Lean On Me – InsunlINdependent Family

I have one of the most amazing support networks anyone could ever hope for. My parents amazingly came to every football game I ever played in, have traveled all over the country for my triathlons and often dress my dog in a Ring The Bolus t-shirt, my younger sister cheers me on like no other, makes sure she handles my parents nerves on race day so I can focus on the race and is there for me no matter what. My close friends who I have let into my soul are incredible and I know each of them would gladly give their right arm for me. As much as they support me, they will never know what it means to be a diabetic athlete. They support me, they love me and they cheer my triumphs, they seek to learn as much as they can about the challenges I face and while my "type 3" friends and family (people who care for people with type 1 but have working islet cells!) give me the strength to face the challenges I do, they only know what I experience through my words.

This weekend I went to Ironman Arizona not sure what to expect. I woke up at 4:45 am on Friday slightly hung over and totally exhausted to drive to Richmond Airport for a flight to Phoenix. On my solo journey across the country I was going to meet a group of people of whom I had only spoken to two on the phone. One of those people, Anne Findlay, was one of my biggest supporters in the early days of my diagnosis leading up to IMLP that I couldn't wait to cheer her on for her fourth Ironman finish! At the same time I've always been kind of nervous about throwing myself out there, going into a situation where I essentially no, no one and have no control over how the situation would transpire. When I landed in Phoenix on Friday I had no clue who I would be hanging out with that night or what the weekend had in store for me.

By the time I left Phoenix on Monday at 1 pm I left with a huge smile on my face, and my heart filled with the incredible journeys I witnessed at Ironman Arizona and the comfort I felt by being surrounded by other type 1 diabetic athletes for an entire weekend. Having to manage my blood sugars has never really bothered me although I'm never like, AWESOME time for another finger prick or carbohydrate calculation. Without question juvenile diabetes is a life changing illness and while I've never asked "why me," I do understand it is a pretty big hurdle to overcome to accomplish my athletic and life goals. Having the opportunity to be surrounded by other people who face the same challenges was one of the most amazing experiences of my life.

The first night there I went to In n Out with a group of people I had never spoken with before; five of the seven people eating those delicious burgers had to test their blood sugars and bolus up before eating. The only other time I have ever eaten with another type 1 was a week or two after I was first diagnosed and had dinner with my friend's wife who was helping me decide if the pump was right for me. There was something so comforting laughing with other JDs as we tried to figure out how many carbohydrates were in a double-double at In n Out.

As the weekend progressed I laughed at how similar all of our actions were. God only knows how many test strips this group went through during the weekend. Although each of us manage the disease in an individual way we were all connected through the desire to help others manage their disease and the desire to revolution how the disease is managed. On Saturday I had the privilege to view the Triabetes Documentary, much like a 21 year old girl drinking too many cucumber margaritas while watching Steel Magnolias, I balled my eyes out (although I tried to not let anyone notice!). Here I was sitting in a theater with even more people I had never met before and couldn't help snot bubbles from forming and tears streaming down my cheeks. There were a few moments in the documentary that touched my soul – the documentary followed the journey the original Triabetes captains took while training for Ironman Wisconsin in 2008 and their Triabuddies, kids with diabetes under 18.

During the early part of the documentary one Triabuddy broke down in tears when she said "I don't want to do this anymore, I just want to be normal." That statement had tears running down my face, later in the film Brian from Buffalo, NY stated, "everytime we go out to race or train we face the risk of a low," yes Brian I've been there and done that! Dave, who has a blog titled Lowboy talked about how Triabetes transformed his life going from someone who hadn't tested in years to someone who now has an A1c below 7! And what really got me was when a brother of one of the Triabetes captains talked about how proud he was of his brother for challenging himself the way he does, the pride he had in him and how deeply his brother's diabetes had affected him. That had me crying a river as I thought about my family, friends and especially younger sister as I know they all feel the same way.

