Friday, May 27, 2011

Managing with Exercise

Note: This blog was going to be posted on Tuesday, May 24 but since I am moving it was delayed due to lack of internet.  Good thing the Solana Beach coffee shop has free wifi.


The last time I saw the endo a couple months ago the doc asked me "how long do you think the exercise reduces the amount of insulin"?  Puzzled, I responded, "an hour, I don't know".  Looking back, she ended up being pretty upset with my answer, "what do you mean an hour? Doesn't it last a full 24 hours?".  (First of all, if she was going to answer for me why did she ask?)

Looking back I've come to realize I didn't know what she meant.  Exercise is such a part of my life that my balas rates (levels of insulin) are set by it.  Exercising six days a week religiously, as if on a mission, I have almost forgotten that my diabetes is partly regulated by it.

This weekend is one of those rare exceptions how I discovered my insulin levels do need to be increased after a period of no exercise.  After a little too much celebration on Friday night upon graduating from graduate school I took Saturday off (which actually is a good thing considering I hadn't taken a day off since the Encinitas Triathlon).  Still feeling pretty sore and on vacation I took the very rare second day off... Mistake I tell you!

My blood sugar was off the roof by 5pm on Sunday.  Obviously a lot of this was my over indulgence of sushi that afternoon, however it seemed impossible to bring the blood sugar back down!  Looking back I should have gone down the elevator of the hotel and jumped on the exercise bike, simulating the insulin in my body.  In the end though it was good for me, reminding me how important the exercise is in controlling my diabetes.

While my type-A personality doesn't need a reminder to exercise, every once in awhile it doesn't hurt to have a reminder the importance exercise plays in managing my diabetes.

Does this mean every diabetic needs to manage their disease with exercise six-days a week?  Of course not.    But that is the course I have set myself on, so if going longer than a 24-hour period I need to remember to increase my balas rates and take care of myself in a different way.  You know what though?  I'd rather just exercise!  Plus who else has a girlfriend that would let you get off a flight and go for a run?  (you're the best Jamie)


“I have to remind myself that some birds aren't meant to be caged." 
Shawshank Redemption


Congrats to Jamie and the rest of cohort 11s that I graduated with this weekend.  It's been a long two years at times but we made it.

Monday, May 16, 2011

Encinitas Sprint Triathlon Race Report

After a night where I was in bed by 8:30PM following a good carb load meal it was up by 4:15AM to make the twenty-two mile drive north from San Diego to Encinitas.  Just before leaving I ate a meal that was made the night before of a few potatoes and "microwaved eggs" (it's not as bad as it sounds).  The diabetes couldn't have gone better in the morning, waking up with a blood sugar of 125.  I gave myself the normal amount of insulin for the meal and head out the door.

Arriving at the race, I set up the transition area at 5:15 before most people had arrived, still in the dark.  I was surprised how relaxed I was this race, finally feeling like it wasn't my first rodeo, which obviously lead to my enhanced blood sugar levels.  By 6:15 I was still at a great 135, I gave myself a tiny amount of insulin then left my pump at transition.  

Go down to the beach, get the race and age group numbers written on my arm followed by putting on the wet suit.  UGH!  Ripped one of the seams on the wet suit!  Right there on my left bicep.  First thought, great here's to a good day.  (After the race though I spoke with one of the sponsors and he told me about a woman that will patch it for only $20.)

I had a Powerbar, 45g carb there then 20 minutes later (my swim wave was at 6:58AM) I checked my blood sugar again and had one gel pack to raise it a little more.  

Well here goes nothing!

SWIM:
Gun goes off and into the water.  Bam!  First wave, fall.  Get up, keep running into the next wave.  Then the swimming started.  As you can see in the video the waves were breaking fairly well.  This is the first time that I got really worried.  After sucking in a few gulps of salt water I realized I needed to calm down, I knew if I could still stay with the group everything would be fine.  

I was shocked at how well I stayed in the group and how much better my sighting was.  Everything felt like it came together.  I knew if I could just get to the buoy and turn around everything would be fine on the way back.  I got to the buoy and turned back around, still with the pack.  Actually I wasn't even the last person, my swimming has definitely come together since joining Master's swimming last November.  

My right shoulder was tight by the end of the swim however, I factor this to two things.  First, I know I was short arming everything, not extending like I should have been.  Secondly, the wet suit seems to be about one size too small (which does explain the easy tare), locking my shoulder, it still works though for a race like this. 

After staying with the group the entire way, with my swim confidence now much higher, I got out of the water and ran up the hill.  The problem with the ocean race is that it's on the side of a cliff, making the transition area further from the beach.  

