?t=16670


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## scanz

Bought an ankle support today which I am going to wear it for a few days whilst walking around. Hopefully it gets better and think I will need to wear it for runs from now on.

Question about runs, does any one go for evening/night runs? Is it dangerous to because of the added risk of hypos during the night? 

During the week I'm out the door at 7:30am and not back home until 6:30pm on a good run. This leaves me with really only the weekends to go the gym or a run. I've tried going to the gym after work before, but never fully justify going as I don't push as hard because really I just want to go home after a day at work.


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## Northerner

I used to run home from work. Where I first worked in Sheffeld it would take me around 30-35 mins to run 4.5 miles, up and down some HUGE hills! I was much fitter then. The journey would have taken about 90 mins by bus as I would have had to catch two buses. Then the company moved so I had to run to the tram terminus (oi! it was a modern tram!), catch the tram into town and then run from there. Here in Southampton it was only 2.5 miles from work to home and I could do it in 15 mins on a good night! All this was before diabetes though, so not much help regarding the hypo possibilities, just me rambling and reminiscing! 

Be careful that the ankle support doesn't interfere with the healing, or cause you to change your running motion otherwise you might fnd it makes things worse (for running). I'd only wear something like that if advised by my physio (a trained sports physio), so make sure it is appropriate for the type of injury you have sustained. Hope you are fully recovered soon!


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## lucy123

Last night I realised the tennis trainers had an extra lace hole and tried that - although the heel hurt from previously, it did seem to support it better - so Scanz - are all your lace  holes being used - you never know could be something that silly?


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## Copepod

Yes, I run in the evenings, both training runs and orienteering, and often cycle to get to / from start point. When not running, I like to eat tea round 6 to 7pm, but ss training group often eats in a pub, around 8pm, after running, it's relatively easy for me to avoid risk of hypos; I have a beer if cycling or getting a lift, but soft drink if driving. 
Definitely agree about experimenting with lacing and being cautious about ankle support affecting running gait. I have to lace my shoes differently for urban (largely pavements) / footpaths / forest locations for orienteering / running.


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## scanz

Wearing the support today really helped, but I will be careful with it. 

Regarding laces, at the top I have 3 holes, like a triangle. I guess I could try a different one to the one I am currently using?

I have a pair of these. You can see what I mean with the triangle. I'm only using the hole in the middle/peak of the triangle, not the other 2 at all. 

Think that could make any difference at all?

A concern i've thought of with running in the evening is that I have my lunch between 1 and 2pm, so by the time I get home at 6:30pm my NovaRapid would have worn off and there may not be enough insulin in my system. I only think this because everything i've read has said to exercise around 2 hours after injecting and eating and that levels will go up when exercising if there is not enough insulin.


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## scanz

Ankle was better this week so managed to go for a run yesterday for the first time in 3 weeks and gosh am I feeling it today 

2 hours after breakfast at 10:45am I was 9.4
Returned from my run at 11:30am and was 5.2 - so I had a 2 finger kit-kat (13.2 carbs)
Half an hour later at 12pm I was 5.6
Again, half an hour later at 12:30pm I was 5.3
Just before lunch at 1:15pm I was 5.5 and strangely 2 hours after I was 5.5 again.

However, since that time my levels have risen to 8.4 before dinner, 9.2 after, 10.4 before bed and 12.7 before breakfast . In general i'm still getting high numbers in the evening and mornings . Seeing my consultant on Wednesday, hopefully he can help to see why.

Was hoping to go for another run today, but don't think my legs could take it


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## lucy123

Best not to overdo it Scanz  - good idea to miss a day.
I have just ran my pb on a 5k run and straight after felt like I could go for longer - however I am now sitting and like you am feeling  so I will be joining you in a rest.
Was such a lovely day for running though wasn't it - I ran around a a lake with all sorts of water sports taking place.

Hope you get things sorted with the consultant this week.


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## scanz

Yes, yesterday and today were lovely days. I went on my running route today, but walked it


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## justMMB

*Running and gym etc...*



scanz said:


> Yes, yesterday and today were lovely days. I went on my running route today, but walked it



Hi - appreciate i'm a little late to this thread but thought i'd share my experience. I train a lot, since diabetic i have training for and completed triathlons to olympic distance, a marathon, half marathons and a marathon swim. 

I balance this with my diabetes and in some respects it makes me almost feel like i am not diabetic! For example if i run in the evening say 10miles finishing around 8pm i will eat a meal andif it would normally warrant say 6units of insulin (i use novorapid) i will give myself 2units. When it comes to going to bed my blood sugar may be elevated and in fact would need to be elevated to around 12-14mmol as by the time i get up it will be around 4-5mmol. This situation would then last for around 24hrs but i would normally trainin again in that period. Consequently when i am fit my insulin doses are very small and my 6monthly blood sugars have never been above 7.5.

The things i do are i make sure that i have not had insulin less than 2hrs before starting and i always carry snacks/sugar with me to fuel what i am doing. What i find is that the recommended amount of sport fuel is adequate to keep me going as if i never had diabetes. Consequently with a blood sugar of 8 i know what i will need to take with me to fuel a 10mile run or whatever it may be. 

Occassionally at the end of a session my blood sugar may be overly high e.g. >10 and i would look to resolve this immediately with food/insulin to balance this.

I think it's all based on individual experience, write everything down. How far you ran/cycled starting blood sugar and end blood sugar what you ate/drank etc. You'll see a pattern emerging and very quickly understand the body more.

i don't know if this is medically accurate or not but i would describe my body when i am training as being more efficient at using insulin. By that i mean my body untrained would need double or triple the amounts i administer for the food i eat. I need lessand so interpret this as being more efficient...

I certainly would advise anyone to do what they want and aim high but just be prepared. Carry food andhave an idea what will happen. Before running outoors use a treadmill where you can easily stop and test etc for example...

Hope this helps!


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## Copepod

Welcome MMB. Always good to hear from people who choose to push their limits. Running on a treadmill is a good idea to get a handle on what levels are needed for a given distance, but just too boring for me! I would be faster if I were more single minded and didn't stop / slow when I saw wildlife / farm animals / nice views etc. 

Although I've only marshalled / kayak patrolled on triathlons, I have done some open water swimming after spending the day setting up transitions, and competed in a few mountain marathons. Just another 6 miles round trip cycling to / from orienteering training tonight.


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