Carbs, Pacing, and Ironman

Here’s a little bit from six-time Ironman world champion Mark Allen’s article “To Hawi and Back: Can you still win Kona on the Bike?” It appears in the September 2014 issue of Lava magazine.

We have enough fat in our bodies (yes, even ultra-lean triathletes) to run about 500 miles. However, we only have about 20 miles worth of carbohydrates stored in our liver and muscles. That’s about 2,000 calories. An Ironman takes at minimum about 6,000 calories to get you from start to finish.

Here’s the catch: Humans can only absorb about 300 calories per hour of carbohydrates. However, during an Ironman an athlete is burning between 700 and 800 calories per hour. What does that mean? Let me engage your math brain for a moment. If an athlete is going through 700 to 800 calories per hour to fuel their pace, but is only able to absorb 300, you can do the calculations. They are burning about 400 calories per hour more than they can take in. If the pace is relatively slow, or if the athlete has developed their fat burning engine to the point where they can go about 80 percent of their threshold pace without activating their anaerobic metabolism, they can in theory get about half their energy needs from stored fat and half from stored carbohydrates. In other words, they will be getting about 350 calories per hour from stored stored fat and about 350 per hour from carbs. . . .

In an Ironman, well-trained athletes can do the entire bike at roughly this point, which is equivalent to racing at 80 to 85 percent of your max heart rate if you’re well-trained aerobically or 70 to 75 percent of max otherwise. However, if the pace is fast, or if there are a lot of surges where your heart rate shoots up suddenly, then carbohydrates become the dominant fuel. This kicks in your adrenal system (your fight or flight reflex), causing your fat burning to be slowed way down for hours, even if you lower your heart rate again.

So that’s pacing and carbs. Now I just have to figure out insulin. Stay tuned.

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Chafing at the Bits

Please pardon the really bad pun in this post’s title.

Last Sunday’s triathlon had a lot of successes: Getting 20 minutes faster on the same course in two years’ time. A new 70.3 PR. Faster transition times. A good hydration strategy. One of my strongest swims ever. Etc. Etc.

Another thing that worked out very well and gives me hope for the Ironman next year is how everything worked out “down there.” Let’s just say that, until recently, any race on my tri bike longer than an Olympic’s 40 kilometers resulted in unpleasant chafing.

But this . . .

Chamois Butt'r

. . . plus this . . .

Body Glide

. . . plus this . . .

TYR Carbon tri short

. . . plus especially this . . .

Specialized Romin Evo channel saddle

. . . yields this:

Happy Jeff

If you ride, you should try ‘em out

Posted in Cycling, Reluctant Triathlete | Leave a comment

The Dark Night of the Diabetic Triathlete’s Soul

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“You know what I’ve learned over the years?” Lisa answered her own question this afternoon as I was recovering from the Rev3 Maine half-iron triathlon. “Triathletes are never happy with their results.”

There’s a lot of truth to that. I’ve even been known to complain about my performance from time to time—last year was particularly bad—but I’ve found little to dislike about this year. The NE Season Opener tri (a sprint) was fast, and I had a solid performance. A couple months later during the Olympic-distance Mass State Triathlon, I put together a very good swim and run, which sandwiched a so-so bike.

Last month, RAGBRAI put a lot of good distance into my legs; my morning swims at the reservoir have been top-notch; and I’ve been having fun putting together some “where does this street go?” runs around my neighborhood. (“Up a hill and down a hill” is the typical answer.) Plus, I had been training on a new saddle, which promised to make riding a bit more comfortable. So I was really eager to see how this season’s big race would go.

Two years ago, this race—the Rev3 Maine—was the first 70.3 I ever did. I trained hard for it, used a training plan from TeamWILD, and was ecstatic with my just-under-six-hour finish time. (5:58:36, for the record.) Since then I’ve done two others, the Patriot Half (5:38:42) and Timberman Ironman 70.3 (5:39:49). They’ve all been challenges in their own ways, which makes the results that much better.

Today was challenging, too, but I’m pleased to say that the results were worth the difficulties. I set a new PR at the 70.3 distance with a 5:33:33!

The faithful reader will remember that I had a problem with very high blood sugar at last year’s Timberman. I started the bike with a 286 mg/dL (15.9 mmol/L) and quickly climbed to 367 (20.5). Micro-boluses of insulin on the bike brought me to a place where I felt okay to head out onto the run without risking my health.

Since that time, I’ve tried to work on my insulin strategy, but I’ve still had a lot of highs during my early morning bike rides and after my swims. It’s been quite aggravating; in fact, much of my experience with diabetes recently has left me frustrated. My endocrinologist and I worked out a plan to address some of these issues, which will hopefully help with the early morning exercise (when I go up a lot) and afternoon outings (when I drop like a rock).

Today, I thought I would try the same thing that I did during the 2012 race, with the addition of a small meal six hours before the race. So I made a peanut butter sandwich, put it in the kitchenette’s fridge, and set an alarm for 1:00AM. In addition to this (which got a full dose of insulin), I had my usual ClifBar breakfast and a much smaller dose of insulin ten minutes before the swim.

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The swim was great! I felt really good during my practice swim on Saturday morning, and I proved that it wasn’t a fluke during the race. Two years ago in similar conditions (64ºF, small swells, clear skies, and light chop) I swam the 1.2 miles in 45:24. Today: 35:20! It’s nice to see all of the hard work at the pool paying off.

About 15 minutes into the bike, I tested my blood sugar. 254 (14.1). Not great, but only slightly higher than the beginning of the swim. I’m not 100% sure why I didn’t check my CGM or retest along the rest of the 56-mile bike course, but I suspect it had something to do with the strength of the field. Last time around I felt like I was passing more people, and this time I felt like I was chasing the whole way. I should have swallowed my pride about continually leap-frogging people and just tested, but I didn’t. I finished the ride three minutes faster than 2012 (2:54:53). Basically a draw.

