How to Pack a Bike for Shipment

I got my bike back from California this week. JDRF takes care of assembling, disassembling, and packing bikes for all of the riders. It’s a huge undertaking, and the folks from Third Coast Cycles do a great job. Whenever I pack my bike myself to fly or to ship to JDRF, I think “What would Mike Clark and his minions think of this?” I’ve learned a lot of tips.

My Grinnell Classmate and triathlon friend Robyn is shipping/flying with her bike to Florida next month, so I thought I would take pictures of the unboxing to show her (and also to remind myself) what a good packing job entails. Enjoy!

Box & Kitty


Notice that the cassette is protected and the skewers have been removed.

Notice that the cassette is protected and the skewers have been removed.

Notice that the seat post and saddle are between the seat stays, and the handlebars have been removed from the stem, which has been rotated 90 degrees.

Notice that the seat post and saddle are between the seat stays, and the handlebars have been removed from the stem, which has been rotated 90 degrees.

Bottom bracket area detail

Notice that the handlebars are placed under the top tube, which has been protected with foam. You can't see it, but the brake levers have been zip-tied to keep the brake cables taut.

Notice that the handlebars are placed under the top tube, which has been protected with foam. You can’t see it, but the brake levers have been zip-tied to keep the brake cables taut.

Anything that isn't part of the frame is wrapped in self-adhesive bubble-wrap.

Anything that isn’t part of the frame is wrapped in self-adhesive bubble-wrap.

Notice that the handlebar is marked so that it's easy to position on reassembly.

Notice that the handlebar is marked so that it’s easy to position on reassembly.

Notice that the derailleur has been removed from the hanger. This is important!

Notice that the derailleur has been removed from the hanger. This is important!

You'll need a torque wrench and drivers (or 4mm and 5mm integrated wrenches), a pedal wrench, a set of hex wrenches (or just use the torque wrench), and a pedal wrench. You'll also need something to cut zip ties, and you might want something to clean your hands

You’ll need a torque wrench and drivers (or 4mm and 5mm integrated wrenches), a pedal wrench, a set of hex wrenches (or just use the torque wrench), and a pedal wrench. You’ll also need something to cut zip ties, and you might want something to clean your hands

Posted in Cycling, Life Lessons | Leave a comment



JDRF Lake Tahoe Ride

Here’s the profile of Sunday’s ride. Don’t forget: all of the distances and heights are metric.

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Tires and Tiaras

Editor’s note: I wrote this on the plane back from the JDRF’s Ride to Cure Diabetes in Lake Tahoe. It’s a little long, and if you don’t feel like reading it, here’s the twitter synopsis: I celebrated my 15th year with diabetes by riding a bike around Lake Tahoe while wearing a tiara after raising $14,000 for diabetes research. I also went to Yosemite, kayaked, and saw lots of wonderful people trying to make type one diabetes a thing of the past.

Today marks the end of my 15th year with diabetes. It’s hard to believe that I’ve had this disease so long.

In some ways it feels like something I’ve had for my whole life. For better and for worse, I’ve integrated this illness into the fabric of my being in a way that I had never thought possible; it’s just part of what I do. If there were a cure for diabetes available now, it would probably take me years to stop wondering what my blood sugar is, counting carbs, and thinking about insulin action. (Of course, I would partake in an instant.)

Considering other aspects of this disease, I feel like a complete newbie. My last year of A1c tests have been in the 8s instead of the 6s I hear people proudly talk about online and in person. While I’m pretty good at estimating carbs, I’m still rather afraid of insulin and have trouble taking the right amount of insulin. I don’t have a lot of confidence in the basal rates and bolus ratios I use with my insulin pump. When I exercise my blood sugar often goes up a lot in the morning, and there aren’t enough carbs in the world to keep it from dropping in the afternoon. (I’m working on all of these, of course.)

Fifteen years is a long time . . . long enough to transition from one part of life, childhood to adulthood for example. Traditionally, Mexican girls have a quinceañera party when they turn 15. While I am neither a woman or Latina, Lisa and I loved the idea of doing something to celebrate the occasion. Next month, on my 40th birthday, we’ll have the actual party.

