My lunchtime basal & bolus was a mystery last week. Although I was eating the same thing for lunch that I had been eating nearly every day since my diagnosis (or so I thought) my carb ratio and/ or basal rate wasn't keeping my blood sugars out of the danger zone. Each day about an hour and 10 minutes after eating I would witness my blood sugars climbing higher and higher above 200, then a headache would ensue and that great feeling of an upset stomach would happen. I worried that I'd never again be able to enjoy a turkey sandwich!
Yesterday I went to Jeffery's at the Essex St. Market where I normally buy my turkey for the week. I asked the guy behind the counter for Boar's Head Oven Gold Turkey (the same turkey I thought I had gotten last week). Counter Man points to the maple honey turkey to which I say no, the other one. Then lightning struck, an epiphany hit me, last week the edges of my turkey were brown not gold!!!! The guy made the SAME GOD DAMN MOTHER FING MISTAKE LAST FING WEEK AND F'D UP MY FING LUNCH TIME BLOOD SUGAR - FREAKING BASTARD!!!!!! I now know I must keep my eye on Counter Man or instill the fear of the angry diabetic in him; it is amazing how assuming we are eating one thing when we are in fact eating a similar but not identical product can destroy our blood sugars. I can't even picture what having a food allergy must be like. Counter Man is lucky that the deli case at Jeffery's is 5 feet high, any shorter and he would have easily wound up in the pile of bananas behind me :).
My other lesson came at the pool last week. I set out for a hard core 3500 meter swim workout. About 2000 or 2500 meters into the swim I started to feel a bit weird and decided it was time to test. If I happen to pass out on my bike or while I'm running I figure someone will eventually find me (in Manhattan someone is never that far away) but I'm terrified of passing out from a low while swimming. Perhaps it's because there are maybe a handful of people at my pool who do more than doggy paddle or the fact that the lifeguard has no teeth but something about having a seizure in a pool doesn't give me a warm and fuzzy feeling. Therefore, I'm a bit more cautious during my swim workouts than with any other discipline. So I climb out of the pool and had thought I dried off pretty well. As I shakily open my vile of test strips a huge drop of water falls from my hair right into the canister!!!!!!! I had combined 2 one touch ultra viles into one before I left for my swim so I just ruined 50 test strips!!! Yesterday when I went swimming I only brought 10 test strips to the pool with me.
Tuesday, January 22, 2008
Friday, January 18, 2008
Basal or Bolus?
Over the past week and 1/2 my lunchtime blood sugars have been running out of control. Each day I essentially have the same thing for lunch, turkey and roast beef with cheddar cheese and mayo or mustard on some sort of multi grain bread. For nearly my entire short diabetic life I have been able to bolus this meal with a carb ratio of about 1 :15. On really active days I'd bring the bolus units down to 2.8 but on less active days never higher than 3.2. But for the past 10 days at 1:30 pm an hour and 1/2 after eating my blood sugars have started to creep into the high zone. On both Tuesday and Thursday my blood sugars closed in on 300. On Wednesday I increased my basal rate by .05 units and reduced my carb ratio to 1:11 but the results Thursday were similar to what they were with the old settings. Pretty confused as to what is going on so I'm going to try and not eat lunch today until 2pm to see if it is my basal rate that is screwing things up - wish me luck and I chew on my arm out of starvation!
The reason I'm pretty stressed out about this change is it has wreaked havoc on my workout routine. To get in a hard swim or bike ride on the trainer I need carbs and I need lots of them. As I shoot myself up with insulin to move away from an unstable 250 and get rid of a killer head ache I know I'm going to need to get my bs back up to 200 again soon. However, the 250 caused by weird events and the 200 that I intentionally hit feel totally different. Due to all the corrections I have had to give myself the past week or so after lunch my IOB is killing my bs during workouts - for example last night I could only bike for 20 hard minutes - it was a great workout but not close to as long as I need to build endurance. If life occurred in a vacuum, ceteris paribus as my old economics professors used to say this would be alot easier to figure out; I'll do my best and let you all know how it turns out though.
