Monday, March 31, 2008

Man In The Glass

I recently became aware of this poem written by Dale Wimbrow in 1934. Part of what drives me is living up to the potential I believe I have; in other words when I look in the mirror I want to know I was honest with myself and gave everything my best:

When you get what you want in your struggle for self,
And the world makes you King for a day,
Just go to the mirror and look at yourself,
And see what that man has to say.

For it isn't your Father, or Mother, or Wife,
Whose judgement upon you must pass.
The fellow whose verdict counts most in your life
Is the one staring back from the glass.

He's the fellow to please - never mind all the rest
For he's with you clear to the end,
And you've passed your most difficult, dangerous test
If the man in the glass is your friend.

You may be like Jack Horner and "chisel" a plum,
And think you're a wonderful guy,
But the man in the glass says you're only a bum
If you can't look him straight in the eye.

You can fool the whole world down the pathway of years,
And get pats on the back as you pass,
But your final reward will be heartaches and tears
If you've cheated the man in the glass.

Thursday, March 27, 2008

Almost Made It The Full Year.....

A week before my first anniversary as a type 1 I came down with the flu. All year I had heard warnings from doctors, friends, and Internet buddies to be really cautious when you get sick because blood sugars can go crazy with illness. I had a rough cold back in October but nothing that really affected my blood sugars - my good fortune turned out to be short lived though.

Tuesday I was all set to head to the pool at 4pm; around 2:45 I got a slice of pumpkin loaf from Starbucks to shoot my blood sugar up into the 200s. Right before eating I had a bs of 130, 30 minutes after eating I had a bs of 75, wtf! I took a sip of coca-cola, 15 minutes later my blood sugar was 70 and my stomach started to feel less than happy. I sat at my desk wondering what the heck to do. Chelsea my most trusted diabetic alli told me to use a small shot of glucagon if my blood sugar got really low but otherwise just take the subway ride home really slowly.

So with great trepidation I set out of my office for the subway ride home. Once in my apartment I curled up in a ball on my bed until the stomach demons arrived forcing a mad dash to the bathroom. I tried to keep down Ginger Ale and Saltines but nothing was cooperating, worse yet after I emptied my stomach 3 or 4 times my blood sugar started to shoot into the 200s as I felt a fever come on. I tried to drink as much as I could, but I woke up at 1am with a bs of 230, a high fever and a ton of confusion. I knew I needed to drink something, and drink something fast so I mustered all the energy I could to make it to my refrigerator; the trip back to bed wasn't as successful as the trip to the fridge! After about 5 steps I felt my legs give out from under me and heard a loud crash and saw a flash of light. Next thing I knew I woke up in a puddle of sweat staring at my ceiling - guess I didn't get those liquids soon enough. Knocking my head on my hard wood floor kicked some sense into me however. Instead of drinking the ginger ale I remembered I was high, bolused and downed 2 water bottles filled with water and smartly kept one next to my bed that night.

Yesterday my blood sugars were still running a bit high so I found the energy to make it to my pharmacy to pick up my new prescription of insulin (was supposed to pick it up the day I got sick). Thankfully everything seems to be back to normal today but I learned a ton from my 48 hours of hell:

1 - Always, always, always, keep drinking fluids when sick with diabetes, the combination of a fever and high blood sugars can lead to huge problems - like passing out on your living room floor.

2 - Monitor blood sugars every 1/2 hour when battling the flu, recovery is alot easier when the bs is under control.

3 - Be less concerned about eating "perfect" foods than you are with eating things you can keep down when sick, 48 hours of white bread and saltines won't kill your A1c.

Thursday, March 20, 2008

Dual Wave & Exercise

The trials and tribulations of a newbie diabetic triathlete continued yesterday with some experimentation of a dual wave bolus prior to working out. My Dad had a doctor's appointment in the city and wanted to take me to lunch afterwards. With my acceptance to Darden a whole lost sense of responsibility has occurred and while I'm technically "still working" one could say my motivation and workload has decidedly dropped off :). Given that, there was no way I could pass up a free lunch. So he took me to Delmonico's Grill where I had what I believe is the best philly cheesesteak this side of Pats. Delmonicos places delicious strips of finely cut NY Strip on a french baguette and covers it in perfectly melted artisinal chedar cheese; I estimated the sandwich and french fries to be 80 grams of carbs. I used a 70/ 30 dual wave bolus to cover the meal and had the second wave last for 2 hours.