With each passing moment I began to feel closer to my fellow Triabeates teammates, people who I had never spoken with before were quickly becoming my friends. To look into someone's eyes and know they have experienced the same fears, frustrations, failures and triumphs that you have was an incredible feeling. There was an unspoken instant support in each handshake and each hug. With each parent of a triabuddy I met there was a silent thank you for the example we all set for their children. With each story about training there was a common bond. And when I finally met Anne Findlay, one of my biggest supporters whom I never met but called me after Ironman Lake Placid, who helped me understand how to train and manage blood sugars and who provided so much guidance, there was a huge hug and a thank you for all she helped me with.

On race day I could barely contain my emotions as I cheered each of the 16 triabetes members on during Ironman Arizona. I didn't have the opportunity to talk a ton with the athletes prior to the race since they were off doing pre-Ironman off your feet stuff. Heck, I couldn't even remember most of their names as they passed by in their Triabetes race kits. But that didn't matter, with each pump clipped to a fuel belt, with each finger prick, with each foot strike, I knew what they were going through. When one member stopped at Triabetes HQ for some extra food because he was going low, I knew what he felt. When each member reached transition and tested again in the changing tent, I knew what worry was on their mind. When each member ran with a smile on their face I knew it was because for a day the disease was not preventing them from doing what only a small portion of the population will ever attempt.

Over the course of the weekend I had the opportunity to meet some incredible people. I heard stories of how frustrated some people were during their teen years with diabetes. I shared test strips with someone who hadn't brought enough on race day. We compared how different foods affect our blood sugars and I found out I may in fact be the most neurotic diabetic on the planet. When fellow diabetic triathletes think you're a geek for having such an in-depth nutrition plan you may in fact truly live up to the nickname of Supernerd. I spent most of race day with three diabetics, Julie, Steven and Ryan. Julie and Steve were both awesome and each was a bit older than me but became instant friends. I constantly mocked Julie for the fact that her and her husband went to Ohio State undergrad but Michigan for grad school while Steve and I shared a deep bond of having been diagnosed about 2 years ago and doing an Ironman shortly after diagnosis (he had done an IM prior to diagnosis as well.) But Ryan was one of the most special people I met all weekend. Ryan is a 10 year old juvenile diabetic from California and was Steve's triabuddy for IMWI in '08. In a few months in Carlsbad this 10 year old will attempt a freaking half marathon, he also is a pretty sweet baseball and basketball player. Beyond the athletics thought he kid was amazing, I never heard him complain about testing, and he was as curious about me as I was about him.

During the dinner on race day the 4 diabetics, and 3 incredible type 3s went to a Mexican restaurant for dinner. I cranked my pump up to bolus for 95 units of carbs and Ryan asked with a giggle "how'd you get that number?" With his parents intently listening in I explained to him how I calculated for 20 grams of carbs in the piece of cornbread, the carbs in the side salad (about 10) and the 80 grams of carbs with my meal, then how I gave a slight discount because of the alchohol in the margarita I was drinking. Ryan laughed then went onto munching on his French fries, then asked me what I eat for breakfast. I told him about chia seeds, Odawala superfood and fruit, he then told his Mom he wanted a breakfast shake with cheerios, milk, syrup and bananas! There was just something really special being around a kid who didn't care that he had diabetes and was just going about his day without a care in the world; I've never been around a type 1 under 20 before and this was a pretty incredible experience, can't really put it into words but the conversations I had with his parents were amazing and Ryan was great – I can't wait to see them again while I'm in Oceanside in March.

Although I've never felt alone in my triathlon journey I did feel like I found my colony of bees like the girl in the Blind Mellon No Rain video. As I watched the Triabetes captains cross the finish line I knew that on this journey to the finish line in CDA there were so many others who face the same things I do. Each story that ran past me brought a new meaning to what it means to be diabetic. I went into this weekend thinking I would network with some people, hand out some business cards and become more involved with Triabetes. I left this weekend having my heart and soul touched, connecting with people on an incredibly deep level with a sense of pride and excitement for what I am now a part of. I left my apprehension about meeting that many new people at the airport and from the first handshake let myself out there. I left Arizona knowing that we all have someone to lean on and that in this battle against lows and highs there are others challenging themselves as much as I do, on my flight back I realized that my support network, the people I care about and the people who care about me got a whole lot bigger – I realized that we all really might be able to revolutionize how people look at this disease. Getting to Arizona was one of the most incredible experiences of my life and the smile still hasn't left my face.

