Friday, February 20, 2009

Getting To Know Me A Bit Better

There's a new blog comment interview trend going around. Kim, left the following questions on my blog for me and since I hardly ever talk about non-diabetes related stuff, thought this was a great chance to share a bit more about me.

1.) What was the moment that made you say "i'm gonna do a triathlon"? Instead of "I'm a meathead, I think I will do a strongman competition"?

My transition into triathlon was a slow and long one. After graduating from college I was a bit depressed that my football career was over and well ballooned to the size of a bowling ball with eyes (according to a good friend of mine at Darden). After my third orthopedic surgery - this time on my knee, I realized I needed to do something to change my physiology. I started working with Ari Weller who began transitioning my thought process from how big can you get to how healthy can I be. I bought my first bike, a Specialized Allez in the spring of 2005 and had aspirations of doing a sprint triathlon in Central Park that summer. I never actually signed up for the race, but the goal of becoming a triathlete began to grow.

In December of 2006 I ran my first road race to prove that I could run 10 miles with no training and not stopping for water - it was a dumb bet but loved competing with people again. For the next year I began to run more often, and ride my bike to Nyack from the city fairly often and started to transition from a meat head to an endurance athlete. By April of 2007 when I was diagnosed with diabetes I was running up to 20 miles a week and riding any warm weekend. The day I was diagnosed was the day I became "hooked" on triathlon, I knew that lifting and eating the way I had in my past wouldn't be healthy anymore, but my desire to compete as an athlete was as strong as ever. 3 months after I was diagnosed I signed up for Ironman Lake Placid before I ever competed in a triathlon of any length and had ridden in just one charity ride. The excitement I felt when I volunteered at the 2007 Lake Placid, and the determination I saw on the competitor's faces was the feeling that I had missed since my last college football game, from that moment I was determined to become a triathlete.

2.) Where is your favorite place to workout, and what is your biggest 'pump you up' song?

The meathead never dies, so my favorite pump up song is "Right Now" by Van Hallen, followed closely by "Welcome to the Jungle" by GnR and "Real American Hero" by Rick Derringer - better known as Hulk Hogan's theme song. All there songs and some others were on my pre-game tape in college and prior to one game while in my warm up routine an opposing coach asked one of our kickers if I was "all there." Apparently, I was singing Thunderstruck at the top of my lounges while walking around the field for about a 1/2 hour.

My favorite place to workout is a really tough one; my favorite memories of working out were at Spring running at Hobart; seeing Ricky Lopez throw up voluntarily so Coach Cragg would have us stop running was always a crowd pleaser and there was just something about being miserable running sprints at 6am that brings a group of guys closer together. For triathlon training, my favorite training ride was the 100 mile loop I'd do from my parents house to Bear Mountain, half the ride was along the Hudson and the view from the top of Bear Mountain was incredible, plus it was on one of those rides that I finally realized I was actually in good enough shape to do an Ironman.

3.) What's your favorite memory with your family? (don't just say, i love moose)

The first time I went to the Florida Keys, my family stayed at Duck Key in this place called Hawks Kay. I caught my first bone fish on that vacation but what really stood out was how insane the breakfast buffet was. The buffet was held in a banquet hall and had every breakfast food imaginable including a belgium waffle bar. I don't think anything could have showed the diversity of my family better than that breakfast buffet. My Dad would pretty much skip the regular breakfast stuff and head straight for the belgium waffles and eggs benedict, he'd come back to the table with a waffle covered in whip cream, strawberries and whatever else he could find. My sister would try and emulate him but would then just start playing with her food, which would usually gross the table out :). I'd pile as much bacon, sausage and french toast onto my plate as humanly possible and eat more than any 12 year old should have ever been able to physically consume, and my Mom would simply have cup of coffee after cup of coffee - I don't think anything could have showcased my family better!

4.) Putting monetary and other concerns aside, where would you live, and what would you do for the rest of your life given a chance?

I've struggled with this question for years; part of me is dying to coach football but my super nerd side has always forced me to aspire for something that matters. My desire to work in the sport I love is counterbalanced by my love of public policy and geopolitical affairs. So given all that I really don't think I could see my life having taken any direction other than the one it has taken. My goal is to work in an area at the intersection of business strategy and public policy to help shape development and globalization from a top down approach, then ride off into the sunset to coach High School football; I feel like professionally without the first I'll be unfulfilled while emotionally without the second I'll always wonder. As far as places to live, Lake Placid might be it - but to me the people I surround myself with are way more important than where I live.

5.) What is the order you follow when showering? Do you shampoo or wash first? Poop? Needle out?

Ha, my showering routine since pumping it up added an extra step. Each morning I take my pump out of my infusion site and leave it in my bedroom (I'm always afraid it will get wet). Then I turn my shower on, let it warm up as I brush my teeth - then soap first, chest, legs, butt, back, face (I use a different soap on my face than my....) Then it's shampoo followed by conditioner; however I'm now shampooing every other day to promote healthier hair (gotta keep the girlfriend happy!)

Well that's probably the least diabetic related post I've ever written on this blog - hope you enjoyed!

To play along:
1. Leave me a comment saying, "Interview me."
2. I will respond by giving you five questions. (I get to pick the questions.)
3. You will update your blog with the answers to the questions.
4. You will include this explanation and an offer to interview others in the same post.
5. When others comment asking to be interviewed, you will ask them five questions.

Wednesday, February 18, 2009

Basal Rate Redux!

A few months back I wrote how my basal rate seemed to be continually climbing. In the days preceding the Ironman my basal rates were around 6 units of insulin per day, around Christmas my basal rate shot up to around 16 units of insulin per day. After 2 months of marathon training and getting back to my training diet my basal rate has been reduced to 11.5 units of insulin per day.

