Night Time Hypoglycemia

With my ramp up in workouts over the past couple of weeks my episodes of night time hypoglycemia has increased. Hypoglycemia during periods of sleep is one of the most dangerous conditions a diabetic can face. Hypoglycemia occurs when blood sugar goes too low, this can result in seizure, coma or death – things that are not fun! From my discussions with Dr. Kirk her research has indicated two spikes in metabolic activity after exercise, one immediately after strenuous exercise and one 4 to 6 hours later. Therefore, if I finish a hard swim or trainer ride at 8 or 9 pm, my metabolic rates are going to spike at 2 or 3 in the morning. During sleep periods one's metabolic rate decreases, therefore my basal rates are a lot higher from 1 am to 6am than they are at other points during the day – a slight increase in metabolic rate will cause a hypoglycemic episode.

So as my episodes of waking up in a cold sweat or from a bizarre dream have increased, I've been able to track a few of the symptoms. One constant theme of the bizarre dreams I have noticed is that they often involve an evil villain, a gun and my younger sister. In each dream I have tried to create a strategy with Lynn to defeat the man with the gun – normally I wake up before the showdown but it's uncanny how similar all the dreams are. So I guess this means that my mind views diabetes as Lex Luger with a gun!

Not surprisingly, my basal rate has dropped a full 2 units of insulin per day over the past several weeks. Right now my basal rate is just above 13 units of insulin per day – I assume that by the end of February I'll be down to 11 units of insulin per day. Interestingly, I've realized that as my work outs become more focused my diet becomes more refined. I've switched back to mainly drinking wine if I'm out with friends, making sure I'm home by 1am and eliminating anything on my plate that I "can't recognize." The combination of the increased exercise and refocused diet has contributed to having just two highs over the past 8 days. Although all that has also increased the episodes of hypoglycemia – the system continues to be a delicate balance.

Fox Hunts, Cujo, Rain & My Couch

Finally, the weather, my energy level and my schedule finally cooperated as I was able to get on El Bastardo for the first outside ride of 2010!!! Coach Orton scheduled a 70 mile ride for me on Saturday, mostly in zone 2 – 3. For the past two weeks I have had a 70 mile ride scheduled but had to choose option B, the 2 hour trainer ride, because of either the weather or exhaustion from travel. I quickly found out that no matter how hard I've worked on my road machine, it did little to prepare me for the hills of Charlottesville!



The ride took me past beautiful farm houses, through small towns and on the edge of the Blue Ridge Mountains. At one point I looked across a wide open field to see the tips of the Blue Ridge covered in frost and couldn't have been happier. Riding down here is breathtaking, getting just a few miles outside of Charlottesville leaves you alone with your thoughts and with nature. The best description I can give a ride like this is cycling perfection; well if some of those hills were a little less steep it would have been total perfection, but I need the work!

About 20 miles into my ride I passed by an equestrian in full English riding gear so I smiled and waved, just down the road was a brigade of horse back riders complete with beagles, red English fox hunting jackets and an austere look on their faces. In all I passed about 15 fox hunters, "sporting," is still a big part of the culture in VA but this was my first encounter with them on my bike. Out in the countryside seeing all these people on horse back was definitely a sight I won't soon forget.
About 15 miles later I was on my favorite 5 mile stretch of road, totally flat, totally smooth and freaking fast. My 93 rpm cadence had me humming along at 26 mph and then I got passed by a pack of roadies!!! I have never been passed on this stretch of road, apparently all that drafting they do off of each other gives them a mph advantage, although these 5 guys looked like studs, all tall, all super skinny and freaking fast. I'm pretty sure they were going at least a mph faster than me, rather than be a meat head I hung back so not to draft off of them and just let them go – small victories for signs of intelligence!

My blood sugar dropped to the 90s around mile 45, so I hopped off my bike for 5 or 10 minutes to have a clif bar and rest up a bit, my back needed a stretch so this wasn't the worst thing. I actually didn't have my usual breakfast before the ride mainly because I forgot to buy Odawala Superfood on Friday afternoon. So I think this "low" had more to do with not taking in enough nutrition prior to my ride than my actual nutrition mix during the ride – or it could have been the hills and all the clothing I was wearing for warmth.