TIME: 19:22.9  

Transition 1
Grabbed my gear and off… A little slow to get the wetsuit off but that's fine.
2:47.6 (Hence the hill)

BIKE:
This is the first time in a race I had my shoes clipped in.  It worked but honestly (as can be seen in the video) I need to learn to hop on the bike quicker and get going.  

The bike course at Encinitas is great, it couldn't be more pretty.  Two loops, up and down the beautiful Pacific Coast Highway.  During the first loop I let an elite draft off me on his second loop, while illegal in USA-Triathlon rules I felt like I played a greater role in the race, with him pushing me a little harder as well.  

During the race I could tell my legs definitely weren't well rested but it's a sprint race with no real taper, so this is to be expected.  The two loops went well, I felt good.  Honestly, this is really where I knew my swimming had come along.  During my last triathlon I knew from the bike that I really needed swim training as I was so dizzy and bloated from swallowing water.  Now however I am looking forward to my next race in a lake with few waves.

At one point, one of the age-group athletes that started in a swim wave after me was screaming at a lady near another male about drafting (remember against the rules).  I looked at the guy next to me, asking "is she serious?".  He just laughed, "no idea man, wow".  

In the last portion of the bike I had an energy gel, some water and took my feet out of my bike shoes.  After finishing the bike portion I went into transition.

TIME: 39.12.0
Slower than I want but hey, it's the first race of the season and I felt like I learned a lot.

Transition 2
Wait, where's my stuff. Couldn't find it, of course, it's behind me the whole time.  Lost some good time looking, showing that I would have a good transition if I could find it.
1:23.5 

RUN:
When I finally found those run shoes I was off.  Two laps, holding a solid pace.  I didn't wear the GPS watch for pacing just like I had stated in my previous blog.  I don't know how it would go in a longer race but I like it.  There are no distractions; "o I need to go faster" or "my heart rate is too high"; just the feel of the race, not a slave to technology.

The first half mile the legs are always a little jello-y but I still felt good.  The legs got rid of the heavier feeling by the end of the first mile.  Let's say I felt a lot better than the two triathlons or the duathlon of last season.  

My time shows I held about a 7:14 pace.  I probably could push myself a little harder next time but I felt comfortable.  My two blood sugars during the run were excellent as well, 137 and 153.  Showing I held good blood sugars levels the whole race.

TIME: 22:31.6

Overall: 1:25:17

Overall
Diabetes-wise I couldn't ask for more.  I woke up with a good blood sugar and held it throughout the entire race.  Swimming is still getting better each time I get in the water.  However, I do believe I could push a little harder on the runs and bike, especially the bike portion.  My transitions will also become faster.  I would say I should practice that but while I was living in Los Angeles where would I practice more of this, leave my stuff with the homeless?  Time to join a triathlon club!

Other
One of the things I realized in the days leading up to the race is how much of an effect the racing does have on my diabetes.  I put so much more emphasis on great blood sugar control because I want to make sure I am completely hydrated and fueled for the race.  Cutting back on coffee consumption, watching what I eat even more such as not finishing a meal that I knew would be bad for me in the days leading up, keeping my blood sugars really under control.  

Also, Jamie got out of bed well before the sun came up and went with me to Encinitas for the race.  Taking all the great video and pictures you see below.  Not to mention taking control and holding my bag full of stuff!  Thanks Jamie!

"Pain is temporary but race results on the internet last forever."
Race t-shirt





Friday, May 13, 2011

Encinitas Sprint Triathlon Race Goal

It's like the opening day of the baseball season, the first race of the season.  The Encinitas Sprint Triathlon (750m swim, 20k bike, 5k run) just north of San Diego.  I'm slightly nervous for my first ocean swim race though, as I hope the pacific will agree with me on Sunday.  I've put a lot of work into my swim training since my last triathlon though, so I have a lot to look forward too and anyway it's a short swim, only 750 meters.  

My training has been going well along with my blood sugars.  Well… that is except for my 382 blood sugar on Wednesday night.  For some reason my infusion set (the needle that brings insulin from the pump to the body) went poor following an eight mile run, I can't explain what happened other than when I took it out blood began streaming out, showing that I had not received insulin for some time.  No telling how long I had gone without insulin but it ended in ketoacidosis, let's just say I was a little sick.  Similar incidents have not happened for some time but it was enough to put me in bed early.

Onward and upward though!  My blood sugar in the morning?  A solid 101, a great fix.  Woke up, went for a 22-mile bike with a short swim later in the day followed by some quick recovery yoga.  I wanted to get a good stretch before the weekends race.  

