Better than Expected: My Season in a Nutshell

Lately when people have asked me what my favorite part of triathlon is, I’ve said, “Finishing.” They laugh at my joke, but this season it hits awfully close to the truth.

My season started with tightness in my legs. It’s quite a bit better now, but I’ve spent the first 2-3 miles of every tri run waiting for them to loosen up. Lately I’ve gotten fast, probably because I haven’t ridden my bike much this year compared to the last few. I love riding when I’m doing it, but I have trouble convincing myself to go train on the weekend. Something about all those miles riding by myself during Ironman training has me yearning for rides with Lisa—she got a road bike!—and other friends, even if the training isn’t as intense. I also had a lot of encounters with rude drivers last year, too, which left me wanting to avoid my two-wheeled friend. Nevertheless, I’ve been commuting to work on my bike, and I can feel strength in my pedaling, even if my brain doesn’t think I’m as strong

Swimming is (ironically) the most consistent thing I do. I’ve been going to the pool consistently for years, and I’ve seen progress each year. And after Alcatraz in June, I feel so much more confident in my swimming abilities; it was that intense.

Diabetes, the fourth discipline in triathlon, has really been bringing me down, almost to the point where I don’t want to workout or race. My blood sugar has risen each race I’ve done this year after the swim, astronomically high on a couple of occasions. And yet, it’s hard not preemptively freaking out about insulin’s power to cause severe hypoglycemia. A couple of very large, very fast blood sugar drops have happened a few times this season during training.

Saturday I was determined to do everything I could to have good diabetes mojo going into race morning. I ate a nice small evening meal, containing a known quantity of carbohydrates, and then BAM! my blood sugar tanked. Maybe it was walking around all day between the hotel and the race venue and the mini-golf and the ice cream shop. Maybe I overcorrected the high earlier in the day from the aforementioned ice cream. Maybe—and I hate to think about it—it’s an unpleasant complication known as gastroparesis, where the stomach empties slowly and insulin timing becomes difficult. Who knows?

Anyway, after treating the low, I went to bed in a normal place and then shot up wicked high by midnight when I woke up for an overnight snack. So I gave some insulin that should have cleared my system by morning. After the meal I couldn’t sleep. In addition to thinking about my blood sugar and being nudged awake every few minutes by the loud air conditioner, I was just plain anxious: I discovered that the wiring in our hotel room is a bit dodgy, and I had the irrational fear of being burned to a crisp. I wasn’t really rested when I got up at 4:30 AM.

Being in transition at 5:15 centered me a bit. I was back in my element and would probably be in my happy place once the race started. Walking the 1/2 mile to transition and back started my blood glucose dropping, and I started having a lot of anxiety. My stomach hurt, and I had trouble eating my breakfast. (It will be a long time before I ever want to see a Chocolate Brownie Clif Bar again.) After putting on my wetsuit and walking down to beach, I debated whether I wanted to race. Triathlon is supposed to be fun, and here I felt like I wanted to be sick.

I was still nervous getting into the swim corral at 6:20, but I set myself up right at the front. The day before I had an excellent practice swim, and it inspired me with confidence. (After Alcatraz, the gently rolling waves of the Gulf of Maine were soothing, instead of intimidating.) As soon as the horn went off for my wave I ran from the beach into the knee-high breaking waves, did a couple of dolphin dives, and settled into a rhythm. I was feeling pretty peaceful . . . until someone elbowed me in the face and my goggles started leaking. So I stopped, adjusted them, and got back into my high-intensity happy place. The water was pretty close to perfect: calm and a bit cool. The sun was hanging out behind some thin clouds. I sighted well. I swam well. It was really only crowded when I started to swim through the wave that started five minutes ahead of me. I swam the 1.2 miles in just under 38 minutes.

This race has a long run up to transition from the beach: about 4-5 blocks. I felt good. My stomach had stopped feeling queasy when I started swimming, despite the motion of the ocean. I was surprised to find that someone had moved my things in transition. This is a cardinal sin of tri, and I blame the Canadians—wonderful people though they are—who made up a large number of triathletes. I learned at the Muskoka 70.3 that they seem to follow different rules about where things go. They are wrong, of course. But to their credit, whoever did it placed it almost exactly as I left it.

I saw Lisa on the beach and as I headed out onto the bike. I got passed by a few very fast people early on and then some dribs and drabs as slower swimmers from different waves put the hammer down. My goal for the day was never a personal best race; in fact, I doubted it could happen because of my relatively low training volume. Early on I decided not to look at the overall time on my watch, because I didn’t want to think about the “what ifs?” and push myself too hard or beat myself up for being too far behind where I thought I could be during any other year. Instead I watched my heart rate, which was my plan. I was a bit surprised to see it hang out in “Zone 2″ (easy riding) for so long.

