Do what you can’t: Running the Marathon des Sables with type 1 diabetes

The days before the Marathon des Sables [MdS] 2019 were a bit like a Craig David song for me. But with no chilling. I developed chest pains on Monday, stuck a thermometer twice up my arse on Tuesday, had a fever on Wednesday and flew to Morocco with dodgy guts on Thursday. On Sunday, I began the run of my life: 226.4 km across the Sahara Desert.

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I’d been working towards the MdS for three years, taking part in marathons, ultras and other nuts races (I was once chased through the Welsh hills by 60 horseback riders) to prepare for what’s been called the ‘toughest footrace on earth’. I spent far too much time in my local Crossfit box, lost countless toenails, tested my wife’s patience to the max and quit my job, partly to allow me to train more.

Running helps me deal with anxiety, so it’s ironic that the weeks before the MdS were the most stressful I’ve ever had. I had to squeeze about a month’s work into a fortnight, weigh and pack all my food for the seven days I’d be in the desert and then pack, repack and pack again to check I could carry and access all my kit, insulin, etc, as I ran across the sand.

So I got ill. I did my best to ignore the ache in my chest and high blood sugar levels (often a sign of illness in type 1 diabetics) but I could ignore it no more when, at the first of my heat chamber sessions to acclimatise for the desert, my core temperature was found to be 39°C. They made me stick a second probe up my bum (no lube) just to be sure (see below pic).

“At the first of my heat chamber sessions to acclimatise for the desert, my core temperature was found to be 39°C. They made me stick a second probe up my bum (no lube) just to be sure”

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Then came the fever. I was sure I had pneumonia. My amazing sister-in-law, a doctor, came to my rescue. Knowing how much I’d put into getting to the MdS, she advised rest until I got there and prescribed antibiotics. I took them like Smarties. I was feeling a lot better when we left Heathrow, save for a weird churning in my stomach. I put it down to nerves.

My guts exploded as we were leaving for the desert from Casablanca on a tiny prop plane. I ran to the toilet. The cabin crew told me to sit down. Seeing my distress (along with 30 MdSers I’d just met), they let me into the cubicle. I sat there for most of the flight, head in hands, guts in turmoil. I’d forgotten antibiotics can cause stomach upset, particularly if you eat them like Smarties.

“Everything – my careering blood sugar levels, the fever, the awfulness coming from my arse – seemed to be telling me that I couldn’t do what I was about to attempt”

It was like an anxiety dream. Everything – my careering blood sugar levels, the fever, the awfulness coming from my arse – seemed to be telling me that I couldn’t do what I was about to attempt. Thankfully, I then had two days to recover and get used to the desert (blazing hot in the day; freezing cold at night). My stomach and blood sugar levels settled and I got to know many of my fellow runners (who, thankfully didn’t seem too put off by my exploits on the plane), before setting off into the world’s largest hot desert with my dodgy pancreas.

Here are my thoughts as they were at the end of each stage of the race, which I ran for three diabetes charities (Diabetes UK, JDRF and T1International – you can still donate here if you fancy it)…

The first stage

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I’m a tortoise. One of the last to start this morning, I marched the first 10km across a sandy plain scattered with jagged rocks and over a steep hill to the first checkpoint. I wanted to run but made myself take it easy after last week’s illness and lack of heat acclimatisation.

The terrain is beautiful but it eats you alive. The rocks bite through the soles of your shoes. The soft sand drains the energy out of your legs. Then there’s the diabetes: a needy child in a pram with a wonky wheel that I have to push over the dunes. Now it wants insulin, sugar, whatever… I’m thirsty but only have glucose drink left, so need to work out and administer my insulin dose in the glaring sun before I can drink.

“I was still eating my breakfast – a massive bag of muesli, macadamias, dried fruit and milk powder sloshed together with water – as I crossed the start line”

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I woke up with high blood sugar this morning and gave myself a correction dose, which brought me down to 7mmol (in range) by the start of the run, kicked off to ACDC’s Highway to Hell and MdS founder Patrick Bauer dad dancing on the roof of a Land Rover (this is the custom, apparently). I was still eating my breakfast – a massive bag of muesli, macadamias, dried fruit and milk powder sloshed together with water – as I crossed the start line, having taken no bolus insulin to account for the day’s exertion. I’d lowered my basal insulin by 80%.