There were some dark moments on the bike. My legs hurt in ways that they usually don’t, even though I was following my typical pace plan. In particular, my inner thighs were burning. When I got off the bike my whole lower body just felt painful. Those three hours felt terrible.

Heading onto the bike

In the bike-to-run transition I chatted with Lisa while putting on my shoes, and she could tell that something wasn’t quite right. I tested my blood sugar as I headed onto the run course: 405 (22.5). For those of you without diabetes, this is quite high. It’s higher than I was when I was admitted to the hospital at the time of my diagnosis. When I’m not exercising, it’s around the point where my stomach starts to turn and I get very grumpy for no good reason. Today, it was high enough to make me wonder whether I was producing ketones, especially since I had to pee twice in two hours.

I immediately took 1.5 units of insulin, which I knew would kick in after about 15 minutes and (ideally) start to clear out the blood sugar. My body didn’t need any extra food; it just needed to use what was floating around in my blood. I spent the first twenty minutes of the run thinking of the filthiest insults possible about diabetes in all of the languages that I knew. («Quel espèce de putain de bordel, la diabète», etc.)

Coming into T2

Meanwhile, I was managing to keep the pace that I had planned to hold during the 13.1-mile run. Last week, I went to the high school track to work on my pacing, and I threw down a 10K at a consistent 8:00/mile (5:00/km) pace. Twenty-five dizzy laps at two minutes each, noting my heart rate along the way. If I could keep my heart rate around 140 BPM, I figured I could have a very good day. As the first few miles ticked by, I started to lose the anger I was carrying, and the running got easier. At the turnaround point I was still on a very good pace of 8:40/mile (5:25/km), my CGM had double down arrows, and I started eating again.

It would be great to say that I ran a half-marathon PR today. Alas, I did not. Instead I finished it in 1:55:05, about 8 minutes off my best. Still, that’s 10 minutes faster than my previous race here, and I ran the last mile at 7:30/mile (4:40/km) pace . . . much to the chagrin of the people I passed along the way.

Now the off-season is upon me. I was reflecting as I sat around after the race that I need to work on two things before the Ironman next year: my bike strength/speed and my insulin/nutrition plan. Fortunately, I have a whole year to get that squared away. Until then, I’m going to keep having fun and working through the (occasional) dark nights of the diabetic triathlete’s soul.

Finishing with a face

Posted in 101 in 1001, Cycling, Reluctant Triathlete, Running, Swimming | 3 Comments

At the Lake

Here’s how I start a few mornings each week:

(Click any picture for a larger view.)

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Foggy

For unknown reasons the high school pool is closed until further notice. People who swam there while I was on vacation said it was especially chilly recently, indicating that perhaps the heater was broken. Maybe it will open in September. Maybe it won’t. It looks like I’ll be swimming at the lake through the end of the season.

Last Thursday, Pat, Jennifer, and I swam the half-mile to the dock and the half-mile back. Pat and I are roughly the same speed in the pool, and we paced each other. Jen, on the other hand, is one of the fastest swimmers at the pool. When I looked forward to sight, I would often see her doing the back- or breaststroke to keep from getting too far ahead of Pat and me.

This morning I was back at the reservoir for another mile, this time with John the Irishman and Phil the Ironman. Phil is typically quite speedy, but he’s tapering for Ironman Mont-Tremblant this weekend. Without someone faster to chase, he seemed content to put in the distance without overdoing it. Usually when Phil passes me, I can only hold on to his pace for a few yards before he’s out-of-touch. With today’s more leisurely pace, though, he gave me the perfect opportunity to practice my drafting.

Drafting has been hard for me. Usually when I attempt to draft or pace off someone else I’m worried about getting too close and bumping into them, which slows us both down. Or I feel like I’m swimming in a whirlpool tub, my vision obscured by the bubbles from the kicking of the person I’m following. I’ve learned that you can get almost the same benefit by staying just to the side of the lead swimmer, as long as you stay within the V of their wake. That’s what I decided to try today. Phil had started from the beach shortly after me, and when he passed me, I swam toward him and settled into his wake. It took about a minute to convince myself that I wasn’t going to bump into his feet or legs. After a while I started focusing on my stroke mechanics again, making sure that I was getting the most of my effort.

It was pretty amazing how well that worked out! As I got more comfortable, I started swimming closer and really getting the benefit of the draft. A few times I had to hold back to keep from swimming past Phil. Other times he started to ratchet up the tempo a bit, and I slipped back to be directly behind him, trying to get comfortable being more-or-less blind to where I was going. (Fortunately, Phil doesn’t create a huge amount of turbulence.) I realized that the water starts to feel differently during the catch when you’re getting close to someone’s feet; it’s a little harder to grab, if that makes sense. (I did accidentally “tickle” his feet a couple of times when I pushed harder and he let up slightly. He assured me afterward that it wasn’t a problem, since he knew I was there.)

As I swam next to Phil for the 15 minutes back to the beach, I reflected a bit on how open-water swimming has helped me be more patient. I’m either on my way out or my way back, but for the most part I’m swimming a straight line for a dozen minutes at a time or longer—unlike at the pool, where I’m changing direction (and possibly stopping) every 25 yards. A couple of years ago, I had to tell myself to have faith that I would eventually get there. I still need this reminder from time to time, but it’s much easier to believe. Basically, I’ve gotten more comfortable being in the moment rather than at my destination.

While I was having this little conversation with myself—taking care to keep Phil within reach—I started to notice the world changing a bit. Usually, we finish a swim in full sun, which lights a notch of trees I use as a landmark when returning. (It’s easy to find the dock; you either see it or swim into it. Coming back involves a little more attention.) Today, however, the sky seemed to be getting darker. Soon it was foggy, and I couldn’t see the opposite side of the lake. I wasn’t concerned about getting lost; at worst we would swim some extra yards. I was, however, glad that I’d come to the place where I was doing something more process-oriented rather than focusing on the destination I couldn’t actually see.