The ride progressed and I was happy as could be. I was outside, I was riding hard, I was riding smart, my legs were burning from the challenge but that's what IM training is all about. That is until I encountered Cujo and his friends. On Dick Woods Rd, I was riding up a particuraly long, steep hill. On the road ahead of me I saw 2 four-legged creatures walking across the road with their brown and white friend (a collie) whom I have thus named Cujo. As I got closer I realized that Cujo was escorting two freaking goats across the street – like complete with horns and goatess, actual goats just chilling, hanging out having a grand old time. Well Cujo must have wanted me to be part of his goat brigade, because he tore ass across the street as I passed his little party trying to get me to join them. I actually said out loud "seriously dog I'll run you over if you get in front of my wheel," I actually thought Cujo understood this as he backed off a bit, or so I thought. I sped up a little along the steep grade, only to hear barking and the click-clack of dog nails behind me, Cujo was right on my back wheel! F-Me!!! I sped up some more and thought I dropped my furry friend, so I slowed up as my heart rate had spiked to the 170s to hear click-clack, click-clack yet again, the snarling beast really wanted me to join him and the goats for tea! Dial it up again Ed, so I hopped out of the saddle and hammered away since a tea party with 2 goats and Cujo really wouldn't help my social life, as I hit the top of the hill I heard click-clack, click-clack, woof, woof, woof! Cujo honestly chased me for at least a ½ mile up hill!!! I know my legs look tasty but seriously there's other fish in the sea pooch. As I hit the top of the hill I cracked up, gave my new furry friend the finger to let him know who # 1 is and took off. No rabies shots needed, but I bet Cujo walked back to his goat friends in triumph, or dejected thinking he lost the chance to not be the third wheel at his fiesta.

3 hours and 45 minutes later I got home and collapsed on my living room floor, sore, tired, but happy as a fat kid at a Chinese buffet. 70 miles for my first ride outside since at least November, I have a long way to go to IMCDA or even Cali 70.3 but I'm on my way. I had to recover quickly though because I had a conference call scheduled about 45 minutes after I got home – was tough not being delirious for that one.

Later that night I went to dinner with a friend, and then to a buddy's birthday party. One of the things I love about training while I'm at Darden is having an excuse not to get black out drunk. Peer pressure is tough to avoid if you don't have a good excuse, but telling my friends, hey sorry I rode 70 miles today and have a 2 hour run tomorrow so I'm just having 1 beer leaves them dead in their tracks. Ahhh the joys of your friends thinking you're totally insane.

Sunday I woke up at 9am, laced up the running shoes and was out the door by 10:30 am; 2 hour run was on tap and I was determined to get it in, even If it was pouring outside. My legs were filled with lactic acid, my head was pounding from a lack of salt and my eyes were blurry with sleep, but I ran. I kept my hr steady in zone 2 and wavered between a 7:50 and 9:20 minute mile pace. With my quads burning I struggled through the run, with a healthy blood sugar and only a slight twinge in my hamstring. I was shocked I was able to run so well and maintain the pace I did in zone 2. 40 minutes after I returned to my apartment, I hopped in my car to head to the pool – the pull buoy was used extensively because my legs felt like 2 blocks of cement but I completed my entire swim workout. As I left the AFC I had a huge smile on my face as I knew I had just gone through the hardest weekend of workouts I've had in 2 years.

I hurried to whole foods, bought a ton of food and then got my butt on my couch where it remained for the rest of the day. I watched Championship Sunday while eating at least 300 grams of carbs, had a few friends stop by during the day, each of whom laughed at the pathetic sight on the couch. I relished in the soreness, I took pride in the pain, as I fell asleep that night I thought – this is what Ironman training is all about, and this is why this sport is so great.

No Food Is Safe

A recent e-mail exchange with Coach Orton has me convinced that my parent's created the world's perfect eating machine.  The exchange was:

Coach:  Are you doing drinks during yur swims? (after he read my training peaks update that I bonked on the 5th 300 in a set of 5)

Me:  Haven't been yet - assuming from that question it would be a good idea if I did?

Coach:  It sounds like always drinking and taking in calories is good for you regardless of length and intensity of ALL your workouts.  I think your issues are cumulative from the weekly load and always topping your system off is a good idea...again regardless of the workout.

