The two peaks of Mont Ventoux, climbing the beast as a T1D
Mont Ventoux, an icon for cyclists, is known for its savage and unitary nature, standing alone and apart from the Provencal countryside. But my experience of riding up it as a Type-1 Diabetic (T1D) was of two peaks, not one.
Exploring the experience that I had on the day I tackled the mountain illustrates some of the challenges that I experience as a T1D.
The noisy interplay between insulin, food, activity, adrenaline, temperature, fatigue and stress is the sub-plot, and occasionally the main narrative, of my dreams and goals; my family life and career; my successes and failures. It is a blessing of memory that although survival, prosperity, pleasure and pain are all accompanied at the time by that noise, the echoes fade as events pass back into memory.
The beast of Provence has a serious reputation. The French philosopher Roland Barthes, a cycling fan, wrote: “The Ventoux is a god of Evil, to which sacrifices must be paid. It never forgives weakness and exacts an unfair tribute of suffering.”
With such characterisations in our minds we had left London at three in the morning on the 1,200-km drive, giving us hours to discuss the climb.
How hard could it be at a steady pace? What would the weather be like? Would there be many e-bikers? Walnutty octogenarians from Italy breezing past us on steel road-bikes? What pizza would we eat afterwards? How had people we knew got on with the ride? What was the worst that might happen?
If it was too hard, I figured I could always turn around and roll back to the start in the village of Bédoin. I didn’t dwell on the fact that all the hard training sessions that I had scheduled fell by the wayside over the summer.
Challenges
It was a damp, sunny morning as we rolled out of the village. The top of Ventoux, and the exertions it would require to climb it, felt a long way off.
There’s a dual process to such endeavours for me as a T1D, two elements that wrap into and around each other, letting each other breathe at times but choking them at others. The physical and mental requirements of the ride are one strand. Trying to manage blood glucose levels, insulin and fuel, while avoiding hypoglycaemia, and coping with the latter when it comes, the other.
Those two parts were with me in Bédoin even before I took the bike off the roof. I’d miscalculated my insulin bolus the night before at our late supper, and my blood glucose had risen through the night.
So even as I checked my tyre pressure, brakes and wheels in the village square, I was pleased that having corrected my insulin dose and measured my food, my blood glucose levels had come back to levels that were not too low or too high. Good work, kid, I thought as we rolled up the valley.
The climb up Ventoux breaks into three sections: the first 6k, ascending under the mountain through vinyards and farmland, do not rise at much more than 5 or 6%, and often less steeply than that.
Few other riders were on the road despite the late summer softness and sunshine. A young couple, he on a road bike, she on an electric hybrid. A pair of brothers with road bikes being photographed by their mum, the two of them in matching French national cycling kit and trainers.
Suffering and graft
The anticipated pain was a distant buzz as we passed the young couple. When they overtook us a few minutes later, it was the signal to my mate to put his head down and start his own ride. He is a diesel (one of our bunch cried out in pain and frustration trying to hold his wheel on a Rapha Day-in-Hell ride a couple of years ago) and I had no intention of trying to stay in touch with someone who could pull so hard for so long.
It would have put me into the red before the gradient started to bite, far sooner than I wanted. My tactic was to preserve every ounce of energy I had for as long as possible, checking my glucose monitor regularly and ever mindful of the kilometres that lay ahead. I drifted off his back wheel and started to tap out my own pace, exerting as little effort as I could as the forest, where the second phase of the climb takes place, loomed on my left. The sun and slight exertion warmed me, determined and present on this mythic climb.
Sometimes the second part of the process (the effort, fuel intake, insulin doses and metabolism) all clicks together perfectly. Reduce insulin, check blood glucose continually, take on carbs accordingly; and my sugars stay between 6 and 9 mmol/l.
Ventoux seemed as though it might be one of these days as I moved into the second section of the climb, which goes another ten kilometres up the mountain through the forest, starting with a sharp hairpin to the left at the small cluster of houses at Saint-Estève. The road ramps up to 10%. On the tarmac in white paint are the names of pro cyclists RUI COSTA, LANDA, NAIRO, VALVERDE, INDURAIN.
Yo, I’m here, I thought, and even as the tarmac steepened my glucose was pretty stable, just nudged this way and that by the exertion and the small amounts of carbs I was taking on.
The air was soft and humid, with sun breaking through the trees in places, as I passed the wide stony parking lots that during the Tour de France would be full of French, Belgian and Dutch camper vans and pop-up tents. The going was harder now. My target before the summit was Le Chalet Reynard, a café for the sporting tourists on the mountain, with a restaurant that specialises in truffle-baked-into-Vacherin and suckling pig. (It would take a particularly robust type of old-school cycle-tourist to enjoy the semi-gastronomic menu on which those two feature. On the way up, at least).
The gradient never really drops much below 9 or 10% till shortly before this small oasis. Each time I lost sight of the road upwards in the forest I hoped it was because the slope was slackening temporarily. But it never did. (It’s a strange phenomenon this, an instinctual optimism that ease may lie close ahead even as the rational mind dismisses that possibility). The road would turn slightly, or move from convex to concave, never easing off as I focused on reaching the next of the distance markers that either help pull riders up the mountain, or deter them with their slow passing.
This climb through the forest was an eerie combination, and one that in hindsight has a kind of wonder: dreamlike in my isolation among the pines, beeches and firs even as I passed and was passed by other riders; and intensely demanding physically.
I passed a man in a Yorkshire cycling jersey a bit higher up the climb. “It’s not exactly Emley Moor, is it?” he mused. And I had to agree.