Triabetes – I’m On The Way!

At this point a lot of second years in their MBA program will have a firm offer for post-MBA employment. Investment banking, consulting and leadership development programs have been giving out offers for weeks but there's one problem with the system – if you don't drop (submit a resume for an on campus company) you can't interview. I have a tendency to do my own thing and think a bit differently than my classmates. Prior to coming to business school I promised myself I wouldn't return to a life of finance and pursue a career in something that I love, in something that I felt I could make a difference and in something that I felt would let my creativity (even if it's with excel!) and ability to innovate thrive. Given that promise to myself I dropped for a total of ONE job and after receiving an offer for a second round interview decided I wouldn't be able to follow my dreams so declined it. Beating to your own drummer has its perks, potentially waiting until April or May to know where you'll be working to pay off an insane amount of loans isn't one of them!

How then does that relate to a blog about diabetes and triathlon you're probably asking yourself. Well, this weekend Triabetes will be premiering their documentary at Ironman Arizona, and I decided to go! For months I have spoken with Peter, the founder of Triabetes and InsulINdependence about how I could become more involved in the organization to help Peter achieve the vision he has. For a bigger role with Triabetes, whether strategic or athletic he just required that I attend IMAZ and meet the rest of the team. So after a week of pondering whether heading to Arizona for a couple days made sense, yesterday I pulled out my frequent flier card and used some of those points to get my butt from VA to AZ!

I know I want to work in something that is related to sustainability and fitness when I graduate from Darden. There are a few very well known companies I have been trying to network with, two of whose products I use almost daily and have written about frequently and recently. In addition to pursuing my mission of educating other diabetics about sports nutrition management the Triabetes premier provides an awesome chance to network with some companies who share the same passions I do. So really this opportunity was too good to pass up. Plus Mary Eggers promised me a beer if I got out there so if nothing else I have that going for me!

I'm really rolling the dice on this one. I'm flying across the country during one of the busiest parts of the school year to meet with a team of people who share my passions but I've never met before. In fact I've only spoken directly to two members of the Triabetes team on the phone but will be spending my weekend sharing a momentous occasion with them. After the documentary the Triabetes' captains will retire to their hotel rooms to prepare for IMAZ, which I'll be volunteering at on Sunday. If nothing else this weekend will give me a tremendous story, hopefully let me develop some great new friendships and without question proves how awesome the triathlon community can be.

This is going to be a blast!

Hungry, Hungry, Hippo

On Monday I decided to go the Ghandi route and use civil disobedience to test my basal rates; ok I wasn’t making a political statement but I did need to know if my basal rates were in the right ballpark to control my base glucose levels. One of the most difficult things to manage as a juvenile diabetic is the relationship between basal rate insulin and bolus ratios. Too often the wrong bolus ratio can make one think that their basal rate is either too high or too low around meal time. The temptation to change the wrong input for the bs management system is pretty high here as altering the bolus ratio is in a lot of ways easier than adjusting the basal rate. Basal rates have two factors, time of day and units of insulin per hour, Bolus ratios only have one factor units of insulin per grams of carbohydrates at a given meal. It’s always easier to adjust a one variable function than a two variable function.


Because both basal rates and bolus ratios affect the level of my blood sugars I knew I needed to eliminate the variability one factor introduces to the system. Therefore, to remove bolus ratios from clouding my test for the accuracy of my basal rates I didn’t eat a thing on Monday until 7pm. Essentially I checked my blood sugars every half hour so I could see any movements in my glucose levels throughout the course of the day. The results of the test were actually great, I was able to identify 3 points of the day where my basal rates were off, at 2 of those points my basal rate was too low and at 1 of those points my basal rate was too high. Going forward I hope this test helps move me back to more stable glucose levels allowing me to avoid the weird high/ low flip I’ve often encountered from 3pm to 5:30 pm.

