Thursday, December 23, 2010

Goals

I've thought about writing this particular blog for awhile.  Setting the goals I have in mind down on paper (or typing it on screen).  One thing I can say I have always been good at is setting goals, both long and short term.  When teachers would say "you need to set goals", I always remember thinking, you mean people don't do that.  I can thank my mother for this.  

I have two major goals to note when writing this blog.  One is athletically and the other concerns the betes.   Long term, within the next two years my aspiration is to complete an Ironman with an A1c (the measure of blood sugars over a six week period) of less than 6.5.   

Here is the layout:

2011
Complete Half Ironman (70.3) distance race (the real goal is to complete two of these races, one mid-summer and the other later in the year)
By July 1 have A1c of 6.5
By September, pick the Ironman and volunteer at it 

2012
Complete an Ironman distance race (hopefully either Wisconsin or Arizona which are later in the triathlon season)

I also thought about adding a marathon to that list but I still don't know if I will ever actually run a marathon before doing one in an Ironman.  If I had to set a tentative goal, it would be Carlsbad in January 2012 with the rest of the InsulinDependence crew.  However, until I feel like I can "race" a half marathon, I don't want to set out to simply run a marathon.  I never want the marathon to just be about completing it, I want to do it well.  

Obviously, I have a handful of professional goals as I graduate with a Master's degree in May and other personal goals but setting goals that will teach me about how to deal with adversity and sacrifice will serve their purpose.  If a career takes a turn and I have to stray the course, then that is fine as but hopefully I will be able to complete these dreams. 

One of the things I've never really done is set goals when it comes to the betes.  Writing down a goal of an A1c of less than 6.5 will definitely help me achieve it.  This is something that should have been done a long time ago but until I became involved with InsulinDependence I never thought of the betes as something "to achieve", when is all actuality it is.   

Setting the evolution forward to fulfilling my Ironman goals will serve to achieving the A1c goal.  I consistency find myself thinking "don't eat that, it will spike your blood sugar and you'll have a bad workout tomorrow".  It is truly amazing how one helps the other.  

Monday, December 13, 2010

Blood Sugar Spikes

Well I didn't run in the Santa Monica 10k last weekend.  On a scale of one to ten, I'd say the whole week of training was about a two or three.  I mean I got a lot in but not one time did I think "this was a good workout".  I wanted to get in a long run on Saturday instead of the 10k but ended up only running ten and a half, my legs were incredibly sore after the run and throughout the day.    


I’ve been experiencing high blood sugars after working out in the morning’s recently. It’s all been in the last 10-14 days and has never happened prior to this.  I’ve heard/ read about diabetics getting spikes after working out but has never really happened to me and now it is, which seems really odd so I don’t really know what to do. 

And when I say spikes I mean a 280-350 BS after 90 to 120 minutes, which I know is something going on in my body because I usually have Accelorade (21-25g) right after the run (or swim or bike) and then eat a meal after a stretch/ shower about another 45 minutes later. I cover these with normal insulin doses and still am having the spikes.  It does mainly seem to be happening after runs.  

Like I said this has never happened before and I’ve always been really active so I don’t know if this will randomly stop again or what. Also, nothing else has changed in my life to cause this.  I’ve tried to think of every outside factor that could have been causing this and can’t think of anything. 


Trying to look for an answer I found from other diabetics on the internet that a lot of insulin doses don't do as much within thirty minutes of working out, until the adrenaline and even the heart rate is completely calmed down.  Maybe I've been covering insulin doses to close to the workout recently?  Who knows, I know I will figure it out and everything will work out, just the sooner, the better.

Tuesday, December 7, 2010

Endocrinologist

Went to the endocrinologist recently (the diabetic doctor, I know why not just call it that right?).  My A1C (a measure of blood sugars over around a six week period) was a full point lower than last time I checked, which is amazing.  I finally am getting the control over my diabetes that I want which makes me extremely happy.  I owe this control to a lot of things; my girlfriend Jamie pushing me to take good control of my diabetes, finding InsulinDependence which allows me to have resources through other diabetics, my parents for always supporting me in these running/ triathlon events and other people from the past like Coach Hartman who I always think of when I want to quit on a run or bike ("33 minutes").

My training has been going well for being the off season, I don't bike as much as I would like but I'm in one of the few places in the country that even allows for winter biking so the little "outdoor" biking I get in I am lucky to have anyway.  My swimming has gotten a lot better with going to Master's, being forced to swim for a full hour and half without insulin is great for learning to control my diabetes during a triathlon when I may go for over an hour without the pump.  Running is going well, I may even run another 10k in Santa Monica this weekend but could opt to stay more on schedule with a long run in preparation for the Carlsbad half marathon.