The magnitude of the swings due to diet and exercise has been striking. During the first semester at Darden my eating patterns were sporadic, workouts infrequent and stress was at an all time high. I would regularly skip lunch, get take out from Chipotle or take in a free lunch provided by a company hosting an information session. The stress level of the case studies caused me to sleep less and travel to interviews took up a ton of time. The combination of all that took away from the consistency needed for good blood sugar control and added 13 lbs to my frame from the 183 I weighed right before the Ironman. A quick Google search suggested that children require about .5 units of insulin per pound; using this logic, my 13 lbs weight gain probably accounted for about 5 units of my basal rate gain.

The rest of the basal rate increase was probably due to the higher fat content of the food I was eating and the slow down in my metabolic rate due to less workouts. This has really made apparently how cumulative diabetes care is. What we did yesterday affects our blood sugar rates a week from now; I now view diet and exercise as a glucose management bank. Increased exercise allows a few more "cheat" meals without having to do with an insulin resistant high; while a healthier diet makes insulin more effective in general. My new endocrinologist - Dr. Kirk at UVA is doing empirical research on physiology and insulin transport. One of the things I have learned from her is that 6 to 8 hours after exercise your insulin sensitivity is increased dramatically. Therefore, the more exercise you put into that glucose management bank, the more affective insulin is going to be. This is no way in saying that exercise is going to eliminate the need for insulin since Type 1's produce it - the glucose management bank is just another tool in our quest for a healthy A1c.

Wednesday, February 11, 2009

When The Food Just Won't Digest

Ever encounter a situation where no matter how many carbs you take in, your blood sugar just won't respond the way it is supposed to? I'm still trying to get a grip on this phenomenon but because it happens so rarely I can't totally grasp what causes it.

Wednesday was speed work day, with 2 miles of my goal marathon pace, then 4, 1 mile tempo pace repeats (about 30 to 40 seconds faster than goal pace) followed by 2 miles of marathon pace. I knew I'd need a decent amount of glucose on board for this run but nothing prepared me for the amount of food I'd have to eat right before it! I was a little low at 1:30 pm for lunch with a blood sugar of 71, so I had chicken with rice and a big chocolate chip cookie (training allows such delights!); I calculated 80 grams of carbs and bolused accordingly. an hour later I turned my pump down to 40% basal rate and had a clif bar (42 grams of carbs), at 3:30 I headed out for my 15 mile drive to the only flat stretch in Charlottesville and took in about 100 grams of carbs via my nutrition mix. However, when I got out of my car my blood sugar was just 108! I felt like my blood sugar was high, but my meter wasn't showing that - 2 more finger pricks confirmed a blood sugar below 115. Since I was training with a friend going home wasn't a real option.

So I did what any insane person would do, ate half a clif builder bar, 3 luna slices and a Gu - all in about 50 grams of carbs and waited until my bs started to trend up. After 7 minutes my blood sugar was up to 130 and I knew I had enough carbs digesting to make it through a Russian winter without eating so I headed out for my run. I finished my run with a blood sugar of 65 and was probably lower than that at points during the tempo intervals but know that my blood sugar reading wasn't indicative of the glucose in my system. An hour after my run my blood sugar was 240, so at least some digestion finally took place!

I have yet to figure out this absorption rate issue, I was well hydrated, hadn't eaten anything overly fatty over the past few days and there were no environment issues to speak of. I guess sometimes my stomach just wants to take the day off.

Sunday, February 8, 2009

Saving A Training Run

With 40 to 50 miles already logged in February, Marathon Training is in full swing! Yesterday, it was about 65 degrees in Charlottesville which was a huge temperature change from the 30 degree run I had last week. With the sudden change in temperature I had to adapt my nutrition plan to ensure safe blood sugars for my run.

The sudden increase in temperature had some buds forming on trees so my allergies were killing me from the moment I woke up. I had to find batteries for my polar stride sensor prior to my run, apparently a size 2430 battery is the least popular battery known to man as it took me about an hour to finally find a store that carried them; thank you Batteries Plus! Finally at Ridge Rd. about an hour later than I had hopped my blood sugar spiked to 323 (I had my usual clif bar and nutrition an hour before I was supposed to run – that turned into 2 hours). Knowing that 323 was too high of a blood sugar to start with, I took in .5 units of insulin and headed out for my run.

2.5 miles into my run my blood sugar had already dropped to 171 and I knew a blood sugar low was right around the corner. In adjusting for my high blood sugar I neglected to consider the high temps and what that would do to my metabolic rate. With the higher temperature my normally high sweat rate becomes well disgusting, this causes my body to burn glucose at a higher rate thus increasing my need for carbohydrates. Since my body hasn't yet adjusted to spring temperatures my nutrition needs were that much more.

At 171 I decided to take in the rest of my first nutrition bottle about 25 minutes early; 2.5 miles later my blood sugar was down to 131. At that point I decided to pound my entire second nutrition bottle and second water bottle – each was supposed to last me 45 minutes to an hour. I knew that by taking in 80 grams of carbohydrates and slowing my training pace from 9:15 to 9:45 minutes per mile (for 1.5 miles) I'd be able to spike my blood sugar high enough to run the last 5 miles to my car to get in enough nutrition to finish up the last 2 miles.

The strategy worked perfectly, when I reached my car my blood sugar was 121, better yet my fresher legs allowed me to run my last 2 miles at an 8:30 pace. No matter how much I train, every experience brings about a new blood sugar management lesson!