Bowl Of Bolognese


Twenty-seven years of living with diabetes.

"Would it be possible just to get a bowl of bolognese, please?" I asked the server in the lower seating area of Alpetta Ristorante in Courmayeur, Italy.

The server responds unapprovingly, "NO PASTA?"

"Yes, please, just a bowl of bolognese," I repeat.

"Just sauce? No pasta?" the server asks.

"That is correct. Grazie!" I say with a smile.

There was an element of desperation in my voice. My mind, body, and soul were depleted in a significant way, even if it was our lowest mileage day of six on this adventure.

I think it reminds me of running through the forest as a kid, perhaps riding motorcycles through the trees by the family's lake cabin or even the dune buggy rides along the country roads. Whatever the reason, I adore running on dirt. In the PNW, where I grew up, the pine needles would heat up, and the smell is unique but unmistakable in the summer.

Twelve of my running besties came to watch my slide presentation in January 2016. It was their invitation for an epic adventure with me in July 2017. My hope was 2-4 of them would join me. In 2003, I halted my training toward this goal with my girlfriend from Switzerland while I lived in France due to my first pregnancy.

If you have been reading along, you know, I moved back to the states, had kids, and directed my energy toward them. It was now time to create a plan to make the goal manifest.

It is a big ask of your close friends. Training for six months, taking the time away from family and work to join. The financial commitment to make it happen was also a significant factor.  I knew it was a big deal to commit. It was, for this reason, I asked 18 months before we were to leave.

In July 2017, seventeen of us embarked on a multi-day 105 mile running adventure around Mont Blanc. We trained together and prepared together for six months. I reserved backcountry refuges and hotel rooms for our journey and designated pairs to manage maps and route details each day.

Elevation profile for our run.

Each day was hours and hours of continuous effort.
Some uphill.
Some downhill.
Some in the rain.
Some in the snow.
Some in glacial shadows.
Some in wildflower patches.
Some in France.
Some in Italy.
Some in Switzerland.
All exuberant.

The views after our descent from Col de Tricot.

I feel confident to say each of us will carry memories of that trip throughout our lives.

On day two, after 8-9 hours of effort, including up large mountain passes, we arrived at Refuge Elizabetta, a backcountry mountain hut in Italy. Walking into the refuge, you smelled all the footwear left in the front mudroom, all of it. I went to check in our group at the front desk.

The check-in woman said, "You are all in the attic to the right."
I thought to myself, "Their attic has a left and right side?" I was intrigued.
Then she adds, "Oh, and the showers are cold."

I walked up to the third or fourth floor; I can't recall exactly how many levels to get to the attic, but our beds were at the top. After 20 miles of mountain running, my legs weren't appreciating this climb up.

The start to day two was marked with a celebration of health and vitality.  We all wore the same pink Buff that day. It was for her, that extraordinary friend who embraced her journey with cancer like the bad-ass human she continues to be to this day. Pushing herself to expand always for those she cares about and willing to receive a reminder, she deserves the same for herself. I hope she felt our love that day as we charged up from Les Contamines to Col du Bonhomme, and then Col du Fours and finally Col de la Seigne, across that snowfield, and down to Elizabetta. She isn't one for accolades, but we forced it on her that evening in the dining hall's reserved room. We were toasting with champagne that her equally-amazing-but-in-her-own-way sister sent ahead to Elizabetta.

Cheers to our kick-ass cancer survivor on day two!

After we checked in, I opted to lay down in our 7 dwarves type accommodations; the line to shower was long. I'd venture there later. Hearing my friends scream as they took their ice-cold showers that afternoon continues to entertain me 3.5 years later. Each one of them knew, accepting my invitation, they would experience adventure in ways they didn't know before. Yet, I don't think any of us could have predicted the growth they would endure in that way.

The attic. If you are reading this on social media, you will have to visit my website to see the images. All of us were shoulder to shoulder that night. The attic meant we were on the floor that had the tapered ceiling. Offering headspace at our head and only toe space at our toes.  Picture it, smell it, feel it... 13 ultra-running, not that well showered, mixed gender, no couples, friends laying shoulder to shoulder as we attempted to rest to continue on the next morning and the following three days after that! There was snoring, farting, requests to "scootch" an inch, and acrobatic moves to get out of the line-up to walk down the stairs to pee, all night long. I didn't mind that the giggles penetrated my ear plugs. I was the guardian of kick-ass cancer survivor's sleep space that night. I purposefully lined up next to her, second in the line-up, and defended her extra inches the entire night. I'm just that kind of friend; committed.

The 7-dwarves style sleeping arrangements in the attic at Refuge Elizabetta, Italy for our group of runners.

It was a very memorable experience, our visit to Elizabetta.