The test itself was not fun! I sat through a day of class with my stomach growling and grew more cranky by the minute. During my last class of the day my friend bet me I would be too hungry to swim that evening; by the time I got home at 6:30 pm, she was right, I was starving and had absolutely no energy to swim. I would have liked to run the basal rate test for 24 hours, but was worried that starving myself for a day would have introduced a different variable (my body releasing glucose reserves to make up for lost food) so once my tummy really started to grumble I filled it up with some black beans and chicken sausage. Although my Monday was an unpleasant experience that turned me into a hungry, hungry, hippo it was necessary to figure out what was going on with my blood sugars. Over the past two days my glucose levels have been a lot more stable and the headache I’ve had for the past two weeks has disappeared. Sometimes a little discomfort is needed to control this disease.

DNF…. Blood Sugars

Well we can cross that career milestone off my list; my first DNF. With the line I toe for blood sugar management during each race, a DNF was bound to happen sooner or later; thankfully my first and hopefully only DNF came in an offseason race where I was just out to have some fun. The laissez-faire attitude I had heading into this race may have had a lot to do with the blood sugar nightmare I encountered; I'm going to have to really think about what went wrong to prevent the same situation from happening in the future. The good news; when I was able to run, the race was AWESOME. Plus, there was a canine walk/ run 5k going on at the same time so a ton of cute pooches were out on the trail as well!

Before getting into the particulars of the DNF; some things I learned about a trail half marathon – THEY ARE FREAKING HARD!!!!!!!!!!! I ran the race with my good friend Laura, who is trying to qualify for the Boston Marathon, her stand alone half mary time is south of 1:45 on a bad day and below 1:40 on a good day, but her finishing time Saturday was 1:57. Hills were abound, there were a few deep water crossings, and forget about trying to run on level ground. I felt like Lewis or Clark during half the race navigating my way through an unknown wilderness just praying a bear wouldn't jump out and try and eat me. So in that, the race was a huge success because I did have a blast with it.

For the first 6 miles of the race was running great; I was about a minute or two behind Laura so in the rear of the front group of runners. My heart rate was sky high because of all the hills so I kept having to back off the gas. From the start my legs felt tired and heavy but I assumed that was from all the cold medicine I've needed the past week and ½, may have been some dehydration issues as well. At mile 6 my vision started to get a little blurry and my legs felt really unstable. I stopped at the side of the trail to test – my blood sugar was 100 and I knew it was trending well lower than that. So I took in a gel and walked a ½ mile, I tested again and my blood sugar had only rebounded to 105. I then pounded a fuel belt bottle and walked another ½ mile, my blood sugar had bounced up to 125. At that point I thought I would be able to run again so I took off. By mile 8 I felt AWFUL, I didn't feel safe running on the trail, couldn't keep my footing and my vision was surrounded by a fog. I tested again and had dropped back down to 115. That was also my last test strip! For the next mile I walked/ slow jogged until there was finally a volunteer I could ask for a shortcut back. A little over a mile later I was back at my car where I was able to test again feeling like I was about to vomit and had a blood sugar of 254.

The roller coaster of blood sugars made my legs feel totally unstable and I 100% believe I made the right and safe choice pulling out of this race. I think more than anything this shows the maturity and growth I have gained over the past two years. I can finally say I've learned to run within myself and that I know that whether I run a half marathon at a 6 minute pace, or a 15 minute pace it doesn't change my perception of myself and will not change the message I am trying to provide for others. In the past I would have fought with my mind on that trail, gotten angry that my blood sugars were preventing me from performing and stupidly forced myself to run which could have caused a dangerous situation. Without test strips, in the middle of the woods, feeling sick and feeling low the smart decision was to call it a day, for once I made the smart and rational choice.

I had to delay my Sunday bike ride by 45 minutes because my blood sugars went low during my pre-ride nutrition. That points to my basal rates having some effect on the lows I experienced during the race on Saturday. I also learned a really valuable lesson on Saturday, I cannot take my blood sugar management for granted; whether it is the biggest race of my life or a simple off season fun run, my nutrition needs to be the same priority in each. Because of my disease, nutrition isn't just something I can "do," it's something I have to live and Saturday reminded me of that. From going out to dinner and drinking wine on Thursday to not eating totally healthy on Friday and not finishing my pre-race nutrition drink I made some really poor choices heading into this race. This disease is very individual and while some of my diabetic friends can go out for a run with a blood sugar of 140; for me that's playing with fire. My muscle mass and sweat rate make me a glucose feeding machine, add to that some hills and tough terrain and you might as well call me Jabba the glucose. From now on, for any race, before having fun, before anything else, nutrition is my number one priority.

