"Don't You Get Tired Of Eating????"

Last night at about 11:15 pm I flicked the bedroom light back on to test. Kim asked what's up and I said, it feels like the room is spinning so I thought I should test. The meter flashed a "51" so I went to my stash of clif builder bars and began to munch away. That prompted Kim to ask "don't you get tired of eating?"

She's not the first person to ask this question and certainly won't be the last but it is one of the most frustrating things about diabetes. Not the question, the fact that sometimes you just can't eat enough to keep glucose levels high enough. Her second question, "well isn't there something else you could do besides eat?" Was also a very valid question and brings up a huge dilemma. I told Kim, I could turn off the basal rate in my insulin pump and hope that my blood sugar rebounds in 30 to 60 minutes but the downside risk with that is huge. At 51, if there is still insulin on board even with a 0% basal rate one's blood sugar level could continue to fall to very dangerous levels (which makes me question the ideology behind the new minimed pump). So in that I have always found the best thing to do when faced with a low is to eat.

Of course I have other options besides clif bars of any variety but have found the blend of protein, carbohydrates and organic goodness is a great healthy way to fight lows or eat in general - I swear I have to be one of clif bar's largest non-corporate consumers. I place a $125 to $250 order through drugstore.com about once a month. I'm not a huge fan of glucose tabs as I don't really like sugary things and gels do some interesting things to my gi tract, fine when you live alone but when your girlfriend is already sick of living with a zoo animal one has to try and keep those things to a minimum.

So to answer the question - yes I get sick of eating but sometimes you just gotta do what you gotta do.

Exercise & Basal Rates

Since moving to Boston for my summer internship I've been working out on a much more consistent basis than my schedule in C'Ville permitted. Seeing Kim train daily for IM Cozumel has given me extra incentive to work out (I can't let my gf make me look soft!) and with Coach E pushing me I have a great incentive for consistent exercise. However, what I forgot to calculate into my nutrition plan was the enormous effect increasing my daily exercise workload would have on my basal rates.

Over the past three weeks I've performed something like 30 hours of exercise and noticed a gradual reduction in my blood sugars. This week my blood sugars were attacked by a pack of rabid dogs so I've had to fight to maintain a blood sugar above 80. At the beginning of the week my basal rate was about 13.5 units of insulin per day, today my basal rate is down to 12.15 units and falling. Each day this week I've had at least three instances of blood sugars below 60 and on Wednesday night I had to have a full on carb fest to keep my blood sugar above 70.

This reminds me of the benefits and dangers of a type 1 diabetic undertaking arduous training. The huge benefit is that as my body becomes more responsive to insulin I'll be able to enjoy some of the foods I've had to avoid over the past year. But if I am not constantly monitoring my blood sugars during this transition period the chance of a really dangerous low is greatly enhanced. That relationship reinforces how essential it is to be vigilant in monitoring blood sugars and flexible enough to adapt environmental factors in blood sugar management.

IOB - How I Haven't Missed You

An increased training load brings all the old blood sugar demons with it, no ticket required. When I was on my own hodge-podge training plan I didn't have to try and squeeze in a workout, if life happened, life happened and I'd just as happily skip a workout as I would ride my bike for hours on end with no real goal in mind. However, now that I'm training under Coach E, there is no way I'm going to skip workouts just because life got in the way. I'm coachable to a fault which makes me something like Pavlov's dog but we'll leave that to another time.

Yesterday, Kim was home sick so when I got home from the internship I decided to help finish cleaning the apartment. We finally received our Rubbermaid Fast-Track storage system and both of us wanted to put it up right away to finally get some space in the "spare room". By the time we finished it was 7:15 pm and neither of us had eaten yet.

I woke up at 5:30 yesterday to get my swim workout in, but throughout the day my blood sugar remained somewhat high. At 7:15 after a couple extra units of insulin my bs was still in the 190s, I needed to take some insulin in for our left over Chinese food before my hour and 45 minute bike ride but also knew I didn't want too much IOB to create a low during exercise. With that I gave myself 3.5 units of insulin for what I assumed was a 100 to 120 gram carbohydrate meal.

At 8:30 I jumped on the trainer for a killer workout that Coach E prescribed. 40 minutes into the ride I started to feel sapped of some leg power and decided to test. When I saw a bs of 90 I knew my workouts were done for the night - just too much IOB to recover from that safely. 25 minutes later my blood sugar had rebounded to just 100, and an hour after that i dropped to 71. I made the right call jumping off the trainer but it reminds me of how exact I need to be to complete all my workouts - looks like I might be moving towards a year of chicken sausage and brown rice!

Selective Amnesia - Ed & The Ironman Meet Again!

After a rather awkward ending to my first job out of college my former manager said to me, "you're really a glutton for punishment aren't you?" Those words couldn't be any truer today. Today I decided to set my second date to dance with the Ironman at Ironman Coeur d'Alene on June 27, 2010!!!!!! I remember the pain, the sacrifice and the misery endured training for and finishing Ironman Lake Placid in 2008 but that race left me thirsty for so much more.

The search for my next coach, the obsession with my Navigator and excitement over the results I posted at this year's Mooseman were all directed towards ensuring I would be capable of preparing for my second Ironman. Ironman Lake Placid meant so much to me, but I was far too novice in the sport and far too new to diabetes to really relish in the athletic challenge of it all. Training for the 2010 IMCDA provides the perfect platform to test the nutrition protocols I've been working on for the past two years and to feel what its like to compete at this distance with experience.