After the dual wave finished my blood sugar was 127 which I thougtht was perfect, what didn't occur to me was that my lunch time bolus lasted 2 hours longer than usual and would have a dramatic impact on my run. Prior to my run I had a clif bar and a Starbuck's yogurt parfait, in the locker room my blood sugar was only 165 so I popped an accel-gel pre run. During my run I sipped on Accelerade (25g of carbs), 29 minutes and 3.1 miles later my blood sugar had hit 68 and I could tell it was trending down.

When I first got off the treadmill I was really disappointed and thought it was back to the drawing board to figure out my nutritional needs. After careful consideration I realized that even though my basal rate was turned down to 10% 2 hours pre-run there was an additional unit or 2 of insulin floating around in my system then I had accounted for. This small change rendered all the usual metrics I use for calculating nutritional needs for exercises useless. Lesson learned.

Monday, March 17, 2008

The 3 Rs - Recovery, Recovery, Recovery (What I Learned Last Week)

Ever since I started this triathlon training thing I've been hearing how important recovery nutrition is. All this information pretty much went in one ear and out the other. I thought I was "tough" enough where I wouldn't need to pound carbs and protein after a long bike ride or run. I said self "dammit, you made it through college athletics not worrying about all this stuff so really you don't need it now." Boy was I wrong!

In the past few months I've noticed that after a couple days of hard training my body would be exhausted. My legs would ache, my muscle felt like they had no energy and I would feel pretty awful in general. Looking at my food logs I was taking in just about the right amount of carbs so I never could figure out why my muscles were fatiguing so quickly.

As I did more research into the endurance sports world it became apparent that recovery food must be ingested within 1/2 hour of finishing a long workout to prevent muscle break down and latic acid build up. Since my carb and protein intake wasn't until much later even though I was taking in the right "amount" of food my body couldn't utilize it in the proper way.

Enter overpriced recovery drinks! Last week I picked up Endurox from the local GNC to give this recovery thing a real try. Endurox is made by Accelerade and is highly recommend by many of the uber-triathletes on Slowtwitch. This past weekend I did a 60 mile bike ride on Saturday and a 7 mile run on Sunday, after each activity I pounded a glass of endurox and can't believe how effective the stuff is. My legs are sore but not dead and my body feels fresh - this stuff really works! Better yet my blood sugars have been stable! The high concentration of carbs in 8oz of this stuff (52 g) is perfect for glucose level recovery and really made an impact in my workouts. Over the next couple weeks I'll be testing Hammer Recoverite and a few other brands to see which works best with my body.

Wednesday, March 12, 2008

That's How We Spell New York

"A Knife, A Fork, A Bottle And A Cork.
That's How We Spell New York."
~ Dillinger
On Sunday evening my parents and I celebrated my acceptance to business school at Perilla, the restaurant had the above line from a Dillinger song framed outside the bathrooms and I could think of no better saying that defined why I loved this city. Almost all of my favorite memories in Manhattan can be linked to a type of food or a meal. My love of culinary conquests was greatly challenged when I was diagnosed with Type 1 but with the right balance of training and nutrition I still get to reward myself.
Prior to my Type 1 days my favorite chowhound and I would traipse all over the city in search of culinary delights. Finding us standing online for a Hallal Cart on 53rd street for an hour wasn't that uncommon. At any given point in the day a phone call might have taken us away from scouring message boards in our search for that next great hidden spot. Fancy meals, cheap eats, holes in the wall, it didn't matter as long as the flavor jumped off our tongues and the wine flowed freely. From a $600 meal at Babbo to a $5 meal at the Cart I had a fantastic time finding food.
My biggest fear when I was diagnosed with Type 1 was that I'd no longer be able to pursue my love of food. For the first couple months of my diagnosis I only ate egg whites, turkey sandwiches, chicken sausage and vegetables. My taste buds craved pasta, pizza, burgers and the creative but I was scared to death of what that would do to my blood sugars. I fought with my favorite chowhound as she would scarf down a cheeseburger in front of me. I yelled at my parents when they would ask me if a stuffed chicken breast was ok for dinner when I visited them on the weekend. At the time I felt like one of my greatest joys in life was taken away from me. I feared a life where the tastiest thing I could eat was a freaking Clif Bar.
Then as I started to train for triathlons I noticed that insulin was more effective on my body. I remember that first bike ride after my diagnosis, it was a 30 mile ride up to Nyack, and the reward was a muffin; my blood sugar held steady and I was happy as could be. The following week I did a bike ride that was a bit longer and took a huge chance - gnocchi for dinner; by God I bolused too much for it!!! I thought how could this be, I just had a carb heavy pasta drenched in gorgonzola sauce yet my blood sugar is going low?!? Over the next couple months I would try pizza, burgers, hallal food, greek food, all the things I used to love and discovered I could still eat them. What I came to realize was as long as I ate healthy "most of the time," and mixed in hard core exercise on the days I was going to chow down I could reward myself with delicious food. I can't have nachos for lunch and creme brule at dinner anymore but I can have nachos after an hour long swim and creme brule later that week after a 2 hour bike ride. Type 1 has forced me to balance my diet, and exercise more to enjoy those things I love.
I reflect on this as I anxiously await season 4 of Top Chef. Perhaps no other show caters to my love of adventurous food quite as much as Top Chef does. Harold the season 1 winner is the owner/ chef of Perilla - after a couple hard weeks of working out I had duck meatballs, edename falafel, broccoli rabe, hanger steak, potatoes, 2 glasses of pinot noir and the most delicious doughnuts (my first as a diabetic or first in nearly a year) I've ever had. Yes with that meal, extra exercise and sacrificing to eat healthy most of the time, a knife, a fork a bottle and a cork is still how I spell New York.

