Monday, December 21, 2009

Altitude – Lets Add Another Variable To The BSM System!

After a little help from some amazing friends I was able to ski during each day of my Aspen adventure and live to talk about it the next day. I'm still in awe of how my friends came to my aid when I was in need of a new blood sugar monitor last week and proved to me once again how incredible my support network is. As much as I'd like to be tough as nails and say I can face this disease alone, the truth is each day is a new battle and it takes a whole network of individuals who come together as family to let someone achieve everything they want to achieve. But, what Aspen let me realize is that there are variables I had never considered in my blood sugar management system analysis; by the time I flush out my thoughts for this thing I'm going to have a laundry list of things to quantify.

From the moment I landed in Aspen my stomach had angry gremlins running around in it. One of my friends politely referred to the gremlins as "alti-tooties," in less suave terms I was smelling up the joint quite frequently – no matter what I ate or drank. The altitude was wreaking havoc on my digestive process so for the first 3 days of fun in the snow I had to constantly eat to maintain a healthy blood sugar. Over the first 3 days in Aspen I think I had 9 to 12 lows. As my metabolic system slowly got adjusted to the altitude the leftover carbohydrates ingested to combat the lows were released into my blood stream causing some nasty highs. On Wednesday, our fourth full day in Aspen and the day I lost my meter my blood sugar was as high as 520 even though I had done nothing different from the prior day.

For the next two days I fought off highs as my body continued to digest the food from the previous 72 hours and become more acclimated to the altitude. I'm also sure that the copious amounts of alcohol had some impact on my blood sugars as well. So if nothing else the crazy blood sugars due to the travel put an additional log on the fire for my choice to pursue a non-traditional MBA path that will not have me travel as much as a job in something like consulting would have. I'm continually amazed by how variable this disease can be and how in-depth the system of blood sugar management is.

I also had the privilege of running hill repeats in the Colorado altitude – it was freaking awesome!!!!! Apparently two of my friends were talking about how I went out to do hill repeats and one said "but yeah well Ed's insane, so it's just a normal day for him," ahh the life of a triathlete. I could not believe how hard the hill repeats in altitude were. Coach Orton had assigned me 6, 1 minute hill repeats at a "train not strain," effort – or just below max effort without throwing up all over myself. I took off on the hill for my first repeat and thought my heart was going to explode. For the next 5 hill repeats I could only go for 30 second at a time. The intensity combined with the altitude was having me get light headed 30 seconds into each repeat so that's all I could last – unreal! On the "cool down" run home I was heading up the access road at a 13 minute pace with my heart rate hitting zone 5 – steep and light air = more craziness. Altitude training definitely has some huge advantages, I had a blast challenging myself in the thin air.

So in closing, altitude is awesome for training, kind of not so awesome for blood sugars, all in all it was one heck of a week!

Wednesday, December 16, 2009

Adventures of a diabetic in Aspen

After four straight days of incredible skiing I took the morning off to do some hill repeats (yes I do hill repeats on vacation, masochist, maybe, bat sh*t crazy – absolutely!) so I had some extra time to collect some of my thoughts and blog about them. So far Aspen has been incredible, I still haven't found that elusive cougar to pay off my student loans but that hasn't stopped this experience with my great Darden friends from being incredible. We were blessed with some amazing powder on the slopes and essentially have the mountain to ourselves. The altitude had made blood sugar management a bit difficult over the first few days but thankfully that's under control now.

Monday, I had one of the most amazing, heart –warming experiences of my life; an experience where I had to totally trust and depend on my friends and an experience that turned some of my Darden classmates into family. As I mentioned above the altitude had made blood sugar management pretty difficult. As my body adjusted to the thin air I wasn't digesting food at the same rate as I normally do, this caused my blood sugars to be pretty low for the first two days in Aspen. By day 3 all that food I had to eat to maintain a safe blood sugar level started to enter my blood system so my bs was above 300 from 7:30 am until 4pm, reaching as high as 520! My friends could see in my face that I wasn't doing well and all of them offered to ski home with me during lunch. Never wanting to admit that I need help I told them I would be ok and skied back to the condo to rest up and hopefully get my blood sugar under control.

Somewhere along the trail on my way back to the condo my blood sugar meter fell out of my pocket, when I realized this I didn't think it was that big of a deal as there is a pharmacy down the road at Snowmass. I tossed on a pair of sweats and took the condo shuttle to the pharmacy – here's where things get interesting – they didn't carry blood sugar meters. Ok, no big deal I'll just head into Aspen to hit up Carl's Pharmacy and pick up a blood sugar meter there; Carl's doesn't keep bs meters in stock and would have had to order me one!!! Seriously, a legitimate pharmacy that fills prescriptions doesn't have blood sugar meters in stock, ok now I'm starting to get a little worried.

I loaded Google maps on my blackberry and searched for pharmacy, it seemed there was a clinic just down the road in Aspen so I hoofed it over there – the clinic was out of business (the plot thickens). One more shot in Aspen, the city market, and you guessed it, no blood sugar meters there either. Apparently the sodalities in Aspen have no need for blood sugar meters, or maybe they are just trying to get rid of all the type 1s in their town. I sat there on a corner by myself in Aspen, terrified; about to break down in tears, I was afraid. I had taken in 2 clif shot gels during my walk, I knew I had a ton of insulin on board from fighting off the 300s, and could feel the symptoms of a low, I trusted my gut and figured in the short term a high was safer than a low in case I misread my symptoms.

I texted Peter, the head of Triabetes, who offered to drive a bs meter to me all the way from Denver! I thanked him for the incredible offer but told him I would try and exhaust all options before that. My phone then rang, Jen, one of my best friends in the world had called the Aspen hospital for me (who also didn't have any blood sugar meters in stock!!!) and told me that they informed her of a pharmacy 25 miles away that would have bs meters. The big problem was, none of us had a car and without my trust steed El Bastardo, my legs couldn't cover 25 miles fast enough.

Hating to have to impose my needs on someone else I texted another Darden classmate whose girlfriend and Darden graduate lives in Aspen to see if they could bring me to the pharmacy. Bucky and Kelly generously and self-lessly of course agreed to help me out and bring me there. After they picked me up Bucky also told me I should have let them know how important the meter was, since when I spoke with them on the phone I kind of just said it is important so I know what my blood sugar is, but it isn't essential that I have it right now. When I described not having my meter as a blind man walking along the edge of a cliff without a guide stick Bucky and Kelly each said that qualified as an emergency. Bucky, a former pro triathlete, skipped a Lance Armstrong book signing to bring me to the pharmacy – how awesome is that; my Darden friends are truly awesome.