Had this been an IM, or a race that I was looking to perform in I'm sure my mentality would have been different. For an off-season race where my only instructions were to just have fun, the pressure was off so that probably allowed me to make the smart choice a lot easier than under different circumstances. As much as a DNF sucks I'm proud of myself for staying safe and staying smart. The race reinforced that all the effort I have put into understanding my nutrition needs was well worth the struggle. I'm frustrated by the DNF and at the same time it may have been the best reminder I could have ever received for how important my focus on nutrition is for achieving what I want to do in endurance sports.

Over The River & Through The Woods

This weekend I'll be running The Pack It Out Trail Half Marathon, my first trail half!!!! I absolutely cannot wait for Saturday to run in this race; one of my best friends at Darden will be running with me so it should be a blast. I really can't think of too many better ways to spend a Saturday morning than running through the woods for a couple hours with a huge smile on my face. Then hopefully afterwards eat a ton of pancakes and have insulin effectively cover the carbohydrates in it – that's a great way to start a weekend!

Coach Orton has given me very specific and technical instructions for the race: JUST HAVE FUN! As I think back to my only other trail race (a 10k on Bear Mountain in '07) I was shocked to how much different the atmosphere was at that race than the NYRR races I had been doing in Central Park. I think the nature of trail races brings all runners back to their youth and makes the atmosphere about as light as it can be. One of my favorite memories from that 10k was seeing a guy with flaming red hair, a huge beard and a breath right nose strip dive off a cliff into a pond; probably the only time I flat out cracked up during a race.

I unfortunately won't be able to run in my Nike Frees this weekend. Eric told me that the frees aren't the safest choice for a trail race and since I'm taking on enough risk with my new kettlebell workouts I decided not to roll the dice again. So yesterday I picked up a pair of Brooks Cascadia; a neutral, light trail running shoe – that also looks pretty sweet with a pair of jeans.

The interesting thing will be to see how my blood sugars react to a trail run of this distance. My pace should be a good bit slower than road running, but the hills and terrain should put me in a higher heart rate zone than the given pace normally would be in. This relationship will be interesting and may shed some light on whether heart rate or muscular intensity (assuming they have different physiological repercussions) affect blood sugars to a greater degree. As we know long sustained efforts will decrease blood sugars while short intense bursts can actually increase blood sugars from cortisol production; the big question is, how will the two balance on Saturday?

The kettlebell workout was amazing the other day. My buddy Joe, a Darden classmate and former Marine, and I went through three cycles with the KB. After the first cycle we both thought we were going to need a bucket – I haven't felt like that from lifting since my college football days! Holly cow the KB offer a great workout, Joe and I were both giddy over how challenging these lifts are, next week I hope to have some pictures of us doing some of the lifts. Oddly enough, the day after I started using the KBs my Dad called me telling me there was an article in that days personal section of the Wall Street Journal about Kettlebell workouts – here's the video from the WSJ website.

Over the river & through the woods to the finish line I go; race report to follow on Monday. And a big shout out to Mary Eggers – good luck at Clearwater!!!!!!!!!!!!!

Bring On The Kettlebells!

A few years ago during rehab for a knee surgery my physical therapist, Tim Stump, suggested I check out kettlebells.  Kettlebells are pretty legendary on the cross fit scene but haven't gained main stream use in regular gyms.  This is in part due to the "active" lifting one does while performing kettlebell lifts and partly due to the fact that the motions require a good deal of athletic coordination.  In other words, if people don't have the right knowledge of how to lift with kettlebells the gym could potentially have 20 to 50 pound weights flying through the air!

So last week I ordered an Ader Kettlebell, Coach Orton suggested I start with a 20 kg/ 44 lbs kettlebell because of my previous power lifting experience.  And for point of reference this is what the kettlebell looks like:

Since kettlebell lifts are all done activley they provide both a muscular and cardiovascular benefit.  Eric knows that I reduce stress by lifting.  I've been lifitng since I've been 14 years old so it's a huge part of my life.  My worst days can become better just through visiting the gym and hammering out a few reps - running and cycling always make me feel great, but lifiting makes me feel amazing.  So I'm really excited to try this out tonight.

