Monday, January 28, 2008

Race Report: Central Park Half Marathon

While fighting through major blood sugar issues and a strained quad I was able to finish my first half marathon in 1 hour, 50 minutes and 29 seconds - an 8 minute, 24 second mile pace; both well within my goal range and faster than the 10k pace from just a few weeks ago! My Coach, Mary Eggers and sports nutritionist, Lauren Antanucci both laid out a tremendous plan for me and continue to help my confidence as an endurance athlete grow.

Saturday I had a hard day of workouts with a 20 minute run and what was supposed to be a 3000 meter swim. I made 2500 meters of the swim and was totally gassed so I determined it was best to fight the water another day. That evening I had what has quickly become my favorite meal and what I will continue to have the evening before all my races:

1 1/4 cups whole wheat penne pasta
1/4 cup of peas 1/4 cup fresh cut mushrooms Red sauce with arugula Fresh Mozzarella cheese Basal, Oregano and Some Chilli Pepper 1/2 lbs. of ground buffalo

Total carbs - 80 and bolused with a 70/ 30 dual wave for 3 hours - perfect pre race nutrition and delicious!

Unlike the night before the 10k where my blood sugar spiked into the 200s I went to bed with a gorgeous bs of 91 - it seemed that my neighbors (in the building that is cady-corner to me) who like to shout chinese at each other and cook until 2 in the morning stayed up even later than usual but I still got a somewhat decent night's sleep. I woke up at 6:35 am and tested with a blood sugar of 125 - off to a perfect start.

For breakfast I had 2 scrambled eggs, breakfast chicken apple sausage and 2 slices of whole wheat toast, 6 oz of black coffee and 5 oz of orange juice. I hopped in a cab and arrived to the engineer gate at 7:40 am as planned, found a bench changed out of my pre-race get up into my CW-X tights, running hat and terminatoresque Oakley Radars.

Of course things couldn't continue perfectly! NYRR decided to have the bag drop be conducted somewhere other than the bag pick up location. They lined up 4 box trucks in a small corralled area to collect the bags from everyone. Each truck had 2 people collecting bags and a mass of people trying to throw the bags at the two people - this may have been the dumbest idea any race organizer has ever had. I've learned that some runners are pushy, arrogant and really annoying - force about 1,000 of them into a small area pre race to hand in their gear bag and it makes for a colorful situation. After fighting through the mash pit for 10 minutes I gobbled up my clif bar and made my way to the start area.

Here's where the day started to get really tough:

8:21 AM - 9 minutes before the start of the race I test and my blood sugar is just 112 - uhoh plan A that Lauren laid out so nicely was now out the window - time to go into emergency plan.

Emergency plan: 1/2 of clif bar (20 g of carbs), Accel Gel (25 g of carbs), 3 glucose tabs (15 g of carbs) in the 5 minutes before the race started.

First mile - ran at a 8:05 pace - so much for starting slow (sorry Coach!), I really thought I had held back but apparently not, I slowed it up a bit at this point and 2 minutes later I had my accel gel (25 g of carbs); at minute 30 - about 4 miles into the race I tested and was shocked to see a blood sugar of only 121 - I had ingested 85 g of carbs unbolused with only 10% of my basal rate in the previous 45 minutes and only had a bs of 121 - not good! I jammed down 3 more glucose tabs (15 g of carbs) which are really tough to eat while running and continued on my way.

At this point I made the decision not to test again for the rest of the race. I know - stupid idea. But, The goal has always been more important to me than my body. Getting the job done and proving to myself that I can do it, and do it well has always been # 1 in my book. My body and my health have always been secondary. This mentality will never change because it makes me who I am but this mentality is also really at odds with being a diabetic athlete.