I am running in the Carlsbad Half Marathon (January 23) to assist InsulinDependence (the group talked about above) raise money, please click here to find my fundraising page.  Please help the cause that has helped me so much, to learn more please click here.

Sunday, November 28, 2010

10k in Temecula

After a fun Thanksgiving Thursday where of course I ate too much food, I had a 10k race on Saturday.  Actually, Jamie and I both did the race together.  I found two separate 10k's that were on Saturday of the long holiday weekend and then she selected between the two, opting for the one closer to San Diego than Los Angeles.

As usual, I had my pre-race peanut butter sandwich (which I am sure as soon as Jamie reads this she will laugh at), going with a normal dose of Novolog insulin as this "meal" was two hours prior to the race.  Two things I did not take into account however, (1) that my blood sugar was already at 185 when I woke up (I know, I know that's a little high for the morning, but let's be honest, holiday weekends aren't a diabetics favorite) and (2) I didn't take any Symlin (which typically requires that I take less insulin).

It took Jamie and I an hour to drive to the race, once we got there registration had already begun.  We even got passed walking to registration by a woman who was yelling at her kids to walk faster while her husband told the children, "hurry, hurry, mommy is in a different zone right now".

We got our race number, put the timing chip on our shoes and waited.  I could feel that my blood sugar had gone a little higher than I wanted, so I took my blood sugar and bolused.  This is definitely something to remember for the future, I either need to take the Symlin or give a little bit more of a bolus when eating my PB sandwich upon waking.

The race began and I think both Jamie and I found out the course was much more hilly than we had expected, however it went through the vineyards of Temecula, on pavement then on tractor track then back to pavement and back to track.  The course ended with a very steep climb to the finish (I think that finish really killed a lot of people but some how I felt a surge going up it meaning I have a lot more in the tank for a flatter course).




I feel I was able to keep a good pace and the pre-race nutrition (a total mix of 50 grams of carb, the typical amount of carbs I have before any run under an hour) along with a small bolus to correct the high blood sugar all ended in a good result.  I found that I enjoy a 10k much more than a 5k, as one is not in the lactic threshold zone the entire time but am still moving quick enough to feel my legs become heavy and my lungs burn a little.  As a result I ended with a 44:50 (7:12 pace) which was 27th place overall, this was faster pace than I had initially thought in my pre-race plan.  I think the next 10k race with less hills, better planning on the diabetic end and the prior knowledge of pacing will end with even better results.

I also believe Jamie was happy with her result as she went well under the pace she thought she would, getting 13th overall in the women's category.  I think she is hooked though, after the race she said to me in the car, "I think I'll really like longer race".  No kidding, anyone that really likes swimming the mile for fun must really like longer endurance events!  Great job Jamie, thanks as allows for going with me.

Monday, November 22, 2010

Masters Swimming

So like I said I would started master's swimmers!

After emailing one of the heads of the Southern California Aquatics (SCAQ) organization nonstop for about two weeks straight, I finally pulled the rip cord and... joined.  The nice thing about SCAQ is that they have multiple pools and tons of options.

Currently the best thing for my diabetes is going to morning swims.  It's been hard to keep my blood sugars up for night workouts after having had a morning workout.  I've typically been heavily carb loading before night workouts, I mean like a 100 grams of carb before a cycling class or swim.  For me this is really about trial and error moving forward, however in the mean time if I am going to go to a controlled swim session I should go in the morning to avoid lows.  (Honestly, as work begins to ramp up I won't be able to attend night workouts anyway.)

So I looked up all of the morning practices and after the numerous emails, decided to attend the long distance swim which is made for triathletes.  It's about five miles away (which doesn't sound like a lot but in Los Angeles can sometimes be a life time away), there are closer pools but this should be the best group to swim with until my swimming improves.

I went to a practice for the first time about two weeks ago.  Sold on the first practice.  Swam further (much further) than I ever have, swimming with other people I was able to push through the threshold and keep going, which until this point I have not been able to do with swimming.  My blood sugar were always good getting out of the pool as well.

The first time I went I was worried about about controlling my blood sugars, however after attending I felt a lot better.  It's just like anything else in life, if I feel low I need to stop and get something.  Plus I rarely have a low blood sugar during a workout.  I realize looking back I was putting my fear of going to masters into my diabetes, using that as a way too make excuses which is what I never want to do.

Now I know though that this will truly make me a better swimmer.  This is the only thing that will push me to be able to do an Ironman swim well someday.  Ultimately this will make my whole triathlon experience better, getting out of the water with more energy will allow my bike to go more smoothly which allows my run to go better.  I'm happy I finally made myself do it and join a master's group.

Next up... 10k over Thanksgiving weekend...