25 miles later I finally arrived at the pharmacy in El Jebel, Colorado and was thrilled to find a shiny blue one touch ultra mini meter waiting for me! The day was saved; during my ordeal I had received so many text messages from my Darden friends making sure I was ok, and each gave me a huge hug when I met up with them again that night. I'm still very much learning how to deal with this disease and I don't always remember that I've had it for less than 3 years. I definitely had my "I just want to be normal," moment on this trip but with friends as amazing as the ones I have I know that no matter what I'm confronted with I can make it through. It was just pretty incredible that people were willing to take time out of their vacation to help out a friend and truly support me when I was scared out of my mind. I've had a few too many life lessons in the past six months but just like I realized in IMAZ that I'm not in this alone, I realized in Aspen that type 1, 2 or 3 people are here to support and care for me; that realization might be the best Christmas present I could ever ask for.

Thursday, December 10, 2009

View From A Mountain Top

Tomorrow at 4:30 pm I fly out from Washington DC to the land where the beer flows like wine, to a little place called Aspen. I am incredibly excited for this trip; about 20 of my classmates and I are headed out for a week of skiing and drinking to celebrate the finish of our third semester at Darden. This is also the first opportunity I'll have to go on an extended ski trip in nearly two years; I went from skiing around 20 days a year to hitting the slopes just 4 times in the past two years! And hey if the snow doesn't work out maybe I can find a countess who will pay off my student loans in exchange for being her pool boy.

One of the things I'm most excited about is the view from the top of the mountain. One of the things I absolutely love about skiing is looking out onto the world from a snow covered mountain. There are no industrial sounds, the wind drowns out the voices around me and one can see for miles. The serenity of being surrounded by nature balanced by the development you can see in the towns at the mountain's edge is one of the most beautiful sights I can think of. There is something so peaceful about that view and for whatever reason it helps put everything into perspective.

There are two huge challenges when it comes to skiing and managing blood sugars (I was eventually going to have a point to this post). The first is ensuring that my meter doesn't get too cold so I'm still able to test. Last year during my two days of skiing I attempted to use my Freestyle and that worked disastrously. My sensor became too cold and stopped reporting to the receiver; I was unaware of how finicky the Navigator was at this point so for the rest of the day I had to ski without knowing what my blood sugars were. The second challenge is understanding how much nutrition to take in to have stable blood sugars. Nutrition needs vary widely due to what trails are open, how deep the snow is and how fast the lifts are moving. If I really have to push through snow to get my board moving my quads will need more glucose to fire; similarly if the terrain is pretty technical my muscles will need a lot more energy than if it's a long easy slope. For the most part I'll know what trails will be open before I hit the mountain, but knowing how fast the lifts will move is a total wild card. If the lifts are moving super quick I can get in 30 runs; if they are moving really slowly I can be limited to 10 runs – obviously the more exercise the more glucose needed.

At some point today I'll finish my paper on tax credits for renewable energy and then it's off to have some fun, run some hills in Aspen while surrounded by some great friends. I think we'll all have some sadness though as we all know, only one semester left until its back to the real world.

Tuesday, December 8, 2009

2010 – It Begins

Anxiously I waited for my Training Peaks account to be updated; since October 5th, the day after the South Carolina Half Iron I was hungry to continue my triathlon journey. Triathlon in two short years has ceased to be a sport and has now become a way of life for me, it is a journey that has had people flow in and out of my life and a challenge that has brought me both happiness and despair. At the end of my 2009 season I finally realized that my love of sport, that my love of spending hours on my bike is about living in the moment and realizing how incredibly lucky I am to have the opportunity and desire to enjoy this sport – it has opened my eyes to an entirely new world. Diabetes got me into the sport; my heart and soul is keeping me in it.

Yesterday, Coach Orton finally updated my Training Peaks account! For two months I had created my own workouts like a schizophrenic on crack; intensity here, going long there, some kettlebells sprinkled in. Eric wanted me to take time off, to mentally rest and to just go out and do the activities that I enjoyed. I would go for slow runs, I would go for fast runs and would smile with each step. However, I was anxious, I was anxious to begin my 2010 triathlon journey, I was anxious to see what hidden treasures would be found during my journey to the starting line of IMCDA. With energy, enthusiasm and excitement that journey began yesterday.

For 40 minutes yesterday I rode my trainer with joy. My mind filled with how much fun training for IMCDA is going to be. I thought about the adventures I'll have in Oceanside, I thought about how amazing it will be to go through this journey more involved with Triabetes, I thought about how my good friends at Darden think I'm crazy but support me in every way possible. Classmates of mine always offer to go for runs, rides or swims with me, some have traveled to races with me and a few are thinking of going out to Idaho for the Ironman. Each of them, in some way will help get me to that starting line in late June. For 40 minutes I thought about the long journey ahead of me and promised myself I would soak in every moment and enjoy every second.

There will be times over the next year where I'll become frustrated by results, where the stresses of searching for my post-MBA job (fingers crossed, big things might be around the corner!), trying to start a small company (triathlon and diabetes led to that idea), enjoying my last semester at Darden and juggling workouts will lead to some stress. But a major goal of mine is to not let any of that get to me and to always remember how lucky I am to have this opportunity. Sport has always been the one thing that has entirely made sense to me; I so often analyzing things in life and try and figure them out, but I never have in athletics, athletics has let me bare my soul, it has let me be comfortable, it has let me, be me. As long as I remember that during each 30 hour training week this season will be nothing short of incredible.

In my e-mail exchange with Eric yesterday we talked a bit about the season and one sentence I wrote struck me for how this journey has changed me. I wrote to him that I realize triathlon isn't about beating the guy next to me, it's about pushing myself to do as well as I can, within myself, not because results matter, not because my time matters, it is because that moment matters. During college football I hardly ever worried about "winning" the play; the plays or games I did worry about that I didn't do very well. When I worried about soaking in the moment and giving that moment all that I had for me, for my teammates, for my coaches is when everything came together. In South Carolina, I only worried about each foot strike, I never worried about my time, I only thought of the journey, not the destination. This season there will be no shouting out Idaho!!! As I shouted out Placid during my 2008 training because this journey is not about beating the course, it is about soaking in the journey.