Every 25 minutes for the rest of the race I had another accel gel (5 during the race) and grabbed gatorade at every other aid station. By the end of the race I had ingested about 250 g of carbs and my stomach paid for it the rest of the day. The biggest challenge I had was around mile 11, my hamstring started to tighten up and I had laid out a lovely fragrance on the course for the past 3 miles (thanks accel gels!) when I saw my salvation - a guy running in a Union Rugby t-shirt. My big rival in college was Union, our football team's hated each other - a maylay broke out after our game my sophomore year - think of this as a D-3 version of Ohio State v Michigan. Anytime I see a Union sticker on a car, someone walking in a Union Sweatshirt I instinctively say F*ck Union! (my friends can attest to this) and then in my head start singing Hobart's fight song - this guy gave me the adrenaline boost I needed to motor it home; for the first time in my life I can be thankful of seeing that awful scarlet color.

Quick update: I turn my pump down to 10% of basal rate at least an hour and a half pre run, maintain that 10% until 15 minutes after run than switch to 50% of basal rate for a couple hours. Thank you all for the suggestions in the comments!

Thursday, January 24, 2008

Half Marathon - Sunday 1/27

This Sunday morning at 8:30 I'll set out for a 13.1 mile run in Central Park. My training runs have been solid the past couple of weeks (with the exception of last Sunday) and my legs are feeling fantastic. I should be treating Sunday like any other run but something feels different about it. Since this is a timed race I know that my blood sugar needs to cooperate so I can start at 8:30 am. Since I'll be running with a sea of people I know that just stopping to check my blood sugar isn't as easy as finding the next bench. This will be my longest run to date and if my competitive history holds true, I'll push myself harder on Sunday than I have at any point during my training. I'll find my pace, focus on my goal, get pissed at all those running along side me and be hell bent on making it through to the finish.

For most "normal" people a NY Road Runners race is a social endeavor, a way to get out for an enjoyable run among people you know or want to meet. For me, these things are way more intense. In addition to the concerns about my blood sugar, I want to do the best I freaking can. In life no matter what I do I want to do my best, I don't want to hold back and I want to push myself as hard as possible. I know I won't win my Sunday race, I know I'll never run consecutive 5 minute miles but if I run even 1 second less than my best effort then I consider that day a failure. We all have a potential that we can reach, be it athletic, academic or professional; fulfilling that potential has been a motivating force behind so much of what I have done in my life. This is why "just finishing" has never been good enough for me.

Lauren has laid out a tremendous nutrition plan for me. I know on Sunday I'll need to ingest a total of 500 - 550 grams of carbs throughout the day. This includes pre-race and race nutrition as well as recovery nutrition. She has noticed that one of the reasons I encounter so many lows during training is because I run at a carb deficit. I had assumed that having solid blood sugars meant my carbs were in balance with nutritional needs - in actuality it just means that I balanced the carbs with the right amount of insulin.

Sunday should be a fun day but for whatever reason I'm nervous as hell about it. My goal time is between 1 hour, 53 minutes and 1 hour 44 minutes - between 8:30 to 8:45 minute miles.

Tuesday, January 22, 2008

The Mysterious Case of Honey Turkey & Other Things I Learned Last Week

My lunchtime basal & bolus was a mystery last week. Although I was eating the same thing for lunch that I had been eating nearly every day since my diagnosis (or so I thought) my carb ratio and/ or basal rate wasn't keeping my blood sugars out of the danger zone. Each day about an hour and 10 minutes after eating I would witness my blood sugars climbing higher and higher above 200, then a headache would ensue and that great feeling of an upset stomach would happen. I worried that I'd never again be able to enjoy a turkey sandwich!

Yesterday I went to Jeffery's at the Essex St. Market where I normally buy my turkey for the week. I asked the guy behind the counter for Boar's Head Oven Gold Turkey (the same turkey I thought I had gotten last week). Counter Man points to the maple honey turkey to which I say no, the other one. Then lightning struck, an epiphany hit me, last week the edges of my turkey were brown not gold!!!! The guy made the SAME GOD DAMN MOTHER FING MISTAKE LAST FING WEEK AND F'D UP MY FING LUNCH TIME BLOOD SUGAR - FREAKING BASTARD!!!!!! I now know I must keep my eye on Counter Man or instill the fear of the angry diabetic in him; it is amazing how assuming we are eating one thing when we are in fact eating a similar but not identical product can destroy our blood sugars. I can't even picture what having a food allergy must be like. Counter Man is lucky that the deli case at Jeffery's is 5 feet high, any shorter and he would have easily wound up in the pile of bananas behind me :).