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Catching up with the Researchers (and Miss Idaho)

I’ve been slowly catching up with the state of diabetes research that was announced around the time I was on vacation. Almost all of these advances are very early in their R&D lifecycle—some that sound promising might go nowhere—but it’s exciting to see the multiple directions that different groups take. I’m all for casting a wide net, even if it means developing soon-to-be obsolete therapies. The best treatment is the one that works well enough and is available now, right?

Speaking of things that work and give me hope that this isn’t all just a (very expensive) pipe dream . . . When I visited her on my vacation, Céline talked about some OMG-I-can’t-believe-how-exciting-these-are-!!! clinical trials going on with the Bionic Pancreas and children. (I linked to the article Kerri wrote about the children involved below.) This is amazing news! Not a complete cure, but probably close enough until some of the therapies described below reduce the technology-related risks of the artificial pancreas.

Which of these do you find exciting?


New Way to Generate Insulin-producing Cells in Diabetes

“We have found a promising technique for type 1 diabetics to restore the body’s ability to produce insulin. By introducing caerulein to the pancreas we were able to generate new beta cells—the cells that produce insulin—potentially freeing patients from daily doses of insulin to manage their blood-sugar levels.” said Fred Levine, professor and director of the Sanford Children’s Health Research Center at Sanford-Burnham.

JDRF Partner ViaCyte Announces Key Project Milestone to Advance Innovative Encapsulated Cell Replacement Therapy Product for Type 1 Diabetes

“We are excited to continue our collaboration with ViaCyte and believe beta cell encapsulation therapy may one day virtually eliminate the daily management burden for those living with T1D. The ability to encapsulate and thereby protect implanted insulin-producing cells has been a focus for JDRF and a product candidate like VC-01 could potentially play a key role in helping us achieve our vision of creating a world without type 1 diabetes.”

More about ViaCyte

ViaCyte’s innovative product is based on the differentiation of stem cells into pancreatic beta cell precursors (PEC-01™), with subcutaneous implantation in a retrievable and immune-protective encapsulation medical device (Encaptra® drug delivery system). Once implanted, the precursor cells mature into endocrine cells that secrete insulin and other hormones in a regulated manner to control blood glucose levels. ViaCyte’s goal is a product that can free patients with type 1 and type 2 diabetes from long-term insulin dependence.

DiabetesMine digs deeper into ViaCyte

This device would be loaded with insulin-producing cells before implantation, and contains pores that allow glucose and insulin to be transferred through, but not antibodies — meaning insulin would be released as needed in response to the varying glucose levels, but no immuno-suppression drugs will be necessary because the device is protected from autoimmune attack by the sheet’s membrane.

Not to be outdone, DRI moves BioHub to clinical trials.

The Diabetes Research Institute (DRI) is launching a pilot clinical trial that will test a new transplant site in the body for a DRI BioHub. In this Phase I/II clinical trial, researchers will transplant insulin-producing islet cells into one of the platforms created for a BioHub – a biodegradable scaffold.

Diabetes Researchers Develop a New Cell Encapsulation Method to Protect Transplanted Insulin-Producing Cells

“Previous efforts in islet encapsulation have failed partly because of the large size of conventional capsules,” said Alice Tomei, Ph.D., assistant professor of surgery and cell transplantation at the DRI, principal investigator and lead author of the published paper. “Islets vary considerably in size and shape, and production of traditional capsules is standardized to accommodate the largest size. This results in capsules that are too large for the smaller islets. The extra space inside the capsule delays access to oxygen and nutrients, causing many islets to die. It also delays the islet’s main function — sensing blood glucose and releasing the right amount of insulin in real time to avoid hyper- and hypoglycemia. Finally, such a large islet size does not allow implantation in sites that are more islet-friendly, and within devices that have been designed to house the islets in the manner that is most favorable for their function, like the BioHub.”

Medtronic merges sensor and insulin infusion set. This might not be anything any patient really wants, but I liked this paragraph from the article:

Medtronic’s Karrie Hawbaker says the goal is to bring “a more frequent cadence of new technologies to the U.S. market…. Our current focus is on working with the FDA on a path toward commercialization of the next step toward an Artificial Pancreas system and future generations of the Enlite sensor.”

Thermalin plans human tests of concentrated insulin next year

Thermalin’s lead drug in development is a highly concentrated version of insulin which could potentially be used to make insulin pumps … smaller. … The company is also working on an ultra-fast acting version of insulin that could be used with artificial pancreas now in development, as well as a form of insulin that can last almost a year without refrigeration. Insulin is now only effective for 30 days at room temperature.

How do you make insulin? Diabetes Forecast tells (almost) all.

The next phase of industrial purification involves an array of giant columns made of a clear material and filled with an opaque resin. Except for their size, the columns look much like standard laboratory equipment. (This part of the Lilly production process was off limits, but the company showed this writer a model of a column.) When describing the girth of an industrial purification column, a smiling Lilly scientist stretched his arms out widely, bringing to mind an insulin-producing Parthenon. The columns are filled with various substances designed to separate insulin from other molecules based on differences in their electrical charge, acidity, size, and other characteristics. The insulin emerges from the columns alone.

Go Bionic! Read this article. Seriously! Go read it!

If a week without blood sugar excursions sounds like an impossible dream, take heart. Take pancreas, too, because this technology actually exists and is currently attached to seven girls in Massachusetts. And not “seven girls stuck in a hospital bed under strict activity guidelines,” but seven girls who are running amuck at camp, swimming, dancing, singing in the dining hall, and burping at picnic tables outside of the cabins.

Scientists discover protein that helps insulin sensitivityin mice …. again.

Several years ago, one of the new study’s authors, Ronald M. Evans, director of Salk’s Gene Expression Laboratory, and his colleagues discovered that FGF1 was capable of helping the body respond to insulin. The scientists found that when mice who did not have the growth factor were put on a high-fat diet, they developed diabetes. This indicated that the protein had a significant impact on blood sugar levels. So then the scientists gave just one dose of FGF1 to obese mice that had type 2 diabetes, and the blood glucose levels in the mice dropped to normal levels without the commonly associated side effects seen with other diabetic drugs.