All of this explains why yesterday I rode around Lake Tahoe with a sparkly tiara attached to my helmet and why later that evening I showed up at dinner wearing the same tiara along with the “I <3 My Paperweight/Pancreas” T-shirt Lisa made for me five years ago. The dinner was the culmination of an amazing JDRF ride weekend. Each of the three JDRF rides I’ve done has been spectacular, and I’m really going to cherish so much about this trip.

I arrived in Reno on Thursday, picked up a rental car, and drove straightaway to Yosemite National Park. Over the years I’ve always yearned to go there, and it did not disappoint. Yosemite Valley is majestic, and I enjoyed walking around it to see different views of the peaks and meadows. (Who am I kidding? I ran around the trails, enjoying the cool mountain air.) I drove to Glacier Point, arriving at sunrise and watched the world wake up. A forest fire in the park lent the early morning light a peculiarly thick ambiance, producing shadows magnifying the size of the park’s high peaks. While there I saw all manner of fearless wildlife: blue grouse, mule deer, and . . . naked British tourists!

On my way into and out of the park, I traversed Tioga Pass. On the first day, I stopped to take a couple of photos, hopping around some boulders and hiking up a short path. Returning to the car, I felt a bit off in a way that’s hard to explain—somewhere between hypoglycemia and hyperventilation. When I crossed the pass, I saw the reason why: elevation 9,950 feet (3,033 m)! This wasn’t the first time I would notice this feeling over the next few days.

Friday afternoon I rolled into South Lake Tahoe, checked in with the always wonderful JDRF ride staff, and picked up my bike, which was waiting for me (fully assembled) in the bike room. My good friend Victoria and I had been trading texts throughout the day, and we met up shortly after I arrived for a weekend of shenanigans. Victoria lived in Alabama when we first met, and—because there are so few New England riders at the JDRF events I’ve attended—the Alabama chapter seems to have adopted me and my chapter’s coach, Steve Berube. It was great seeing so many of them again: particularly Ross, Sarah, Susan, and Drew.

When I arrived at Lake Tahoe, I wasn’t particularly nervous about the ride. At 72 miles, it’s the shortest of the JDRF rides I’ve done, and after a season of triathlon training and RAGBRAI, I wasn’t worried about the distance or the hills or keeping up with other people. In fact, I had no idea who would keep me company as I rode, since Ross was now coaching and Greg (who rode with me in Nashville and Death Valley) wasn’t there. Nevertheless, on Saturday we did a few things that started to make me a bit anxious.

Source of stress #1: In the morning, we took a short bike ride just to make sure that everything was right with our bikes. There was that altitude feeling again! The ride was short—just five miles—but the hills felt tougher than what I would have expected. I remembered this from when I rode in the Rockies a couple years ago, but I needed to remind myself exactly what I was getting myself into, so at one point I just took off in a full sprint to see how long I could keep going and how long it would take to recover. Answers: shorter than usual and longer than usual.

Source of stress #2: After lunch, Susan, Victoria, and I drove out to Emerald Bay to kayak. The road we took was the beginning of the route we would ride the next day. At 2:00 on a Saturday it was pretty heavily trafficked, and there were some steep drop-offs without guard rail protection. And the car was really working to get itself and the three of us (and our half-dozen bottles of water) to the parking area, which was the first rest stop on the bike ride. (Yup, we drove up so that we could walk a mile down to the water.) I had confidence in my abilities to be awesome, but I wondered what it was going to be like going up this steep, narrow road with cars and other riders around me. I think everyone felt a bit worse about the ride after our time on the water.

The kayaking however was amazing. Lake Tahoe is incredibly beautiful. The water was crystal clear and placid, and the alpine setting is a perfect backdrop to the gem-like lake. We had fun paddling around Emerald Bay, staying close to shore except when we headed out to a small island, where we hopped out of our kayaks and went ashore. I’ve never kayaked before, but it turns out I was a natural. By the end of our two hour rental, I was keeping the kayak pretty straight and working up a good head of steam. I especially enjoyed the way the water dripping off my paddle kept me cool.

Sunday, ride morning, dawned clear and crisp. I was glad that I brought cold weather gear, and I rolled out from the MontBleu Casino into the 39ºF (4ºC) air wearing three layers. When I reached into my jersey pocket to look at my CGM, I realized that my fingers felt a little rubbery.