My other lesson came at the pool last week. I set out for a hard core 3500 meter swim workout. About 2000 or 2500 meters into the swim I started to feel a bit weird and decided it was time to test. If I happen to pass out on my bike or while I'm running I figure someone will eventually find me (in Manhattan someone is never that far away) but I'm terrified of passing out from a low while swimming. Perhaps it's because there are maybe a handful of people at my pool who do more than doggy paddle or the fact that the lifeguard has no teeth but something about having a seizure in a pool doesn't give me a warm and fuzzy feeling. Therefore, I'm a bit more cautious during my swim workouts than with any other discipline. So I climb out of the pool and had thought I dried off pretty well. As I shakily open my vile of test strips a huge drop of water falls from my hair right into the canister!!!!!!! I had combined 2 one touch ultra viles into one before I left for my swim so I just ruined 50 test strips!!! Yesterday when I went swimming I only brought 10 test strips to the pool with me.

Friday, January 18, 2008

Basal or Bolus?

Over the past week and 1/2 my lunchtime blood sugars have been running out of control. Each day I essentially have the same thing for lunch, turkey and roast beef with cheddar cheese and mayo or mustard on some sort of multi grain bread. For nearly my entire short diabetic life I have been able to bolus this meal with a carb ratio of about 1 :15. On really active days I'd bring the bolus units down to 2.8 but on less active days never higher than 3.2. But for the past 10 days at 1:30 pm an hour and 1/2 after eating my blood sugars have started to creep into the high zone. On both Tuesday and Thursday my blood sugars closed in on 300. On Wednesday I increased my basal rate by .05 units and reduced my carb ratio to 1:11 but the results Thursday were similar to what they were with the old settings. Pretty confused as to what is going on so I'm going to try and not eat lunch today until 2pm to see if it is my basal rate that is screwing things up - wish me luck and I chew on my arm out of starvation!

The reason I'm pretty stressed out about this change is it has wreaked havoc on my workout routine. To get in a hard swim or bike ride on the trainer I need carbs and I need lots of them. As I shoot myself up with insulin to move away from an unstable 250 and get rid of a killer head ache I know I'm going to need to get my bs back up to 200 again soon. However, the 250 caused by weird events and the 200 that I intentionally hit feel totally different. Due to all the corrections I have had to give myself the past week or so after lunch my IOB is killing my bs during workouts - for example last night I could only bike for 20 hard minutes - it was a great workout but not close to as long as I need to build endurance. If life occurred in a vacuum, ceteris paribus as my old economics professors used to say this would be alot easier to figure out; I'll do my best and let you all know how it turns out though.

Update - Seems to be the bolus and not the basal - in fact the reset basal may be too high. I went low today (44) after breakfast as I over corrected for under bolusing the muffin I had - wasn't in the mood for egg whites this morning and vainly thought my abs looked better than usual so figured what the heck :). Some glucose tabs got me back up to 97 at 12 but by 1:45 I was down to 68 and had a lamb scwharma pita - we'll see how the bolus holds for that. Confusion continues!

Wednesday, January 16, 2008

The Byetta Decesion

Today I meet with Dr. Baker to discuss the results of my 72 hours of monitoring hell and debate the merits of Byetta (exenatide) in treating my recent onset Type 1 diabetes. In mice exenatide has increased the mass of B-Cells located in the pancreas improving their endogenous production of insulin; however trials in humans have been less conclusive. In addition to the preservation of beta cells exenatide delays the absorption of food and nutrients into the blood system similar to symilin. The side effects have been pretty severe though including massive weight loss, pancreatitis, increased hypoglycemia, nausea and diareah (sounds fun doesn't it!)