Tuesday, November 2, 2010

Flying

Blair Ryan and I had an interesting conversation about the betes recently that I thought about a few times this weekend as I was at home for my grandfather's induction into the Wisconsin Aviation Hall of Fame.  First I'll tell you about my grandparents.

My grandfather and grandmother grew up on farms in Wisconsin, long before flying was the norm.  Long story short, he came home one day and said "I have something to confess, I've been taking flying lessons, I'll stop if you want".  Our family would be completely different had she demanded he stop, luckily she believed in him and he went on to at one time own the 6th largest air cargo hauler in the country.  Growing up I was always around planes and flying.  I always dreamed of being a pilot until... the betes.  I still think the movie Top Gun every time I see a sign around San Diego that says "Miramar".   The FAA isn't to high on diabetic pilots and one can't get anything above a privates pilots license (meaning they can't fly more than a single engine in nice weather).

This leads into to my conversation with Blair.  I believe I am completely different because of the betes, she feels different, as she would be the exact same person even without the betes.  Somehow though I can see how it has changed me.

For one, I probably would have ended up becoming a pilot.  Although I can't fly or join the Air Force, at least I can take a bike down a hill at 35 miles an hour.  Now that's flying!   I've had conversations (and heard about many more) with diabetics that are really negatively affected by it.  It's never been a problem with me on the other hand, getting it so young probably has a lot to do with this.   I did learn later in life that I needed to admit I wasn't completely "normal", I've found talking about the betes it is good for the soul.  I use to really dislike when people outside of my "circle" would ask questions about it but now I like explaining it.  For one it's a lot better when the people around you know about it.  Secondly, how else would people ever know anything about diabetes if people with it never explained.


Without the betes I know I would not take such joy and happiness in life.   When your 23 it's easy to think you'll live forever but the betes allows me to realize how special of a gift life really is, that things like a functioning body should never be taken for granted.  Heck, I know I wouldn't work out this much.

So grandma, thanks for letting gramps get off the farm, and grandpa thanks for going against the grain and being a crazy farmer with a dream of flying.  My other grandpa decided to get off the bread truck one day and open his own grocery store.  Its because of bold choices like this I'm able to live out my dreams and more importantly control my betes well through exercise and knowledgable management.

Monday, October 25, 2010

"are you still breathing, than you can keep going"

I don't even really want to talk about it because I'm disappointed but here's my first Olympic Distance race. 

On Friday I left for Vegas with Christian Chiappe, also a fellow Triabetes athlete.  The drive there was great, talking about the organization and about the betes, training with it and living with it.  On the way we talked about how hard the course was supposed to be, it didn't really sink in until we got there.

After packet pick up and dropping off our running gear at transition 2 for the point to point race we drove on the last part of the bike course down to Lake Mead.  (If you have ever been to the Hoover Dam, it's the road from Boulder City to the lake.)
This is the elevation.  Even though the map shows how the hill goes up for the last 15 straight kilometers, it's even worse in person.  It...just...keeps...going...UP!  (And the elevation height?  Those numbers are in meters, not feet.)

Come race morning, Christian did the Half-Ironman that started at 7AM, so I was alone until 8AM.  Just enough time to start freaking out about the swim and allowing my blood sugar to rise.  I worry about my swim because frankly I'm bad at it.  I called my parents with thirty minutes to go to just calm myself down and think about something else.  I didn't tell them until after the race why I called right before.

In the water... Panic... I had a bad swim until the turn around, when I thought about what Jamie told me.  Just sight the buoy's.  After that I followed from buoy to buoy and I was fine.

Out of the water... 28:02... I'm very happy with that for my first Olympic race (1500 meter swim)...

Transition... 3:49... That will only get better as my swim improvements, I definitely took my time as I was trying to get my barings from the swim.

The bike started... Of course it started with an uphill but really a lot of triathlons do as you leave a park or lake until the road.  This was the moment that I swore I would join a master's swimming group.  I was so disoriented from the swim that it makes the first four to five miles of the bike difficult when it shouldn't be.  When I say difficult, I mean I didn't drink or eat anything because of the water I swallowed and the disorientation.  My heart rate was far too high at 169 when I first climbed on the bike as well. 

The bike was going well once the disorientation went away.  Although it was a hilly up and down course, I could catch up on the downhills.  Then that 15 kilometers happened.  Just UP!  It was like it was never going to end, NEVER.... I started to get a cramp in my hamstring but it went away and I was fine...

Then I felt it in my back...

As soon as I stopped at the dismount line, I pulled up and BAM... back cramp.  It was so bad that it wrapped around my right side to the front.  I could hardly breath.  I walked my bike in transition, twisting in hopes it would go away.  Bike time: 1:39 over the 40k.  Actually, as slow as a time as that it (average 14.7 mph), considering the course when compared with other official times I did pretty well.