I got it wrong. I was going slower than normal so needed more insulin. The muesli was rapidly breaking down into glucose in my blood, but without enough insulin to aid its conversion into energy, my blood sugar was soaring, making me feel lethargic and thirsty. I took a correction dose. At about 14km we passed some old mines in the sand and my blood sugar began to stabilise. I felt great and ran the next 10km or so, until I slipped on some rocks, snapped one of my trekking poles and grazed my shoulder and leg.

“A creature the size of my fist ran out at me to show me its fangs. They were huge. It seemed very angry about something”

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It wasn’t serious, but the loss of a pole this early on is a blow to morale. I stopped by a bush to sort myself out and a creature the size of my fist ran out at me to show me its fangs (see above pic). They were huge. It seemed very angry about something. I think it was a camel spider but I’m not sure. What an amazing animal. What an amazing place. We are all dwarfed by it. I’m full of fear and excitement and macadamias. I crossed the finish line, exhausted, after a final 10 km of dunes.

It took me 5 hours 31 minutes. The winner did it in 2:19. This tortoise won’t be catching that hare.

The second stage

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What a day. Today we took on the largest continuous stretch of sand dunes ever tackled in the MdS’s 34 year history: Erg Chebbi, 13km of dunes the size of mountains. On paper, today was much harder than yesterday. The dune section was spoken about with fear. The checkpoint following the dunes had more doctors than runners at any given point, I was told when I finally reached it. This year’s MdS is about 25 km shorter than usual (it’s usually 250km), because of this stretch of dunes.

But, somehow, today was easier. I felt less like a fish out of water. My blood sugar stayed in range for most of the run and I felt I was able to predict and respond to diabetes’ whims better (I took a bolus with breakfast today to avoid the spike I got yesterday and again lowered my basal by 80%).

Technology is helping me do this. Two years ago I ran a lap of the Isle of Wight, pricking my fingers every 20 minutes or so and injecting myself when needed to ensure my blood sugar stayed in a safe range. Now I have a Dexcom G6 continuous glucose monitor, which I can read by glancing at my smart watch. Crucially, it doesn’t just tell how much glucose is sloshing around my body at any given time, it shows whether my glucose levels are rising or falling and how quickly, allowing me to counteract highs and lows before they happen. This, combined with my Omnipod insulin pump, has transformed my running. I don’t think I would be here without either.

“The landscape was amazing… drifts of sand, palm trees and half submerged villages that looked like ruins until kids emerged from doorways… I was buzzing when I hit the dunes and destroyed by the time I left them”

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The landscape was amazing – fewer flat, monotonous, sharp rockfields; more drifts of sand, palm trees and half submerged villages that looked like ruins until kids emerged from doorways to cheer us on. And that dunefield, of course. I was buzzing when I hit the dunes and destroyed by the time I left them. I’ve been imagining landscapes like this for years. The first nine km flew past, even if they did take me more than two hours.

I bumped into Mark (Manxbadger), who I’d met at Heathrow, at the top of a dune and we marvelled at the view together before going our separate ways. Every time it felt too tough to continue (which was often), I would stop, breathe deeply and take it all in. It was such a privilege to be alive in a place that wants to kill you.

It was trying it’s best to do just that. The ascents felt like they took hours. It was like trying to run up a downwards escalator. The descents were over in just a few seconds.  Bouncing down the dunes with sand spraying like fireworks around me felt like walking on the moon. Picking your route along the crests of the dunes to avoid too many unnecessary ascents helped take my mind off the hammering in my chest. It was a joy.

“Every time it felt too tough to continue (which was often), I would stop, breathe deeply and take it all in. It was such a privilege to be alive in a place that wants to kill you”

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Until the final 4km or so, when I ran out of water. The checkpoint came into view after about 10km. It looked 15 minutes away but the sand, which seemed to be softer here and more undulating, played cruel tricks. The checkpoint would disappear behind dunes and then pop up again, apparently no closer than it had been minutes earlier. My mouth was dry and my legs were on fire when I finally got to the checkpoint about an hour after I first saw it. I collapsed into a tent and rested for 30 minutes.