Update - Seems to be the bolus and not the basal - in fact the reset basal may be too high. I went low today (44) after breakfast as I over corrected for under bolusing the muffin I had - wasn't in the mood for egg whites this morning and vainly thought my abs looked better than usual so figured what the heck :). Some glucose tabs got me back up to 97 at 12 but by 1:45 I was down to 68 and had a lamb scwharma pita - we'll see how the bolus holds for that. Confusion continues!
The reason I'm pretty stressed out about this change is it has wreaked havoc on my workout routine. To get in a hard swim or bike ride on the trainer I need carbs and I need lots of them. As I shoot myself up with insulin to move away from an unstable 250 and get rid of a killer head ache I know I'm going to need to get my bs back up to 200 again soon. However, the 250 caused by weird events and the 200 that I intentionally hit feel totally different. Due to all the corrections I have had to give myself the past week or so after lunch my IOB is killing my bs during workouts - for example last night I could only bike for 20 hard minutes - it was a great workout but not close to as long as I need to build endurance. If life occurred in a vacuum, ceteris paribus as my old economics professors used to say this would be alot easier to figure out; I'll do my best and let you all know how it turns out though.
Update - Seems to be the bolus and not the basal - in fact the reset basal may be too high. I went low today (44) after breakfast as I over corrected for under bolusing the muffin I had - wasn't in the mood for egg whites this morning and vainly thought my abs looked better than usual so figured what the heck :). Some glucose tabs got me back up to 97 at 12 but by 1:45 I was down to 68 and had a lamb scwharma pita - we'll see how the bolus holds for that. Confusion continues!
Wednesday, January 16, 2008
The Byetta Decesion
Today I meet with Dr. Baker to discuss the results of my 72 hours of monitoring hell and debate the merits of Byetta (exenatide) in treating my recent onset Type 1 diabetes. In mice exenatide has increased the mass of B-Cells located in the pancreas improving their endogenous production of insulin; however trials in humans have been less conclusive. In addition to the preservation of beta cells exenatide delays the absorption of food and nutrients into the blood system similar to symilin. The side effects have been pretty severe though including massive weight loss, pancreatitis, increased hypoglycemia, nausea and diareah (sounds fun doesn't it!)
In order for Byetta to be an option for patients with Type 1 a glucose tolerance test must be performed. A couple weeks ago Dr. Baker had me down bottle after bottle of the homeless man version of McDonald's Orange Hi-C to find out if my body was still producing any insulin. Turns out I still have traces of C-Peptide in my blood when large amounts of glucose are consumed proving that I am still in the "honeymoon" phase of diabetes. This "honeymoon" phase is also the reason why I sometimes can't get my blood sugars high enough to work out, am able to enjoy pizza on occasion and encounter so many hypoglycemic moments - guess the only positive out of that is pizza.
According to Dr. Gitelman of UCSF ~
"It’s extremely important to conserve the endogenous insulin secretion that you still have during the honeymoon phase," Gitelman says. "Even when patients have to take insulin shots, if they can continue to make some of their own insulin, it’s much better for long-term outcomes. Those patients who continue to make their own insulin for longer periods of time have better blood sugar control, lower risk of hypoglycemia and lower risk for long-term complications. "It’s like the difference between riding a bike versus riding with training wheels. It’s very hard to fall over and do something wrong when some of your beta cells are functional."
So the question is will these training wheels help me or hurt me? I have alot of fears about introducing a new drug in my system when my main goal is conquering the Ironman; there's a good chance this drug could really interfere with that goal. Currently I only have 10% body fat so massive weight loss would be pretty unhealthy and if I am unable to absorb all the nutrients my body is ingesting workouts are going to be much less safe and my recovery will take much longer. While improving my body's natural production of insulin would be fantastic I'm not sure this is the best way to go about it. Some studies have suggested that intensive insulin therapy (i.e., pump therapy) also helps preserve insulin production in recent onset type 1 diabetics. Currently I believe my best course of action is to stay the course and not worry about a "miracle" drug - your thoughts?