I was trying to get my cramp to go away but when I bent over to put on my running shoes, it really locked.  That was the worst, it just locked.  I started to limp out of transition.  I passed over the timing mat and just sat on the curb.  I tried to stretch, it wouldn't go away.  I thought about stopping... Then I thought of the video I had just uploaded on Jamie's profile, it's about a handicapped individual who trains for an Ironman.  In the video he says "are you still breathing?  than you can keep going".  So I did. 

It was the worst thing physically I had ever done.  Worse than Mr. Olson's 400meter sprint as a fat eight year, worse than the hell week that Coach Verdugo put us through in college.  I just limped, for about two miles.  My visor was in my mouth half the time from the pain.  After two miles I would say it started to loosen up or maybe I just accepted that my time was going to now be awful.

I went through a lot of emotions at the time.  It almost seems silly now even thinking about it.  At the time though, it hurt so bad and I refused to take a DNF ("Did Not Finish").  I wasn't going to do that.  I tried to run at about the half way point, made it about ten steps.  Locked up, the visor went back in the mouth. 

I finished though, I finished.  I was so upset at the time but now in reflection, you know I made it.  I got myself through that. 

Total time: 3:50:34
Run split: 1:39.14 over a 10k

Although I hate the time, I learned a lot more about myself than if I would have finished.  My blood sugars were pretty good the whole time too.  I really think it had to do with sitting awkwardly on my triathlon bike while trying to climb so much.  I would never do an overly highly course again without a road bike.  I also believe I am such a heavy sweater and such a heavy salt sweater that I need to take in more electrolytes during the bike.  That goes into my swimming, not drinking for awhile after the swim hurts me a great deal. 

And the master's swimming I said I would do while on the bike?  Ya, I emailed them.  I'll start that when I get back from home next weekend, need a little break and recovery.  If I want to be good at triathlon I need to do the things that will make me better at it.    







 

Tuesday, October 19, 2010

440 and still going strong

440.  No, that wasn't my bib number during my last race, that was my blood sugar at 2:30AM.  Here's the kicker, I still woke up two and half hours later and ran. 

I woke up to my continuous glucose monitor (CGM) beeping out of control, I have the sensor set to beep if my blood sugar is over 200.  At the time, it read 223.  I knew right away it was higher than that.  My body was in ketoacidosis.  "Ketoacidosis is a medical condition usually caused by diabetes and accompanied by dehydration, hyperglycemia, ketonuria, and increased levels of glucagon."   Basically it's awful, my stomach hurts, I go to the bathroom when I finally wake up for about five minutes because the body is getting rid of everything and I have no energy.  After going to the bathroom, I went back to my room, took my blood sugar and it was 440.  

I knew right away it was the infusion set.  I had a swim workout the night before, ate right away, bolused and went to bed.  There was no way it was that high. 

Although I have given praise in the past to the insulin pump, it does have its fault's.  Mainly, that the infusion set can fail, the tubing can kink, over time the "sites" a diabetic uses can create scare tissue making the site work less, all of this among other small problems.  The worst is when it fails at night.  Sometimes the pump beeps "delivery error", sometimes though the pump is getting enough insulin through the tubing and doesn't realize anything is wrong.

After concluding in my half sleep state that the infusion site was bad, I ripped it out and started to set up a new one in.  The site bled the second I took it out, obviously something happened from the time I went swimming until 2:30AM, or should I say about 11:00PM.  To be that high the site must have been bad for awhile.  I didn't have any insulin for at least three hours, probably four or five. 

After putting in a new site and giving myself a hefty bolus, I went back to bed.  When my blood sugar is that high, nothing feels better than just laying back down. 

I woke up to my alarm going off two and a half hours later at 5:00AM.  I had to get up a little earlier than normal because of a work function early in downtown Los Angeles. 

My first thought "I still don't feel good, maybe I should just go back to sleep".

My second thought "ya right and let the 'betes win".

If I would have laid down and gone back to sleep, the 'betes would have won.  I'm sure my Dad will read this and think "no it didn't, sometimes you are just sick".  No, it would have.  I don't have something that should ever hold me back, failed infusion set or not.

When I started the run by about 5:20AM, I felt good for about the first mile.  I started to think "maybe this won't affect anything today".  Then the second mile happened.  Dehydration, my legs felt heavy, my stomach was upset, the whole kicker for ketoacidosis.   I started to think about stopping again.  I didn't. 

I ran this morning, despite still obviously being in ketoacidosis.  I ran 4.53 miles this morning, despite still feeling the effects of ketoacidosis.  I won, not the 'betes.