Tuesday, March 11, 2008

JDRF Mentor Training

Tonight I'll be at JDRF HQ for their mentor training program. I had reached out to the JDRF shortly after I was diagnosed to see if there was any way I could lend an ear to people struggling with the daily grind of the diabetes. As I understand it this is the first time the JDRF will be launching their mentorship program in NYC although it has existed for a while in other cities. I'm pretty excited to see how it goes and am really looking forward to meeting some like minded people tonight.

As a public service announcement - remember to set your DVR to Bravo tomorrow night 9pm, Wednesday March 12th for the season premier of Top Chef Season 4 - Chicago!!!! Top Chef is my favorite show and tomorrow's post will be dedicated to my love of NYC food.

Monday, March 10, 2008

The Emptiness of An Endurance Sport

Sunday, for the first time in months I decided to skip my long run, put my feet up for the day and relax. My mind, body and soul all were exhausted from a draining few weeks so I simply needed to recharge. After a long and in-depth conversation with my Coach we decided to pull out of the Shamrock Marathon in Virginia Beach. Coach Eggers fully felt that I could finish the race but only at a slow and steady pace. My competitive spirit won't allow me "just to do something," I feel the need to challenge myself at every turn. Entering an event with the idea of just finishing really sat poorly with me, I knew full well once the gun went off I would have killed myself to get past the finish as quickly as I possibly could. Given my psychotic competitive spirit we both determined that the marathon would be a huge detriment to my training.

But all this got me thinking about endurance sports, the challenge they present and how they directly contrast to my athletic past. As a football player I was motivated not only by my desire to be a good player but more importantly my refusal to let my teammates down. I would have done anything for my fellow lineman; Haggs, Latimer, Nate, Adam, Ricky, Noz, Archer, Ryan, Kubs, Baker and Ralphie are like brothers to me - I haven't spoken with some of them in years but if my phone rang and they needed anything I'd be the first to volunteer. The family spirit that football creates is totally absent from endurance sports. Where I would have been devastated if I ever let the boys down, the onus of preparation falls squarely on an individuals shoulders in Triathlon training. If I fail to prepare, if I don't give my all the only person I'm hurting is myself; sure I may fail to live up to other's expectations but in no way have I violated their trust.

Diabetes in many ways is like training for a triathlon. Each day we grind away, testing our blood sugars, measuring our carb intake and making it through to the best of our ability. When we can no longer handle all the metrics we must calculate to control our blood sugars we can take a meal off and in the short-term the only person we're hurting is our self. However, contrary to endurance sports in the long-term our families will suffer along with us due to the complications of not controlling our disease while the fear of death is constant motivation to manage one's blood sugar. In triathlon training, the only motivating factor is the question of whether crossing the finish line is important enough.