This is why I’m here. I want to do what I once thought I couldn’t. I want it to be hard. I want it to test me. I want to prove the people who listed all the things I couldn’t do because of my diabetes (including the old me) wrong. The uncertainty of whether I do actually have it in me is exhilarating. I ran the final six km to camp with these thoughts in my head. I finished on a high, literally and metaphorically. My blood sugar was at about 12 mmol (it should be between five and nine). But I didn’t care.

The third stage

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Today tore me to shreds. It took me eight hours to do 37 km of dunes and rockfields. Every time the wind let up the heat hit hard, blasting down from that acetylene sky and bouncing off the sharp rocks beneath our feet. The heat was everywhere. The terrain was flat and monotonous. The temperature passed 45°C, I’m told. It was the toughest day I’ve ever had.

Diabetes was a total shit. My blood sugar was over 20mmol all last night, which meant that me and my tent mates were constantly being woken by the alarm on my Dexcom. I had to keep getting up to drink water and pee. This morning I had to change my insulin pump, which needs replacing every three days. The first two I tried malfunctioned, I think because I’d taken them out of their packaging to cut down on the weight I’m carrying. Thankfully, the third worked.

“This stuff matters. If my insulin pumps fail, it could mean the end of the race for me… multiple daily injections would likely mean more highs and lows”

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“When I finally got my new pump on, I taped it to my abdomen and reapplied tape to my Dexcom before giving myself a higher dose of insulin to bring my blood sugar back within range”

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This stuff matters. If my insulin pumps fail, it could mean the end of the race for me. I’d have to go back to giving myself multiple jabs with two types of insulin (one fast acting, the other slower) in injection pens I’ve buried at the bottom of my bag. I find balancing my blood sugar with injections difficult when I’m at home, let alone in the desert.

Multiple daily injections combined with the miles I’m doing and this environment would likely mean more lows and highs. Both are dangerous. When I finally got my new pump on, I taped it to my abdomen and reapplied tape to my Dexcom before giving myself a higher dose of insulin to bring my blood sugar back within range.

It was too much. I had three hypos during the day. There was no shade, so I had to treat myself in the full glare of the sun. In that light I couldn’t read my insulin  pump screen, so I had to do it by touch. Eventually, after my legs had started shaking and then gave way, I managed to turn it off, to stop my levels from periodically plummeting in the heat and exertion.

“I had three hypos during the day. There was no shade, so I had to treat myself in the full glare of the sun. In that light I couldn’t read my insulin  pump screen, so I had to do it by touch”

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I was weak and tearful when I got into the final checkpoint. A doctor took my vitals, which were okay. He told me I had done the right thing in turning off my pump to avoid further lows and radioed ahead to doctors on the course, telling them to keep an eye on me. I was scared they were going to pull me out of the race.

It was at this checkpoint that I saw James (MorningCoffeeRun), who I’ve become friendly with during the week. We did the final six km together. We exchanged stories and he encouraged me every step of the way. I am so grateful for the support he gave me. I hope I get to share some more miles with him one day.

“My feet are ruined. I had two deep blisters on the balls of both feet lanced and filled with iodine, a haematoma lanced through the nail and a couple of minor blisters on my toes sliced”

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On crossing the finish line I was taken to the medical tent. My vitals were taken again and they were fine. But my feet are ruined. I had two deep blisters on the balls of both feet lanced and filled with iodine, a haematoma lanced through the nail and a couple of minor blisters on my toes sliced. I discussed my diabetes with the doctor, but in not so many words they told me what I already know: it’s up to me to manage this condition.

So, I’ve upped my insulin dose to avoid another night like last night and crossed my fingers.