This happening is exactly why I would use long acting insulin in the days leading up to an Ironman and maybe even a marathon for my balas rate then use the pump only for bolusing.   With the pump there are many unknowns with the infusion set and the tubing.  Although this won't happen again for a long time, I know in my mind it will happen again. 

As Ashley Hall (a fellow diabetic) once told me, "and no one at work that morning has any idea you went through that last night".  No they don't. 

Race this weekend, first Olympic Distance race in Vegas

Tuesday, October 12, 2010

About the 'betes

Sorry about the long time period period between posts.  With graduate school, working full time, training and an extra job working a few events on the weekends sometimes I just don't want to spend the time on the computer writing.

My cousin Chris sent me an interesting email this last week.  He congratulated me on writing the blog and the training but said he doesn't always understand the 'betes part.  This got me thinking, sometimes I just throw out terms and talk about diabetes as if everyone knows what I am talking about.  A lot of times, my close family members don't even understand what I am talking about.  Although 'betes is a lot like riding bike, meaning I can explain to you how to ride a bike but you'll never fully understand until you try to actually ride the bike, I can hopefully assist in your understanding of it. 

Type 1 Diabetes is (Diabetes Mellitus Type 1, also know as Juvenile Diabetes) is simply when your body does not produce insulin from the pancreas.  At some point a person with type 1 diabetes had their immune system attack the pancreas and destroy it's ability to produce insulin, which in a non-diabetic controls the level of glucose in the blood stream.  As stated by my friend Blair Ryan, another type 1 athlete, "my body is so strong it can simply take out an organ".

This is all completely different from Type 2 Diabetes (Diabetes Mellitus Type 2), which is a metabolic disorder.  A person with this disorder has a functioning pancreas but their body is resistant to insulin.  Simply put, a type 2 diabetics body does not accept the insulin.  This can be treated by exercise and managing diet and sometimes pills or insulin.  Juvenile diabetes (type 1) is when the body attacks the pancreas from no fault of the person.  It really upsets me and other type 1's when people confuse the two, they shouldn't even have the same name. 
Since my body and the body of anyone with type 1 diabetes does not have the ability to produce insulin, we take insulin to regulate the level of glucose in the blood system.  The easiest way to describe this is the riding the bike analogy.  Lean to much to one side, you fall over, lean too far to the other side, you fall over, you need to be somewhere in the middle.

A person with a functioning pancreas typically has a blood glucose (also known as blood sugar) somewhere between 75-120.  When a person without diabetes wakes up in the morning, their blood sugar will be on the lower end and after eating on the higher end of 120.  There are many ways to treat the diabetes; shots, the pump, there are even oral insulins now.  Personally, to control my 'betes I use the pump.  I feel this is the best way because I can live a much more "normal" life.  I describe the pump much like a manual car, a nondiabetic drives an automatic, I drive a manual.  This is better in my mind than the old horse and carriage of giving shots.

The pump gives me a "balas rate" throughout the day, a prescribed amount that drips through the tubing of the pump all day.  The "infusion set" or needle at the end of the tubing of the pump is changed every three to four days (if you work for the FDA I promise I change it every three days, which they require).  This "needle" however is actually just tubing in the body that moves with the skin, I don't even feel it.  When I change the infusion set, I change the insulin, which otherwise would go bad because due to the heat of the body (insulin goes bad in heat).

There are many types of insulin, however in the pump I use a type called Novolog.  It acts within about ten (10) minutes of hitting the fat cells the tubing sits in.  When I eat, I give myself a "bolus", meaning a dose of insulin for the amount of carbohydrates I eat.  This is one of the common mistakes nondiabetics make about diabetes, diabetics don't measure the amount of sugar in food, we measure the amount of carbohydrates.  Personally, in the morning I use a ratio of 1:1, meaning if I eat ten (10) grams of carb, I give myself one full unit (1.0) of insulin.  This amount changes to around 1.5:1 later in the day when the insulin becomes more active as the body awakens.  All diabetics are different though, everything depends on height/weight, level of fitness, level of activity, sensitivity to insulin, everyone is different.

Now with the pump most people ask "o so that takes your blood sugar too".  No.  This has to be done separately.   Basically I take my blood glucose with a glucose meter (prick my finger), figure out my level (hopefully between 80-120) then make corrections if my levels are too high (give insulin, a bolus) or eat carbohydrates if it is low (below 80).  The bolus (giving insulin) always takes into consideration both the correction factor and the carbohydrates I eat.  There are also devices known as a CGM (continuous glucose monitor), this measures your blood sugar from fat cells so there is lag time.  This is like being the back car in a roller coaster, as the first call goes over the hill, the back car doesn't feel it yet (meaning the diabetic must still take their blood sugar from their finger).  



