It's time to come clean, I was burnt out.
For the first four years after my diagnosis I did everything right, I obseviely calculated the carbohydrates in a meal, tracked every second of exercise and was so regimented about logging I had automated excel models that would predict my future blood sugar. Due to all that I was obsessive, I wanted my blood sugar to be perfect every single time I tested and when it wasn't I would either work out like a fiend or spend an hour working out a new predictive formula. That in the end had me burn out from the daily tracking and hard core exercising that had made me so successful in the management of my disease; that is also what lead me to stop blogging except for the occasional outburst here and there. I simply couldn't focus on the disease with the same intensity I had in the past and needed a break.
Fast forward to the end of 2011/ start of 2012. I had lost my job and began to seriously doubt the value of my MBA. I was determined to pursue my mission of helping people live healthier lives and to pursue a career that personally meant something but my dream had seemed to vanish. I was unemployed for 6 months, and was facing a huge decision about where to move to. While in San Francisco I met the most wonderful woman I could imagine and no longer was thinking just for myself so couldn't just jump at the next risky and interesting opportunity, I had to analyze the consequences and make a real adult decision. That landed me back in NY, back where I belong (as I've come to truly believe over the past month).
Given all the stress and the travel that Katie and I did my blood sugars were thrown into dissary. If my parents offered help for a high or a low I couldn't handle it, I simply didn't want people to be concerned about my disease because it was one more responsibility I couldn't focus on. Thankfully I stock piled insulin and pump supplies but not a day went by where I didn't feel like I had to ration my insulin intake or test strip usage. Add to that the constant job search had me cutting back on workouts for fear I would miss a phone call that would get me off a pay check from Uncle Sam. I was still exercising and doing the occasional bike race but overall I wasn't the same active, happy guy that people have come to know.
When we hit mid-March I began to really worry. I had some kindles in the fire but I really didn't know when the job thing would flush out. I had to contact an old endo to write me a script for Novolog which my parent's so generously paid for. I was finding cheap test strips online so that my Dad could still be compliant with his type 2 diabetes. My sleep cycle was off and I was fearful that I would never recover from the mountain of student debt I accrued during my time at Darden. I was perhaps, for the first time, lost.
I did the best I could to muster enough energy for one last big push to find a job I still believed in. I had been networking with a few companies but the process was slow and agonizing. But I pushed hard knowing that I wanted to be back in NY and knowing that I still wanted to be in healthcare. Finally in late April I was offered what I truly consider to be my dream job or launching pad to something great, and I finally got to return to the city I love.
Being back in NY has me re-energized, it has me in a place where I am comfortable and happy and in a place where I am so excited to start the next chapter in my life. That wonderful woman is still with me, and things are about as serious as they get and I know I couldn't have gotten through those dark months without her, and that family of mine has always supported me with everything they have and of course this time was no different. They were there for me like they never have been before (maybe because they never really had to be there for me like this before).
On Tuesday I got in to see my old endo, Dr. Baker. I have an amazing relationship with Dr. B and believe he is one of the greatest doctors out there. The numbers in his office didn't lie, it showed how much focus I had lost over the past 6 months. My weight was 200 lbs, the first time I have reached that number in 5 years (normally I'm around 190), my A1c was 7, the highest it has been since I gained control of blood sugars after diagnosis. That visit served as a wake up call and this city is serving as a platform for me to Ring The Bolus again.
I spoke with Dr. Baker and have 3 simple goals for my August re-visit. I will be 190 lbs or lighter, I will have an A1c below 6.5 and I will reduce my daily basal rate by at least 10%. I am signing up for 3 triathlons this summer, 2 olympics and 1 half iron and I am starting to bike into work again. I have already seen a change in my blood sugar consistency after running 3 mornings this week and I am getting back into the weight room later today. It's time to get back to basics, gain control of my disease and return to sharing my story about how I fight to control it.
Hello again.
Friday, May 11, 2012
Friday, April 20, 2012
The ADA just doesn't get it
Today the ADA will launch new guidelines for blood sugar management goals. As usual the article focuses on type 2 diabetics but I'm going to assume that the new guidelines will not discriminate between the two diseases. Historically, I firmly believe, the ADA has focused on type 2 diabetes with both their research and guideline efforts. As a disclaimer this organization frustrates me to no end and I think the JDRF is way more valuable, ethical and with it but that's beside the point.