Now the impact on diabetes. Knowing what I know about my body, it's physiology, the reason our third day was challenging for me. I know glucose uptake continues on its own agenda in a recovery pattern that lacks the predictability science claims. It's continuous and it occurs in the absence of insulin. Since I manage my insulin adjustments, each time through that night when my continuous glucose monitor would beep, I'd reduce my insulin dose down. For insulin pump wearers, this means a temporary insulin adjustment. Now I was highly aware my beeping would be heard not only by my 12 friends I was "spooning" with but the other 40 people sleeping on the larger left side of the attic.  No one wants the beeping diabetic to keep waking you up from a deep slumber after a full day in the mountains. They are distinct sounds diabetes devices make. I am pretty sure the FDA has a list of the most annoying beeps a medical device can produce. This beeping was not as awful as the Animas R1000 alarms. A nervous system would collapse hearing the alarms on that pump introduced in 2000. The point is, at 2 am, in a mountain hut, it's annoying, the beeping of a medical device. I mitigated the best I could.

I also didn't want to deal with a low blood sugar event that night. Not that I ever "want" one but the inconvenience was significant. The logistics of this trip, I packed  my nutrition to last for several days. The hydration pack was highly limited on space. If i didn't have to use a glucose source, I didn't want to. I was particular about my glucose if I had the opportunity to be. My pink lemonade Honey Stingers chews continue to be my preference.  The lemon-lime PowerGels exhausted on 1 climb up Mt. Rainer (see 1998). The Honey Stingers are still going strong in 2020. I decided to adjust my insulin versus keeping insulin constant and supplementing with carbs.

Not that anyone "slept" well that night, but I truly didn't. I felt good knowing I played beeping interference well, and the kick-ass cancer survivor had a better night's sleep than her other nights. In their sleep, those ultra-running friends kept asking me to "scooch". Persistent they were!

Through the night, my glucose levels hovered 70-110 mg/dL. Most type one diabetics and their health care team and their loved ones and their, well, everyone would view those glucose levels as PERFECT. Yet they were NOT. It is contextual; what I would need from my body the next day was different than what I optimized for through that night.

The next morning the dwarves and I woke up, packed up, and hobbled down the stairs to breakfast. Our third day was our "easiest" day in our adventure. Lowest in mileage, just 13-14 total and overall, a descent into Courmayeur, Italy. An adorable ski-town located in the alps. The reserved accommodation upon our arrival was a HOTEL in town. That meant private rooms, hot showers, and a comfortable bed with pillows: espresso, wine, and cute shops to peruse at our disposal. Just the idea of it that morning felt luxurious.

At Elizabetta for breakfast, the tables had baskets of pre-packaged pastries and coffee, tea and juice. It was not what I expected, but I compensated by having a Cliff bar. As we began our run down,  my body felt lethargic, exceptionally so.  The feeling was that of elevated blood sugar, but my continuous glucose monitor showed values around 100. I'd check on my blood glucose meter, and the value was similar, around 100.  I fought fatigue that day like no other day on our adventure. It significantly impacted my morale, and I recall a break at the top of a chairlift. I walked out to a vista and just allowed the tears to drip. I stood out in front of my running besties, thinking I was hiding my emotion, but I am an open book, and they know me too well.

We continued our descent; they took turns hanging back with me. It was kind, their company. Once we arrived in town, we decided on Alpetta Ristorante, a pizza, pasta, salad place for lunch. We were a large group and took over the seating in their lower area. They ordered pizza, salad and pasta, I ordered my bowl of bolognese.

An afternoon nap, shower, and then full dinner helped me to recenter for the next three days, completing our circumnavigation of the tallest peak in Europe. The following day, as I traversed a 5-mile section of exceptional trail, I knew if I was the last person on earth, this is where I would want to be, and this is what I would like to be doing. That day included a thunderstorm as we climbed to Col du Ferret. The descent into La Fouly was fast for me, really fast. Kick-ass cancer survivor's sister and I played, and we played hard on that descent. I even fell flat on my ass in the grassy section next to the stream, after the scree field. She busts my ass on the downhills, trying to keep up with her; I love her for that. We enjoyed beers, diet cokes, and fries that afternoon in La Fouly, Switzerland. Another night in Switzerland, and then we finished back in Chamonix, France. In the last hours of our 6 day adventure, the route required us to climbed ladders to ascend rock walls. A reminder that even the finish will be thrilling. It was pretty cool to watch a few besties climb right into their fear of heights not allowing it to stop them, they did have 6 days of momentum. Yeah, it was quite the adventure.

I went through the list of possible areas I missed the day I struggled from Elizabetta into Courmayeur. I kept an eye on hydration, electrolytes, and glucose levels. It didn't appear any of these was the issue. Looking back, perhaps I missed one, total daily insulin. There is no way to confirm what brought so much struggle for me that day. I think my significantly reduced insulin levels didn't allow proper metabolic recovery to occur through the night as I continued to deplete my insulin to keep my CGM from beeping. Instead of taking the insulin AND the carbs to replenish, I kept the insulin levels low to keep glucose levels optimal. This experience changed how I deal with back to back days of activity. Now I pay attention to total daily insulin to know I am getting enough back into my muscles to perform.

Even now, 30 years after living with diabetes, I am still gathering information from each experience. And some days, it just works to have a bowl of bolognese with no pasta.

Top of our first climb on day one.