What many also do not understand is that there are many factors a type 1 diabetic has to take into consideration when checking blood glucose levels and giving a dose of insulin.  Factors such as stress, illness and adrenaline must all be taken into consideration.  One of the best examples I have heard about adrenaline affecting blood glucose levels is through my friend Peter Nerothin who started InsulinDependence.  When he did his first Ironman, he exited the swim with a blood glucose of 120, after only 45 minutes on the bike his level was around 450.  It's literally almost impossible to have an increase happen that fast, he later found out from another diabetic Ironman that it happened because of adrenaline.  

Stress levels affecting blood glucose is one of the major reasons I love exercising.  With exercise my stress levels are much more under control.  The exercise then allows my body to require much less insulin as I have talked about in previous discussions.  Exercise is literally the most important thing in my mind in controlling my blood glucose.

The final point I would like to make is that many people believe a diabetic person is limited.  This is absolutely not true.  Currently, three diabetics have scaled everest, diabetics have ran a 9:07 Ironman and previously won an Olympic Gold Medal.  These are things the average population without diabetes can only dream about.  I had a diabetic friend once tell me "if you aren't type A, diabetes will make you type A".  I'd like to think that's what drives me, that the 'betes actually makes me better than I otherwise would have been without it.   


My friend Blair Ryan has also written a similar blog to this one, explaining how the 'betes works and exercise.  To learn more about the 'betes and exercise please read her blog here.

Sunday, September 26, 2010

Question everything

The training week was... alright.  Not the best and definitely not what I want.  I had two workouts in which I had to stop for a low blood glucose (BG), once while running, another while swimming.  It pains me to do this as this is really when the "I hate being diabetic" thoughts come to mind.  I try to stay positive in these moments, "maybe if you weren't diabetic you wouldn't even be working out".  I really believe that my obsession with fitness is due to the diabetes.  I understand how hard it must be to stay motivated when you don't have the 'betes as I do.  I see instant results.  On days that I don't workout, I need vastly more insulin than days I do.  Days with a really hard workout, lets say a "brick" workout, I need even less.  Normal people set goals such as "I want to lower my PR" or "I want to lose 10 pounds", when those results don't come, they become discouraged.  It's much easier for me to understand the biological benefits of working out instantly.  (Plus, runner's high isn't bad either.)

Both of these workouts were my second of the day, I never have problems with workouts in the morning.  I simply wake up, carb load and reduce my basal and I'm good to go.  My initial thoughts are that my afternoon basal rate is too high on a day's that includes a second night workout.  Tomorrow I have a second run scheduled at night so I'll reduce my basal starting at around 2PM or 3PM until the workout which will be at 6PM or 7PM.  This will make less insulin active in my system for when the workout starts.  My feelings are this is where most of the problem stems from.  The insulin that is still in my body from my mid-day snack and the basal rate instantly gets kicked into gear once my night workout begins, bringing my BG down quickly, faster than the morning workouts.  

As my running and eventually my triathlon training has really stepped up over the last year, I've needed far less insulin.  During college I understood the importance of reduced basal and carb loading before a workout but not like I do now. Studying these effects like my night workout basal rate and the meter I use is what really brings my diabetes into focus.  I really do suggest that any diabetic question everything, "why this meter and not that one", "is there a better pump out there for me", "what new insulin's have been developed lately".   In my opinion, this is one of the biggest problems diabetics face, comfort.  Much like the couch potato doesn't want to go for a run, a diabetic on injections doesn't want to change to the pump. 

As any diabetic runner/ triathlete knows, sometimes you need to take your BG while on the run.  The CGM is great but frankly you need instant results (especially with the Minimed CGM).  For those of you reading this that aren't diabetic it's really hard to explain the difference between an adrenaline rush and a low blood glucose, they can give the same feelings (at least for my 'betes).  All of the sudden that excitement hits you and my first thoughts run to "is this a low sugar or adrenaline?".  (Really though it doesn't matter, adrenaline messes up the blood glucose in such an odd way that a runner or any athlete should take a reading at this point.)

While running my favorite meter is the TRUE2go, it's typically sold as an off brand meter. 

As you can see by this picture, it's perfect because it's small.  


Because of it's size and having the meter/ test strips in the same piece, I find that it's great to run with (so far my record is maintaining a 7:30/mile clip while testing the BG).

However, typically in my "everyday" life I use the OneTouch UltraMini (I also use the OneTouch on my bike as it fits perfectly on the aero bars) but have found that sometimes I really like using the TRUE2go during the day as well.  I can throw it in my pocket with a lancet and go (o the irony with it's name).