In this NPR article the ADA is now stating that for older/ existing cases of diabetes the target A1c can be 8 and that for newly diagnosed type 2 diabetics an A1c of 7 is ok. As a type 1 diabetic or someone who produces no insulin, who even if they ran on a hamster wheel continuously without insulin would still have blood sugar spikes well above 300 an A1c of 8 would be an incredible failure, incredibly dangerous and overall poor for my lifestyle!
To explain, A1c is kind of the 3 month moving average of daily blood sugar values. A person with neither type 1 nor type 2 diabetes has an A1c of around 5 which equates to an average blood sugar of 90 - 100. An A1c of 8 equates to an average blood sugar of 183! How that is deemed medically safe is beyond me. If my average blood sugar is above 160 I become dehydrated, urinate more frequently, will have low level headaches and overall be flat out miserable. I strive to achieve an A1c below 6 but at my last test my A1c was 6.3.
I would love to know how the ADA came to this conclusion rather than suggesting more stringent guidelines to suggest better eating, exercise and lifestyle habits. They really frustrate me to no end.
In this NPR article the ADA is now stating that for older/ existing cases of diabetes the target A1c can be 8 and that for newly diagnosed type 2 diabetics an A1c of 7 is ok. As a type 1 diabetic or someone who produces no insulin, who even if they ran on a hamster wheel continuously without insulin would still have blood sugar spikes well above 300 an A1c of 8 would be an incredible failure, incredibly dangerous and overall poor for my lifestyle!
To explain, A1c is kind of the 3 month moving average of daily blood sugar values. A person with neither type 1 nor type 2 diabetes has an A1c of around 5 which equates to an average blood sugar of 90 - 100. An A1c of 8 equates to an average blood sugar of 183! How that is deemed medically safe is beyond me. If my average blood sugar is above 160 I become dehydrated, urinate more frequently, will have low level headaches and overall be flat out miserable. I strive to achieve an A1c below 6 but at my last test my A1c was 6.3.
I would love to know how the ADA came to this conclusion rather than suggesting more stringent guidelines to suggest better eating, exercise and lifestyle habits. They really frustrate me to no end.
Friday, March 9, 2012
A Special Egg
My foray into endurance sports all started standing in line to register for Ironman Lake Placid. The day prior I was working an aid station on the run course when the girl I was dating at the time gave some woman with a big smile and a running skirt a huge hug. I had no idea who this mysterious woman was at the time but her enthusiasm was infectious so I gave her a hug just the same.
The next day that same woman happened to be standing behind us in line to register; her joy at the race was a big motivation for me to sign up for IMLP '08. Later on that woman became my first triathlon coach and someone who provided an amazing amount of emotional support during my first year with type 1 diabetes. Her name, Mary Eggers, or to me the Egg.
Egg has always had crazy ambitions; she never doubted that I would finish my first IM with a smile on my face (having never done an endurance event when I first signed up for IMLP), she never doubted that I could push myself beyond perceivable limits and she never doubted my ability to tackle diabetes. She has brought that same support and enthusiasm to Teens Living with Cancer; a non-profit devoted to helping kids fighting cancer.
So it came as no surprise to me when she called out none other than Lance Armstrong to a kick off in buffalo on April 28th. Lance will be in Buffalo for a public speaking opportunity so the Egg thought nothing of it when she challenged him on Twitter and wrote this amazing blog post challenging LA. When Egg gets an idea in her head it's pretty tough to convince her otherwise. So it also came as no surprise to me that Lance RESPONDED TO MARY EGGERS ON TWITTER!
Armstrong v Eggers will go down in late April in Buffalo. This excites me for a ton of reasons, it shows the good that social media can bring, it shows how an ambitious woman's idea can bring help and joy to others and it shows that when someone is committed to doing great things for others all the tools we need are right there in front of us. Good luck Egg, I'll be cheering you on and I don't see how its possible not to get excited about what you just accomplished. Readers, check out the charity, check out the challenge and if you knew this woman as well as I do you'd expect nothing else from her.