Normally I set time goals and try to have race predictions.  This time?  Nothing.  During my training this last week I've thought a lot about how I want the race to go.  Simply put, I want to have a good race and maintain good blood sugars.  My goal is to keep my blood sugar in check prior to the race as I've always had trouble with the morning meal on race day.  

Heck, I may not even wear the normal Garmin GPS or heart rate watch.  I may just go out by feel, only wearing a usual wrist watch.  Go out and have fun, that's the goal.

"Your thoughts become your reality, both in the positive and negative sense."
Mark Allen, Six-Time Ironman Triathlon Champion

Monday, May 9, 2011

JDRF Los Angeles Gala

What does Los Angeles do better than anyone?  Okay, okay, after the traffic.  Celebrities.  Now it's probably not like everyone in the midwest thinks but depending on the area one lives they will see a celeb or two on a regular basis.  For goodness sake the last time I got a bike fitting Barry Bonds (yes, balco Bonds himself) sat on the couch next to me for the entire time, laughing and telling jokes like any other normal guy.  

The JDRF (Juvenile Diabetes Research Foundation) Los Angeles Gala was no exception.  I was able to talk my way into the event through a friend that works at the foundation, Jennifer Bergmark.  She couldn't have been more generous, comping me two tickets for donating a few items from the PGA TOUR event I work, the Northern Trust Open.  

With Jamie as my guest we fought the Los Angeles traffic four and a half whole miles to the Beverly Hilton in Beverly Hills.  After Jamie wouldn't allow me to valet park we walked into the event, immediately seeing one of my former professors who's Public Relations firm, Crimson PR, does all the publicity for JDRF in Los Angeles.  (Yes, even JDRF has a PR firm in Los Angeles.)

Our names were validated on the list and we received our auction number.  After a quick run through of all the silent auction items I bid on a few, Jamie talking sense into me over bidding on the three night hotel stay on the big island of Hawai'i.  Now that I think about it, I may have won an item or two but I will wait to hear back from Jen about that.  

A curious check of the blood sugar, 136, and I got a little out of control, ordering a sparkling water from the bartender.  Thanks for the drink JDRF!  Patrolling the event further, Jamie and I ran into fellow diabetic, Team Type 1 Athlete, Eric Tozer (who's wife, Jen, works for the Los Angeles JDRF chapter) before sitting down and finding out Jamie and I were seated next to Eric.  

Once seated we were able to sneak a glance at the always classic moment in Los Angeles, the 40-something rich guy with the barely legal girl seated next to Jamie.  O let the good times roll!  

The live auction now underway we were treated to Ray Romano and his brother getting people to bid higher and higher on items from Packer tickets with a "frozen tailgate" (if these people only knew what that was) to a fourteen day African Safari.  Once completed we took in a wonderful steak dinner polished off with desert.  Now it wouldn't be a diabetic event without some sugar added at the end.  

After a few awards, the night concluded with a heart wrenching story of a young diabetic who died in his sleep from hypoglycemia (low blood sugar).  It really put things into perspective, the room was silent as his parents told their son's story.  The chapter was then able to receive some incredible donations as the auctioneer brought out cards with amounts for people to bid, raising needed funds to find a cure for diabetes.  

After the Charlie Sheen sighting in the audience, Jamie and I were able to sneak out before valet traffic got heavy.  Wait, I didn't valet it, okay truthfully we were able to sneak out before the parking ramp was packed.  

The Los Angeles JDRF Chapter put on a wonderful event, full of "LA-only" auction items, celebrities (Sugar Ray is a lot shorter than you'd think) and great food.  Special thanks to Jen for getting me the tickets and to Jamie for coming.  

"Fundraising is the gentle art of teaching the joy of giving."
-Hank Rosso

Current Blood Sugar: 168

Thursday, May 5, 2011

There's no stopping us

This article was originally posted on the Chicago Tribune's website (citation below).  I believe this is one of the better diabetes related articles I have ever read.  It shows that a diabetic can do anything and the ignorance of many endocrinologists (diabetic doctor) regarding sports.

By Anne Stein, Special to Tribune Newspapers
2:57 PM CDT, May 4, 2011

Former NBA center Chris Dudley was 16 when he exhibited the classic signs of Type 1 diabetes. "I was incredibly thirsty and going to the bathroom all of the time," said Dudley. His uncle, a diabetic, recognized what was going on, and after a home test kit showed Dudley's blood sugar was sky high, he went to the hospital.