By the time we got to the first climb I was feeling pretty good. My fingers had warmed from the exertion, and (more importantly) I was reminded that climbing a mountain on a bike is different than in a car. A lane that’s just wide enough for a car can comfortably fit two to three cyclists, leaving me far away from the edge. Plus, since we left early and were on a climb, there weren’t many cyclists running amok.

I loved that first climb. It was steep and slow and beautiful. It wasn’t the longest climb I’ve ever done, but it was the best that I’ve done recently. And the descent was great! I touched the brakes a few times to prevent myself from going around hairpin corners too quickly, but I listened to my bike and really let myself fly. I topped out at 43 mph (70 km/h) for a pretty good stretch and enjoyed the feeling of the road beneath my wheels.

And that’s when I met Jed, a fellow JDRF rider from Kentucky. I had been riding by myself, leapfrogging a couple of riders. I would catch them on the uphills before they overtook me again on the downhills. Since we were both riding alone, we agreed to ride together for a while. We ended up completing the 72 miles together, talking about bikes and Tahoe and diabetes and whiskey. Midway through one long climb, he shouted out, “Jeff, you’re an animal!” I reminded him that he was keeping up alright. Later he said, “Dude, we’re passing people like they’re standing still.” I said I felt bad about that . . .well, just a little.

By the time we finished the second large climb of the day. I was pretty warm. I had long since doffed my jacket, arm warmers, and beanie, but I was still wearing a base layer and jersey, which was now completely unzipped. In the span of four hours the temperature had risen more than 40ºF (23ºC). Shortly afterward, I enjoyed the seven-minute, four-mile, continuous descent, where we lost 700 feet (215 m) of elevation. (I will let you do the math about how fast I was going. It would definitely have been quicker without the headwind.)

I was kind of surprised to discover that after the descent we still had a half-hour of very lumpy riding remaining. In fact, it was the most consistently rolling terrain we had all day. I’m not sure if my blood sugar was falling too quickly or if vigorous day in the saddle was catching up with me, but I was really happy to see the casino’s towering hotel, which drew us like a beacon to the finish. My BG readings were pretty good throughout the ride. They went up more than I had expected in the hour leading to the start, but they were pretty stable throughout the first half of the ride (hovering around 240 mg/dL, or 13 mmol/L) until I gave some insulin along with lunch. Following that, they were on a nice glide path into the finish, where I tested and saw a very happy 145 (8.1).

Over the next three hours my BGs were pretty near perfect. In my head I pondered whether this Ride to Cure Diabetes had done just that. And, of course, that’s why we ride: to find a cure for diabetes, to turn type one into type none.

Hanging out at the finish, eating, and waiting for people I knew to finish is one of my favorite parts of the ride. I love talking to people about their rides, hearing about the awesome moments as well as the darker ones, seeing the joy in their faces when they finish, and reveling in the belief that we’re making a difference while we have a good time on our bikes.

And I have to believe that we are making progress. It’s a common, cynical quip that diabetes is always five years away from being cured. If you look at the progress that we’ve made over the last five years—with encapsulation, the artificial/bionic pancreas, smart insulin, and understanding the biological pathways of diabetes—I can’t help but believe that we’re not only getting closer, we’re actually getting close to a time when diabetes is easier. A time when a person like me who tries really hard to “do the right things” will have the technology to actually see the results of that hard work pay off more easily. A time when people who are newly diagnosed (and their loved ones) won’t have to worry about dying in their sleep. A time when being diagnosed leads to a simple medical procedure that returns normal blood sugar control permanently. A time when being diagnosed with diabetes never happens at all.

The 200 JDRF riders at Lake Tahoe raised over $900,000. Thanks to your donations and a very generous corporate match from MathWorks, you and I are responsible for over $14,000 of that. I ride my bike because I love doing it, and I’m so happy that at least once a year I get to do it for an even bigger reason: love for all of the people affected by diabetes and the hope that we’ll see the ass end of this disease soon.

Sunday evening, Steve (the coach) and I were talking about how one day we’re going to have rename these Rides to Cure Diabetes. We weren’t quite sure what a good name would be, but it’s going to be celebratory. I can’t wait!

Posted in 101 in 1001, Cycling, Diabetes | 5 Comments

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

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The Dark Night of the Diabetic Triathlete’s Soul


“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.


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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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.

Posted in Life Lessons, Swimming | Leave a comment

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?

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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