"Nature without check with original energy," that is my motto for this season. I have learned much about myself over the past two years through this sport. Over the past two years I had a lot of questions that I sought to answer, in a way that made the past two seasons about the destination; 2010 however is all about the journey. Where it will take me I have no idea, what I do know is that my goal is to do each workout with joy and passion. 2010 here I come!

I Celebrate myself, and sing myself,
And what I assume you shall assume,
For every atom belonging to me as good belongs to you.

I loafe and invite my soul,
I lean and loafe at my ease observing a spear of summer grass.

My tongue, every atom of my blood, form'd from this soil,
this air,
Born here of parents born here from parents the same, and
their parents the same,
I, now thirty-seven years old in perfect health begin,
Hoping to cease not till death.

Creeds and schools in abeyance,
Retiring back a while sufficed at what they are, but never
I harbor for good or bad, I permit to speak at every hazard,
Nature without check with original energy.


~ Walt Whitman

Song of Myself (I, II, VI & LII)

Wednesday, December 2, 2009

Flying & Blood Sugars

With all the travel I did in the past two weeks my blood sugars turned into an utter mess.  What I have noticed is that it seems everytime I fly my blood sugars get totally out of whack (whether I change time zones or not).  Car trips greater than 4 hours also tend to elevate my blood sugars but to a lower degree than flying does.  When I fly I make sure that I eat as healthy as possible and try to drink as much water as possible.  However, the pressure changes in altitude can change the digestion process and flying dehydrates you in general.  I haven't yet figured out a way to counterbalance the metabolic effects of flying for blood sugar management; it would be nice to not have blood sugars of 400 everytime I fly though!

Monday, November 30, 2009

Each Ironman A Story

Last week when I was at Ironman Arizona I was shocked by the difference between watching an Ironman as a person who had completed one compared to watching one as a person who was aspiring to compete in one. As a volunteer at Ironman Lake Placid in 2007 I was in awe of the athletes, and wondered if I had what it took to train for the event, if diabetes would prevent me from finishing the event and if I had the guts to push through to finish an Ironman. When I watched IMAZ last week as a person who had finished an IM I felt a silent camaraderie with each athlete. I realized that every competitor in the race was so much more than a single moment. I realized that every competitor had a year of stories just getting to the starting line, that each competitor had a support network that helped them wake up at 4am to get in a run, swim or bike. I realized that each competitor had faced their own challenge or demon and persevered through whatever it was to get them into the race.

I saw some amazing things at IMAZ, I witnessed a woman come in just before the bike cut off who needed help getting off her bike. I witnessed 16 type 1 diabetic athletes come together as a team and put on a tremendous display of courage finishing an Ironman overcoming a "silent disease." I had the privilege and honor to congratulate Rudy Garcia-Tolson finish his first Ironman. Rudy is the only double above-knee amputee to finish an Iron distance race; congratulating him on his finish was humbling to say the least. As I sat in the bleachers at the finish line I was struck by the emotion each athlete had on their face in the finishing shoot, it became apparent that each person who came down that last 50 yards had a year's worth of stories to tell and that in some way their life had changed.

In my two short years of triathlon the sport has given me so much, has provided so many life lessons and has provided an opportunity to meet some amazing people. I am anxiously awaiting the start of my third season; I can't wait to see what training for IMCDA holds. I'm realizing that each season is a book unto its own, year 1 was about proving to myself that I was still the same person I had always been even though I was diagnosed with a life changing disease, year 2 was about finding my inner self, maturing as an individual and learning to truly enjoy endurance sports, to not focus on results but to focus on how amazing it is just to compete. I won't know what year 3 will be about until after IMCDA but I do have some ideas for a motto for the upcoming season although I have some more thinking to do to solidify that.

Each person who toes the starting line at an Ironman is worthy of praise and each journey that crosses the finish line should be celebrated. I'm thankful and feel privileged to have had the opportunity to challenge myself in endurance sports and am starting to love every step I take in this sport. I never would have thought a guy who used to dread running 3 miles could love grinding out a 6 mile run before Thanksgiving dinner let alone crossing 140.6 miles in one day – yeah this sport is pretty damn cool.

Tuesday, November 24, 2009

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.

Thursday, November 19, 2009

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!

Wednesday, November 18, 2009

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.

Monday, November 16, 2009

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.

Thursday, November 12, 2009

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!!!!!!!!!!!!!

Monday, November 9, 2009

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!

Thursday, November 5, 2009

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?

Monday, November 2, 2009

The Adventures of A Type 1 on Halloween!

Although Coach Orton hasn’t officially ended my off season yet I’ve determined that in October I did enough damage to my liver and body that November is a perfect time to get after it again. Knowing that Monday would restart my diet of clif bars, and whole grains I had to blow it out on Saturday asking the question, “what would Brian Boitano do?”

Saturday started harmlessly enough with an 8 mile run on gorgeous Ridge Rd. The leaves continue to change colors in Charlottesville so running out in farm country is absolutely breath taking. I had planned to go for a long ride on Saturday but woke up with a stomach ache and some high blood sugars so I thought a run was the safer option. During October I have definitely noticed a change in the effort required to maintain a decent pace. I haven’t been eating as healthy as I normally do and my off season workouts have paid the price – we all need a break every now and again though!

After my run I showered up to head to Darden’s tailgate for the UVA v Duke game; and was pretty excited since I actually had seats for the game! Normally I’m crammed up on the hill with 500 undergrads but this time I was on the 40 yard line 3 rows from the field. I left midway through the third quarter to get myself glammed up for Halloween – that’s when the adventure started!

This was actually the first time I would be dressing up for Halloween as a diabetic. I knew the parties I’d encounter would have chocolate goodies and was a bit worried since my costume didn’t have any pockets. My blood sugars have been a bit bouncy lately so I went into the night with some trepidation. When I got home from the tailgate my blood sugar was at 216; not too awful since I had 3 beers at the game and a couple York peppermint patties; I corrected for that and was off to the first of 2 pre-parties.

Since my costume didn’t have any pockets I carried my meter with me in a fuel belt pouch that I have; the palm sized pouched was the perfect solution. I tend to freak out if I don’t have constant access to my meter so having something that fit in my hand gave me blood sugar confidence for the night. After playing some flip cup I left the first pre-party and headed downtown for the second party and to eat some pizza. At this point my blood sugar was in the 300s, so I bloused and corrected a ton for 2 slices of pizza. I was a bit worried at this point since my blood sugars were starting to get out of control but tried to push that to the back of my mind so I could enjoy hanging out with my friends.