Most people with the 'betes know that the OneTouch UltraMini is accurate.  I think every diabetic magazine has given more praise to this meter than an Elvis fan praising the King at Graceland.  Recently however, my endo made comments about the TRUE2go.  "You only use that thing to get a semi-accurate picture while running right?".  No, I stated, I like my little meter and use it a lot actually.  Heck, the FDA approved the device.  I decided to investigate.

Below you can see my little study.  After twenty three (23) readings with the same blood sample.

Average: 12.37
Median:   8.5
Standard Deviation: 12.84

So on average the TRUE2go and UltraMini were within twelve (12) points of each other.  Well within the FDA's 20% range.  The median is even closer.  I did find that the readings tended to be different on rapidly raising or falling blood readings, accounting for a difference in the average and the median.  (This could have been from the sample itself since blood that comes from the finger first isn't always as accurate as the blood that comes out after.)   This justifies in my mind my use of the TRUE2go but also tells me the device could be off a little, which means I will keep using it the same way I do now, TRUE2go for runs, UltraMini for daily living.






Sunday, September 19, 2010

Dawn Phenom: Malibu 5k Race

After a great week of training, an appointment with the endo which saw a lot of changes in the management of my diabetes and a 50 mile ride the day before, Sunday called for InsulinDependence's Los Angeles Dawn Phenom which just happened to be a 5k race.  (Dawn Phenom's are group exercise get together's, it helps to promote the group and allows group member's the opportunity to socialize with one another.)

The previous day's ride took a lot out of me, I woke up a little sore and tired, I didn't really expect much from the race but this is good for the training.  Running with heavy legs and a tired mind will only help me during the run portion of a hard triathlon or longer race (or even life).  I woke up with a blood glucose of only 67.  I felt a little low but it wasn't that bad.  I went straight to the kitchen for my prerace sandwich, PB on wheat.  No insulin and 30 grams of carb had my blood glucose up to 140 less than an hour later.  Let's face it, race or not the 'betes isn't going to keep me down.

Drive up the PCH (Pacific Coast Highway) to Zuma Beach (20 miles north in Malibu), register and go back to sit in the truck.  God I love being up early.  No new emails, nothing important on the radio, just the peace of the morning.

Checked the BG: 140.  It went a little higher over the next 15 minutes but nothing big, I bolused 0.5 units to stop the rise.  Let's face it, I love the calm of the morning but I can't sit still, so I get out and start wondering.  Looking to see if anyone else from InsulinDependence/Triabetes showed up yet.  Didn't find anyone.

More runners start showing up and the sun is now almost completely over the Malibu Mountains. 
Check the BG again, 220, so much for stopping the rise.  I start eating a Powerbar, I eat about half and bolus.  Warm up run time.  1.5 miles later I feel awake, I was worried about the soreness until that point, now I was completely awake. 

At this point I found Peter Nerothin (founder and president of InsulinDependence), he drove up from San Diego for the event.  I always love conversations with Peter, there is constantly something to learn about diabetes from him, not to mention finding out how InsulinDepedence is progressing.

They call us over to the start line, 240.  Fine, it's only before a 5k, this will only last 23 minutes tops.  I grab a gel (25 grams) and start to down it on the way over.

GOAL: On the watch, under 23:00 minutes.  Real mental goal, new PR.  Come on!  I just started this 5k running stuff, I've only been doing "true" speed work for two months, I can PR.  My mind is in the way though, I'm sore, tired and not mentally prepared.  I can hear Hartman (strength and conditioning coach in college) right now "get your head right".



As you can see on the map, it's a two turn around course.  Flat, fast and on a "not so wide" bike path.  I saw the southern half on my warm up run but didn't know much the northern half.  Once the race started it seemed to go further north than I thought it would.

Shots fired!  Race is off!

First mile: 6:40... wooo wooo, slow down...

Second mile: Under 7:00...

My legs are so heavy at this point.... All I could think was "just get through the last mile".  I followed a guy in front of me, I mean he pulled me the last mile and a half.  I knew if I stayed on him I could keep his pace to the finish, if I let him get too far out, I would fall apart.  Crumble.  "Quitting lasts forever".  Not happening. 

Third mile: Right around 7:00...

Finish: my watch says 20:53.  Official results: 20:53. 

Final blood glucose: 323... Dang!  The Powerbar had obviously fully digested and the gel as well.  The adrenaline of  race probably kicked it up a lot too.  Even though I wasn't fully "up" for this race, just before the start I feel all the adrenaline hitting my body, at first it gives the feeling of a low blood glucose (at least for my 'betes) then as the gun goes off I know it's just the adrenaline.  Either way, the race is over, I bolus and it goes down.

Overall, the race was good, it hurt during the race but my time keeps getting faster.  20:53 is nearly a complete minute faster than my previous PR, it keeps me excited to keep racing and more fit.

Special thanks to Peter Nerothin for coming up to San Diego and getting up at 4:00AM for the dawn phenom.