The next day that same woman happened to be standing behind us in line to register; her joy at the race was a big motivation for me to sign up for IMLP '08. Later on that woman became my first triathlon coach and someone who provided an amazing amount of emotional support during my first year with type 1 diabetes. Her name, Mary Eggers, or to me the Egg.
Egg has always had crazy ambitions; she never doubted that I would finish my first IM with a smile on my face (having never done an endurance event when I first signed up for IMLP), she never doubted that I could push myself beyond perceivable limits and she never doubted my ability to tackle diabetes. She has brought that same support and enthusiasm to Teens Living with Cancer; a non-profit devoted to helping kids fighting cancer.
So it came as no surprise to me when she called out none other than Lance Armstrong to a kick off in buffalo on April 28th. Lance will be in Buffalo for a public speaking opportunity so the Egg thought nothing of it when she challenged him on Twitter and wrote this amazing blog post challenging LA. When Egg gets an idea in her head it's pretty tough to convince her otherwise. So it also came as no surprise to me that Lance RESPONDED TO MARY EGGERS ON TWITTER!
Armstrong v Eggers will go down in late April in Buffalo. This excites me for a ton of reasons, it shows the good that social media can bring, it shows how an ambitious woman's idea can bring help and joy to others and it shows that when someone is committed to doing great things for others all the tools we need are right there in front of us. Good luck Egg, I'll be cheering you on and I don't see how its possible not to get excited about what you just accomplished. Readers, check out the charity, check out the challenge and if you knew this woman as well as I do you'd expect nothing else from her.
Sunday, March 4, 2012
Back On the Bull
Sorry for being MIA the past few months; between the job search, moving back to NY and a trip to Thailand the opportunity to collect my thoughts have been few and far between. I've had some great blood sugar management learnings over the past few weeks but today's post is about getting back on El Toro.
Living a bi-coastal life has made consistent work outs a challenge. But now that I'm camping out at my parents house as I continue my job search I've had the opportunity to get back into the gym and back onto my bike. My fitness is feeling surprisingly good and the weather has finally ticked up a few degrees in the North East. With that and El Toro (my Cervelo) arriving from California I was itching to stretch the legs and race. Much to my delight I found a crit about 30 minutes away from my parent's hosue, the Bethel Spring Series.
To Katie's worry I signed up for the race without having full health insurance coverage. I've been out of work a bit longer than anticipated (thankfully I stock piled diabetic supplies) but that doesn't limit the chance of a crash during a crit. I spoke with some people who had done the series in year's past and they said it was more like a circuit than a crit. The difference? Crit's are lap races in which riders race in tight quarters on a course that's less than a mile. Normally there are at least 4 75 - 90 degree turns on the course making for some sketchy situations. A circuit is normally on a slightly longer course and the turns are much more gradual so the field can spread out a bit more. The Bethel Spring Series is on a .9 mile course with only one "real" turn so I was less worried about crashing out in a corner than I had been at the Early Birds out in CA.
I signed up for Sunday's race on 3/1 but sadly found out that I was on the waiting list. After e-mailing with the great race organizers a few times they finally informed me at 7:30 pm on Saturday night that I was in fact in the race! My excitement was tempered by the fact that I was at a wine bar with my sister and brother-in-law greatly enjoying a fantastic d'Abruzzo. With some hesitation I cut off the drinking picked up some dinner on the way home and got to bed by 10:30. 6:20 am came far too early and I was out the door by 6:55 am to make my way to Bethel.
My biggest worry was my fitness level. Since Thanksgiving I have ridden my bike outside a grand total of 3 times! Logging about 150 miles over those 3 rides hardly makes a fit rider. But I've been hitting the trainer pretty hard, running 20 - 30 miles a week and recently found out about freaking awesome trainer videos, Sufferfest. But I knew I wasn't logging good base miles on the road like I needed so I really wasn't sure if I could hold a zone 4 heart rate for 30 + minutes; I'd soon find out...
The Cat 5 race started with a basic skills clinic to make sure riders were aware of the proper way to ride a crit. Most crashes are caused by a rider coming off of his line or making an aggressive move; since you ride in such close quarters each mistake is magnified. It seemed like the field was realxed enough for a good race so we were all set to go.