I didn’t really feel like pushing the pace. In fact, before I got in the water I told myself to go out, look around, enjoy the beautiful course, and just have fun. I saw much more of the scenery this year than in the previous couple times I’ve raced here. I played leapfrog with a few people and eventually started picking up the pace on my way back into town. About halfway through my blood sugar started to rise a lot, as it has all year, so I got out ahead of it and gave myself some extra insulin and cut back on the food. That seemed to work well. Overall, I averaged 20.0 mph, completing the bike in 2:43:13.

I saw Lisa as I came into transition and was excited to see her again going out on the run. In the meantime, as I put on my shoes, the DJ was playing Redbone’s 1973 classic hit “Come and Get Your Love.” I fully admit to singing along because I loved that scene from “Guardians of the Galaxy.” Plus it made me think, “Come and get your run.” Lisa thought I might be having a good day.

Back out on the run my legs were tight but I got loose about 5K in, and I just started picking people off. The course is an out-and-back, so I saw all of the half-IM racers ahead of me. The lead man was 9 miles ahead; the first woman about 3. I’ve never been this close to them. I still wasn’t looking at my overall time, but I was feeling hopeful that I might have a good day. The weather was gorgeous: warm but not too hot, sunny but shady with a light sea breeze.

I felt like I could run for days. I was pushing myself but not too hard. I watched my heart rate so that I wouldn’t flame out, but I was pushing the pace faster than any other half-ironman I’ve done. With 5K left to go, I tried to pick up the pace a little, but my body was like, “We’ll just keep doing what we’ve been doing until the last mile, okay?” Works for me, friend. I did throw down in the last mile, passing the guy who was set up next to me in transition (and who probably moved my stuff). I did the half-marathon in 1:52:45.

“That seemed fast,” was Lisa’s reaction at the end. And it was. 5:21:53, the fastest I’ve ever done a half-IM. I set my previous best two years ago on this same course, and I have mostly done stupid hilly races since then, so a PR wasn’t likely in the meantime. Even though I was in good form and on a fast course, I wasn’t expecting this result. I’m beyond thrilled with the result.

My season is now (probably) over . . . at least for tri. In the off-season—and I really do need to take a proper one this year—I’ll be spending some time thinking about what I want to do and figuring out how to do it without dreading it. Wish me luck, friends.

Posted in Cycling, Diabetes, Reluctant Triathlete, Running, Swimming | 1 Comment

500+ but no DNF – Ironman 70.3 Muskoka

Editor’s note: Somehow I managed not to post this almost a month and a half ago. Oops! I present it with minimal additional editing.

What can I tell you about Sunday’s Ironman 70.3 Muskoka in Ontario? [That's Sunday July 10th.] I almost DNFed for the first time in my life, but I didn’t. Why? It’s all about the ‘betes.

First the details. I finished 538th of 1314, which is respectable. I swam 1.2 miles in 37:16, biked 58.3 miles (instead of the official 56) in 3:20:22, and ran 13.1 miles in 2:02:40. My total time with transitions was 6:11:43. There were also tears during and after the race.

Lisa and I headed over to Ontario on Thursday for a little pre-race vacation. We missed Niagara Falls our first time through 13 years ago, so this was the time to see it. As long as you look toward the water, it’s a beautiful place. Look away, and it’s a touristy wasteland. We walked across the Rainbow Bridge from the Canadian side to the American and back. We got slightly lost in New York and ended up going much farther than we anticipated, which made us miss our chance to see Scully.

While we were sightseeing, someone tried to steal my bike off the car. Fortunately, they gave up when they saw the cable locking it to the bike rack. Unfortunately, I hadn’t noticed that they had unbuckled two the three straps holding it to the rack. As we drove toward Toronto, we hit a bump and it came unmoored. I was very lucky that the bike didn’t hit the ground and was uninjured and that a nice driver pointed it out to me right afterward.

Not seeing Scully, having my bike almost stolen, suffering through Toronto’s awful traffic, and getting my bike rained on overnight before the race . . . all that had me in a less than excellent mood going into the event. Once we got to Deerhurst on Sunday morning, though, I felt pretty chill, excited actually.

The swim was awesome! I found feet to draft off. I sighted well and felt fast. One part of the lake had a definite taste of cucumbers. I must be swimming okay these days, because there were still a lot of bikes in transition when I arrived. It seems everyone in Canada rides Cervélo bikes—as do I—which made it extra difficult to find my ride.