In order for Byetta to be an option for patients with Type 1 a glucose tolerance test must be performed. A couple weeks ago Dr. Baker had me down bottle after bottle of the homeless man version of McDonald's Orange Hi-C to find out if my body was still producing any insulin. Turns out I still have traces of C-Peptide in my blood when large amounts of glucose are consumed proving that I am still in the "honeymoon" phase of diabetes. This "honeymoon" phase is also the reason why I sometimes can't get my blood sugars high enough to work out, am able to enjoy pizza on occasion and encounter so many hypoglycemic moments - guess the only positive out of that is pizza.
According to Dr. Gitelman of UCSF ~
"It’s extremely important to conserve the endogenous insulin secretion that you still have during the honeymoon phase," Gitelman says. "Even when patients have to take insulin shots, if they can continue to make some of their own insulin, it’s much better for long-term outcomes. Those patients who continue to make their own insulin for longer periods of time have better blood sugar control, lower risk of hypoglycemia and lower risk for long-term complications. "It’s like the difference between riding a bike versus riding with training wheels. It’s very hard to fall over and do something wrong when some of your beta cells are functional."
So the question is will these training wheels help me or hurt me? I have alot of fears about introducing a new drug in my system when my main goal is conquering the Ironman; there's a good chance this drug could really interfere with that goal. Currently I only have 10% body fat so massive weight loss would be pretty unhealthy and if I am unable to absorb all the nutrients my body is ingesting workouts are going to be much less safe and my recovery will take much longer. While improving my body's natural production of insulin would be fantastic I'm not sure this is the best way to go about it. Some studies have suggested that intensive insulin therapy (i.e., pump therapy) also helps preserve insulin production in recent onset type 1 diabetics. Currently I believe my best course of action is to stay the course and not worry about a "miracle" drug - your thoughts?
Monday, January 14, 2008
This Train Is Back In Service
Last Sunday my training just seemed off. After landing in Richmond the day before my interview with Darden I needed to find something to eat and grabbed a Subway sandwich - immediately after eating it I regretted that decision. For whatever reason I felt like I couldn't digest that tasty processed meat but still knew I needed to get a run in that evening. Prior to my run I had a small turkey sandwich, clif bar, accel gel and some Gatorade. During the run I felt like a Hippo after ingesting 15 kegs of beer and promptly threw my guts up after my hour long run. Tuesday evening I had a time trial test on my trainer but nearly passed out 42 minutes into it - my blood sugar dropped from 160 to 106 in a 5 minute span making me feel completely out of it with almost no power in my legs. I kept trying to fight through the malaise but the fog of depression, uncertainty or just sheer exhaustion continued to engulf me.
Finally on Thursday night I started to break free of whatever invisible hand was holding me back. I had a 1/2 hour trainer ride scheduled, perfect just a nice way to get the legs back in shape. As I grinded away I began to feel the strength come back in my legs, with each passing minute my cadence became quicker and speed became faster. At the end I had, had my best workout in a week's time. Friday brought a lifting session and a running session - I was able to complete each with the normal tenacity I have when going through my workouts. Then Saturday's hour long bike ride was my best yet although I was operating on not alot of sleep (social life is back!) and a slight hang over. Add to that yesterday's 70 minute, 8 plus mile run and this train is fully back.
I'm not sure if the troubles with my workouts last week were caused by the stress the Darden MBA interview put me under, something diabetes related, a virus or frustrations of a past relationship. Whatever it was, I was able to put that behind me, force myself to push and break through the wall. Training for an Ironman is all about finding the mental fortitude to push yourself through the hard times. Each run I have, each bike session Coach has me do won't be my best. There will be days where my legs feel weak and heavy, where my back is screaming and my shoulders are crying out. But each time I'm able to push myself through that pain, to defeat the mental demons is a day that brings me closer to my goal of finishing IMLP to the best of my ability while showing that Diabetes won't slow me down.
