Tuesday, June 30, 2009

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

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

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

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

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

Friday, June 26, 2009

Exercise & Basal Rates

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

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

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

Wednesday, June 24, 2009

IOB - How I Haven't Missed You

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

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

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

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

Monday, June 22, 2009

Selective Amnesia - Ed & The Ironman Meet Again!

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

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

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

Thursday, June 18, 2009

New Beginnings

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

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

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

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

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

Wednesday, June 17, 2009

When it works.... Its Awesome

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

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

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

Tuesday, June 16, 2009

Off To A Better Start

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

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

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

Monday, June 15, 2009

Thankfully I'm Not Lost

Because the Freestyle Navigator has about as much ability to lead me out of the darkness as Mr. Magoo could lead me through the Amazon. Having gotten into the swing of my summer internship I decided to give the freestyle navigator another try, hoping that my dismal results with it during the marathon were an aberration. However, after today I'm about ready to go to town on this device with as much vengeance as Peter and the boys had for the office printer in Office Space. I don't know if John Connor has as much loathing for Skynet as I do my Freestyle Navigator!

Last night I inserted the oh so well designed infusion site as Kim watched in horror. She also very logically asked, "you mean to tell me that thing is held on by that small amount of tape." Yep, they clearly designed this thing with the end user in mind - great job Abbott. Finally at 9am this morning the blood drop icon shows up on my Navigator so I go to calibrate, my blood sugar was oddly high at 180, so the test results weren't valid for calibration. An hour later I was below 160 and was able to calibrate.

Then the real fun started, even though my blood sugar was below 170, my CGM was showing my blood sugar to be above 220. As the day progressed my blood sugar on the CGM continued to climb above 300, but from finger pricks I was never above 270 (it was a really weird blood sugar day). After seeing my blood sugar at 340 on the CGM, but 220 as a finger stick I went to the gym. Upon returning from the gym my blood sugar was in the 60s - but wouldn't you know, the damn sensor failed already.

Less than 5 hours, my new sensor lasted less than 5 hours!!!!!!!!!!!!!!!!!!!!!!! The rip off Cabbage Patch dolls of the 80s that spontaneously burst into flames were designed better than this thing. But don't worry, I have a whole box of sensors so I'll keep trying, I swear one time I'm going to get this thing to work or its as worthless as Crystal Pepsi.

Wednesday, June 10, 2009

Miracle Noodles - A Type 1's Best Friend?

Imagine for a moment a food that doesn't require a bolus, has the consistency of pasta, helps diabetes research and has zero calories. No this isn't a mind bending exercise or an episode of the Jetsons the future is here in Miracle Noodles!

Kim had found out about Miracle Noodles a while ago from a triathlete friend, but had yet to try them. Monday night we decided to make a pad thai recipe with the enigmatic noodles. After our first nervous bite we realized the noodles are darn good! With 0 calories, 0 grams of fat, 0 grams of protein, 0 grams of carbohydrates, 2.5 grams of fiber and 0 grams of sugar you have to wonder what exactly you're eating. But the gluten and soy free noodles taste delicious and provide a great proxy for carb laden pastas.

Best of all a proceed of each purchase goes to the Diabetes Research Institute. I don't think the noodles will completely replace my carbohydrate craving, but it's nice to know that a product exists that doesn't require me to break the bolus bank.

Monday, June 8, 2009

Mooseman International Distance Race Report: Finally Progress!

In just my fourth triathlon and first race of my second season as an endurance athlete I finally flashed signs of progress and reached my timing goals! The Mooseman International Triathlon held on June 6th at Newfound Lake, NH proved to be my best race yet and has me tremendously excited about the upcoming season and beyond. Headed into the race I had wondered if I would ever reach my timing goals if some great training sessions on the bike would translate into success on the course and if my blood sugars would finally cooperate, on Saturday things started to come together and while I have a ton of work left to do when I crossed the finish line I was proud of not only finishing but of the time I finished in.

Pre Race:
Kim and I headed up to the Common Man Inn, in Plymouth, NH on Friday after work. I packed my usual pre-meal race of a 1/2 lbs of ground buffalo, whole wheat penne pasta and Rao's Tomato Basil Sauce in rubber maid containers, while Kim was able to enjoy a fresh pasta dish at the Inn's restaurant. Shortly after our meal we watched Slumdog Millionaire and waited for Anna, a friend of ours who was doing the race with TNT.

I used a regular bolus for my meal of 85 grams of carbohydrates but that proved to be a bit of a mistake. About an hour after dinner my blood sugar was 58, and remained below 70 after half of a clif builder bar. At midnight my blood sugar started to rise, when I woke at 5am my blood sugar was 200 - not awful for a race day morning but way higher than I had hoped. I still need to refine my bolus schedule for my pre-race meal, I had unfortunately left my notes on what I did for the marathon in my Virginia apartment.