Muskoka’s bike course is reputed to be one of the most difficult of the Ironman-brand events. I’ve done more difficult events by other organizers, but this was definitely hard. It started with lots of punchy little rollers for the first 30K or so, followed by a lot of long, gradual climbs and descents for 30K, culminating with a final 30K of wicked steep uphills and fast downhills. I witnessed a lot of ugly sounding shifts and dropped chains. I got passed by a good number of very fast people in the first 45K, while I also passed a lot of others during that time, too.

Halfway through the bike leg, the wheels fell off my day.

When I got into the water, my blood sugar was about 300 mg/dL (16.7 mmol/L), which is a lot higher than I wanted. It was frustrating because it was a beautiful 120 (6.7), or pretty damn close to perfect, when I went to bed. For whatever reason, it went up after I ate my midnight-before-a-race snack. So I dosed some extra insulin before I got in the water, ate a little bit less of my pre-race snack, and swam my heart out, knowing it would lower my BGs. And it did. I was in a good place and on a good trajectory when I exited the water. So I decided to eat like normal on the bike: 20g of carbs every 30 minutes.

Halfway through the 90km/56-ish mile ride I felt awful: lots of aches, no power. My continuous glucose monitor (CGM) showed my blood glucose going straight up, so I gave a little bit of insulin to try to bring it down. When I tested with 30K left to go, it was over 500 (28)! Everything hurt; even my hands were achy.

To give you an idea of how unusual this situation is, I’ve maybe seen it that high twice in the 18 years since I was diagnosed. Being over 400 (22) is unusual. This is vanishingly rare. I’ve tested almost 65,000 times, and this is only the third time it’s ever been over 500.

I gave a metric shit-tonne of insulin and contemplated dropping out. Since I was at an aid station, it would be easy enough: just tell a volunteer and SAG back to transition, possibly with a visit from the EMTs. I didn’t want to have a “DNF” as my result, but I also didn’t want to end up unconscious or in the hospital if it went higher. I decided to watch my CGM and drop out on the way back to transition if necessary.

My muscles were incredibly painful for the next half-hour. It was really awful. Turning the pedals made me wince, but pedaling continuously was better than stopping and starting, which caused everything to seize up. People were passing me right and left, but my only goal was to keep spinning my legs to help the insulin work and to move closer to the end of the route.

High BGs jack with my mood, and I was feeling a bit of despair. I was crying a little bit, and I was angry. At one point I said (out loud, of course), “I don’t want to DNF. I want to rock it. Yeah, I want a rocket.” Welcome to my brain. Eventually I could feel the insulin doing its job. Now my concern was making sure I didn’t go too far the other direction and end up hypoglycemic (which is actually worse than being high, since it’s much easier to lose consciousness).

When I got back to the resort where the event was held, I tested, saw a 300 (down from 500+) and decided to do the run, even if I had to walk the whole thing. I saw Lisa about a half-mile out. We walked and talked a little bit, and I could tell she was concerned. Me? I was certain I could handle it. I just wanted to finish, whether it took 2 hours or 4.

After walking about half of the first two miles, I started running and didn’t look back. Okay, okay . . . I did walk for about five minutes with 4 miles left to go. I was eating a lot to manage my blood glucose, but I find that food digests better when I’m not running, so it was a necessary evil. I decided to throw down for the last mile, because if I’m going to finish, I’m going to do it while passing people.

A short two hours after seeing Lisa on the way out, I saw her again on the way in. Soon enough I was done. And my blood sugar was a perfect 135 (7.5). Boom!

I saw Lisa after I finished, assured her I was okay, got my photo taken with my medal, and then had a bit of breakdown. I honestly wondered for an hour whether I would be able to finish, and I was so relieved to be able. I was angry at diabetes and happy for sticking with it. The feeling of accomplishment when it wasn’t guaranteed was a bit overwhelming and much more than I was able to keep under wraps after six-ish hours of swimming, biking, and running. I cried behind my sunglasses a little.

I have another race in about seven weeks. I plan to use that time to build a bit more fitness and practice my insulin and nutrition strategy. Wish me luck! [Last weekend I did Rev3 Maine. More about that very soon. Promise!]

Posted in Canada, Cycling, Diabetes, Life Lessons, Reluctant Triathlete, Running, Swimming, Travel | Leave a comment

I Escaped from Alcatraz

Hi, friends. I know it’s been a while since I posted here. Sorry. Since late April, I’ve raced three triathlons: the sprint that starts every season, Escape from Alcatraz, and Ironman 70.3 Muskoka. I’ve also gone on a few vacations where I did a few really wonderful rides, hiked a lot, saw a bunch of excellent scenery, met up with friends, and ate delicious food.

How do I get through the last 10 weeks? A little bit at a time I guess . . . but not necessarily in chronological order.

Let’s start with Escape from Alcatraz.