The plan is to do kettlebell lifts twice a week through the offseason, and regular lifts once a week while continuing with Eric's NXT training.  This should help lean some of my muscle mass, improve core strength and potentially make me faster.  The goal is to be 175 lbs for IMCDA; if I can reduce the size of my arms and shoulders just a little bit while tightening my core, that shouldn't be  a problem.

I had planned to start the KB workouts last week but unfortunetely came down with a nasty cold so was out of comission.  I thought I was getting better on Thursday and decided to head to Darden's weekly Thursday night party.  At first I thought I was black out drunk off of a few beers, but when I totally lost my voice 30 minutes later I realized that my cold had come back 10 fold.  Of course I totally lost my voice on a night when there were non-Darden students at the bar with us, figures, my luck!  Not the worst thing in the world though since I'm taking alot of time to just focus on me.  So I spent most of the weekend in my apartment but was thankfully feeling well enough to head out for a 8 mile run on Sunday since it was gorgeous out in C'Ville!

The way I see it, sometime this week I'll either write about how I absolutely loved this workout, or I'll write about how I'm in the hospital because my arm ripped away from my body and flew across my apartment.  Unless you have something against two armed diabetics lets hope I write about really enjoying the kettlebell!

Blood Sugar Management As A System

Professor Landel, my favorite professor at Darden has often talked to me about blood sugar management as a system or a process. Professor Landel teaches operations consulting and systems design classes at Darden and has had performed some pretty influential consulting work throughout his career. Like me he tends to think in terms of inputs and outputs, lever points and strategic design. Also, like me Professor Landel has often been frustrated by the infinite variables that affect blood sugar management as he has many times asked his wife to design a system for her insulin controls (she is also a type 1). This often results in Mrs. Landel telling Professor Landel to stop thinking like a business professor!


My conversations with Bob and my most recent A1c has gotten me thinking about the precision and accuracy of our blood sugar management. Disappointingly my last A1c was 6.7; while the ADA would consider that in the healthy range, that number is a bit too high for me. I had some issues with blood sugars around lunchtime over the summer and a few very high days were mixed into that. So there are certainly some explanations for why my blood sugar moving average has crept up, it provides little solace.

What I’ve started to consider is whether basal and bolus rates need to be actively managed on a daily basis, or if there are periods of stability. Putting my systems thinking cap on I realize that historical actions influence future blood sugars. Nutritionally, the level of fat, fiber, protein and glycemic index of the carbohydrates in the food we eat and amount of alcohol we drink can alter the rate of conversion for food to glucose. Our level of exercise will alter a body’s insulin sensitivity as will hydration rates and metabolic functions. Those are the variables we can record, but then there are environmental variables which we have almost no control over. Environmental variables include quality and duration of sleep, outside temperature and humidity, level of stress for a given day and just about anything else under the sun. So when we combine things that affect metabolic rate with environmental factors is it possible to really predict blood sugar levels or are we stuck in an ebb and flow of recalculation?

Then I started thinking about bolus ratios, and how they change throughout the day. Why is it that my bolus in the morning is 1 unit of insulin for 14 grams of carbohydrates, at lunch it is 1 unit of insulin for 12 grams of carbohydrates and at dinner 1 unit for 17 grams of carbohydrates. Additionally, these ratios have all been calculated more by feel and experience than anything else. I really feel that to calculate these ratios properly I need to eat the same exact food at each meal with the same exact metabolic influences for a week to calculate the ratios properly – that’s a huge pain the a** but one that might be worth it for tighter blood sugar control.

So if I view blood sugar control as a system, to better calibrate my insulin intake I need to control the variables I can control so that my insulin rates are as right as possible ceteris paribus. Since life isn’t lived inside a vacuum it makes blood sugar management much more artistry than science. The question then becomes how do you use insulin to become more like Picasso than a 3 toed sloth on crack with a paint brush?