My breakfast consisted of 2 slices of whole wheat toast with Almond butter; bolused with 1.5 units of insulin and could feel my blood sugars coming into line. After breakfast is when the fun started though!

We left the hotel at 6:15 am, probably a bit later than we should have. On the drive over I had my clif bar, and turned my pump down to 40%. Parking at Mooseman tends to be a bit of a disaster. We finally pulled into a spot at 6:48 am, leaving me just 42 minutes to set up my transition area and get into the water for my swim start. The parking lot was about 3/4 of a mile from the race site, during the walk I downed my nutrition mix with 2 scoops of cytomax and 1 scoop of pre-formance. When we arrived to packet pick up at 7:00 am, the volunteers couldn't find my packet! Finally they set me up with a new race number, but it was now 7:18 am, I had 12 minutes to make it to the swim or I'd be DQ'd!!!! Kim didn't fare much better as she had left her wet suit in my car and had to run back to the parking lot to get it for the race! We really need to leave earlier for our next race....

I frantically entered transition and set up my area as best I could in 5 minutes, thankfully due to the new race number I was set on a back rack virtually by myself. I didn't have a chance to take my bike gear out of my transition bag or place my running shoes on my transition mat - there simply wasn't time; I did however take the time to test and was so thankful my meter read 228. At 7:25 am I sprinted over to the swim start, about a 1/4 mile from the transition area while bobbing and weaving my way through the athletes who were in later waves. I literally made it into the water 1 minute before my wave went off!!!!

There is potentially nothing worse than entering 60 degree water, in a full sweat with your heart rate above 180. Sprinting to a swim start in a triathlon is not something I would ever suggest. Placing my face in that cold water with a high heart rate was awful and caused me to hyperventilate almost immediately. For the first time in any race I thought about quitting. I couldn't get my body to relax since I was so hot from my sprint over but so cold in the water. I decided to breast stroke for a few hundred yards to see if I could clear my head, finally my heart rate started to slow down, my core temperature cooled down and I was able to put my face in the water. At that point my stroke came back to me and I was able to catch up to the middle of the pack by the end of the swim. I finished the swim in 30 minutes with a blood sugar of 170 - the sprint over did nothing to help my time but 30 minutes was too awful, give the circumstances I was pretty happy with it.

Swim Grade: B
Swim Nutrition Grade: A

I can't really say I actually had a T1 transition, it was more a dive into my transition pack to find everything I needed to set up my bike. My transition time had to be at least 6 minutes, which is awful but there was nothing I could do. My Rocket Science transition pack actually saved me a ton of time, the back pack has a specific pocket for each piece of gear, this was the only thing that kept me organized on race day with the confusion at the start.

After loading up my bike with everything I needed I headed off to the bike course to hammer. My Garmin took a while to kick in but once it did I was happy to see I was holding a pace of 23 mph - the Mooseman course is really hilly so I knew I needed to crush the flats to post a good time - my goal was to ride at a 20 mph pace. Headed up the first hill of the course my chain fell off the front ring, I knew the 2 minutes I lost putting the chain back on was going to cost me that 20 mph goal but I also knew it wasn't enough time to be disastrous.

For the 27.5 mile bike course I used a 1 nutrition bottle strategy. I filled my water bottle with 3 scoops of cytomax (70 grams carbs), 2.5 scoops of carbo-pro (90 grams carbs), 1/2 scoop of pro-formance (20 grams carbs) and 1 gatorlyte packet. The mix seemed to work perfectly as I felt strong the entire bike and at no point did I feel any ill effects from blood sugars.

I hoped back on my bike and was really happy with the way I was riding. I didn't want to push it too hard as I had only done one transition run in training and also didn't want to loose my legs. I hadn't had a chance to stretch before the race so also knew the chance of pulling a muscle was pretty high. Throughout the bike leg I had back spasms which cost me some time on the hills but all in all I rode just about the way I wanted to. I finished the bike in 1 hour and 26 minutes for a 19 mph pace and came off the bike with a blood sugar of 168. I think my chain popping off cost me the 20 mph goal, but I'm satisfied with averaging 19 on that course but know I can do better.

Bike Grade: B+
Bike Nutrition: A

Much like my T1 transition, my T2 transition was no better. With my solid blood sugars and knowing the run was just 6.2 miles I decided to pound 1 fuel belt bottle filled with 1.5 scoops of cytomax, a thermolyte tablet and 1/4 scoops of pro-formance in transition. The decision worked perfectly as I finished the race with a blood sugar fo 185 - 17 points higher than my blood sugar when I left T2, exactly what I was shooting for!