In February I went to San Francisco on business. (It’s another thing I haven’t posted about here. Ditto for our South American adventure a couple months earlier. Oy vey, what’s my problem?) While there I ran from my hotel to Marina Green, where the Escape from Alcatraz Triathlon transition would be. I also took a lovely, 14-mile urban hike where I saw lots of excellent scenery. On each of these outings (book-ended by some really awful norovirus or E. coli or something, which is truly awful while traveling) were beautiful. The skies were clear, blue, and calm. The Bay was flat. “The Rock” looked so close as I stood directly across from it at Aquatic Park, just one mile away.

Fast forward four months.

There was a moment about 40 minutes into the swim when I was sighting well on the finish and looked around. As the Bay moved up and down I could see the Palace of Fine Arts (the only remaining building from the 1918 World’s Fair) and the Golden Gate Bridge. I couldn’t see any people, which is really unusual for a triathlon swim. When 1,500 of us all jumped off the ferry earlier in the day—I was among the first 200 or so to go—there were a lot of people, but since there were no buoys and we were sighting based on landmarks, the pack thinned, and I was alone.

What I could see was a set of 3-foot whitecaps coming at me. For the previous 10 minutes—ever since I passed the three beige piers of Fort Mason—the wind had risen, and I was getting picked up and dropped by the seas. I have a pretty high arm recovery, but a few times I punched a wave and got a very poor catch on the water. Other times, I was at the crest, and there was no water to catch. The current was pulling me in the direction of Marina Green, which was near the swim exit, but I was also slowing as I stopped more often to check my bearings and assess the seas. I retched a few times from the water I was swallowing, and I wondered about what the fuck I was doing in the middle of the Bay.

I had been training for this swim for more than eight months. I swam about half of my yards breathing only to my left, since the Alcatraz waves normally break over swimmers from the right. I practiced diving for months until I realized everyone except the pros jumps in feet-first. I bought a neoprene swim hood and used it a few times in the reservoir, expecting water temperatures in the mid-50s. I watched YouTube videos about how to sight, since there were no buoys marking the course. I swam and swam, building my strength to traverse 1.5 miles (allegedly) of rough water.

Eventually, I saw some bright yellow swim caps going in the same direction as me and a jet ski about 50 meters away. I knew I was going the right way and I probably wasn’t going to drown without being noticed by a volunteer.

(Incidentally, I hung out with Emily, one of my Massachusetts swim/tri-peeps, on the ferry from Pier 3 to Alcatraz. Her sister was also racing. We chatted on the trip to the island and basically kept each other from freaking out. It was good. After we got in the water we all went our separate ways. Emily’s sister heard someone shouting for help about 20 minutes into the swim. I am so glad I wasn’t near that. I think it would have freaked me out.)

After 52 minutes, I was done with the swim. It’s billed as 1.5 miles (2,640 yards). I swam a very straight course, but my Garmin clocked 1,230 extra yards, for a total of 2.2 miles (almost a full Ironman swim). I measured the distance in Google Earth at 2.0 miles if you swim a completely straight line. It was the toughest swim I’d ever done. Except for the Ironman, it may be the toughest tri, too. (The over-the-top hilly half-IM I did in Connecticut last year probably has it beat, but maybe not.)

I had given so much thought to the swim for a long time that I hadn’t given a lot of thought to the bike and the run. I had been training but not worrying about what it would be like. A bike ride in hilly terrain is where I excel, and I’m typically strong on the run.

Today’s bike followed the model of what I was expecting. The ride was up and down, with monster climbs and fast descents with sharp corners. If you weren’t in the right gear, bad things could happen; I saw someone who snapped his chain. I climbed well and descended as fast as I safely could. My fellow triathletes (most of whom consider cycling their strength discipline) kind of suck at bike handling. They don’t keep a straight line, and they swing wide to make a turn without looking to see if anyone is there. I didn’t get to open up as much as I could have, but I did hit 40 mph coming down from the Presidio to Crissy Field. I could have gone a little bit faster but I actually couldn’t get into my three fastest gears because my shift cable was starting to come out of the lever.

As an out-and-back, I had watched the lead pros returning during my departure. When I returned to the bike-to-run transition, the winning man was being interviewed. Overall, my bike split was a respectable 17 mph for the 18-mile course with 1500+ feet of climbing.

For the second time in the day I saw my people as I came into the bike-to-run transition. Lisa and I had come out to the Bay Area a week earlier, and my mom and in-laws joined us a couple of days before the race. We loved seeing them, and they got to experience their first triathlon. Lisa had made them and our friends Mary and Adam bright orange “Team Jeff” T-shirts. This made them very easy to spot, and I loved having fans out there. I waved at them as I left for the final leg.