This one isn’t about new insulin-oriented therapies. Rather, it highlights the need for a different kind of treatment for people with diabetes: mental-health. Mental-Health Risks of Diabetes Underrecognized

“Despite the potential adverse effects of mental-health problems on diabetes outcomes and healthcare expenditures, only about one-third of patients with these coexisting conditions receive a diagnosis and treatment,” write Barbara J. Anderson, PhD, of the Baylor College of Medicine department of pediatrics, in Houston, Texas, and colleagues.

And I would be remiss if I didn’t talk about the awesomeness of Miss Idaho rocking an insulin pump with her bikini. The always wonderful Miriam Tucker wrote about it on the NPR “Shots” blog. #ShowMeYourPump #TiarasAndPumps #Winning #LiterallyWinning

“It seems that insulin pumps and diabetes devices are now a symbol of community. … It is becoming more and more common to see them widely displayed, because of the opportunity that brings for connection to others. In the diabetes community, we use the visibility of our devices as a badge of courage and a connector. There is a pride in successfully managing the condition and surviving.”

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RAGBRAI: 20 Questions Edition

I honestly don’t know how to write about RAGBRAI. It was just too big and wonderful. Maybe I’ll just answer some of the questions I’ve been asked over the last few weeks, along with a couple I wished I people had thought up. For now, I’ll stick to the bike-riding part of my trip.


How long was it? Average distance per day? Longest day? Shortest? I’m not 100% sure how far I rode. My Garmin computer’s battery died a few times, so I didn’t get accurate distances. (Access to electricity while camping is a luxury.) The “official” distance was 443 miles, but we always rode a little farther each day going between our campsites and the actual start and finish spots. I’d say the average distance was about 65 miles per day. One day, we rode about 45 miles. The next day I rode 112 miles after biking across Forest City a few times.

How many riders were there? Officially, 10,000. I’m pretty sure that there were between 10-15,000 on the road every day, though, as many people just rode without going through the lottery. Having that many riders on the roads meant that you were always in sight of other people. In fact, I’m sure that there was never more than a couple hundred yards between me and another rider while I was on the route. That was really cool! There were just so many people to talk with and gawk at. The highway patrol did a very good job of discouraging drivers from being on the route, so most of the time, we had both lanes to use. Of course, with that many riders, there were a bunch of times when everyone had to dismount and walk into town.

Whom did you ride with? Lots and lots of people! A couple of days, I rode mostly by myself, occasionally hanging out with some people I didn’t know for a half-dozen miles or so before moving on. It was always gratifying to look behind me and see that I had a tail of riders letting me pull them across the prairie. Most days I rode with a group of new-to-me people from Grinnell: Nihad and Melanie from Colorado, Joanna from New Mexico, Jared (Melanie’s brother) from Chicago?, Mary from the ’80s, Ellen and Molly, etc. (Grinnellians are quirky, and it’s nice to have people who get me.) I also spent time on the bike with a couple of cousins.

Favorite moment? I’m not sure it’s possible to pick just one. I loved seeing each little town go all out for RAGBRAI. It’s hard to describe just how into it everyone was. It was like a huge block party every 10-15 miles: music, games, attractions, tons of food, etc. And it wasn’t just in the towns; people sat on lawn chairs outside their farmhouses all day to wave at people passing by.

Most memorable moment? Buying the freshest, most delicious glazed donuts from an Amish teenage girl on the last, most beautiful day of the ride and standing around eating them with the four people I’d ridden with most of the week.

What did you eat? Everything! Granola with yogurt, bananas, burritos, PB&J sandwiches handed out by marines, BBQ, pork tenderloin sandwiches, breakfast burritos, slices of pizza, gyros, ice cream, and pie (of course). Everything except fresh fruits and veggies, that is. I even stopped by “Mr. Pork Chop,” who only sells—wait for it—a pork chop (and a napkin).

Favorite pie? I ate a lot of pie, and most of them were quite tasty. But, believe it or not, the gooseberry pie I got on the first day left the best impression. I’d never had gooseberries before, so I was pretty surprised by how delicious it was. À la mode, of course. The simple apple pie I ate during a downpour in Tripoli on day 6 was really good, too.

Hardest part? Trying not to EAT ALL THE PIES! That, and not talking to Lisa in overnight towns lacking AT&T mobile reception.

Was it a race? Were there any timed segments? Nope, not at all. Some people made Strava segments, but that really wasn’t what the ride was about. That isn’t to say that I didn’t ride quickly or work hard. The first day I didn’t yet understand RAGBRAI and left without anyone to ride with, so I just did my average going-to-work pace. I was the third person (out of 130+) to arrive at our campground. It was just after noon, and I had a hot, sunny afternoon to think about what I had done wrong. On part of another ride, I rode really, really hard to catch up with my peeps after taking a “nature break” without realizing that they had stopped just up the road; I rode an extremely aggressive tempo for 20 minutes before deciding I wanted some ice cream. Mostly I took it pretty lazy, though.

What was a typical day like? Wake when the camp starts to get loud at 4:30 or when my “just in case” alarm goes off at 5:00. Stand in line for a port-a-potty. Get kitted up in my tent. Take down the tent. Put everything on the truck. Hang out until it was time to leave, usually before 6:30. Ride 45 minutes. Stop for breakfast/coffee. Ride 45 minutes to an hour. Refill water, eat pie. Ride. Stop. Eat. Visit a cornfield. Repeat. Roll into the overnight town. Find our campground. Set up camp. Stand in line for a shower. Maybe have a dip in the pool. Get a snack. Have dinner with people from the group (or my relatives). Sit around and chit chat. Crawl inside my sleeping bag by 10:00. Repeat each day in a new town.