Me:  I think my next tattoo should be of a hungry, hungry, hippo!

Remember To Eat

Coach Orton is challenging me in a way I've never been athletically challenged before. Each workout I've performed over the past two weeks has incorporated endurance and speed as we prepare my body for what I hope to be my best season of triathlon yet. Prior to the start of the season I told Eric I wanted to go into this season in the best shape I have ever been in, I'm hungry to push myself in this sport, to challenge my body and mind to see what I am truly capable of. I'm curious to see how my blood sugars respond to such a strenuous schedule and I'm dying to see what this means for my transition from a strength to endurance athlete. So far the training has been a blast, I'm getting faster and stronger but need to remember to eat.

Last week I had 14 hours of workouts scheduled. According to my nutrition formulas, for 14 hours of workouts I need 3,700 grams of carbohydrates!!!! By Friday of last week I knew I had screwed up, I was exhausted, my blood sugars could barely get above 80, and in the pool I felt like I was going to fall asleep each time I touched the wall. I had been aggravated that from Thanksgiving to Christmas I put on 6 lbs. and wanted to take that off as soon as possible. On Friday night I saw some friends who I had went to Aspen with and they asked, "um, how much weight have you lost since Aspen?" Whoops, might have been a bit too aggressive on cutting calories over the past couple weeks.

I figured I was in the carb hole for about 2,000 grams. As much fun as it would be to sit on my couch like Jabba the Hut with bikini clad beauties feeding me pancakes and pouring syrup in my mouth I unfortunately have a life to lead (and bikini clad beauties who will hand feed me are tough to find!) So I needed to adjust my plan slightly. Friday night I ate as much pasta and bread as I could hoping that would get me through my hour swim and 70 mile bike on Saturday. 1,000 yards into my swim I knew there was no chance I could finish the workout. Like an engine without oil I had nothing and my muscles began to seize. I headed to Whole Foods to grab some sandwiches, tortilla chips and anything else I could find that was carb dense. After a sandwich, clif bar and an apple I tried to get on my trainer, 37 minutes into the ride I could barely push down on my pedals, at an easy gear the highest I could get my cadence was 70 – the tank was empty.

Since one of my goals this season is to be smarter about training and to enjoy every moment of the ride I decided to retreat for the day, and fuel up so I wouldn't screw up this week as well. Saturday, I ate, and ate, and ate and ate. I ate sandwiches, I ate nachos, I ate pizza, I ate apples, I ate clif bars I ate pasta and I drank juice. Amazingly I was in such a carbohydrate deficit that I had to take in just half the amount of insulin I normally would for such a glutinous feast. Sunday when I woke up my blood sugar was 160 and I was off to train! I had a pumpkin muffin prior to my 45 minute trainer ride, fueled during the ride, took in a gel and was off the bike with a bs of 200 – time for a 2 hour run! 13 miles later I cruised back to my apartment with a blood sugar of 150 – salvaged the most important workout of the week; time to eat some more, oh and watch the Jets win!!!

Although the memories of my 2008 IM journey are still fresh in my mind the details somehow got lost. I forgot about how much food I need to maintain energy and glucose levels to train hard, train smart and train well. I forgot about the snacks I need to eat, that having 7 meals throughout the day is better than having 5 that fruits are my friend and that getting leaner will happen over time and not in one week. One of the hardest things to do is remember that taking insulin isn't a bad thing and it's ok if my daily intake goes up to 50 units per day instead of 30. Triathlon is a 4 legged race; nutrition is probably the most important leg but the easiest one to screw up.

Mind vs. Body

Tuesday was my first "hard" workout of the new season. In December I had some speed work and a few hill intervals but nothing close to a trainer workout that brings on the deep burning in my quads that I crave. I had e-mailed Eric Monday morning letting him know that I was only able to get in a 40 minute run on Thursday & Friday because of networking meetings that I had in Portland and asking if he wanted me to add some extra time to Monday's 40 minute zone 2 run. His response was not to worry, that getting in what I could over a stressful couple days was terrific and to be ready for Tuesday because it would be "a hard day." With that statement I smiled and was excited for what my training peaks account would reveal.