The run was not so good. All of that saltwater I ingested had upset my stomach, and I could feel it sloshing around as I started to run. I got 3/4 of a mile into a slow jog before I stopped to walk for the next 1/4 mile. For the second time today I wondered what the fuck I was doing and whether I actually enjoyed triathlon, but I told myself to STFU because I’d been through worse, and yes I really do enjoy this variety of masochistic badassery. I drank some fresh water from my bottle, ate a gel, told myself that it’s okay to be the guy walking in the first mile of an 8-mile run, and decided it didn’t matter how fast I would run because it was so beautiful on the course. Ahead of were the Presidio hills, the Golden Gate with its bright orange bridge, the Marin Headlands, the bright blue of the sky, and the wine-dark sea.

I was getting back into my element and started to run. After those 3-4 minutes of walking, I would run everything except for the uphill steps to the Golden Gate Bridge and the infamous Sand Ladder. The ladder was ridiculous: 400 stairs made of logs holding sand in place. It connected the beach, where we had been running for about a mile, to the Presidio’s highlands. Since I was going slow (for me . . . I averaged 9:30/mile over the course) I spent a lot of time looking at the scenery. It was beautiful and something I’ll treasure forever. I started to feel spry again by the last two miles of the run and picked up the pace.

After an hour and twelve minutes, I passed my people in the finishing area. I got my medal and hung out in the finishing corral thinking about the race. My friend Emily finished about 5 minutes behind me, and we talked about the race in the way that only fellow participants can do: the swim with its ridiculous waves, the steep hills of the bike and run, how I got passed on the steepest hill by a guy riding a single-speed who I could hear panting for half a block, but mostly about how it was beautiful and brutal and so worth doing.

Posted in 101 in 1001, Cycling, Reluctant Triathlete, Running, Swimming, USA | Leave a comment

Groton 10K: Not my best day, but still a pretty good day


It’s been a while since I wrote about running—or biking or swimming for that matter—but I’m still doing it. There’s even a race that didn’t make it here: A couple days before we flew to South America, I finished fifth in Milford’s Santa Parade 2-Miler. I wore a Santa hat with Yoda ears and ran those two, uphill miles in 12:49. Unfortunately, the person who finished just 12 seconds ahead of me (also wearing a Santa hat) was the first person in my age group. Stupid Santa.

I have been running (and cycling and swimming and skiing) regularly since last year’s Ironman. I thought I gave myself enough time off after the big race, but I wonder if those seven races in seven months (plus a couple weeks of intense trekking) were a bit too much. As spring slowly came on this year, I’ve had a lot of tightness in the muscles of my left leg. I can also detect a lack of smoothness in my gait, which is relatively new . . . or not. Maybe I’m just noticing it now that things hurt a little bit. The pain usually goes away completely after a couple of miles, but I’ve had enough of it that I started to worry before yesterday’s 10K race. (The race was a meetup of sorts with some Boston-area alumni.)

To compound the tightness, I also didn’t have the warmup that I wanted because my blood sugar was a little bit lower than where I needed it to be before starting to run. So I waited about five minutes for the food to start doing its thing. When I started running, my heart rate strap immediately fell down to my navel, so I adjusted that. The drawstring on my shorts also wasn’t tight enough, and they were sagging a bit with all of the diabetes stuff I carry in my pockets. So I had to stop to retie them. All told, I probably only warmed up for about 5 minutes, instead of my usual 15-20.

Consequently, when my friends Mark and Robyn were taking pictures at the start, I couldn’t really force myself to look my usual calm, collected, take-no-prisoners, fuck-’em-up self.

A re-enactor’s musket shot started the race—as Lisa later said, “18th and 19th century wars must have been very loud!”—and we were off w-a-y too fast. I did the first mile in 6:37, which led to my first F-bomb drop of the race.

As soon as I started to slow my roll, my left calf started cramping, as it has done so much recently. I wasn’t sure what kind of a day I was going to have, but now I suspected a PR was out of reach. Everyone around me was inspired by the bagpiper playing for us in the hillside field, but I wasn’t feeling it. I did my 2nd mile in 7:30 and the next in 7:45. A steady trickle of about 20 people passed me.

Passing the 5K clock in a touch over 23 minutes, my leg was starting to loosen up. I thought, “I’m not having my best day, but it’s still a pretty good day.” And I decided it was time to get my head back into it.

A woman in a green top slowly passed me, and I decided to tuck in right behind her. She was running the pace I wanted, so I hung out just over her shoulder. We traded positions a few times, with me generally opening up on the downhills and her overtaking me again as the next rolling hill started.

Then we merged with the 5K crowd, which had started 10 or 15 minutes after us. It was chaos! The road had been all but empty, and now we were fighting to move through a sea of people running 4-5 minutes per mile slower than us. I didn’t want to back off Green Shirt Lady, but I didn’t want to clip her heels as we tried to find the best line.