What was the weather like? Two words: polar vortex. It was unseasonably cool and dry for Iowa in late July. Daytime highs were in the high 70s and low 80s without much humidity. Overnight it dipped into the 50s, making a light jacket a nice choice. On the sixth day from Waverly to Independence, a cold front blew through overnight bringing thundershowers and miserable riding before it cleared out. I was riding hard to keep warm enough in the 55F (13C) chill with torrential rains and 20-40 mph (30-65 km/h) winds. It wasn’t really working, and I was so happy when the rain stopped. Other than that, most days were pretty great, with moderate winds.

How did it feel? Was it difficult? How were the hills? This was a pretty easy year, all things considered, and I was in pretty good shape. There weren’t that many hills. In fact I didn’t actually realize that we were going over some of them! I kept waiting for the massive hills promised on the last day. Riding 450+ miles in a week is going to be hard, though. I discovered something about my saddle, too! The faster/harder that I ride, the more comfortable I am. When I’m just tootling around at a conversational pace, my sit bones don’t really sit on the saddle, which is rather uncomfortable. (“You’re saddle is too narrow,” Joanna said.) Looks like I’ll be buying a new saddle for my road bike.

What were the roads like? One the last day of RAGBRAI, we passed a sign advocating for better rural highways in Iowa. For the most part the backroads were decent, but many of them shared a flaw, which ran down the middle of the pavement. Iowa’s highways are often constructed of slabs of concrete, with half-inch or wider seams between lanes. The result is a dangerous gap that traps bike tires. State and county highway engineers often seal these with tar, which becomes slippery in the heat. While the roads are mostly safe, it paid to exercise good judgment and pay close attention. On the last day, we were the first group with medical training on the scene of a rider who was thrown after getting her wheel caught. She claimed to be okay, but it was pretty clear that she had a mild concussion. Iowa also has a penchant for using full-lane rumble strips to mark intersections. These are annoying but not inherently dangerous . . . except to riders trying to dodge the cyclists trying to avoid them.

What were the bikes like? Any recumbents? Most bikes were “normal” road bikes. But there were also mountain bikes, recumbents, tandems, tandem recumbents, handcycles, ElliptiGOs, fixies, and just about anything else you can imagine. One person on Team Kum&Go had an articulated recumbent with yellow fabric on it, converting it into an enormous banana. Another person had something called a “Rowbike,” which (as the name implies) you “pedal” by rowing. Some people decorated their bikes with flags or flowers. Other people just decorated themselves. It was pretty weird and pretty awesome! Two people were riding skateboards. At least one person was running the whole route.

Any crashes? Thankfully, no . . . but almost! As I called out that I was passing someone on their left, they looked over to see where I was and veered into me. This isn’t my first rodeo, so I held my line, but his mirror banged into my elbow. I was worried that he was going to fall, and I’m really glad that he didn’t.

Would you do it again? Absolutely! But I wouldn’t do it every year. Some people do that, but it’s a big time commitment, especially if you have to travel to get there. But, you know, every few years or so would be fun.

Would Lisa do it? Let me see if I can quote Lisa correctly. “Aww hell no!” I think that’s a maybe?

Did you see any family on the trip? I sure did! My aunt and uncle in Forest City were nice enough to invite me over to their house for a nice meal and conversation. (I totally used their shower, too!) The next day I rode with a couple of my cousins. A couple days after that, a different auntie and uncle drove the half-hour from Vinton to visit me in Independence. We had dinner and ice cream. I’m so glad to have seen them all.

How was the ‘betes? Meh. I’m writing a whole post about that.

Did you take pictures? Did I ever! There will be more in another post.

The one thing you wish you’d have done? In Graettinger Ringsted, all of the townies had shirts that said “Velkommen, cyklister!” Later I realized that a lot of towns sold their shirts, I wished I’d found and bought one.

Best discovery? New friends? Gooseberry pie? Who knows. The wonders of Chamois Butt’r have to be right up there.

Posted in 101 in 1001, Cycling, I am Rembrandt, RAGBRAI | 2 Comments

56 Weeks To Go

Hey, everybody! Did you miss me?

I promise I’ll write about RAGBRAI soon, but I just wanted you all to know this:

Unless something goes horribly wrong, I’ll be racing Ironman Wisconsin in just over a year! I put the money down while I was on vacation, and now I can relax until spring . . . once this racing season is over, that is.

Believe me, I’ll keep you up-to-date with every little thing about this not-so-little event.

Posted in Reluctant Triathlete | 1 Comment

RAGBRAI, Here I Come!

Last night I “attended” a webinar about RAGBRAI, which I will be doing at the end of the month. I’m starting to get excited about it and the roadtrip to follow.

“What’s RAGBRAI?” you ask.

Sometimes I forget that some people have not lived in Iowa, where—whether you ride a bike or not—everyone knows about the Register‘s Great Bike Ride Across Iowa, or RAGBRAI. (This is the 42nd edition, making it slightly older than me.) As the name implies, the ride starts on the western side of the state and continues over the span of a week to the Mississippi River on the eastern border. When I was but a wee teen at camp, we would often talk about the enormity of such an undertaking as we pedaled our bikes over the plains, past the farms, and through the little towns of Iowa. “One day I’ll do RAGBRAI,” I told myself back then. Twenty-five years later, I’m finally going back to ride it.

Iowa is blessed with lots and lots of paved county roads linking close to a thousand cities and towns, both “big” and small. These roads typically have very little traffic and seem to exist for three things: getting the corn from the fields to the grain elevator, going to Grandma’s house, and RAGBRAI. With so many roads and towns available, event organizers have a lot of options; unlike some other cross-state rides (such as the Pan-Mass Challenge, which is also on my “someday” list), the course changes every year. Some years are longer than others. Other years are hillier.

This year’s ride is the third-shortest route and second-flattest in RAGBRAI history. Yay?