Tuesday I had two workouts scheduled, an hour and 15 minute trainer ride and a swim workout with a moderate half hour continuous swim. The trainer ride was what I have been craving, a brief warm up followed by a 5 minute build to zone 4b, then 45 minutes of zone 4a riding! Quadzilla was hungry and needed to be fed, 45 minutes in zone 4a was just what the doctor ordered. Sweating away like aqua-man in a sauna I had an epiphany about why sweating my butt off, legs burning and heart rate soaring makes me smile so much.

Sport gives the individual the rare opportunity to test one's physical limits, there comes a time in every tough workout where one's body wants to quit, at that time the mind and heart can either push past that pain, soak in the challenge and push on, or the mind can succumb to adversity and falter. In our everyday lives it is rare that we have the opportunity to truly test what our bodies are capable of. As my legs were burning on that trainer, it took every ounce of mental fortitude I had to push through the pain and to relish in the opportunity to see what my body was capable of. There are few other things in life that give us the opportunity for that challenge.

Then during my second workout of the day yesterday a much different challenge was presented. Eric wanted me to swim continuously for a ½ hour (in a freaking pool), which is about as much fun as having every hair on my body plucked out with tweezers one by one. Triathlon also presents the challenge of slowing down the body, letting off the gas when the body wants to push as hard as it can. For a ½ hour continuous swim my mind has to force my body to slow down, as bored as I was plodding along at a medium effort, swimming 500s on a 9 minute pace I knew I couldn't complete the workout if I pushed any harder. The test of restraint is a lot harder in many respects than the test of pushing through adversity, which is what makes this sport so neat.

Of course the challenge to push through or the challenge to hold back can be trumped by blood sugar management. I have control over my mind and body when my blood sugars are in line with what I need to work out, but in the times when my glucose levels are off, diabetes prevents me from challenging myself. For me the hardest test is to know when to say when, whether it is a twinge in my hamstring or a reading of 105 on my blood sugar meter I have to know when to walk away. The confidence to say today is not my day and I need to live to SBR another day is maybe the biggest lesson I have learned from triathlon and that challenge of mind over ego is one of the most interesting.

Of Pine Trees, Coffee & Sustainability

I spent last week in Portland, Oregon trying to cast as big a net as possible to land a job that incorporates strategy and sustainability when I'm done with my MBA in May (and after IMCDA of course!). I had high hopes for this trip as I had created a vision that Portland was the epicenter for the companies that will make an impact in the future. I firmly believe in stakeholder theory as the road map for profitability and believe that the days of focusing on short term quarterly returns are over. After 7 meetings in a two day period my expectations were met and belief that firms that use stakeholder theory to guide them are the right fit for me was solidified.

I woke on Tuesday at my sister's house in West Linn to go for a run. I was excited to go out for a run in shorts and my wind jacket. The weather was perfect for a 70 minute run, about 50 degrees, a little damp and barely any wind. I was cranking out a 9:05 pace in zone 2 and an 8:25 pace in zone 3 and just loving life. The view was breathtaking, hills covered in evergreens, a raging river next to me, and everything was just so lushly green. I ran past farms, houses, horses and people. Each person I passed was happy to smile at me, the road construction crew gave me a wave and I had a smile on my face the entire time.

Later that day, after I met with my sister at her kitchen (she's a chef) I headed into downtown Portland to find a coffee shop. Portland has no shortage of shops that serve one of my favorite vices. Maybe that's why I get along so well with Mary Eggers, we share a common passion – coffee! I drink a lot of it and am always in search of the perfect brew. I was slightly disappointed by Stumptown coffee which has a reputation as Portland's best, but having spent close to 3 hours in the shop I probably shouldn't complain.

On Thursday my networking meetings began, I won't list all the companies I met with but was insanely excited by the thought process out there. Companies were focused on doing well, while doing good; community involvement was a priority for each company I met with and each is looking to source the least harmful materials possible for their products. As I explained some of the projects I'm doing at Darden the people I was meeting were enthusiastic about our mutual interests and excited that MBAs are beginning to see the light.