In order for Byetta to be an option for patients with Type 1 a glucose tolerance test must be performed. A couple weeks ago Dr. Baker had me down bottle after bottle of the homeless man version of McDonald's Orange Hi-C to find out if my body was still producing any insulin. Turns out I still have traces of C-Peptide in my blood when large amounts of glucose are consumed proving that I am still in the "honeymoon" phase of diabetes. This "honeymoon" phase is also the reason why I sometimes can't get my blood sugars high enough to work out, am able to enjoy pizza on occasion and encounter so many hypoglycemic moments - guess the only positive out of that is pizza.

According to Dr. Gitelman of UCSF ~

"It’s extremely important to conserve the endogenous insulin secretion that you still have during the honeymoon phase," Gitelman says. "Even when patients have to take insulin shots, if they can continue to make some of their own insulin, it’s much better for long-term outcomes. Those patients who continue to make their own insulin for longer periods of time have better blood sugar control, lower risk of hypoglycemia and lower risk for long-term complications. "It’s like the difference between riding a bike versus riding with training wheels. It’s very hard to fall over and do something wrong when some of your beta cells are functional."

So the question is will these training wheels help me or hurt me? I have alot of fears about introducing a new drug in my system when my main goal is conquering the Ironman; there's a good chance this drug could really interfere with that goal. Currently I only have 10% body fat so massive weight loss would be pretty unhealthy and if I am unable to absorb all the nutrients my body is ingesting workouts are going to be much less safe and my recovery will take much longer. While improving my body's natural production of insulin would be fantastic I'm not sure this is the best way to go about it. Some studies have suggested that intensive insulin therapy (i.e., pump therapy) also helps preserve insulin production in recent onset type 1 diabetics. Currently I believe my best course of action is to stay the course and not worry about a "miracle" drug - your thoughts?

Monday, January 14, 2008

This Train Is Back In Service

Last Sunday my training just seemed off. After landing in Richmond the day before my interview with Darden I needed to find something to eat and grabbed a Subway sandwich - immediately after eating it I regretted that decision. For whatever reason I felt like I couldn't digest that tasty processed meat but still knew I needed to get a run in that evening. Prior to my run I had a small turkey sandwich, clif bar, accel gel and some Gatorade. During the run I felt like a Hippo after ingesting 15 kegs of beer and promptly threw my guts up after my hour long run. Tuesday evening I had a time trial test on my trainer but nearly passed out 42 minutes into it - my blood sugar dropped from 160 to 106 in a 5 minute span making me feel completely out of it with almost no power in my legs. I kept trying to fight through the malaise but the fog of depression, uncertainty or just sheer exhaustion continued to engulf me.

Finally on Thursday night I started to break free of whatever invisible hand was holding me back. I had a 1/2 hour trainer ride scheduled, perfect just a nice way to get the legs back in shape. As I grinded away I began to feel the strength come back in my legs, with each passing minute my cadence became quicker and speed became faster. At the end I had, had my best workout in a week's time. Friday brought a lifting session and a running session - I was able to complete each with the normal tenacity I have when going through my workouts. Then Saturday's hour long bike ride was my best yet although I was operating on not alot of sleep (social life is back!) and a slight hang over. Add to that yesterday's 70 minute, 8 plus mile run and this train is fully back.

I'm not sure if the troubles with my workouts last week were caused by the stress the Darden MBA interview put me under, something diabetes related, a virus or frustrations of a past relationship. Whatever it was, I was able to put that behind me, force myself to push and break through the wall. Training for an Ironman is all about finding the mental fortitude to push yourself through the hard times. Each run I have, each bike session Coach has me do won't be my best. There will be days where my legs feel weak and heavy, where my back is screaming and my shoulders are crying out. But each time I'm able to push myself through that pain, to defeat the mental demons is a day that brings me closer to my goal of finishing IMLP to the best of my ability while showing that Diabetes won't slow me down.

Wednesday, January 9, 2008

The first 16 hours...