RAGBRAI is a huge group ride with 10,000 cyclists partaking in a week-long rolling party. Food and adult beverages are available everywhere, I am told. I will be tent camping every night. It’s an experience . . . not a training camp. I’m going to try to perfect the art of balancing cycling, food, and insulin as I eat and ride my way across the state. BBQ, pork tenderloin sandwiches, pie, ice cream: bring it! Some of my college friends are riding, as are a huge contingent of my family on my father’s side. It will be great to ride with them.

Don’t get me wrong; even with these priorities, it’s still going to be a challenge. At 455 miles (732 kms) long, I will still need about 30 hours in the saddle to finish the ride at a moderate 15 mph clip. Fortunately, that’s spread out over seven days. As is the 11,780 feet (3,590 meters) of climbing. People who remember my hilliness scale, will remember that I wrote “if it’s less than 30, it’s flat. If it’s between 30 and 50, it’s slightly hilly.” This year’s RAGBRAI’s days range between 17 and 46. Of course, Iowa’s hills are a little different than New England’s, since they tend to be long and shallow. Here’s the breakdown:

Day Distance (mi.) Climbing (ft.) Hilliness
1 69.2 1771 26
2 40.8 1078 26
3 105.7 1800 17
4 38.5 695 18
5 65.8 1743 26
6 67.4 1623 24
7 67.5 3073 46

With all of this cycling distance in my legs, I should be ready for the Rev3 Maine half-ironman triathlon at the end of August and the JDRF Lake Tahoe ride a couple of weeks after that. (Please consider helping JDRF improve the lives of people with diabetes with a contribution to my ride. If you do, I’ll send you something special from RAGBRAI!)

Posted in Cycling, RAGBRAI | 4 Comments

Try Try Again

It’s not a secret that I’ve been frustrated with the Medtronic Enlite sensor. I started using it in January but never could quite get it to work as well as I had expected (i.e., well enough to deserve the label of “the world’s first breakthrough in Artificial Pancreas technology”). It took me about four months to realize that, like others, I wasn’t doing things wrong, and I stopped blaming myself for not being able to get the Enlite to work for me. (Others are still coming around.) I really wanted it to work, but each sensor I took out at the end of its sad little life was kinked in some way or another, which (I surmise) led to the inaccurate readings. When I ran out of Enlite sensors at the end of May, I took a little CGM hiatus.

The truth is, I need reliable CGM. June was a bunch of uncaught highs and defensive actions against the dark arts lows. My daily averages were higher; there were a lot more ups and downs throughout each day; and I had less insight into what happened during exercise. I definitely got back in the habit of checking my blood sugar more often, but I missed being able to see where my BGs were trending when I was just sitting around. So at the end of June, I called Medtronic to reorder supplies, hoping to switch back to the Sof-Sensor. While it’s possible to use the 530G together with the older Sof-Sensor, reordering would require a new prescription from my endocrinologist. Since time was of the essence to get them before a trip out of town, I decided to go with another batch of Enlite, hoping that somehow the past was just a bad dream and this time it would work out right.

And you know what? For the first few days it actually did. The Enlite still wasn’t catching my super high readings, but it was tracking my overall BGs pretty accurately. But then Saturday (the fourth day) came along, and I went for a run. Twenty minutes into the run I stopped to double check whether I had actually dropped 100 mg/dL (5.6 mmol/L) since starting. I hadn’t budged more than a smidgeon. From then on, the sensor was consistently reading low and failing to calibrate. Overnight between the fourth and fifth days, this happened:

Just your run-of-the-mill Enlite batshit craziness

My BGs hadn’t actually changed at all during those three hours, so I pulled the sensor, started a new one, and am hoping for the best.

Let’s recap.

Enlite is approved for six days of “artificial pancreas” use. I got three days of good readings and then a day and a half of bullshit results before pulling the plug. Now I’m on the second sensor in a week’s time, and so far it’s working out of okay. We’ll see what happens on Wednesday or Thursday when I reach day three or four.

Oh, and I am calling called my endocrinologist this morning to get a new prescription for the Sof-Sensor.

p.s. — While I still want to see how Dexcom works out for me, all y’all with that system can feel free to say “I told you so.” If you don’t have CGM yet and are trying to decide which to get, be sure to try them both and see which works better for you!

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My friend’s Ironman

Last weekend, my high school friend Ian did Ironman Coeur d’Alene. We used to run all over Casper, Wyoming, together and travel the state on debate and cross country trips. When I asked him how the race went, here was his staccato, stream-of-consciousness reply on Strava:

Hey saw your message on FB. 1st IM tough. Brutal Wyomingesque wind. Breakers did not bother Andy Potts [who won the men's race] but everyone else. Tough swim rolling around no organization in the group. 10 minutes slower than expected when I swim alone. Deep lung fulls of lake water. People screaming. Worst wind I have seen here. Casperesque. It was whipping. Timing chip ripped off my leg during wetsuit strip. I realized this on bike. I had to stop at every turnaround to have it radioed in. The athlete meeting said they would have extra chips at the turnarounds but alas everyone was like “huh, dunno, ask that guy.” Very defeating. Wind was changing direction and I had to ride the brakes down every hill. Unstable over 33mph. Deep dish rims total waste. Power meter waste. 5.5 pct grade and strong head wind means you can’t spin a 27 [easy gear]. Not fun to be outta the saddle for 5000 feet of climbing just to get over the hills. Power meter pointless given conditions. Man. Bike taken away at T2, quickly forgot 910xt [watch]. Got a new chip at T2. First three miles 6:51. Had no idea my pace. Finally just kinda said “Screw it, been through a lot, just run easy.” So I did that. Basked in the local athlete love and had an insanely easy and pleasant no worries 3:52 marathon. Could have run 5 more miles easily. Operated the next day and did full day of work next day at 7:15 am. [He's a surgeon.] Swim: hell and swells. Bike: windy misery. Run: zen. Atypical… In the end 11:16. Not exactly what I wanted but I will take it… Everyone was 30 mins off usual times. Double the DNFs. Dangerous conditions. Almost yard sale. Brake riding. 223/2500. Good enough…

Sounds like fun, eh?