The ‘long’ stage

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This race smashes you to pieces every day. Then, somehow, you put yourself together a little stronger than you were before. That’s what happened after the dunes, after stage three and countless times on this, the long stage. The people I’m running this with help make that happen. When I got back to Tent 53 (a black rug propped up with sticks that me and seven others have been trying to sleep under each night) after stage three, it felt like home.

“When I got back to Tent 53 it felt like home. Not because of the dubious stains on the prickly rug on the floor or the weird smells. Because of the people…”

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That’s not because of the dubious stains on the prickly rug on the floor or the weird smells. Because of the people. I was the last to get back to the tent. I was greeted with cheers. Everyone has found their place here. Whoever gets back first each day clears the stones from under the rug. Me, Simon and one of the Matts collect rocks to anchor the canopy. Rob makes fire (to cook with, he’s not a pyro). Preet (‘Pete with an ‘r’’), an army physio, advises on injuries (she’s even spent her downtime strapping others’ knees). Everyone looks out for each other. We share food and supplies and tell jokes.

My sides hurt more than my feet from all the laughter. Yet all of us are suffering. ‘Fast’ Matt’s knees are knackered and he can barely walk, but he still manages to finish each day in the top 50. ’Slow’ Matt (still fast) has injured his ankle. James has the shits. ‘Fast’ Rob, (guess who’s ‘Slow’ Rob?), who is only 19, was found collapsed under a bush in the dunes on stage two yet still sets off every morning like a rocket with the elites. Lim, from Malaysia, has run the whole thing in flip-flops.

So, yesterday was the long stage: 76.3km of dunes, saltpans & mountains, which took me 20 hours to cover. I loved it. Increasing my dose after stage three helped avoid the night highs of earlier in the week (it still went high, but in the teens rather than twenties). I started the run in range and with my basal rate reduced by 80%. I felt fresh. I alternated between running and marching for the first 30 km or so, topping up with food & glucose gels and turning my pump off periodically to keep my blood sugar in range.

“We passed houses half submerged in the sand and shoeless kids waved at us and reached out for high fives… Getting type 1 here in the desert, a day’s drive from the nearest hospital, means an early death”

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We passed houses half submerged in the sand and shoeless kids waved at us and reached out for high fives. They reminded me of one of the reasons I’m doing this. Half the world’s type 1s can’t access insulin, so they die. In some parts of Africa, kids don’t survive six months after diagnosis. Getting type 1 here in the desert, a day’s drive from the nearest hospital, means an early death. T1International, one of the charities I’m running the MdS for, is fighting to change that.

The landscape was jaw dropping. Forming the border with Algeria to the east was a plateau of red rock. Dust devils swirled across the scrub and through the occasional stunted tree. To the west, the horizon was gnarled with slopes and pillars of the same reddish brown rock. We headed south along a trail that took us through scrubland and dunes before turning west, over a lung busting pass. It was very hot.

“As the sun set, I sped up. At last it was cool. The sky was purple and the hills were glowing crimson. The insulin pump was off and my blood was stable. I felt like I’d escaped diabetes” 

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As the sun set, I sped up. At last it was cool. The sky was purple and the hills were glowing crimson. The insulin pump was off and my blood was stable. I felt like I’d escaped diabetes. I ran my fastest 15 km of the week. The pack had spread out, so I put some music on my phone (for the first time; my headphones are at home). When The Man Comes Around by Johnny Cash came on as checkpoint four came into view from the top of a dune. I sprinted through the gate with the eyes of a raver, grabbed some water and went on my way. I felt electric. I’ll always remember how that felt.

It didn’t last. About five km from checkpoint five, I ran out of steam. The tortoise had become the hare. I stopped, turned my head torch off, opened a bag of pork scratchings and lay back on my pack to look at the stars. It was like the sky was showing off. Orion would have blushed if he’d known how much of him I could see. As if on cue, a shooting star passed overhead. Down below was me, munching on fried pork fat as a family of gerbils played in the sand.