With a stable blood sugar of 150 the gun went off and I was out to race for the first time in nearly 6 months! I finished the first lap feeling great, I probably pushed the pace a bit too much but wanted to stretch the legs and see how hard I could punch it up the finishing hill. By the 3rd of 15 laps I had settled into my rhythm and was drafting off the pack to save energy. The backside of the course had a pretty strong headwind which tempted me to hammer to try and gain some space on the field but I held back. No reason to kill myself in a spring series and only my 4th cycling race. Going into the final laps I was right where I wanted to be. I had kept my heart rate at a low zone 4 for what I thought were laps 13 and 14; sadly they were laps 12 and 13.
Right before the climb to what I thought would be the bell lap (final lap), I punched it hard and opened up a decent split on the field. I came across the line but to my horror did not hear a bell! I kept the pace and maintained my lead through about 3/4 of the 14th lap. Knowing that were some much lighter riders in the field I felt I needed a slight lead heading into the climb for any chance to pull out a win. Had the 14th lap been the 15th I would have executed my plan perfectly; apparently they didn't teach counting or being Pavlov at Darden.
Up the climb when I realized there was another lap left I was gassed and knew I wouldn't be able to hang with the leaders on the final lap. I made my move a lap too early and then just stayed with the pack for the finish. I've gotten progressively better with each of the now 4 crits I've done and I'm really excited about racing on the east coast. Since I know the Northeast so well it's way easier for me to know which races are within driving distance and to find friends to stay with before a race. I'm already signed up for 2 more races in the Bethel Spring Series, for a circuit up in Binghamton and potentially a stage race in the Catskills. Hopefully I keep improving, I simply find cycling races to be a flat out blast!
Living a bi-coastal life has made consistent work outs a challenge. But now that I'm camping out at my parents house as I continue my job search I've had the opportunity to get back into the gym and back onto my bike. My fitness is feeling surprisingly good and the weather has finally ticked up a few degrees in the North East. With that and El Toro (my Cervelo) arriving from California I was itching to stretch the legs and race. Much to my delight I found a crit about 30 minutes away from my parent's hosue, the Bethel Spring Series.
To Katie's worry I signed up for the race without having full health insurance coverage. I've been out of work a bit longer than anticipated (thankfully I stock piled diabetic supplies) but that doesn't limit the chance of a crash during a crit. I spoke with some people who had done the series in year's past and they said it was more like a circuit than a crit. The difference? Crit's are lap races in which riders race in tight quarters on a course that's less than a mile. Normally there are at least 4 75 - 90 degree turns on the course making for some sketchy situations. A circuit is normally on a slightly longer course and the turns are much more gradual so the field can spread out a bit more. The Bethel Spring Series is on a .9 mile course with only one "real" turn so I was less worried about crashing out in a corner than I had been at the Early Birds out in CA.
I signed up for Sunday's race on 3/1 but sadly found out that I was on the waiting list. After e-mailing with the great race organizers a few times they finally informed me at 7:30 pm on Saturday night that I was in fact in the race! My excitement was tempered by the fact that I was at a wine bar with my sister and brother-in-law greatly enjoying a fantastic d'Abruzzo. With some hesitation I cut off the drinking picked up some dinner on the way home and got to bed by 10:30. 6:20 am came far too early and I was out the door by 6:55 am to make my way to Bethel.
My biggest worry was my fitness level. Since Thanksgiving I have ridden my bike outside a grand total of 3 times! Logging about 150 miles over those 3 rides hardly makes a fit rider. But I've been hitting the trainer pretty hard, running 20 - 30 miles a week and recently found out about freaking awesome trainer videos, Sufferfest. But I knew I wasn't logging good base miles on the road like I needed so I really wasn't sure if I could hold a zone 4 heart rate for 30 + minutes; I'd soon find out...
The Cat 5 race started with a basic skills clinic to make sure riders were aware of the proper way to ride a crit. Most crashes are caused by a rider coming off of his line or making an aggressive move; since you ride in such close quarters each mistake is magnified. It seemed like the field was realxed enough for a good race so we were all set to go.