From there I was off to Darden’s dance party and had an absolute blast. For 3 hours my friends and I danced up a storm and drank a ton of beers – however I was a sweaty mess by the end of the 3 hours. Once our tab ran out and the party was over we all headed outside. I finally tested and had a blood sugar of 61; hmmm not so good, time to find a deli. A group of us were headed to a second bar for the rest of the night but I got separated from them as I was trying to find a soda or something anywhere.

The first open place I passed by was a fairly upscale wine bar – heads turned around as I walked in with my slightly over the top costume. The bar tender asked me with hesitation if she could get me anything. I asked for a coke; she said I’m sorry we don’t have any soda. I then asked her for anything with sugar, orange juice, cranberry juice, anything. She then said something like “oh so you just need to carb up?” I responded with a smile and said “yes, ummm… something like that.” She then realized that they had “Italian soda,” so I said that was fine and drank the Orange-gina or whatever it was, while the 2 people seated at the bar gawked at me.

Finally the two people seated at the bar started talking to me as I drank my soda, and I explained to them that I go to Darden and was at their Halloween party and just had to run in here to grab a soda and then was going to reunite with my friends. The couple then started asking me questions and the guy who was a computer science graduate student began asking me for career advice. Seriously he was asking a guy dressed like this:

For career advice! Looking back on it I should have said, the only thing you need to ask yourself is “what would Brian Boitano do?” But I put sarcasm aside tried to be as nice as possible, wished him well and was off to find my friends again. As I walked the Downtown Mall I realized I must be far less intimidating dressed as Chaz Michael Michaels,” then I normally am as a couple groups of guys talked some sh*t to me – I of course had to say something back but just kept walking. Finally I reunited with my friends, danced for an hour or two more then headed home as I started to feel a bit low. Once I got back home my blood sugar dropped into the 50s so I ate some whole wheat toast with almond butter and chia seeds before bed. I woke up with a blood sugar of 98, ate a clif bar and then hoped on my bike trainer for an hour. Yep the off season is over, now it’s time to get back into shape – but at least I ended the off season in style!

and yes - Kent (or should I say Jimmy) and I did lifts on the dance floor!

Thursday, October 29, 2009

Food Intolerance & Diabetes

Recently I randomly picked up "The Epoch Times," in the Pepsico Forum at Darden and was surprised to find an article titled "Can Wheat Cause Diabetes?" in the life and science section of the paper. The article starts off with a plot twist discussing how wheat requires extra insulin production and then Dr. Briffa switches gears and states "However, this column is not about the relationship between wheat and type 2 diabetes. Type 1 diabetes is actually the focus here." At that point I read with a new level of interest.

An article in the Journal Diabetes highlighted a study conducted by Dr. Fraser Scott that analyzed the relationship between wheat polypeptides and immune response. The study was conducted on 42 individuals with 20 of the individuals demonstrating a reaction to the protein. According to the article the rate of individuals who had reactions was much higher than expected. Similar studies that focused on milk proteins have demonstrated the same relationship. Interestingly, other auto-immune diseases such as rheumatoid arthritis have already been linked to food intolerance, so why not juvenile diabetes?

Prior to my diagnosis I had always noticed that a glass of milk made me feel like a balloon and caused my derrière to be a musical instrument. I always associated that with a form of lactose intolerance but could still eat cheese, yogurt and other dairy products without any discomfort. This article makes me think there may have been something more there. The causes of juvenile diabetes are still unknown, statistics have demonstrated the form of the disease is changing though. A decade ago it was exceedingly rare for someone over the age of 15 or 16 to develop type 1, however examples of that are abound now. Interestingly, most of the people I have met who have developed adult onset type 1 have been fairly high level athletes as well. While the causes were previously thought to be viral it is becoming clearer that environmental factors are playing a huge role in auto-immune and chronic illness.

The Natural Step a consultancy focused on sustainable business practices and industrial eco-systems was founded by Dr. Karl-Henrik after he noticed the number of children he was treating in his oncology practice was rapidly on the rise. The argument over the threshold level of toxins that causes disease and illness has shifted in the past several years. Originally the argument focused on the level of toxins that would cause a severe reaction. However, scientist have now identified that a low level of toxins over an extended period of time can cause genetic triggers to turn on and off. In our sustainability class first quarter we had a scientist tell us that everything from breast milk to proteins could contain toxins and that everyone had some level of toxins in their body. As Dr. Briffa's column identifies, the game has changed and the environment is becoming a much larger component of disease creation than it was in the past.

Monday, October 26, 2009

Old Rag Mountain Hike

On a beautiful fall day in Charlottesville some classmates and I decided to forget about interview prep and case studies to hike one of the most famous hikes in the Shenandoah National Park at Old Rag Mountain. The 8 mile hike climbs more than 2,500 feet and has some of the most breathtaking views I have ever witnessed. Whether skiing or hiking there is just something about staring out from the top of a mountain that puts life in perspective.

For blood sugar management, I turned my pump down to a 75% basal rate and had more than enough Clif Bars with me for the hike. When we started the hike my blood sugar was actually above 300 from the Pumpkin Muffin I had for breakfast screwed that up a bit so I adjusted with a 1 unit bolus. After climbing for about a mile my blood sugar was down to 71 so I gobbled up my black and white lumpy scone (it's the offseason I can't be healthy all the time!) About an hour later I had a clif mojo bar and then had a clif protein bar about a mile from the top.

Now for the fun stuff – pictures:

Sitting on a ledge with a view like the one above reminds me that high blood sugar or low, tough workout or off season there can be something magical about everything that we do.  There can be beauty in everything that we see, triumph in everything that we overcome and joy in everything that we encounter.

"Those who contemplate the beauty of the earth
find reserves of strength
that will endure as long as life lasts." 
~ Rachel Carson

Friday, October 23, 2009

Off Season Basal Rates

I’ve often talked about how consistency can be the key to good blood sugar management. As my operations professors say; variable is the enemy of good. The more variability a diabetic introduces into their blood sugar management, the harder it is to maintain happy blood sugars. During the peak of triathlon season the amount of carbohydrates I eat, length and intensity of exercise and amount of sleep are all pretty consistent. During the off season my Coach has instructed me to just have fun to recover both mentally and physically; that means training is no longer a top 3 priority, having fun with friends, focusing on my job search and enjoying my last year at Darden all take precedent.