Eventually, I needed to make my move. I found some space on the very edge of the road and bolted on a downhill. It was great. I was feeling pretty damn fantastic by this point. Green Shirt Lady tried to come with me, but the elastic holding us together snapped, and I wouldn’t see her again until after the finish.

With about a mile left I heard Lucinda (the instigator or our alumni 5K/10K meetup) yell something at me. I had been looking for her yellow/green, long-sleeve shirt since we joined her 5K crowd, and it didn’t occur to me that she might have it tied around her waist. It was great to get that little boost from her.

The race was over quicker than I expected, despite being very well marked. That last mile is either surprisingly short or interminable. Yesterday it went very quickly. It finished on the same asphalt track where it started, and I made an “adorable” face for Robyn, Mark, and Kathy as I went by. My final time of 45:31 was good enough for 49th place out of 385. It’s not my best (44:27 on the track in 2014) but was definitely plenty fast.

It was great hanging out after the race. We cheered Lue as she finished her 5K a few minutes later. And we huzzahed for Lisa’s first 10K finish not long after that. I was seriously impressed with her consistent 10-minute miles. She seemed pretty happy about it, too.

I have about three weeks before the first triathlon of the season. Let’s see what I can do to make my leg feel better.

Look at all the happy people

Posted in Running | 1 Comment

Step 9

Step 9: Communicate more with my diabetes team. Thanks to my health network’s patient portal, I’m in closer contact with Awesome Endo and Awesome NP than ever before. This option isn’t exactly new, but I haven’t made much use of it with my endo’s office before this visit. (See step 6.) As we test and adjust my basal rates, this kind of quick contact is going to be the key to getting it figured out.

(Can I just say how much I really value health portals? In addition to having secure “e-mail” with Awesome Endo and Awesome NP, I can see my test results, immunization record, and vital signs from my office visits. Healthcare providers and their staff complain whenever their provider network changes the EHR and HIMS they use—which I understand—but it is so nice to have access to it. We can go so much further: prescription refill details, all my diabetes data as part of my EHR, etc. It’s a brave new world.)

Posted in Baby Steps, Diabetes | Leave a comment

Step 8

Step 8: Record the data. That should actually say, “Record and act on the data.”

I’ve been recording all of my diabetes data—fingerstick BGs, CGM values, carb consumption, insulin delivery, exercise details, infusion set changes, etc.—for the better part of the last decade. I’ve been uploading, downloading, or otherwise saving it for the last few years. And thanks to Tidepool, Minimed Connect, and Garmin Connect most of this data is on the cloud, and a lot of it was put there automatically. I’ve also done the (hard) work to get all of the forms of data into the same place sync’ed up with each other. It’s great being able to see so many relevant things in one view.

What I haven’t been so good at is going back through and reviewing the data for patterns. I mean, I do know (generally) what’s happened in the past and have a vague intuition about what will happen if I change one thing or another. I could be much more systematic, though. In the past I’ve written down by hand a lot of the information that gets automatically stored for me (plus the all important “active insulin”/”insulin on board”/”IOB”) and then used that to figure out what might happen next. It’s a long and tedious task, but it’s worth it to jot down a few key details and see how results compare with each other.

Over the last couple weeks of basal testing, I have been manually recording values and looking for patterns. It’s not that hard, and I should extend it to exercise and the meals I routinely eat. Additionally, now that I’m trying harder to follow the rules or change them to be the right rules, I have the opportunity to gather higher quality data. (For a while a lot of the necessary context about where I was diverging from “the rules” weren’t adequately captured in my data, which makes it less useful.)

I’m still going to take the first cut at looking for the patterns and come up with new and better rules, but there’s also a role for software to aid with the analysis. I’m hesitant to lean on this too much, since I need the mindfulness of looking critically at my diabetes experience on a daily and weekly basis. Nevertheless, I’ve been exploring machine learning techniques recently, and that seems like an excellent reason to keep gathering the highest quality data possible.

Posted in Baby Steps, Data-betes, Diabetes, Life Lessons | Leave a comment

Step 7

Step 7: Get believable basal rates and carb ratios. They have a huge impact on how my day plays out, but it’s been a while since I verified these basic settings. They’re the baseline for changes that I need to make to accommodate my workouts and races, and they will be critical in eliminating a lot of the “winging it” that I’ve done recently.

Awesome Endo’s Awesome NP and I have decided to start with an afternoon basal test, since that part of the day is my biggest problem area right now. Eventually, we will progress our way around the clock, checking evening, overnight, and morning settings, too.

I had hoped to start yesterday, but I underestimated breakfast, which caused me to be too high for the test. I’m going to try again this afternoon.

