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.