In the past week my basal rate has jumped 1.5 units of insulin per day and my blood sugars have been much less consistent. I’m not sure why but I am still shocked by the effects exercise has on blood sugar management. For breakfast I’m now eating egg whites instead of a fruit and protein shake, I have switched from turkey sandwiches to salads for lunch and am having just chicken sausage and brown rice for dinner and am eating far fewer clif bars during the day than during the season. In all I’ve dramatically decreased my calorie and carbohydrate intake, yet my insulin needs have still increased. It’s crazy to think that reducing my exercise from about 14 hours a week to about 8 hours a week would increase my basal rate by more than 10% per day.

The off season is a necessary evil as I know my body and mind need recovery. However, I also know that when I get Coach Orton’s e-mail telling me to hit it hard again I’ll be faced with blood sugar lows instead of blood sugar highs as my basal rate is re-calibrated. Perhaps the most frustrating part of type 1 is that when a lifestyle change is introduced, all the work done to calibrate basal rates becomes inaccurate. The more I learn about blood sugar management, the more I realize how a holistic vie of all metabolic variables is essential. Maybe I’ll just skip the off season and live on a hamster wheel!

Tuesday, October 20, 2009

That Whole Hydration Thing

This post is going to get filed in the "I'm an idiot," category. Just because it's the offseason does not mean I should forget about nutrition or hydration. Thus far I've done a pretty good job with nutrition, even if I've enjoyed some of the delightful fattier foods like burgers, fries and guacamole my weight hasn't really gone up and my body is still pretty much the same. However, I have been totally lax on the amount of water I've been drinking and electrolytes I've been taking in. Since Friday I swam 2,000 yards, biked for 30 miles, lifted for an hour and ran 11 miles; add to that drinking three of the five nights and some very high blood sugars on Friday gives the recipe for some dehydration.

Last night I had a couple of glasses of Malbec while I watched House and then my buddy Joe came over for some beers during Monday Night Football. Each time I got up to fill my wine glass or grab a beer I felt dizzy but really didn't think anything of it. After Joe left I turned off the TV and went to bed, after tossing and turning for 10 minutes I decided it was time for a change of venue; I haven't been sleeping all that well and moved to the couch. At 2 am I woke up pretty light headed and went to make my way to bed – huh what….. smack, my face cracked into the beam of my door and I was down and out. This is the first time I've passed out since a pretty bad stomach bug in my first year after diagnosis.

Worried, I crawled into my bedroom and tested, blood sugar of 160 so I was a little high, a relief as I was worried I was headed for some glucagon. I got into bed, gave myself some insulin and was out. When I woke up this morning it dawned on me – I have hardly been drinking any water. During the season I was having at least 60 oz of water outside of exercise with some thermolyte tabs for electrolytes. However, I'm only having one or two glasses of water right now (plus some coffee and diet coke) but the alcohol, exercise and high blood sugars pretty much canceled out any of the hydration I was trying to take in. Thankfully my gorgeous mug isn't bruised and I learned my lesson – it's back to carrying around my water bottle at school; just because it's the offseason doesn't mean I can ignore the important stuff.

Monday, October 19, 2009

Reminded Of Life Pre-Diagnosis

Friday night I had a couple of my friends over for the first game of the ALCS. It had been a while since we had a low key night to just watch some sports and chill out; a lot of nights at Darden quickly turn into all out black out booze fests for no particular reason. Knowing that it would be a night of sports, sports and more sports Jeff and I headed to Whole Foods to pick up some craft beers, pizza dough, tortilla chips and guacamole. Our buddy Rob brought over more beer and some wings – so this was going to be a gluttonous night, my blood sugars have been solid recently so I thought what the hell I can bolus for all of that – ummm I think I was a little wrong with that assumption!

At some point I will learn my lesson that either due to the high fat content of guacamole or something else it is just about impossible for me to bolus for one of my favorite condiments (is it a condiment or dip?). Combining guacamole with home made whole wheat pizza, wings, and beer makes for a blood sugar disaster. I first tried to use a dual wave bolus for 70 grams of carbohydrates for the chips, beer and wings, I then added a second dual wave bolus for 50 grams of carbs for the pizza. About an hour after eating the pizza my blood sugar was down in the 80s with a ton of insulin on board so I ate a no-fat pumpkin yogurt (delicious!) After my friends left I was still feeling kind of funky but for some reason was craving diet coke – then the memories started to flood into my mind.

Prior to my diagnosis one of the scariest moments of my life happened during a ski trip to Sugarbush in Vermont. A group of us were at my friend's ski condo, had been drinking pretty much all day and ate a ton of pizza for dinner. As the night wore on I remember feeling like the condo was 300 degrees and was convinced that a diet coke would make me feel better. I got in my car and drove from town to town trying to find a gas station that was open, or a soda machine (stuff closes pretty early in Vermont) but had no luck. As I drove the dark, snowy Vermont roads I felt confused, emotional and lost. I remember feeling like I was having an out of body experience yet could only focus on the idea of finding a diet coke. I returned to the condo thinking regular coke would be a good alternative – God only knows how high my blood sugar was by the end of that night; about 10 days later I went to a party with my friends who were on that ski trip, each of them were shocked at how much weight it looked like I lost over the past 10 days – that's when I started to think I may have a serious problem.

Friday night a lot of those feelings of confusion, heat and mental loss began to overwhelm me again. Although my glucose meter showed a blood sugar of 87, I knew it was only a matter of time before my blood sugar sky rocketed. I became emotional about things I shouldn't be that emotional about, I remember at one point collapsing on my ottoman just trying to get the world to slow down around me. My mind was racing from thought to thought, the walls were closing in and I was scared. I knew this time that it wasn't a diet coke that would make me feel better, but insulin.

Even though my blood sugar was below 90, I decided to give myself 2 units of insulin; I had my emergency supply of sugary food and decided if I tested every 10 minutes that I would be able to correct a low before any serious problems occurred. 10 minutes after I gave myself the bolus my blood sugar was up to 130, 10 minutes after that I was up to 168 – I added .7 units of insulin. I laid in bed at 11:40 pm and decided to read, at midnight I tested again and my blood sugar read 230. At that point I upped my basal rate to 150% and added another 1.5 units of insulin. Finally the world around me began to slow down, finally I was able to collect myself and feel as if my feet were on the ground again. I tested again in 20 minutes and was happy to see a blood sugar of 225. Although nervous because of all the insulin on board I was pretty confident that I had not over corrected; I really believe my blood sugar was headed north of 500 and the quick action I took to correct saved me from a pretty painful night.