Finally on Thursday night I started to break free of whatever invisible hand was holding me back. I had a 1/2 hour trainer ride scheduled, perfect just a nice way to get the legs back in shape. As I grinded away I began to feel the strength come back in my legs, with each passing minute my cadence became quicker and speed became faster. At the end I had, had my best workout in a week's time. Friday brought a lifting session and a running session - I was able to complete each with the normal tenacity I have when going through my workouts. Then Saturday's hour long bike ride was my best yet although I was operating on not alot of sleep (social life is back!) and a slight hang over. Add to that yesterday's 70 minute, 8 plus mile run and this train is fully back.
I'm not sure if the troubles with my workouts last week were caused by the stress the Darden MBA interview put me under, something diabetes related, a virus or frustrations of a past relationship. Whatever it was, I was able to put that behind me, force myself to push and break through the wall. Training for an Ironman is all about finding the mental fortitude to push yourself through the hard times. Each run I have, each bike session Coach has me do won't be my best. There will be days where my legs feel weak and heavy, where my back is screaming and my shoulders are crying out. But each time I'm able to push myself through that pain, to defeat the mental demons is a day that brings me closer to my goal of finishing IMLP to the best of my ability while showing that Diabetes won't slow me down.
Wednesday, January 9, 2008
The first 16 hours...
Day 1 of project CGMS has started and it is off to a somewhat annoying start. Yesterday I met with Renee the rep from Minimed at Dr. Baker's office. We went over the details of wearing this monstrosity while she informed me that I wouldn't be able to swim during the monitoring process - sorry Coach! The device looks like this:
I think the information I'll get from wearing this damn thing for 72 hours will be fantastic but seriously can't they make it look like something other than a 1970s style handheld video game! The clip on the back is awful - I normally click my pump to the bottom of my boxers when I get home from work and toss on a pair of shorts - because of how heavy this thing is if you clip it to something upside down it will fall off. Minimed provides you with a sexy shower bag but since the meter is the size of an elephant it pulled my shaving mirror off the wall and fell out of the sexy shower bag - not a fun start to the morning. But in the name of research I'm willing to endure.
Cornell application goes in tonight, Darden (UVA) is still far and away the top choice but I need to make sure I cover all bases, doesn't look like I will receive an interview invite to Berkeley.
Tuesday, January 8, 2008
72 Hours of CGMS
Today at 4:30 I meet with Renee of Minimed/ Medtronic to get fitted with a 72 hour CGMS. Dr. Baker is really into getting all available information about a patient to give them the best care possible. That's exactly the way I believe this disease needs to be managed. So around 5 pm today I'll be hooked up to the 72 hour monitoring system and will then know exactly how my blood sugars moved over that period - this should be a huge help with training and everyday life. I'm really interested to see how my blood sugar reacts to the heart rate test I have on my bike this evening.
In other news I had my interview with the Darden MBA program at UVA yesterday. This year Darden changed their policy of open interviews to invite only so receiving an invitation to interview was a huge step in the process. Normally I come out of interviews feeling like I 100% sold myself to the best of my ability. I wish I could say the same for yesterday, I brought out almost all the points I wanted to but still feel like I left something on the table. Now the long wait until February 1st when decisions are released begins. The format of the interview is open - the only question the interviewer asks is "I want to hear your story from the time you were a child to your decision to apply to Darden," then you go off and try and sell yourself.
In other news I had my interview with the Darden MBA program at UVA yesterday. This year Darden changed their policy of open interviews to invite only so receiving an invitation to interview was a huge step in the process. Normally I come out of interviews feeling like I 100% sold myself to the best of my ability. I wish I could say the same for yesterday, I brought out almost all the points I wanted to but still feel like I left something on the table. Now the long wait until February 1st when decisions are released begins. The format of the interview is open - the only question the interviewer asks is "I want to hear your story from the time you were a child to your decision to apply to Darden," then you go off and try and sell yourself.