Posted in Reluctant Triathlete | Leave a comment

Random bits of Kona

I talk to myself a fair bit when I’m training. Usually it’s happy, encouraging talk to get me through a tough spot. (Or it’s just ridiculous nonsense that pops into my brain to crack me up until I get sick of it, and why won’t the voices stop, and . . . Sorry. Where were we?)

Yesterday was hot, there’s just no denying it. When I left the office around 4PM, the mercury—does anyone use mercury in thermometers anymore?—said 91°F (33°C). It was also humid, and there was a pretty strong breeze that alternated between a head- and crosswind depending on the direction I was going. My inner dialogue was staying remarkably upbeat, though, after it settled on this observation:

“It’s hot, humid, and windy in Kona, too. So you’d better [expletive] get used to it.” (My little shoulder-Jeffs have potty mouths, it seems.)

It’s so true.

Posted in Cycling, Life Lessons, Reluctant Triathlete | Leave a comment

Bike-Swim-Bike

My exercise week during the summer (ideally) looks something like this:

Monday: Swim in the morning
Tuesday: Bike to work (about 18 miles), run off the bike (about 3-4 miles). Bike home from work.
Wednesday: Swim in the morning. Run about an hour in the afternoon.
Thursday: Bike to work. Bike home.
Friday: Swim in the morning. Run in the afternoon.
Saturday: Long run of about 1.5-2.5 hours.
Sunday: Long bike ride of about 3-6 hours.

Lately, travel has thrown off my typical training schedule. I haven’t swum or biked much recently, since I didn’t take my bike with me. Instead, I’ve managed to do a lot of running, and I’m feeling pretty good about where I am there. I put together a couple of nice 13-mile routes in Pacific City, Oregon, and Benton County, Iowa. In typical Oregonian fashion, I was drenched after running through rain showers, but I was (ironically) just as wet when I returned from the very humid gravel roads and dirt trails of Iowa. Plus, Lisa, her father, and I did a beautiful 8-mile hike in the Mt. Hood Wilderness. Nevertheless, I’ve missed swimming and biking, and I’m eager to take advantage of some of this freshness to rebuild a bit of fitness.

Because we arrived home very late on Monday, I didn’t ride to work yesterday, so I decided to ride my bike to work today, even though it’s a Wednesday. What to do about swimming? Simple: Bike to the lake, swim, and then bike to work.

When I got there, Alex zipped me into my “speedsuit” and asked whether I wanted to swim a bit longer than usual. At the pool, I regularly swim longer than an hour. By contrast, at the lake we usually only swim the 35 minutes it takes to get to the dock and back. Alex and I had talked about adding distance at the lake, and we were joined by Craig as we ventured past the dock. At the turnaround point, we agreed that we’d do a two-mile swim by the end of the season.

After a rather beautiful frolic in the lake, I headed to the office a new way. Route 135 isn’t terrible in the morning, but it also isn’t as much fun as my usual track. There’s quite a bit more traffic (made worse by the later hour) as well as a couple of railroad crossings with very bad angles, which had me rolling to a stop to take them cautiously. When I do this again, I’ll try a different, slightly longer route.

A few observations about bike-swim-biking to work:

  • If you bring a bike to a lake full of triathletes, those triathletes will lust after it. (Of course, some of those triathletes will also think you’re playing hooky from work.)
  • Everything is wet at the end of the ride. I wore my tri kit to the lake and then to the office, and a half-hour commute just isn’t long enough for everything to dry off off. Hopefully the back of my backpack isn’t still wet when I leave this afternoon.
  • Heading out from the lake is faster when you don’t have to change clothes.
  • It felt different wearing a tri-top and tri-shorts to the office than my usual bike kit. Not that I felt (or looked) naked, but there’s definitely more skin showing. And I was dripping a bit, too. (See above.)
  • A speedsuit/swimskin is the way to go when a wetsuit isn’t an option. FINA and USAT rules prohibit wearing wetsuits in races when the water temperatures rise above a certain point, and one of my races last year almost reached that point. A speedsuit is the legal way to get the compression and smoothness of a wetsuit while staying within the rules. It uses a woven fabric and doesn’t have any neoprene for buoyancy—both of which are required—but it does have a water-repellent coating. Plus, it covers over the seams and edges of my tri-kit which further reduces drag.
  • I wore the speedsuit because I wasn’t going to bring a wetsuit with me on the bike. I’m definitely faster in a wetsuit—by about 5-10 seconds per 100—but it was good to get some practice.
  • Swimming became much more of a thinking activity without a wetsuit. I had to concentrate a lot on keeping my hips up and not freaking out. I swim longer than this at the pool all the time, but for some reason not using a wetsuit has caused me a bit of anxiety, including today. Midway through the first leg of the swim, I had to do some positive self-talk: “Hey, look! We’ve gone about 15 minutes without a problem. Worrying about drowning is like worrying about sharks. Wait, was that a shark?! See how silly that sounds? No worries. Now, let’s focus on stroke mechanics a bit. There we go.”
  • The swimskin is a bit like a snug-fitting onesie, which means energy gels stash nicely in the thigh.
  • I can’t draft off anybody in the water to save my life. Practice practice practice.

When’s the next bike-swim-bike to work opportunity?

Posted in Cycling, Diabetes, Reluctant Triathlete, Swimming | Leave a comment

Diabetes, Please See a Gate Agent at the Podium

I wrote this on the plane and posted right after we got home from the airport . . . at 1:30AM.

Lisa and I have been experiencing our fair share of travel shenanigans recently. Two weeks ago on our way to Oregon our flight from Boston was cancelled because torrential rains wreaked havoc with JetBlue’s schedule. We eventually arrived on a different airline fifteen hours later. Our return trip after a week of fun in the Northwest was uneventful.