My goal was to finish the run in less than 54 minutes, my ultra aggressive goal was to finish the run in under 50 minutes but wasn't sure if I had trained enough to hold an 8 minute pace for the entire run, but I knew I could break 9 minute miles if I fought through the pain. Even after calibrating my Polar RS800 it proved to be off!!! I have made the decision to get rid of the watch and join the Garmin crowd, I'm sick of technology not doing its job. My watch shows I ran 6.47 miles, almost .4 miles longer than the actual course. My final run time was 52 minutes and 52 seconds for an 8:31 pace - my best pace in a race of this distance since the Bear Mountain duathlon 2 years ago! Maybe training on all those hills in Charlottesville really did pay off. Better yet I ran the 6.1 miles at an even pacing split!!! That is proof that my training is really working.

Run Grade: A-
Run Nutrition: A+

Overall I am super psyched about how I performed on Saturday. I finished the race in 2 hours, 57 minutes and 33 seconds, good for 356th place out of 884 athletes. Rather than leave this race frustrated about something that went wrong which was out of my control I leave this race hungry for more. My passion and desire to improve in this sport and challenge diabetes is as strong as ever, it's amazing what some signs of progress can do. Now it's time to bust my butt for the Mussleman Half Ironman in a month and 1/2, I still have miles to go before I can sleep. Plus, I wasn't the only one to have a great racing in a Triabetes Race Kit, PJ, a fellow type 1 diabetic also is part of Triabetes, we met after the race adn it was great to share the excitement with another Type 1!

A huge congratulations to both Anna and Kim for outstanding races. This was Anna's second triathlon and she did an outstanding job. She headed into the race nervous she wouldn't be able to finish the swim and really doubtful about her ability on the run. She however rocked the course and crossed the finish line with one of the biggest smiles I had ever seen. Kim did a phenomenal job, her run time was hurt a bit because she got punched in the calf during the swim which had her calf spasming for the entire run. However, she did an awesome job fighting through that, did a great job on the bike and had a stellar run. The three of us were all pretty happy after the race.

Friday, June 5, 2009

A New Car & A New Idea

Last night after a frustrating process of registering a car in NY after buying it in MA, I finally picked up my new Mazda 3 Hatchback! I've downgraded from my Nissan Pathfinder which was starting to have some big time problems to a smaller, more nimble, more gas friendly, sportier car. My big goal with this car is to keep it clean! The Pathfinder at times served as my locker for triathlon gear and haven for months of test strips. As I sit here on day 2 of my Zoom Zoom experience I'm trying to figure out how to keep my test strips from commandeering my car.

Some ideas:

Old Grocery Bags: while this would be the least expensive option, old grocery bags don't do the best job of holding things in them, tend to get rips on the bottom which would allow test strips to escape and can be a bit of an eye sore.

Thule Litter Bin:
Great design and large enough to fit the occasional diet coke or sandwich wrapper and the cap will keep my test strips from being liberated. The big draw back is that it sits facing the rear of the car, it's dangerous enough to test while driving, now I have to reach into the back seat to throw them out.

Tallus Trashstand:
This one has some promise, but it will take up the passenger side floor and will thus need to be moved anytime someone else is in the car with me. Plus I'm not sure that the can would stay vertical as I'm zoom zooming, and that would basically defeat the purpose of the trash can.

Trash Cup:

This required some innovative thought; take a product designed to be an ash tray in a cup holder and use it as a garbage can. It would only hold test strips but it would not require me to reach in the back seat to throw them out and would be smartly placed directly next to my testing supplies.
Anyone have other ideas?

Thursday, June 4, 2009

Season Kick Off

This Saturday I will be competing in the Mooseman International Distance Triathlon which kicks off my 2009 triathlon season! In keeping up with my motto for the 2009 season of "consistency, improvement and fun," my only goal for the race is to perform on race day as I have been in training with a smile on my face. I unfortunately don't have any comparable race distances from last year to use as a benchmark. Saturday will mark my 4th triathlon (5th if you include the 2007 Bear Mountain tri that was turned into a du) but the first of the official international distance. Last year the 2008 Spring Bassman had a .6 mile swim, 29 mile bike and 4.2 mile run; Mooseman has a .93 mile swim, 27.25 mile bike and 6.2 mile run. If my blood sugars remain solid and I just remember to have fun I have a pretty good idea of what my time should be, but since I've had mechanical bike failures or blood sugar issues in every race I've done so far I just want a consistent day.

In other news, I have not yet had the opportunity to re-test my Freestyle Navigator. I had major car issues which prompted me to trade in my old Pathfinder for a new Mazda 3 (which I still haven't received delivery of!) and also started my summer internship. These 2 life events took priority and prevented me from adding one more ball to juggle. Hopefully I can calibrate the Freestyle Navigator sometime today so that I can test it out again on race day - although I still have no idea how a swim will affect the sensor.

Full race report on Monday, I promise!