Wednesday, January 2, 2008
First Ski Trip
It was with much trepidation that I embarked on my first ski trip since having Type 1 diabetes. While I'm not the best snowboarder who ever walked the planet a day on the slopes is one of my favorite things in the world. There is something about being in that cold mountain air and those amazing views that lets me relax and forget about anything that might be going on in my life. With all the issues I've had with blood sugar lows from working out I was really nervous that diabetes would prevent me from enjoying the mountains.
On Thursday night I fought the traffic leaving Manhattan and headed up to Sugarbush in Warren, Vermont. On the way up I stopped at the supermarket to stock up on multi grain bread, turkey, yogurt, whole wheat pasta, oj, turkey meatballs and some vegetables - I wasn't taking any nutritional chances! On Friday morning I had the breakfast I'd normally eat before a run (2 eggs, 2 slices of toast, black coffee) and gobbled up a clif bar as I was putting on my boots. While standing in the lift line my blood sugar was 120 so I popped my first accel-gel. After 2 runs my blood sugar was in the 120s so I had another clif bar which lasted me well past lunch - the first day was a success, the only low I had was after the last run of the day.
I followed the same protocol on the second day and had similar success - after lunch (where I had 2 beers) we decided to hit Stein's Run a double black, Stein brought my bs down to 56! I still had to get down to the lodge so I could get carbs pronto. So I popped an accel gel, waited a couple minutes and as relaxed as I could got down to the base lodge. Worried that my diabetes was going to crash the fun I told the 2 people I was with that I'd just meet them at the lodge when they were done. Lee, AJ's boyfriend had nothing of it and asked if I wanted him to come with me to grab a gatoraide. I said no it's cool I'll be ok then in one of the nicest things anyone has ever said to me Lee responded with, "well if it's ok with you I'd really like to get that gatoraide with you." Here I was worried that I'd be ruining my friend's vacation and all they wanted to do was make sure I was safe.
This totally made my day and let me realize that while diabetes is a pain when you're surrounded by awesome friends its alot easier to deal with. So this trip was an awesome end to 2007 - I look forward to sharing all my athletic pursuits with you and dealing with diabetes in 2008! Happy New Year.
On Thursday night I fought the traffic leaving Manhattan and headed up to Sugarbush in Warren, Vermont. On the way up I stopped at the supermarket to stock up on multi grain bread, turkey, yogurt, whole wheat pasta, oj, turkey meatballs and some vegetables - I wasn't taking any nutritional chances! On Friday morning I had the breakfast I'd normally eat before a run (2 eggs, 2 slices of toast, black coffee) and gobbled up a clif bar as I was putting on my boots. While standing in the lift line my blood sugar was 120 so I popped my first accel-gel. After 2 runs my blood sugar was in the 120s so I had another clif bar which lasted me well past lunch - the first day was a success, the only low I had was after the last run of the day.
I followed the same protocol on the second day and had similar success - after lunch (where I had 2 beers) we decided to hit Stein's Run a double black, Stein brought my bs down to 56! I still had to get down to the lodge so I could get carbs pronto. So I popped an accel gel, waited a couple minutes and as relaxed as I could got down to the base lodge. Worried that my diabetes was going to crash the fun I told the 2 people I was with that I'd just meet them at the lodge when they were done. Lee, AJ's boyfriend had nothing of it and asked if I wanted him to come with me to grab a gatoraide. I said no it's cool I'll be ok then in one of the nicest things anyone has ever said to me Lee responded with, "well if it's ok with you I'd really like to get that gatoraide with you." Here I was worried that I'd be ruining my friend's vacation and all they wanted to do was make sure I was safe.
This totally made my day and let me realize that while diabetes is a pain when you're surrounded by awesome friends its alot easier to deal with. So this trip was an awesome end to 2007 - I look forward to sharing all my athletic pursuits with you and dealing with diabetes in 2008! Happy New Year.
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