"I was scared because I didn't know what diabetes was," recalled Dudley, who went on to play 16 seasons in the NBA. The first question he asked his doctor was if he'd be OK; the second was whether he'd be able to play basketball.

"The doctor said 'yes' and 'yes,'" said Dudley, whose foundation advocates and educates about Type 1 and sponsors clinics and basketball camps for kids with Type 1. "You can live a long life, and you can play if you take care of yourself."

Former NFL player Jay Leeuwenburg was a sports-crazed 12-year-old when he started losing weight and had "an unquenchable thirst." Leeuwenburg's doctor diagnosed him with Type 1 diabetes. He went on to a nine-year NFL career.

Of the 26 million Americans with diabetes, an estimated 3 million have Type 1, according to the Juvenile Diabetes Research Foundation (JDRF), including Philadelphia Flyer Nick Boynton, Chicago Bears quarterback Jay Cutler and Olympic cross-country skier Kris Freeman, who like the pro athletes before them, work hard to balance training and competition with the disease.

Often referred to as juvenile diabetes, Type 1, according to JDRF, occurs when the body's immune system destroys beta cells, which produce the hormone insulin. Insulin moves the glucose (sugar) in food into the body, where it's used as fuel. Without insulin, glucose stays in the blood. High blood sugar levels left untreated can lead to ketoacidosis, which can result in coma and death. Type 1 diabetics must take insulin to survive.

Lifestyle is more important in controlling Type 2 diabetes, which is on the rise due to an increasingly obese population. "In this form of diabetes, the pancreas still produces insulin, but the body does not produce enough or is not able to use it effectively. Treatment includes diet control, exercise, self-monitoring of blood glucose, and, in some cases, oral drugs or insulin," according to the JDRF.

Are there limitations?
Whether or not they're encouraged to keep competing — ultramarathoner Missy Foy was told by four doctors that if an athlete could qualify for the Olympic marathon trials, it already would have been done — Type 1 takes lots of trial and error to control. "Exercise changes a lot of things, including your requirements for fuel," explained Dr. Andrew Ahmann, professor of medicine and director of the Harold Schnitzer Diabetes Health Center at Oregon Health & Science University.

"While you need insulin to get glucose into tissues, you also become much more insulin-sensitive when you exercise and have a greater risk of having low blood sugar when exercising, so it's always a complex balance."

Three-time Olympian Gary Hall, Jr., for example, thought his swim career was over when he was diagnosed with Type 1 just before the 2000 Olympics, but with the help of a nutritionist and medical professionals, he adjusted his diet and medication, was able to continue a grueling training schedule and won gold in 2000 and 2004.

Knowing your body

Symptoms of low blood sugar can include trembling, accelerated heart rate, sweating and increased hunger — all of which can be confused with how the body reacts to working out. In a study on athletes ages 9 to 17 at the York University Diabetes Sports Camp in Canada, researchers found that low blood sugar levels decreased basic sports skills an average of 20 percent.

Low blood sugar can also impair cognitive skills. "It's helpful to have somebody you know who recognizes what's going on and says, 'I think your blood sugar's low,'" said Dudley, whose wife can quickly sense when Dudley needs food.

A big part of managing diabetes is testing blood sugar, explained Dudley, who on game days would test 14 to 15 times (six to eight on nongame days.) "You have to get to know your body and how it reacts to exercise and food."

Foy learned she had Type 1 at age 33, just as she was launching her professional road running career. She then became the first diabetic athlete to qualify for the Olympic marathon trials.

Foy practiced her marathon runs on a 1.5-mile course with her coach to figure out when and what she needed to eat. "We'd come up with a plan for race day, and sometimes it wouldn't go right," she said. "Twice I had to drop out of a race because my blood sugar went higher and higher and I couldn't take in carbs. If you don't have enough insulin on board, you can't take in carbs," she explained. "You have to have enough insulin to get the sugar out of the bloodstream and into the cells, but not too much insulin that you end up with no sugar in your bloodstream."

Many things affect blood sugar levels, from adrenaline and stress to injuries, illness and weather. Dudley and Leeuwenburg are proud they never missed a game in their pro careers because of diabetes, although Leeuwenburg thinks he wasn't picked until the ninth round (by Kansas City) of the 1992 draft because of the disease.

"At the time," he said, "Kansas City had Jonathan Hayes, the only diabetic I knew playing in the NFL. I don't think it's a coincidence that he was able to be successful with the Chiefs, and they were the only team that would take a chance on me."