I woke on Saturday to a blood sugar of 150 and was happy to see that; although higher than I would have liked it gave me some confidence that the bolus I gave myself the night before was just about right. It also reminded me of the dangers of thinking I can eat anything; all foods can't be exercised out of your system and good choices need to be made. Eating wings, pizza and guacamole is all ok in moderation, but eating all 3 on the same night while drinking 5 or 6 beers probably isn't the best idea for me. Usually I'm pretty good about my choices, and Friday reminded me of the reasons why that is so important.

Thankfully I was able to get my blood sugars under control to have my first cold weather outdoor bike ride of the season on Saturday and an awesome fall run on Sunday. Coach Orton has me in off season mode right now meaning I get to do whatever I feel like for exercise. I hammered away for 26 miles on Saturday in 40 degree weather with my leg warmers and winter vest on; at one point I maintained 32 on a flat for 2 miles with the biggest smile on my face. Sunday I went out for a run on Ridge Road, the leaves have started to change in Charlottesville making the farms look more beautiful than ever; I ran with joy and enthusiasm and finished the 8 mile run in an hour and 7 minutes – it's kind of fun to lay it all out there; in the off season you can take that extra day to recover, it's nice just going out there to have some fun.

Wednesday, October 14, 2009

Nike Frees

Prior to doing distance running for triathlon training I had never had what one would call a typical runners injury. For the better part of my life I had trained in minimal sprinters shoes; as most of the training I was doing was targeted towards getting my 40 time as low as it could go. However, once I transitioned into endurance training, got a beefier, more “technologically” advanced sneaker I started to get pains in my lower back, knees and flare ups in the joins of my toes. Maybe I was just too heavy to run for distance I thought. As my weight dropped the pain remained and I thought there was something more to it.

While reading “Born To Run,” in August I was shocked to find out that as shoe companies have advanced corrective technology in their sneakers the incidents of runners injuries (plantar fasciitis, IT Band syndrome, etc) has increased. Even more shockingly, when Nike visited Stanford University in 2001, they noticed that the Stanford track team was running in Nike’s cheapest shoe, not the one with uber technology. Vin Lananna, the legendary coach, told the Nike Reps that his athletes preferred the cheaper shoe, were faster and got injured less in them.

The research Nike performed led them to develop the Nike Frees, the shoe I am currently running in, healthier and faster than ever before. The crux of the argument is, in our physiological evolution our feet were our initial sensors for protection. Our feet have an unbelievable amount of nerve endings in them (as certain pursuits will let you know) which are made deaf through the advances in shoe technology. In other words, corrective shoe technology may have been correcting a problem that was never a problem – your feet tell your body how it should run, your body doesn’t tell your feet how they should strike.

Nike developed a shoe that provides shock absorption but lets the foot move naturally or “freeing the foot”. The sole is constructed through individual compartments that act as receptacles for the nerve endings but provide protection since we now run on pavement not dirt. Since I have been running in the Frees I have felt no knee pain, hardly any back pain and the tightness in my hamstrings and hips has all but disappeared. Additionally I am back to the form and speed I had when all I did was speed work but can maintain that stride style, cadence and pace for much longer distances than ever before (the pace thing is all about training though).  This is the shoe I also ran in for the South Carolina Half Iron.

So why am I writing all this? I’m not a doctor so I can’t say that the Frees are the solution to runner’s problems around the world. I however do know from my experience that I have run more comfortably for longer periods and at a faster pace than ever before. Sometimes getting back to the natural way of doing things is just what the doctor ordered. I can’t promise they will work for you but if you’ve tried everything else they just might be worth a try. If you do give them a try it is suggested you use them for just a half hour at a time on grass as you build the strength in your foot muscles if you haven’t done barefoot work or high intensity speed work in the past

Monday, October 12, 2009

A Picture Is Worth 1,000 Words

It's safe to say I was pretty happy at the finish of the South Carolina Half.  And yes Coach, I promise I have only been doing functional strength training!

Monday, October 5, 2009

Finding Myself – South Carolina Half Ironman Race Report

On an early morning in the middle of South Carolina I arrived at the transition area filled with more doubts and apprehensions then confidence or inner strength. As my last post touched on; over the course of the past few months I had lost a big part of myself, the fuel in my confidence tank was running low and I was starting to lose faith in my ability to ever perform in the sport of triathlon. The combination of some really tough personal stuff, perhaps for the first time being totally over my head intellectually during my summer internship (working with a guy who has a PhD from Harvard in physics can tend to do that), crashing and blowing up during the run in my last race create the perfect confluence of events for me to wonder if I ever could get back to the confident person I was. My journey to South Carolina answered all those questions and more. For the first time in any of my previous triathlons, I can hold my head high not for the great achievement of crossing the finish line, but for the awesome achievement of having hours upon hours of training and sacrifice finally produce results. This will be a pretty long race result so the abridged version – 5:33!!!!!!!!!!!!!!!!!!!!!!!

Days Leading To Race

The days leading up to the race were actually pretty interesting. Normally life is as life does leading up to my triathlons for this race I attended a U2 concert, took a 7 hour drive, and was fascinated by the people at a Waffle Works. Thursday night U2 played at Scott Stadium in Charlottesville. The atmosphere of the town could only be called electric. Our professors talked about the concert, a 60 year old woman at the pool asked me if I was going and if there would be a "mash pit," the woman at Whole Foods asked me if I was tailgating for U2 – it was crazy. I can only imagine the atmosphere on Thursday was like the atmosphere for a 1970's stadium concert during the hey-day of rock n' roll.

Attending a concert sober is a totally different experience; my friends were hammered but I had a race to run dammit and had given up so many drunken nights already that wasn't going to change for Bono & Co. The concert was great and actually started to relax my mood, I had been pretty down in the dumps but just hanging out and having fun with my classmates really started to make me smile. When Bono wailed "It's a Beautiful Day," I thought he just might be onto something. And in an informal poll women are more attracted to Bono than Edge by a ratio of 5:1.