On Saturday I completed my first training session under Eric's coaching, I cannot begin to express how alive I felt under a workout program again. The strategy it takes to prepare for an Ironman is just awesome and keeps me energetic and enthusiastic each and every day; add to that the knowledge I can gain in blood sugar management with a better heart rate device and better blood sugar monitor and this year is just going to be amazing. I can't wait to encounter all the surprises, twists, turns, bumps, bruises and smiles I will have on my path to June 27, 2010. Blood sugar high or low, I'm looking forward to this ride!

New Beginnings

Ever since IMLP I have been on my own for training, I developed my own training program for the Charlottesville Marathon, have set my own distance and timing targets for rides and runs and well stolen Kim's workouts for the pool. (I know nothing about swim workouts!) But I have realized to reach my goals in the sport I need a coach; but more importantly I needed a coach who understands how to transition a power athlete into an endurance athlete with power. Most triathletes and triathlete coaches come from an endurance sports background; quadzilla, charging rhino and custom maid suits because your chest is more than 10" bigger than your waist are things foreign to most of those that train for hours on end. So my needs for success in triathlon are slightly different than the norm. For me, it is essential that I work with a coach to learn how to harness my athletic advantages which are best suited for quick bursts of speed towards sustained effort and pace. That requires a different knowledge and experience base than the traditional triathlon coach.

Mary Eggers will forever be the most important coach I will ever have in this sport. She helped change my mindset to believe that the journey to the finish line is vastly more important than the step across the line. Coach Egg helped lead me to the realization that the self awareness a triathlete gains through hours of solitary training and the internal fortitude one gains through the challenge of daily training is where the true beauty in the sport lies. Those mental lessons will go further for my success as a triathlete than any training day ever will and for that I am eternally grateful.

However, Coach Egg and I both knew that to harness my athleticism I needed a coach with a strength and conditioning background and a coach who matched my curiosity about innovative ways of doing everything. In Eric Orton, I think I have found everything I have been searching for and more. Coach E (as he will now be known) is a former division II tailback turned endurance runner and all around fitness geek. Coach E formerly served as the director of fitness for the University of Colorado Health Sciences Center and is certified as both a USA Triathlon Coach and USA Cycling Coach. Even more interesting he helped in the writing of "Born To Run," currently ranked #14 on the NY Times best seller list. "Born To Run," is about the training of a former non-runner to ultra-runner through some of the training methods of the Tarahumara Indians.

Best of all Coach E believes in training the mind as well as the body. He takes an innovative, curious approach to training where he strives to integrate movements from other sports into training for triathlon. In this his goal is to create an athlete that is strong from the foot to the mind with training that focuses on quality not quantity. Coach E and I are both really excited to work together and believe our geeky curiosity towards training will make this a great partnership.

I can't wait to finish my fitness tests and really get after it.

When it works.... Its Awesome

Day 3 of the Navigator Experience has been going great. Unlike the troubles I had during the Charlottesville Marathon and unlike the SNAFU on Monday, I've been getting accurate readings and great comfort from my over sized bundle of blood glucose readings. Having the Navigator in my pocket during a meeting or on the bus ride home gives me peace of mind that I'm not going to bust into a spontaneous sweat because of a low. So for that I give the Navigator huge props for actually working over a 48 hour period! PROGRESS!

Amazingly enough the sensor stayed in place during my charging rhino impersonation on the track last night. I'm currently performing new threshold tests for my new triathlon coach (more on that tomorrow and hopefully a big announcement on Monday) and had to do my 6 minute run test last night. I ran .93 miles in 6 minutes with an average heart rate of 173 and a max heart rate of 179, I have no idea what any of that means, except I thought my lungs were going to explode when I had finished. I continued to cough up whatever badness accumulated in my lunges since IMLP until about midnight last night. So I'm pretty sure I reached my threshold. What was really cool and relevant, was the Navigator was able to immediately sync back up with the sensor when I was done with my run (no idea how the blood sugar was during the run) and continued to be accurate for the rest of the night.

Additionally, the CGM has identified a basal rate that is too high at 2am, too low at 3:30am and just right from 7 am to noon. That's the real beauty of a CGM, to see what the trends in a basal rate are, especially those little trends that can creep up on you and turn a 110 into a 250. Anyone can adjust either a basal or bolus rate for blood sugars that go really high or really low, but the blood sugars on the margin of good and bad are the ones that wreak havoc on an A1c. Hopefully the Navigator Experience continues after my swim test tonight!

Off To A Better Start

Last night I inserted my second Navigator sensor in as many days to continue my attempt at getting my CGM to work right. This time after insertion I was met by a nice gushing of blood which dripped all over Kim's bedroom floor - she has to be thrilled I'm living with her for the summer! Between the random test strips she finds all over the apartment, to my bleeding on the floor and piles of triathlon equipment (although she has that too) I don't know how she puts up with it!

Anyway, unlike yesterday after the 10 hour warm up period I tested my blood sugar and was greeted with a bs of 101 - perfect! Since that point the CGM has been pretty much spot on; I just did a check to compare the results of the CGM with my Ultramini; the CGM has me at 173 and the ultramini at 191 - not bad after some falafel for lunch about an hour ago.

The real test will come tonight when I test my heart rate thresholds in a 6 minute all out track workout. If the sensor stays attached through my charging rhino act the Navigator may have promise after all; if not its back to the drawing board where I need to figure out how to get the sensors to stay in my skin.