Day 1 of project CGMS has started and it is off to a somewhat annoying start. Yesterday I met with Renee the rep from Minimed at Dr. Baker's office. We went over the details of wearing this monstrosity while she informed me that I wouldn't be able to swim during the monitoring process - sorry Coach! The device looks like this:

I think the information I'll get from wearing this damn thing for 72 hours will be fantastic but seriously can't they make it look like something other than a 1970s style handheld video game! The clip on the back is awful - I normally click my pump to the bottom of my boxers when I get home from work and toss on a pair of shorts - because of how heavy this thing is if you clip it to something upside down it will fall off. Minimed provides you with a sexy shower bag but since the meter is the size of an elephant it pulled my shaving mirror off the wall and fell out of the sexy shower bag - not a fun start to the morning. But in the name of research I'm willing to endure.

Cornell application goes in tonight, Darden (UVA) is still far and away the top choice but I need to make sure I cover all bases, doesn't look like I will receive an interview invite to Berkeley.

Tuesday, January 8, 2008

72 Hours of CGMS

Today at 4:30 I meet with Renee of Minimed/ Medtronic to get fitted with a 72 hour CGMS. Dr. Baker is really into getting all available information about a patient to give them the best care possible. That's exactly the way I believe this disease needs to be managed. So around 5 pm today I'll be hooked up to the 72 hour monitoring system and will then know exactly how my blood sugars moved over that period - this should be a huge help with training and everyday life. I'm really interested to see how my blood sugar reacts to the heart rate test I have on my bike this evening.

In other news I had my interview with the Darden MBA program at UVA yesterday. This year Darden changed their policy of open interviews to invite only so receiving an invitation to interview was a huge step in the process. Normally I come out of interviews feeling like I 100% sold myself to the best of my ability. I wish I could say the same for yesterday, I brought out almost all the points I wanted to but still feel like I left something on the table. Now the long wait until February 1st when decisions are released begins. The format of the interview is open - the only question the interviewer asks is "I want to hear your story from the time you were a child to your decision to apply to Darden," then you go off and try and sell yourself.

Wednesday, January 2, 2008

First Ski Trip

It was with much trepidation that I embarked on my first ski trip since having Type 1 diabetes. While I'm not the best snowboarder who ever walked the planet a day on the slopes is one of my favorite things in the world. There is something about being in that cold mountain air and those amazing views that lets me relax and forget about anything that might be going on in my life. With all the issues I've had with blood sugar lows from working out I was really nervous that diabetes would prevent me from enjoying the mountains.

On Thursday night I fought the traffic leaving Manhattan and headed up to Sugarbush in Warren, Vermont. On the way up I stopped at the supermarket to stock up on multi grain bread, turkey, yogurt, whole wheat pasta, oj, turkey meatballs and some vegetables - I wasn't taking any nutritional chances! On Friday morning I had the breakfast I'd normally eat before a run (2 eggs, 2 slices of toast, black coffee) and gobbled up a clif bar as I was putting on my boots. While standing in the lift line my blood sugar was 120 so I popped my first accel-gel. After 2 runs my blood sugar was in the 120s so I had another clif bar which lasted me well past lunch - the first day was a success, the only low I had was after the last run of the day.

I followed the same protocol on the second day and had similar success - after lunch (where I had 2 beers) we decided to hit Stein's Run a double black, Stein brought my bs down to 56! I still had to get down to the lodge so I could get carbs pronto. So I popped an accel gel, waited a couple minutes and as relaxed as I could got down to the base lodge. Worried that my diabetes was going to crash the fun I told the 2 people I was with that I'd just meet them at the lodge when they were done. Lee, AJ's boyfriend had nothing of it and asked if I wanted him to come with me to grab a gatoraide. I said no it's cool I'll be ok then in one of the nicest things anyone has ever said to me Lee responded with, "well if it's ok with you I'd really like to get that gatoraide with you." Here I was worried that I'd be ruining my friend's vacation and all they wanted to do was make sure I was safe.

This totally made my day and let me realize that while diabetes is a pain when you're surrounded by awesome friends its alot easier to deal with. So this trip was an awesome end to 2007 - I look forward to sharing all my athletic pursuits with you and dealing with diabetes in 2008! Happy New Year.