One pro team is promoting Type 1 athletes: Team Type 1: sanofi-aventis cycling was founded by two Type 1 cyclists and includes a men's pro team with six diabetic and 14 nondiabetic riders, a women's pro team, amateur triathlon and running teams and several development teams.

The men's pro cycling team has a full schedule this year, including the Tour of California and the Tour de Suisse. The Tour de France is the ultimate goal.

"We can change people's lives, being out there competing and succeeding and showing 12-year-old kids that their lives will be OK," says CEO Phil Southerland, a Type 1 diabetic and former pro.

This year the team will monitor the blood glucose levels of its men at the Tour of California and send the research back to scientists. "What if we can figure out what normal is and what tools and technologies we need to mimic the nondiabetic body?" said Southerland. "Then we can build guidelines for children and adults at all levels of athletics. We want a baseline that'll shorten the learning curve and make life a lot easier for parents, kids and anyone else trying to compete out there."

Citation:
Stein, Anne. "There's No Stopping Us." Chicago Tribune: Chicago News, Sports, Weather and Traffic - Chicagotribune.com. Tribune Company, 4 May 2011. Web. 05 May 2011. <http://www.chicagotribune.com/health/sc-health-0504-fitness-diabetic-athle20110504,0,6903237,full.story>.

Wednesday, May 4, 2011

Yoga

The last few days of training have gone very well.  Sleep being a great factor in all of this.  I haven't slept so well the last two weeks but on both Saturday and Sunday night I slept like a new born baby.  This lead to a great 40 mile ride on Sunday afternoon leading into my recovery week with a track interval workout on Monday morning followed by a Brick (bike + run) workout that night.  Tuesday morning I had a good short swim followed by.... Yoga... there I said it, it's out.

I feel like a long-haired-Venice-living-hippy even saying it.  I did yoga ... again.  The first time was on my business trip to San Francisco, at that point I could justify it because my bike workout wasn't available.  Actually, I liked it.  The stretching feels great.  This allows my to stretch out muscles that would otherwise never be stretched, gaining increased blood flow throughout the body.

Now I didn't do yoga at a yoga studio (heaven forbid I do that) but to a video I downloaded on my computer in the safety cocoon of my room.  From what I found it didn't have any profound affect on my blood sugar pattern but the workout was after a swim, so from the one workout it's hard to say.  I will state it's not as bad as some people like to make it sound.  I did sweat a little but I can do that from reading too hard in the library. 

The gain from all of this is that I have another way to help speed recovery.  I can't say I'll ever be a huge fan of yoga but I can say it seems like a good option during recovery weeks when I have more time and am attempting to speed recovery.  Next time I look to see the true affects of it on my diabetes. 

"Seeker of truth, follow no path, all paths lead where, truth is here."
E.E. Cummings

Current BG: 138

Monday, May 2, 2011

With Friends Like These...

In the past I always thought diabetes was a self lead battle.  That the fight was mine and mine alone.  After finding InsulinDependence I discovered it isn't at all.  It's about the people I surround myself with as well. This hit me for the first time I read the groups first core value:
"An important step toward healthy living is acceptance of diabetes".

Accepting it is difficult once I actually thought about it for more than five minutes.  This is some of the reason why I write this blog, not for others but for myself.  Heck, I'd make fun of me for writing this if I was one of my buddies but in the end it helps me.  This started as a class assignment that I thought was stupid but it has turned into an important step in dealing with the diabetes, making it a log on both training and steps toward healthy diabetes management. 

This last week really reminded me how important other people are in that management and how surrounding myself with good people are at the core of taking care of myself.  Obviously people like Jamie and my parents play a large role but it goes beyond that.  By now most of my friends know that I eat gluten free, while many of them may not know how it helps me, they know it assists managing my blood sugars. 

This last weekend I realized this when I was in the car with Brooke (Jamie's sister) and Nik (Brooke's boyfriend).  We were looking for a place to eat and I said, "there's a Subway", Nik, without hesitating said very quickly "but you don't eat bread man".  No sign of annoyance or disgust.  While I know he was certainly thinking "what a pain in my butt", he didn't make mention of anything like that, being a great friend, understanding what I have to do to best manage my diabetes.  We ended up going to Subway because I said I could find a salad there but the fact that Nik thought of my nutritional habits means everything.

One of my graduate school professors has another term for this, "lobsters".  In other words, don't let people drag you down to the bottom of the pot, inevitability becoming like those weaker people.  Surrounding myself with people like Brooke and Nik there are definitely no worries like that.

“You are the average of the five people you spend the most time with.”
Jim Rohn