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

Finishing

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

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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.)

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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.

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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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Baking

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.

Posted in Getting Baked, Life Lessons | 3 Comments

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 https://api.tidepool.org/auth/login', 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('https://api.tidepool.org/query/data', 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.

Posted in Baby Steps, Diabetes, Life Lessons | 2 Comments

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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Step 1

Step 1: Test my BGs more often. Whether it’s high, low, or in that happy 80-150 range, not knowing what it is doesn’t change the number. It only means it takes longer for me to react to it. So . . . test.

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The Big Picture

It’s going to take me a while to get through all of the photos from our trip, but I thought I’d give you the big picture, so to speak. Here are eleven panoramas from different parts of our Patagonian adventure. Click any of them for a more detailed view.

Los Torres

Los Cuernos and Lago Nordenskjöld

Lago Nordenskjöld

Valle Frances

Glaciar Grey

Glaciar Grey and Lago Grey

Rio Serrano

Glaciar Perito Moreno

El Chaltén (or Mont FitzRoy)

El Chaltén and Lago de los Tres

On the way to Mirador Pliegue Tumbado

Be back soon .  .

Posted in Patagonia, Photography, Travel | 2 Comments

Sí, Se Puede

After more than two years, I’m finally done.

Duolingo-small

Whew! That was a lot of work.

Posted in 101 in 1001, Patagonia, Travel | 1 Comment