With a stable blood sugar of 150 the gun went off and I was out to race for the first time in nearly 6 months! I finished the first lap feeling great, I probably pushed the pace a bit too much but wanted to stretch the legs and see how hard I could punch it up the finishing hill. By the 3rd of 15 laps I had settled into my rhythm and was drafting off the pack to save energy. The backside of the course had a pretty strong headwind which tempted me to hammer to try and gain some space on the field but I held back. No reason to kill myself in a spring series and only my 4th cycling race. Going into the final laps I was right where I wanted to be. I had kept my heart rate at a low zone 4 for what I thought were laps 13 and 14; sadly they were laps 12 and 13.
Right before the climb to what I thought would be the bell lap (final lap), I punched it hard and opened up a decent split on the field. I came across the line but to my horror did not hear a bell! I kept the pace and maintained my lead through about 3/4 of the 14th lap. Knowing that were some much lighter riders in the field I felt I needed a slight lead heading into the climb for any chance to pull out a win. Had the 14th lap been the 15th I would have executed my plan perfectly; apparently they didn't teach counting or being Pavlov at Darden.
Up the climb when I realized there was another lap left I was gassed and knew I wouldn't be able to hang with the leaders on the final lap. I made my move a lap too early and then just stayed with the pack for the finish. I've gotten progressively better with each of the now 4 crits I've done and I'm really excited about racing on the east coast. Since I know the Northeast so well it's way easier for me to know which races are within driving distance and to find friends to stay with before a race. I'm already signed up for 2 more races in the Bethel Spring Series, for a circuit up in Binghamton and potentially a stage race in the Catskills. Hopefully I keep improving, I simply find cycling races to be a flat out blast!
Monday, January 23, 2012
Thursday, January 19, 2012
Disgusted by Paula Deen
As most of you have read by now Paula Deen will be a spokesman for Novo Nordisk to promote their type 2 diabetic drug. In my view this alliance and Paula Deen's development of the disease represents everything that is wrong with both the American health system and the obesity issue in America. Paula Deen should in no way be viewed as a role model for people with type 2 diabetes, she should rather be viewed as the poster person for EXACTLY HOW NOT TO EAT.
I took a quick look at her top recipes on foodtv.com, I've listed the high fat, high carb ingredients in the top 3 recipes:
Rather than promoting someone whose cooking habits and lifestyle no doubt led to the development of a lifestyle disease shouldn't we celebrate people like Jamie Oliver or studying the glycemic index of foods like Michael Montignac suggested? Paula Deen is addressing the problem after something has happened rather than making a chance prior to the problem happening. Think about what would happen if you didn't change the oil in your car's engine until after your engine seized. That would be a tad more expensive than the $40 oil change and your local shop, right? That's exactly what Novo Nordisk is suggesting by using Paula Deen as a spokesmen. We need to get ahead of the problem and change eating habits, not address the consequences once we are too far downstream.
I took a quick look at her top recipes on foodtv.com, I've listed the high fat, high carb ingredients in the top 3 recipes:
- Chicken & Rice Casserole - 1 can condensed cream of celery soup (220 calories, 13.6 g fat, 21.4 g carbohydrates), 1 cup mayonnaise (916 calories, 78.5 g fat, 56.2 g carbohydrates), for a total of 1,136 calories, 92.1 g fat and 77.6 g carbohydrates.
- Lady & Sons Chicken Pot Pie - 1 quart heavy cream (3,284 calories, 352 g fat, 24 g carbohydrates), 1/3 cup butter (542 calories, 61.3 g fat, < 1 g carbohydrates), 2/3 cup all purpose flour (309 calories, < 1 g fat, 64.6 g carbohydrates), 4 sheets frozen puff pastry (1.036 calories, 71.6 g fat, 84.8 g carbohydrates) for a total of 5,171 calories, 484.9 g fat and 173.4 g carbohydrates
- Chicken & Dumplings - 1 can condensed cream of celery soup (220 calories, 13.6 g fat, 21.4 g carbohydrates), 2 cups all purpose flour (910 calories, 2.4 g fat, 191 g carbohydrates) for a total of 1,130 calories, 16 g fat and 212.4 g carbohdyrates
Rather than promoting someone whose cooking habits and lifestyle no doubt led to the development of a lifestyle disease shouldn't we celebrate people like Jamie Oliver or studying the glycemic index of foods like Michael Montignac suggested? Paula Deen is addressing the problem after something has happened rather than making a chance prior to the problem happening. Think about what would happen if you didn't change the oil in your car's engine until after your engine seized. That would be a tad more expensive than the $40 oil change and your local shop, right? That's exactly what Novo Nordisk is suggesting by using Paula Deen as a spokesmen. We need to get ahead of the problem and change eating habits, not address the consequences once we are too far downstream.