Now is as good of a time for a confession as any: I exercised this morning. Awesome NP (and everyone else) has said to do basal tests without exercise beforehand to “reduce the number of variables” that could change my insulin sensitivity. Eventually I will test again on a weekday where I didn’t fitness in the morning, but I wanted to do one on a day that’s like my typical day, which means training. I figure, I’ll give Awesome NP both sets of data and we can decide with as much context as possible.

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Step 6

Step 6: Ask for help. Nobody knows my diabetes experience better than me, but that doesn’t mean I’m the only one with ideas. Other people can help, too, by providing insight into diabetes, information about what’s in the food I eat, tips for exercise, and encouragement.

Lisa’s been asking me for a while how she can pitch in. I really don’t know what to suggest—she already gives me a lot of support and encouragement—but I love that she’s willing to help.

Today I met with my endocrinologist’s nurse practitioner. We discussed how to improve my A1c, attenuate the wild swings in my blood glucose when I exercise in the afternoon, and generally get me more confident in my own diabetes self-management plan. We were on the same page from the beginning of my appointment, when he asked me what I wanted to focus on. Me: “Well, I slide into lunch almost low, then I feel like I have to go very high before exercise, when I often drop 100-200 mg/dL in an hour. So, I was hoping to focus on noon to 7PM.” Him: “Great! That’s the part of the day I wanted to start with, too.”

I mentioned that I was unhappy with where I’ve ended up—with my A1c, not my accomplishments—so we talked a bit about how I got here. “Last year, training for the Ironman was so important that I tolerated a lot of highs that I didn’t really like just to make sure that I could get the work done. I think I got too used to being high—and had so many large drops—that I started to feel comfortable in the 200s. I feel like I need to reset a bunch of things.”

So that’s what we’ll be doing: getting back to basics while accommodating my training. We’re starting with an afternoon basal test soon. I considered trying today, but my pre-lunch BG was only 78 mg/dL (4.3 mmol/L). We will also be reviewing my data online, which is kind of exciting.

For the first time in a while, I’m hopeful that I can make some positive changes that stick. As I told my NP, if doing an Ironman taught me any lessons, it’s that putting my head down and just doing the work everyday eventually makes an impossible task achievable.

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First Thoughts on the Dexcom G5

Blip 2016-03-28

I’m coming up on the end of my first Dexcom G5 sensor, which is to say six days. (Yes, I’ll be trying to restart it and see how good zombie sensors can be.) So far I’m really pleased. It largely tracks my blood glucose, often to within a few mg/dL, which is pretty impressive. It hasn’t had any unexpected dips and bounces where it showed my BG changing in absurd ways.

As for exercise, my experience has been mostly positive.

After swimming with it twice—this morning and five days ago—the sensor still seems firmly attached. Following some advice from a few online peeps, I did cut a hole in a piece of Tegaderm and place that over the site of the sensor. (Covering the entire thing is not recommended.) I put the receiver inside two Ziploc bags and kept it at the end of the pool to see what happened. As expected, I lost reception while swimming, but when I stopped between swim sets with my sensor just out of the water, it picked up the signal and gave me a value on the receiver. Nice!

When I went for a bike ride, the sensor gave extremely accurate results. It was encouraging to see a smoothly changing curve, rather than the (incorrect) massive downward swings from the Minimed Enlite. Running has been a mixed bag. On Friday (day 3), during my treadmill run, I had yet another smooth graph with readings that matched at each endpoint. Yesterday (day 5), my CGM reading started to drop quickly right after I started before leveling off after I ate a bunch of food. My fingerstick readings at the end show there wasn’t the massive dip, and the CGM graph more-or-less caught back up with reality after about 20 minutes. (You can see the craziness on the left of the picture above.) I’ll be keeping my eye on this, but I’m still pretty impressed.

My big challenge is figuring out where to put the receiver when I’m sleeping. I need a nightstand.

p.s. — I’ve been playing around with Tidepool’s Blip app. I like it! It made the snazzy chart above.

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Step 5

Step 5: Use CGM. Once upon a time I used a continuous glucose monitor, and it was helpful . . . when it worked. It didn’t work often enough for me to trust it, though, so I stopped using it. As a result, I slept better, but I lost insight into my blood sugar. My A1c went up. My confidence went down.

So . . . Try using a better CGM. Everyone seems to love Dexcom, and I’ve had my own since Tuesday. So far so good.

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The first bake

I like pastries. I love pain au chocolat, and I’ve wanted to make my own for a while. Last October, my mother- and father-in-law gave me a stand-mixer. My mom got me some supplies. Lisa got me a couple of books about bread. Mary and Adam got me a couple more plus some bread baking supplies, including a scale that has sub-gram accuracy! Since then I’ve baked about a half-dozen loafs of country bread (mostly with a poolish preferment). They’re tasty and imperfect . . . and surprisingly easy to make. I’m still getting used to working with dough.