“I sprinted through the gate with the eyes of a raver, grabbed some water and went on my way. I felt electric. I’ll always remember how that felt”

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I was exhausted when I got to the fifth checkpoint, 50.7 km into the stage, where there was a surprise waiting for us: deck chairs and a stall serving sweet mint tea. I took my cup and looked up at the stars. It was 10pm. I closed my eyes. Next thing I knew it was 2am. My blood sugar level had soared as I slept because I hadn’t readjusted my basal rate. I felt like crap. I took a correction dose and got going.

My blood came down as I ran the final 20 km through rockfields, dunes and mountain passes to the finish line. We passed two streams, the first water I’d seen all week that didn’t come in a plastic bottle. The final checkpoint was at the end of the steepest climb of the week so far, a heap of sand between two summits that were jet black in the night sky. I didn’t stop at the checkpoint and ran as fast I could for the final five km. I passed the finish line as the sun was coming up. What a ride. I’ll cherish those 20 hours forever.

Today is a rest day before tomorrow’s marathon stage.

The fifth stage

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Sadly, today was the last official leg of the race. Eight km in, after a succession of dunes, was a rocky peak that everyone refers to as ‘the jebel’ (mountain in Arabic). This is a steep ascent of loose sand followed by a rocky ravine. At its steepest the incline was one in four. We had to to pull ourselves up, single file, on a rope attached to the rocks. It’s a bottleneck, so we had to queue with all the other runners before summiting the peak and continuing down the other side.

No one likes queuing. Especially 700 tired people who have been legging it across the Sahara for a week. To the left of the ravine was a drift of sand that led all the way to the top. Some runners decided to try their luck on this and run up the slope. The sand was too deep. None of them made it. Each started out strong but soon had their energy sapped by the sand and were forced to accept defeat. People were booing them. I heard someone shout ‘everyone hates you, mate’ as a runner sloped back into the queue.

Perhaps it was foolish to try and run up that dune, but that didn’t warrant the scorn and derision of those of us who’d taken the easier route. The MdS is a race not a queuing competition, after all. I wonder if those I’ve seen jumping the queues for medical attention, water and emails throughout the week are the very same who were booing.

“We had to to pull ourselves up, single file, on a rope attached to the rocks. It’s a bottleneck, so we had to queue with all the other runners before summiting the peak and continuing down the other side”

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Hey ho. The view from the top was tremendous: dunes and scrub stretching to mountains in the direction in which we’d come; a rocky basin and slat flats that reached to a rocky pass in the direction we were heading. After the long wait to get up the Jebel, the next section flew past. Checkpoint one marked the beginning of the flats. Checkpoint two was at the end, in a lush oasis where there was a campsite. I’m not sure what was more of shock to see, the lush green, the birds in the trees or the German campers cheering us on.

Between here and the finish was the most incredible scenery I’ve ever seen. A huge herd of camels was being driven across a dry lake bed five km across as we crossed it. Then there was a series of steep rocky ridges that took everything I had to get over. The last flat section was just beautiful: 3km of undulating orange sand hemmed in at either end by rocky outcrops half buried by the stuff.

“The view from the top was tremendous: dunes and scrub stretching to mountains in the direction in which we’d come; a rocky basin and slat flats that reached to a rocky pass in the direction we were heading”

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At the top of the final brutal outcrop, the crescent of tents of basecamp came into view. I was relieved and sad to see it, knowing that the race of my life was nearly over. Before the finish line was the longest dune descent of the week. Bouncing through that soft sand, knowing that the pain in my feet and legs I’d had for a week would soon be over, felt fantastic. I crossed the line exhausted. Dad dancing MdS founder Patrick hugged me, put a medal round my neck and it was over.

For Fast Matt, it wasn’t over for several more hours. He started stage five at 11am with the elites. The rest of us started at 8am, when it was still relatively cool. This meant he had three hours less than us to make the 7pm cut off, and had to get over the Jebel (no queuing for him) in the midday sun. It was here that his knee injury deteriorated. He left the Jebel unable to run, faced with the prospect of hobbling the next 34 km through the sand. He worked out he had to cover a kilometre every eight and a half minutes to make the cut off.