Friday I drove two of my classmates down South; one was dropped off in Danville, VA and the other in Charlotte, NC. In Danville Lauren and I stopped at Subway for lunch; for some reason Subway absolutely messes up my blood sugars. After lunch my blood sugars remained above 350 for 5 hours! I had then totally over corrected for the blood sugar high that I had to continuously eat to make sure my bs didn't plummet. I finally had it corrected after dinner of some South Carolina pizza and clif bars. After dinner I fired up Net Flix on my computer and watched the Peaceful Warrior. The video store clerk at IMLP recommended it to me last year but I never had a chance to watch it. As will happen when you watch a movie about an athletic struggle as you're trying to find yourself through your own journey the movie can feel like it's speaking directly to you. These quotes from the movie moved me closer to my goals from the weekend:

"A warrior is about absolute vulnerability"

"Accept you don't control what will happen"

"The journey brings us happiness not the destination"

I slept a lot later on Saturday than I had planned, so I didn't get out to the race site to do my final warm up until 10am. At the race site I couldn't figure out where the swim was actually going to start from so I skipped it to just bike and run. During my run I began to throw up and realized that my blood sugar was trending very low – time for waffles!

Waffle Works in South Carolina was an experience unlike one I have ever had. Thick southern accents, more camouflage than an Army/ Navy store and conversations about what I have no idea. I loved this experience as its not often one can be exposed to a totally different side of America than the one you've come to know and expect. Shift your perceptions and open your eyes to new experiences – ok I'm really starting to remember what I was all about at this point. Oh and the waffles – chocolate and strawberry – deeeeeeelicious.

I went back to the race site to pick up my race packet, drove the bike course, then headed back to my hotel room for the rest of the day. I consumed a ton of clif bars, and had my typical pre-race dinner of whole wheat pasta and buffalo meat much earlier than usual. This proved to be a great decision as I had a nice ummm "movement" by 10pm and was actually able to sleep that evening. I was beginning to drop my "bag of sh*t" as Coach Egg used to call it. I still couldn't have full confidence in my race visualization like Coach Orton wanted me to do, but I was able to relax and view my race plan, things were starting to slow down.

Race Morning

I woke up race morning at 4:45 am feeling a bit different than I had for the previous month. I began to feel the fog that had been surrounding my mind lift and when I looked into the mirror I saw a bit of fire return to my eyes. My eyes still didn't show the passion and intensity they normally have but they didn't look as confused as they had for the past month and ½. For breakfast I had a cup of coffee, and my breakfast shake of a banana, mixed berries, odawala superfood and chia seeds. I arrived at the race site at 5:50, pumped my tires and headed to transition – it was still pitch dark out!

Listening to my pre-race mix on my ipod Van Hallen's "Right Now," ceased to be about winning, and became a reminder of how important living in the moment is and how this moment, this race, this day was all about getting back to the right mindset, finding myself and getting back to Ed. I crotched down at the edge of the lake and starred out to the darkness. I thought about all the days of the training, the two years I had devoted to the sport, my emotions the day I was diagnosed with diabetes. I thought about the e-mails I had received from people who have supported me, I thought about my friends and family. I thought about all those who have helped me along the way, I realized on this race morning although I was so far away from everyone I knew, I was not alone; I also realized the only person who could get my confidence back and find myself, was the person I look at in the mirror every day. With that the song came to an end, and it was time to eat my clif bar finish setting up my transition area and head to the water for my swim warm up.


My blood sugar had been a bit high prior to heading over to the swim start, so I took in a tad more insulin than usual. In total I took 1 unit of insulin over the 1 and ¼ hours I was at transition before the race; .6 units for my clif bar and .4 units before heading to the water – this turned out to be perfect! I downed my nutrition mix prior to my warm up, hopped in the beautifully warm water and felt great. My shoulders were a bit sore, but nothing to be too worried about, just needed to stretch some more.

The open division wave went off and we were set to enter the water. I said hello to a few of the people in my wave and talked to the guy next to me in the water as we bobbed water waiting for our horn to go off. For the most part I just kept thinking to myself, this is it; let the race and the day come to you. I refused to let a time goal cross my mind, my only goal was to enjoy the race, find my confidence and be able to run when I got off the bike; I tried to stay calm and refused to let my mind drift to the dark places it used to before football games.

The gun went off and so did I! I was swimming up towards the front of the pack and felt amazing. My arms felt strong, my legs felt light, my hips were up as I glided through the water. Hot damn this was going to be a good day. My swim was fantastic – except for a period where I swam totally off course. There were just 8 or 9 buoys for the entire swim course in this massive lake; at one point I could have sworn I was on course, but a few strokes later when I looked up I realized I had take a 90 degree turn and was totally off course. I was all alone in the middle of the lake and had to swim diagonally to avoid a dq as I needed to make my way around the next buoy – probably lost 3 or 4 minutes due to this mix up. No big deal, got back on track and finished my swim pretty strongly.

My swim time was totally consistent with the time of my past couple of races. More importantly I came out of the water with a blood sugar of 140 – perfect! Since you're horizontal when you swim the digestive process is totally slowed down. Additionally blood flow during swimming isn't as good as it is while not swimming so a slightly lower blood sugar is fine coming out of the water. From my experience at Musselman when my blood sugar went sky high on the bike; I knew at 140 I didn't need to take in any additional nutrition; so I left T1 confident my bs would be fine; this proved to be an awesome decision.

Swim Time: 36:39, 71st overall

Swim Grade: B+, points have to be taken off for going that far off course

Nutrition Grade: A


The big challenge: loose my ego; just let it go, I have nothing to prove to anyone on the bike, triathlon is not about how you perform against other people. Triathlon is about how you perform for yourself, triathlon is about embracing the journey, to find motivation through internal struggle and living in the moment is vastly more important and powerful than finding motivation in biking faster than the "other guy." Would I be able to expose my vulnerability, have the confidence in myself, my coach and my training that letting people pass me on the bike is "ok?" Or would I let fear rear its ugly head and think I needed to hammer on the bike to justify being out there? The 56 miles on the bike let me answer those questions and more, the 56 miles let me find some of that intestinal fortitude that had been lacking the past couple months.

The bike course was not suited to my strength on the bike at all; at no point was there a stretch of 5 or 10 miles where I could get into a rhythm and just glide, rollers were everywhere. No hill was super steep, but a bunch were pretty long; and no descent lasted too long but each was long enough to let my heart rate settle back down. Orton wanted me to keep my heart rate in high zone 3/ low zone 4 for the bike; and man did I stick to that. In the Patriots I blew up my run because I was biking at a heart rate in zone 5a for the entire bike leg – not smart. Race smart Ed, let the course come to you and bike within yourself, don't worry about the next guy, I kept repeating that to myself as I biked.