Baking bread has taught me a lot in a short time, and I’m so happy to be making delicious things. But I really want to make pastries. My big goal is to make viennoisserie (delicious laminated pastries like croissants) but that’s some hardcore baking, so I’m starting with simpler things that will teach me about working with eggs, butter, flour, temperature, and time.

Pastry cream ingredients

For the most part everything is turning out well. (Except the chipas de paraguay, which we had in Patagonia but have proved to be my kryptonite.) I’ve been making 1-2 things each week, usually on Sunday: pretzel rolls, gougères gruyères, choux pastry, crème pâtissière, meringues, madelienes. The meringues were an afterthought, since I didn’t want to waste four egg whites. “Add sugar and cream of tartar, whip, and bake? Why not?!” I’m still baking bread, which Lisa and I usually eat entirely ourselves. A lot of the other things going to my office, where I share with my coworkers. They’re a bit bemused by my foray into baking, but they seem appreciative. Sadly—especially for them—the first batch of éclair shells were overbaked, so there weren’t enough to take to the office.

Here are pictures of the before, during, and after of baking over the last 4-5 months.

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Reading Diabetes Data from Tidepool into MATLAB

Here’s what I did over the weekend with the help of my awesome coworker Kelly.

email = 'your email address';
password = 'your password';
cmd = sprintf('curl -I -X POST -u %s:%s', email, password);
[status, loginResult] = system(cmd);
result = regexp(loginResult, 'x-tidepool-session-token: (?<token>[a-z_A-Z0-9\.]*)\s', 'names');

opt = weboptions('KeyName', 'x-tidepool-session-token', 'KeyValue', result.token, 'MediaType', 'application/json');

query = sprintf('METAQUERY WHERE emails CONTAINS %s QUERY TYPE IN activity, basal, bloodKetone, bolus, cbg, cgmSettings, deviceEvent, deviceMeta, food, grabbag, note, pumpSettings, settings, smbg, upload, wizard', email);

data = webwrite('', query, opt);

Yup that’s (almost?) all of my diabetes data from Medtronic Carelink, which I uploaded to Tidepool. Yay!

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Step 4

Step 4: Tolerate lower blood glucose. 120 mg/dL (6.7 mmol/L) isn’t low. 80 (4.4) isn’t low. Context matters, of course: 120 during exercise is time for action, and 80 before bed means it time for a snack. But right now, a lot of these numbers lead me to snack unnecessarily. So stop it. Wait a bit. Use that new CGM (which should arrive any day now) and watch what happens. Stop thinking “low” until I see the 70s (a.k.a., the low 4s). And stop thinking “OK” when I see 180 or higher.

(BTW, this is not what I expected step 4 to be. But I realized when listening to the Juicebox Podcast that other people have a much lower set-point when it comes to blood glucose, and they’re talking about kids. So, really, what’s my problem? It’s all tied into how my BG behaves when I exercise, I’m sure. That’s going to be hard to tease apart, of course, but it’s not a catch-22; any little bit of better is better.)

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Step 3

Step 3: Bolus more insulin. More than sixteen years after I started using insulin, it still freaks me out. There . . . I said it. It’s not the insulin itself but the potential for hypoglycemic events. They feel terrible, get in the way of my exercise plans, and can even be life-threatening. Despite trying almost everything last year during Ironman training, I saw a lot of episodes of massive blood sugar drops when exercising after work, often while riding my bike home. It was frustrating, and eventually I stopped giving as much insulin as I knew I needed at lunch. At the same time, my carbohydrate intake increased. When you put it all together, my blood sugars were higher than I would like, my tolerance for those values went up, and my desire to take full doses of insulin decreased.

So . . . This one is going to be hard work and has multiple facets. I need to take more insulin but not always. I need more insulin when I know that I won’t be exercising right away: with breakfast and dinner, for example, or overnight when my 6AM workouts are still hours away. I need to look at the recommendation from my bolus calculator which seems big—OMG! 12 units!—and start to feel confident that it’s actually the right amount if I’m not heading into exercise. But even before I feel confident, I need to JFDI and take the insulin. Fake it ’til you make it. (All this assumes that the carb inputs to the calculator are correct. See Step 2.)

It’s possible to make this step easier if I also add in some future steps, like eating fewer carbs and journaling more, but let’s talk about those later. Baby steps.

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Step 2

Step 2: Try harder to know or estimate carbs. Knowing the number of carbs in things makes bolusing decisions (somewhat) easier, so why not do it? Taking the right amount of insulin is a separate issue, so let’s leave that till next time.

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