Friday, January 13, 2012
Ooozing Insulin
So this may be my grossest blog post of all time...
Upon my return trip from Thailand (full bolus food report forthcoming) my blood sugars were unsurprisingly wacky. A 12 hour time change and 30 hours of travel to make it home can send a person's metabolism totally out of whack, even if they have no issues to speak of. So for a type 1 diabetic extensive travel often comes with some blood sugar management issues.
However, when I got back from Thailand my blood sugars were all over the map. My bs didn't want to be consistent, cropping up at weird times and staying stagnant for a short period of time after a meal until a big spike occurred. I assumed it was just my body getting used to a different eating schedule and planned to suffer through for a couple days.
On one of my last boluses before changing my infusion set I began to think something other than the time change was affecting me. The long trip had my stomach in knots and a wacky sleep pattern had me not very hungry. So for my first 2 days back in the States I was living on toast and chicken soup. For dinner on Wednesday night I had 2 pieces of whole wheat toast and a can of Campbell's Chicken & Stars soup - we're talking a total of no more than 80 grams of carbohdyrates. Even though I took in 7.5 untis of insulin for that meal my blood sugar spiked to 308 about an hour and 1/2 after my meal. I had around 7 units of insulin left in my pump so it was time for a change anyway.
When I removed my infusion set and was rewinding my pump I suddenly felt a ton of wetness on the side of my stomach. When I looked down there was something that looked like water around the injection area. I then ran my hand over it and it smelt like insulin - hmm odd I thought. I ran my finger over my infusion old infusion site and some more insulin seemed to pop out. So then like any curious person would do I squeezed the old infusion site and the hole gushed insulin - I'd say at least 10 units!
Disgusting! As I changed my infusion site insulin was freaking leaking out of my body, doesn't it know it's supposed to stay in there! I checked out the old cannula and it was crimped at the end - something that seems to be happening way more often with my Animas sets than my old Medtronic sets. At least I finally have an answer for where all the unused insulin goes when your site is crimped, it comes out the other end...
Upon my return trip from Thailand (full bolus food report forthcoming) my blood sugars were unsurprisingly wacky. A 12 hour time change and 30 hours of travel to make it home can send a person's metabolism totally out of whack, even if they have no issues to speak of. So for a type 1 diabetic extensive travel often comes with some blood sugar management issues.
However, when I got back from Thailand my blood sugars were all over the map. My bs didn't want to be consistent, cropping up at weird times and staying stagnant for a short period of time after a meal until a big spike occurred. I assumed it was just my body getting used to a different eating schedule and planned to suffer through for a couple days.
On one of my last boluses before changing my infusion set I began to think something other than the time change was affecting me. The long trip had my stomach in knots and a wacky sleep pattern had me not very hungry. So for my first 2 days back in the States I was living on toast and chicken soup. For dinner on Wednesday night I had 2 pieces of whole wheat toast and a can of Campbell's Chicken & Stars soup - we're talking a total of no more than 80 grams of carbohdyrates. Even though I took in 7.5 untis of insulin for that meal my blood sugar spiked to 308 about an hour and 1/2 after my meal. I had around 7 units of insulin left in my pump so it was time for a change anyway.
When I removed my infusion set and was rewinding my pump I suddenly felt a ton of wetness on the side of my stomach. When I looked down there was something that looked like water around the injection area. I then ran my hand over it and it smelt like insulin - hmm odd I thought. I ran my finger over my infusion old infusion site and some more insulin seemed to pop out. So then like any curious person would do I squeezed the old infusion site and the hole gushed insulin - I'd say at least 10 units!
Disgusting! As I changed my infusion site insulin was freaking leaking out of my body, doesn't it know it's supposed to stay in there! I checked out the old cannula and it was crimped at the end - something that seems to be happening way more often with my Animas sets than my old Medtronic sets. At least I finally have an answer for where all the unused insulin goes when your site is crimped, it comes out the other end...
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