From the moment I started to pedal my legs hurt, and I don't mean sore from lactic acid, I mean they hurt like someone was taking a pick and scrapping away at my muscles. I have never felt pain on the bike like I did on Sunday; my bike seat may have been a bit lower than my ideal fit from the new frame or I may have slept wrong, I really had to struggle to keep pedaling. I thought about quitting when my legs really hurt, I thought about unclipping, throwing my bike to the side of the road, and screaming "I'm done!" Then….. I woke up…..

The conversation in my mind went something like this, "Ed, when did you let adversity, pain and disappointment stop you from being who you are. At what point did you lose the passion for the journey and the ability to turn adversity into a positive. At what point did you stop believing in yourself and stop trusting all that you have accomplished in your life. At what point have you allowed yourself to give up? You have the choice right now to stop being who you are and accept defeat and disappointment or you can forget the pain, remember why you're out here and find your strength and confidence to turn negatives into positives – the choice is up to you." After that conversation my "bag of sh*t" got a little bit lighter; after that conversation I forgot about the pain, overcame the mental demons and rode with a smile on my face; after that conversation I became one step closer to being me again.

Maybe 20ish people passed me during the first 35 miles of the bike. With each person who passed me I had to remember to just let them go, this is my race, I'm racing my plan not theirs. Those who are really good at tris will tell you, let people pass, you'll catch them later if you just hang back, just race within yourself. And holly crap – they are right! From mile 42 to 56 I reeled in about half the people who had passed me previously. As those people who hammered past me earlier in the bike struggled up the final hills, I rode by them smiling and enjoying the ride – no wonder those people who are really good figured that out.

In each of my previous races I had been so obsessed with seeing my average speed over 20mph for the bike, I forgot that the bike was just one component of the race. At Musselman, Patriots and others I tried to crush the bike; this time I said screw trying to crush it and just enjoy it. Instead of going out at a 25 mph pace, I went out and followed my heart rate and didn't pay any attention to my pace. By the time I finished the bike leg I was astonished at my results – I broke 3 hours!!!! Are you kidding me? Biking within yourself, following your coach, trusting the training can lead to better results than riding like a maniac????? Wow, how have I been so wrong for so many races – this was an incredible experience!

Bike Time: 2:58:57

Bike Grade: A+, I didn't ride like an idiot, and had legs for the run; I guess that's riding like a triathlete. I raced my race and lost my ego – athletically this is my greatest accomplishment of the past couple years.

Bike Nutrition: A+, I came off the bike with a blood sugar of 212 and was fully hydrated – perfect to start the run.


"Ed it's now or never, you are either a triathlete or not, you either are dropping the rest of that bag of sh*t or you're not going to find yourself, enjoy the run, remember the journey and believe in yourself." That was my thought process as I took my first steps on the run course. 2 miles into the run, something was different; instead of my pace slowing my pace increased, instead of my legs cramping they felt fresher, instead of my back tightening I stood more upright; I was able to run!

Coach Orton had told me that losing a minute or two on the bike could save 10 to 15 minutes on the run, I'll tell you what, the guy is onto something! This guy who has totally kicked my ass over the past couple months knows what he's talking about. From long and slow to interval training everything had been preparing me for these 13 miles.

With each passing mile an article from my bag of sh*t was left behind; as the miles ticked off my confidence came back. Mile to mile I began to believe in myself again, I began to truly understand that this was my race and not about anyone else who was on the course. I began to run past my last few months of heart ache and found the inner passion I had lost. I started to understand my journey and I started to find myself.

Having legs for the run was simply incredible. Although this race was not about beating or passing anyone, I could not believe the amount of people I was able to run past. I saw a bunch of my fellow competitors slowing or stopping due to cramps and could only think of how I failed in past races. My stomach felt great, I had no cramps and I was able to run each and every mile. So this is what triathlon is all about!

For nutrition I used 4 fuel belt bottles so that each bottle would be more diluted. For a half marathon I can fit all my nutrition into two bottles, but the nutrition is so concentrated it makes it really hard to digest; the less concentrated nutrition formula really helped me out. By mile 10 I still had legs, still felt strong and went after it. I turned to the shaved headed 41 year old who had run the previous 5 miles and asked, "ready to bring it home?" He answered with a resounding "yes sir!" and the two of us ran almost side by side for the final 3 miles of the run – that was a lot of fun!

Amazingly the final 100 meters of the run was up a very steep hill. I couldn't help but think that this was a fitting end to an amazing journey. I truly had to climb a mountain to find myself again, I had to scratch and claw my way back to being me. To find my confidence and to find my inner strength I fell to low valleys and needed to navigate my way out of the darkness. I strode up the final 100 meters, clapped my hands 3 times in triumph and gave a gun show when I crossed the finish line. For the first time in my triathlon career I was as happy with my performance as I was with finishing the race.

Run Time: 1:51:45

Run Grade: A++++++++++++++++++++++++++++++++++++

Final Thoughts

I was lost heading into this race; as a student, triathlete and individual. I had forgotten all the things that had gotten me to where I am and had all but lost every shred of confidence I once had. I had forgotten how to trust and had forgotten how to believe in myself. I went into this race questioning what direction my life was headed let alone my triathlon career. I began to wonder if I was truly inspiring anyone or if I would ever accomplish what I had wanted to. I felt like I lost so much over the previous few months that I didn't know how I would find my path to the future.

After I crossed the finish line I sat on a hill alone with my thoughts and shed a couple tears; finishing this race with confidence meant the world to me. My 2009 triathlon journey taught me to live in the moment; taught me to expose my vulnerabilities and reminded me that forcing something is hardly ever the right path. The journey for me was learning to let the moment come to me, not forcing the moment. I learned to accept that I can't control the future and that dictating terms or obsessing on an outcome does not achieve results. In the South Carolina Half I found myself, I found the confidence I need to let life come to me and reconnected with my inner strength. This journey has allowed me to once again believe in myself, it was a hard struggle to find that again but a journey that I will not soon forget – next up California 70.3 in March; this journey is starting to get really exciting and I think I'm finally doing it the right way.

Total Time: 5:33:16; a perfect day