Hitting the limits
But this experience of aloneness and intensity, and the privilege I enjoyed to be there, became more more laden and fraught at the point that I had a T1D jolt.
My blood glucose moved out of the range and shallow curves that I wanted. Till this point the arrow on my continuous glucose monitor had been horizontal, or angled down by 45 degrees, a signal to have a couple of Jelly Babies. But halfway up the forested slopes of Mont Ventoux, the arrow on pointed down vertically and I took a gel and a bar, mindful first that I didn’t want a hypo; second that I still had ten or 11 kilometres of the climb to go; third that I was likely metabolising rapidly; and fourth might still have some of the correction dose I had given in the morning knocking around in my system.
These thoughts were not necessarily logical, but I was in the grip of the physical challenge, focused on completing the climb unhindered and without having to stop to deal with a hypo.
The third and final section, in which you ride across a notorious moonscape of white scree and rock, is at a lesser gradient of between five and seven percent, till the final kilometre when it kicks up again cruelly.
Cramping and crouching
Having reached Le Chalet and started on the somewhat lesser slopes on the open part of the mountain, I thought I had passed my personal crux on the steep lonely road of the forest.
But my complacency was checked in an abrupt and humbling way. Cramps gripped my adductors and then hamstrings, meaning that every 500 metres or kilometre I had to stop, painfully climb off my bike (try straightening your leg as painful spasms alternate front and back) and squat like a bear on all fours, attempting to shake out my legs, which would give me a few minutes’ relief after I climbed back on to my bike, made in steel by Rob Quirk.
This was the apex of my tribute of physical suffering, I supposed.
The temptation to stop, a weakness that the mountain would not forgive, started to play through my mind. I could just turn round after all and roll back down. I’d put my arse into it already and if it didn’t work out, who would it matter to? Did it matter to me, I’d done a good day’s exercise? The mountain will be here; why not come back tomorrow?
Still, I figured if I stopped often enough and I rationed my efforts to stop the cramps from destroying my legs I could make it to the top. I was aiming to make each spasm a literal decimation rather than letting them run to my ruination. A couple of years earlier my attempt to run the Yorkshire Three Peaks had ended with a death march off the hill after I was struck down by cramps in my calves, which writhed like snakes wrapped in clingfilm, unable even to shuffle any further. (Kindly couples strolled past me, offering me shortbread and tea from their flasks in a way that was both quizzical and charitable).
I was steering between such a pole at one extreme and on the other actually making it to the top of Ventoux.
Aware of the deadly reputation of the mountain for cyclists, occasionally other riders stopped to ask whether I was ok. From my knees and palms I would try to smile, then croak: “J’ai des crampes aux jambes.” By this time my mate had come back down from the summit and agreed to climb back with me. We figured this would be helpful in the event I fell off. He would be on hand to call an ambulance or take comical photos, perhaps both.
At the same time as this, perhaps because the stopping and starting to quell the cramps was reducing my energetic output, my blood glucose started to climb. And then continued to climb.
When I finally made it to the top of Mont Ventoux, urged on by my pal over the brutal final hundred metres, I rested for a minute on the top tube before gingerly climbing off my bike and taking up a bastardised version of the baby position under the sign that signalled the summit of Mont Ventoux. In contrast to the solitude of the forest there were scores of cyclists, taking photographs and talking about their rides.
And I began to deal with the second peak of the day, giving myself an adjustment bolt of short-acting insulin, knowing that whatever effort the descent would require, it was unlikely to last much longer than half an hour and that the hard work was done.
When we finished the descent I wanted my blood glucose to come down, as much as I was satisfied to have climbed the mountain. I wanted to crown the day by enjoying my BG sitting between six and nine as it was at the outset of the ride.
Because having high sugars is horrible. Some question whether it is meaningful to say that you can feel high glucose in any sense at all, because of the lack of the distinct range of symptoms that characterise low blood sugar or hypoglycaemia.
But, even leaving aside the sense of fuzziness and thirst, knowing that the glucose levels in my blood are high fills me with dread, a sense of mortality, stacking up in my small blood vessels and pulling me down into the fire and earth sooner than I might otherwise have gone. I think in literal terms of the surplus glucose clogging up my capillaries and feeding viruses, fogging my eyes and more.
(I wrote before about how continuous blood glucose monitors have enabled life for T1Ds, while noting the nuances and complexities that the data they provide create. This awareness, facilitated by continual testing, when I am not at the right levels, is perhaps one of those instances).
So it frustrated me to be back in Bédoin and for my glucose levels still to be rising. I calculated the carbs in the pizza I planned to eat and added an adjustment dose as I figured that given the work my body had done, and the cell replenishment that would need to go on afterwards, that would work. I could have had a steak and salad, sure, but that wasn’t what I craved.
It eventually took four or five hours to come back into range, which somehow felt like an eternity. Swimming laps of the pool did nothing to make it fall faster.
This second peak, and the long painful descent, was hard in a different way from climbing Mont Ventoux itself. I was enjoying the early autumn sunshine, hanging out with my pal, and pleased to have completed the ride, but there was resignation, sadness and fear too as the unruly sugars coursed through me.
Such time is painful and deep; the vice of the condition chastening and hard to ignore. In hindsight, I reflect: was it this that caused it? Or that? What might I have done differently?
I could push my solid flesh up the mountain. But even part-cyborg, with the amazing technology I wear on my skin and in my body, I had not been able to control my glucose in a way that didn’t cast a small, cold shadow over the day.
Living with T1D can be like a daily Mont Ventoux. On that day in autumn I felt it especially keenly because of the contrast between what I could make my body do, and what I couldn’t.