On Monday we ran into more weather-related delays when returning from a weekend trip to Iowa. We arrived on Friday to celebrate my grandmother’s 90th birthday, and it was time to go home. (She is incredibly spry, by the way. I hope I’m doing that well when I’m her age.) Our flight from Cedar Rapids to Chicago was delayed on account of thunderstorms in Chicago, and we eventually left too late to make our 1:15 connection to Boston. Seven-and-a-half hours after our original flight was scheduled to leave, we were still at O’Hare having boarded and disembarked our plane twice.

“I need to change my insulin.” My BGs were high, and I was hungry, and I was almost out of insulin in my pump. I wanted to eat, but I didn’t have enough to eat, correct, and make it home. “What I could really use is a quiet, out-of-the-way spot with a flat surface.”

“Good luck with that,” Lisa replied as we looked around the airport. I’ve changed my insulin and infusion set in airports before. But Oakland and Rochester were pretty quiet, and it was easy to find an empty gate without any passengers. Today was different. Stranded and delayed passengers occupied almost every seat and lounged in the terminal’s hallways. We walked toward the far end of the terminal as I scanned for a place to take care of business.

“Over there.” I pointed and headed toward a bunch of people.

A moment later I was taking supplies out of my backpack: insulin, insulin reservoir, Silhouette infusion set, harpoon launcher Sil-Serter inserter, and the vitamin bottle acting as my portable sharps container. I placed all of these on a vacant podium used by gate agents. It was perfect: It had a flat countertop where I could place my stuff, and it was tall enough that I could do the insertion without drawing a lot of attention.

Nonchalantly I drew 180 units of insulin into the reservoir, flicked at it to dislodge air bubbles, and attached the infusion set’s tubing. I pushed a bunch of buttons to rewind my pump and fill the new set’s tubing. When the drops of elixir appeared at the end of the needle, it was time to do the deed. I put the infusion set in the inserter, removed the needle guard, exposed the tape, cocked the spring, pressed it against my skin, and pushed the button. Like a pro, I pulled out the needle, affixed the tape, and attached the tubing to the infusion set, now securely attached to me.

Nobody seemed to notice or care. I’ve learned that if you look like you belong—if you just blend in with the scenery and go about your business as if it’s what you do every day (which in a very real sense it is) without looking around to see if anybody is paying attention—then you do belong and almost no one will say anything. Of course, if anyone had asked me what I was doing (or had done) I would totally have told them about diabetes and insulin pump therapy and how these unexpected things (like tending to medical devices in public) are just part of the joy of this little disease. But no one did, and I’m kind of glad, because I was rather tired and cranky.

“Ah, there’s the life-preserving smell of band-aids that we all know and love.” Lisa had wandered off for a minute, and she returned just as I was cleaning up my diabetes trash. “Is that some of your insulin there?”

I wiped the droplet away with the palm of my hand, and we headed back to our gate. On the way, I looked at Lisa—and in my best airline voice—and said, “Diabetes, please see a gate agent at the podium.”

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The D.O.C. Needs a Dark, Brooding, Imperfect, Badass-Wannabe Like Me

You may have noticed that I don’t write quite so much about diabetes here as I used to. (About my diabetes, that is.) If you and I are friends on the The Facebook, you might have also noticed that I don’t mention it quite so much there either. Or on The Twitter. I’ll still talk about it with anyone who brings it up, and I still rock the awesome diabeTees Lisa has lovingly made for me. But online I’m a little quieter. Why is that?

It takes time for me to write well—especially if I’m not 100% sure of what I want to say—and if I’m going to do something I want to do it well. Work, training, travel, learning a new language or two, staying caught up with my reading, writing diabetes self-management software, and spending as much time as I can with Lisa and the cat . . . these all compete with my desire to write here.

Lately when I have set out to write anything related to diabetes, I keep hearing a voice in the back of my mind (a bit like the chorus from an ancient Greek play) asking whether I really have any business writing on the subject. I’m not a model of good diabetes outcomes if you look at clinical indicators (A1c and average BG readings) or at the things that matter just as much to me: the ability manage diabetes during exercise, how often I go low overnight, the ridiculous amount of “defensive eating” I do to prevent lows, whether I can successfully dose insulin for foods that I eat all the time, etc. Despite all of the training, racing, traveling, and everything else that I do with diabetes, it’s never been particularly easy for me, and I find it hard to put myself out there either as some kind of diabetes role model (which I never intended to do) or to air my dirty laundry. (For example: “Yep, the only reason I didn’t go low while riding my bike home the other day was because I had enough of a blood sugar cushion to drop almost 200 mg/dL [11 mmol/L] in an hour and half. Yay?”) It’s not that I haven’t tried to figure things out; it’s just been really fucking hard for me to get it right.

All of this difficulty (for want of a better word) often causes concern for people who care about me. While I’m not worried enough about any of this to stop doing triathlon or other things that make diabetes harder to “control,” the more that I share, the more that I have to remind people that everything really is okay (or okay enough anyway). I understand where the anxiety on my behalf comes from; I really do, but it’s not an emotion I aim for when I write about diabetes or what’s happening in my life. More than anything, my writing is an attempt to connect with my people: folks with diabetes, triathletes and other athletes, family, and friends. Each of these groups is going to bring something different with them when they read these dispatches—which is why I still explain diabetes and triathlon basics in more detail than I would if I were writing for just one community—but it often means that I have to reassure one group when talking about things that wouldn’t concern another.

But I miss writing as much as I used to about my life with diabetes, the good and the bad. All the best role models have dark sides, which is what makes them interesting, right? (Sorry, Superman, but Batman and almost any other superhero are way cooler than you, even if you can easily kick their asses.) I’m not giving up on my seemingly never-ending journey toward better diabetes self-management; I’m just going to write about more of the trip.

Posted in Diabetes, MetaBlogging, This is who we are | 2 Comments