Monday, September 13, 2010

First Tri

Had my first triathlon this last weekend.  Rising at 4:45 my first blood glucose (BG) reading of the morning was 176, the night before I had a big pasta meal which ended up in a low right before bed (81 but obviously going down according to the CGM).  The 32 gram Gatorade ended up bringing it up right away which allowed me to go to sleep. 

I had a peanut butter sandwich (45 gram), gave a normal bolus (however, I did not take symlin which I normally do for three meals a day, this is something I need to practice more during training rides before trying it on race day).

Drove to the event and after setting up transition I took my BG again (about 80 or 90 minutes later).  146, pretty solid.  I thought it could be higher since I hadn't had symlin but it wasn't.  (I am learning that the symlin does seem to hold over once it's in your system, it's when you stop using it completely that it stops working.)  

I had a powerbar (45 grams) at that point, didn't have any insulin.  I wanted to wait to see where it would go.  I had to go set my pump in transition so I knew after this I wouldn't have any balas.  The race website said waves would go off every three minutes, I was wave nine.  That means at 7:27 I would start my swim.  So I put my pump in transition at 6:30, about one hour without insulin before the swim starts.  Well that was the plan anyway. 

When they started announcing instructions they told us it would now be every six minutes... UGH!  Took my BG at 6:50, already up to near 280.  Luckily, my girlfriend Jamie had my symlin pack which had a needle with a vial of insulin in.  Gave myself one unit.  Took my BG about 25 minutes later at 7:15, it was up to 340, okay then, more insulin.  I gave myself about 1.5 units.  At 7:35, it was 330.  I was fine with that, the rise had stopped. 

Swim started at near 8..... well I didn't die at least but that is going to take a lot of work.  Got out, one thing I learned is to take my BG right before getting on the bike (good luck with that, I'm too competitive to slow down like that on a short race).
 

 I took my BG about four miles into the bike, 280, I had a gel (22 grams), gave myself 2 units, knowing I would have another one soon.  In the last mile of the bike I had another gel along with more water. 

At T2 switched into my running shoes and was off.   The run went well, had a 23:06 split in the 5k.  Happy with that, feel closer to my current goal of a 20 minute stand along 5k (current PR 21:45).


Finished the run and was done with the event.  Solid finish, happy with the race overall.  The biggest thing is that I need to improve my swimming.  My BG after was 240.  That's fine with me, overall I'd rather have it lower but for a short race where cramps and dehydration won't be an issue that's completely fine.  So the 'detes didn't stop me....



Special thanks to Jamie for getting out of bed early and going with me (and taking all those pictures).

Friday, September 10, 2010

Introduction

I’ve always been an athlete. But I’ve also always had the ‘betes. Well not always but since I was twelve. Might as well be forever, I don’t really ever remember eating without thinking “how many carbs are in that”. I got really sick when I was 12, lost a ton of weight. I still remember my dad, Paul Mirr (friend growing up that I always played baseball with) and I standing in the garage and Paul saying “Brennan has lost a lot of weight”. I had but maybe it was a growth spurt right? We loaded up the truck and went up north to the baseball tournament. About four days later we all knew I had the ‘betes.

Fast forward to college. I still played baseball but didn’t pay close enough attention to the ‘betes yet. Granted, I took care of it and worked out all the time but there was still always something missing, I knew the control could be tighter.

Fast forward again, just before graduating from college I decide, “I still need something to do with sports”. So I did two things: (1) I bought a tri-bike (babe the Blue Ox as I like to call her) and (2) I went to graduate school for Sport Management in California. Seems like a good idea right? Out in beautiful California with a bike and soon to be master’s degree.

Best decision I ever made.

So I’m 23, two days away from doing my first triathlon and a year away from having a master’s degree. The control of the ‘betes is 100 times better. I don’t party anymore (like in college), I joined a great group called InsulinDependence and met a ton of great people in the diabetes community. My goals include someday completing an Ironman and longer distance races to help support Triabetes (the subgroup of InsulinDependence) and help mentor a child with the 'betes.

Thanks to people like Peter Nerothin (founder of InsulinDependence), Nate Heintzman and others I’ve met through InsulinDependence (click on the link on the left to find out more about them) I have the network of people I need to help me with my control of my ‘betes. From Ashely Hall who always answers my random CGM questions to Christian Chiappe who I will go to Vegas with for a triathlon in October, this is the support team I need to help maintain and support my healthy lifestyle and control the ‘betes.

I’d also like to thank my parents, who without their support I’d never be able to workout and do triathlons/ running events while in graduate school. Thanks Mom and Dad for all your love and support. And of course thanks to Jamie for putting up with the long runs and rides and always going with me.