“Before the finish line was the longest dune descent of the week. Bouncing through that soft sand, knowing that the pain in my feet and legs I’d had for a week would soon be over, felt fantastic. I crossed the line exhausted”

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I’ve met so many heroes this week: my friend Kevin Webber, who’s now completed his fourth MdS since being diagnosed with terminal cancer; Amy Palmiero-Winters, the first female amputee to complete the race with a prosthetic leg; Joe Robinson, who began the MdS on the 10th anniversary of a car crash that killed a close friend and left him with a broken neck, back and skull and a 3% chance of survival. I’ve been lucky to spend time (not enough) with Joe this week. He’s always smiling; always seems calm and determined.

Then there’s everyone who made Tent 53 feel like home, Jean-Michel (a type 1 from Toulouse I’ve become friends with despite my appalling French) and MorningCoffee Run James. There’s tent mate James, who’s made me laugh all week (with not at) even when I feel broken, Fast (laid back) Rob, who went for a five mile walk in his flip-flops the day before we set off and got blisters and sunburn, yet still gave each day everything with a smile on his face, and Preet, who’s approached the whole thing like it’s a Park Run and still smashed it.

But the real hero of the MdS for me is Fast Matt. He didn’t just maintain his 8:30 minute pace for the rest of the stage, he beat it, despite the pain he was in. He later told me that all he wanted was rest when he got to each checkpoint but knew he’d be disqualified if he did. He got to the last checkpoint with three minutes to spare and then had those brutal hills and dunes to get over before the finish. He could barely walk when he got here, one of the last to cross the line. Yet, overall, he’s still the 143rd fastest of the week. Amazing.

The ‘charity’ stage

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This is the charity stage, in support of MdS charity Solidarite, which is helping to transform the lives of people living in the Moroccan Sahara (on Sunday it will open a school in the city of Ouarzazate). Tent 53 walked the whole way, chatting. We crossed the finish line together. I will miss then all. I wouldn’t have had such an amazing experience without them. I will miss the desert too. I hope I see them all again soon.

My wife, Natalie, who has supported me throughout the whole journey (looking after the kids while I’ve been away for weekends on end running, worrying as my blood sugar levels have been careering up and down, putting up with my worrying, etc), was at the finish line. We are now in a taxi on the four hour journey back back to Ouarzazate with Joe, his sister Grace, who sadly had to pull out with dehydration on stage four, and a chap called James, who’s dodged the communal coach convoy back with an infected blister. I can’t believe it’s over.

I am not a likely athlete. My love of cold lager and pork scratchings mean I’ll never look great in Lycra… If a diabetic former fatso can do this, what can you do?

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Can’t is a word I heard a lot after I was diagnosed with type 1, aged 13. You can’t join the forces. You can’t go anywhere, ever, without sugar. You can’t live without injecting yourself several times a day with a hormone that can kill you if you take too much. You can’t expect to live very long if you don’t test your blood several times a day and perfect your insulin dosage. You will spend every day of the rest of your life thinking about your blood sugar level.

I spent most of teens and twenties feeling completely overwhelmed by diabetes. The stress and anxiety of trying to manage the condition (and always feeling like I was failing) took over my life. The old me wouldn’t believe what I have just done. I have done what I’d convinced myself I could not. Diabetes is a coward. It wants me to stay at home, stick to a routine, live an ordinary life. This week, I’ve delivered an almighty Fuck You to type 1. And it feels amazing.

I am not a likely athlete. My love of cold lager and pork scratchings mean I’ll never look great in Lycra. I’m built for comfort, not for speed. I finished the Marathon des Sables 592nd, out of 752 competitors. Of course, where I finished doesn’t matter. I have had the time of my life and proven to myself that I can do whatever I put my mind to. If a diabetic former fatso can do this, what can you do?

My mind is already racing with possibilities for my next challenge. But, first, I chill, as Craig David would say.

Disclaimer: I have no medical training. I am not a doctor, a nutritionist, a physio or a sports therapist; I doubt they’d even give me job handing out oranges at half time of a football match. I am just a type-one diabetic and former fat bloke with a stupid idea. This blog is my account of following that idea to its conclusion. Do not attempt anything similar without seeking prior medical (and psychiatric) advice.

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