Like everything else in life sacrifices must be made; the only way one can have the stomach to sacrifice is if that goal, that person, that event is important enough to give you the strength to do it. Proving to myself that I am still an athlete and inspiring others with chronic illnesses is important enough to me to keep me motivated to train. In the recent past I have lost some of the other influences that gave me the strength to train but must focus on the positive as endurance sports are lonely enough. It is easy to sacrifice when you fear letting people whom you really care about down, but either when others aren't important enough or you're competing in an individual event you must find that one thing that will continually motivate you to train and sacrifice.

Thursday, March 6, 2008

The Important Things In Life

With every twist and turn of life it is important to keep the big things in perspective. Whether we miss out on what we think is the "perfect job," the "perfect school," or the "perfect whatever," we have to continue to follow our hearts and keep that larger picture in mind. As a diabetic we are reminded of this on a daily basis, that one bad blood sugar reading doesn't mean we'll go blind tomorrow. As a triathlete this lesson is reinforced on a daily basis and as a maturing adult I'm realizing this balance will be emphasized throughout my life. We ultimately are all in charge of Myself Inc. and are responsible for the well being of our own corporations.

Today at 3pm I'll speak with my Coach about my planned marathon next week. I think there is a really good chance she'll tell me to pull myself from the event. Over the past couple weeks I have felt grossly unprepared to run 26.2 miles. Sure I had a great 1/2 marathon time of 1:50, an 8:23 mile pace but on all my runs sometime between 1 and 1/2 and 2 hours my body breaks down and my legs seize up. At 5'8 and 185 lbs I am not a long distance runner and I am not an endurance athlete - as a very wise friend once told me "you can't make a bulldog into a poodle." So I feel unpreparred not because I'm under trained - I've done everything prescribed to me, I fell unpreparred because I do not beleive my body is ready to take the pounding of a marathon.
I know in my heart by July 20th I'll be able to conquer the Ironman course in Lake Placid that is the goal, running the Shamrock Marathon is not. I need to be mature enough to understand that not running that marathon may be more beneficial than running the marathon - that the pain, cramps and body fatigue I will experience from that race could have serious negative effects to my training, not to mention my blood sugars and body.

My family and I must also consider the daily struggle my dog is going through. We can neither get too high nor too low as he experiences the ups and downs associated with chemo therapy. But it's tough not to stay positive and do everything you can to help out a guy that makes you this happy:

Monday, March 3, 2008

What I Learned Last Week - DON'T START OUT HIGH!

The Shamrock Marathon on March 16th in Virginia Beach will be my first marathon. Right now I have about as much confidence in my ability to perform during that race as a live chicken would have for its chance at survival in a tank filled with alligators. For the past month and 1/2 I've been going out for runs greater than 13 miles on Sunday and each Sunday brings about a different issue. Whether it's my surgically repaired knee flaring up due to a bone on bone condition, my blood sugar starting off too low, dehydration or not enough salt, something has made these runs way more painful than they should be. Of course this is all part of the transition from a strength/ power athlete to an endurance athlete but to be honest - the process SUCKS.

Yesterday I learned a really valuable yet frustrating lesson as a diabetic athlete. I was up at my parents all weekend spending some quality time with Moose and had planned to run on the Northern Westchester bike trail yesterday. However, a brief snow storm Friday night covered the trail in snow and ice (I had hoped it would melt away by Sunday but no such luck.) Of course I didn't realize that the trail was not clear enough to run until after I had gone through my morning protocol - eggs, a muffin, a clif bar, basal rate down to 10% - blood sugar up to 200 + and ready to go. At 12 pm I frantically packed my things - hopped into my car and drove to central park.

Since my body still produces some insulin when it feels so inclined I knew I'd need to eat something else prior to my run so I had 1/2 a turkey sandwich 45 minutes pre run. By the time I parked my car on 93rd street my blood sugar was 310!!!! No matter how much water I drank during my run or how much ensure I took it felt like my body was just blowing through whatever liquid I ingested. I could only manage 2 hours out of my 3 hour scheduled run and ended with severe cramping in my left calf - so bad that I could barely walk back to my car.

Diabetes and athletics takes a really delicate balance for success. Each day presents a new challenge; blood sugars spiking after you expect them to forcing you to miss a workout, blood sugars running too high ruining a nutrition plan. My knowledge base grows with every workout but between runs in cold temperatures, sore legs and a heavy heart I really could use a nice easy week :).