It was incredibly refreshing to be able to speak with individuals about sustainability and my theories on business without having to convince them of the benefits of it. The managers I met with didn't look at me like I had 7 heads when I said "we need to refocus on businesses responsibility to the social contract," and shared my visions on how to make a company profitable. By the end of the week I had made inroads with some giants of industry, companies that are growing fast and boutiques that are trying to create change. I came back to VA about to start Q3 energized knowing that there are businesses out there seeking to do things in a better way.

My Name In Bright Lights!

A few weeks ago I received an e-mail from Elizabeth at trainingpeaks.com.  Apparently they had come across my blog and wanted to feature me in their "featured athlete" section.  So today as I logged onto training peaks to check my workouts for the day, a familiar name caught my eye at the bottom of the page.  As I was typing in my user name and password I saw the headline, "From Juvenile Diabetes to Ironman:  Ed Liebowitz Training Peaks Member."  Elizabeth never told me when the article would be published so I'm now sitting in a Portland coffee shop with a huge smile on my face - what a nice surprise!  Hopefully it brings me luck for what could be a very, very, very important day tomorrow.

What are we eating?

Since returning to my Virginia apartment I have been shocked by the stark difference in my insulin needs compared to the 10 or so days I spent at my parent's house in New York. In Virginia I have 100% control over the foods I eat and pay super close attention to where the food is sourced from, the level of processing and how organic the contents of the food are when I go to the super market. In NY my parents do the best they can to cater to my nutrition needs but without the hours spent with a sports nutritionist, countless articles read and dedication to studying food labels that I have the effectiveness of food choices is somewhat reduced. Additionally, since I was at home for just a short time a lot of food choices aren't as economical for my parents as they are for me, and lets face it eating healthy can be prohibitively expensive.

My diet in NY was not all that different from my diet in VA but the composition of the food was very different. The major noticeable meal difference was what I had for breakfast. At my parent's house I don't have access to my blender, chia seeds, odawala super food or organic fruits that I have in VA. So instead of making my customary fruit shake for breakfast each morning I would have an English muffin with peanut butter; I tried going with yogurt and granola but the taste of the strawberries in my Dad's industrial size bag of frozen fruit was kind of disgusting, so I thought the English muffin was an "ok" alternative. It was the less noticeable differences that caused the biggest problem for insulin needs.

At lunch I normally have an organic salad of baby romaine or spring mix with some organic chicken sausage, chia seeds and an oil & vinegar dressing. At my parents house I would have a non-organic salad mix, oil & vinegar dressing, and chopped up turkey cold cuts (no chia seeds). For my customary salad I need anywhere from 2 to 2.5 units of insulin depending on how big the salad is and if I add any extra veggies to it. At my parents house I needed close to 4 units of insulin to cover the salad! Is it possible that processed cold cuts and non-organic greens could make that big of a difference?!?

While at home each evening my blood sugar spiked well above 250; granted my dinner meals were a bit less healthy than they are in VA but it's not like I was having fast food or pizza. On three separate vacations I had to take in an additional 6 units of insulin after dinner to get my blood sugars inline. The major difference between meals at my parents and at my VA home was where the food was sourced from. In VA I shop almost exclusively at Whole Foods, in NY my parents shop at the A&P. I make sure I eat grass fed meats where my parents will buy what the supermarket has that day; I eat as little processed food as possible, where my parents will buy a lot more canned goods. To no fault of theirs, we expect lean meats and vegetables to be healthy, but then why were my insulin needs so much higher in NY than VA?

I also recently watched Food Inc., and was shocked at how the industrial food complex has fundamentally altered the composition of the foods we eat. In the past chickens took twice as long to mature as they currently do and never reached the weight that today's industrial chickens do. Corn and soy were introduced to the diet of cows and chickens to make them grow bigger, faster. Given all that the meats that I eat in Virginia are grass fed, organic and antibiotic free; the meats I was eating in NY however were lean but not organic or grass fed. I think that small difference also contributed to my much higher insulin needs; which is food for thought.

Now that I've been back on VA for about a week before I embark on my next cross country trip to network in Oregon my blood sugars have come much more inline. I've had way more lows than highs, and for me that's a good thing. I'd much rather have a blood sugar of 75 than 300; as orange juice tastes a lot better than blurry vision and a head ache make me feel. I'm not sure I'll ever have a full understanding of why my insulin needs were so much different but I do know this past month has heightened my awareness of how important it is for me to eat clean.