The “Just In Case” Scenario

It’s easy to read posts on diabetes blogs and get the sense that we’re not letting diabetes slow us down at all. That we’re invincible. That, sure it’s an annoyance, but we’ve totally got this.

I don’t think any of us set out to cultivate this idea in our interactions with others, but diabetes is a disease that’s easy to look past, particularly because it is such a 24/7 affair. We lead such normal lives doing normal things the overwhelming majority of the time that it’s conceivable that it’s like that—normal—all the time. Test your blood sugar, wear a pump, refill prescriptions at the right time, and diabetes is all taken care of. Even if we don’t like to do all of the nonsense associated with diabetes, most of us do it so naturally that it doesn’t look difficult. And because the effects of fluctuating blood glucose aren’t something you can usually see, it’s hard to tell when someone is having a good or bad diabetes day. To the external viewer, it’s all just “normal life” with a little bit of finger-pricking and insulin-pumping thrown in.

And I’d say the majority of the time this is true. Even if we can’t get our blood glucose to do exactly what we want—and this can be very frustrating—it’s a relief not to worry the people around us unnecessarily. Sure, in the back of most of our minds is the understanding that every diabetes decision has consequences, but who can have a good life giving that thought constant attention?

I don’t like to write about the challenging times, because I don’t like them when they happen and because I know it makes others concerned on my behalf. I can’t stop that from happening, and I get it. But it would be wrong for me to avoid posting about the troubling moments, even if it causes worry in others. Mortality is worrisome, which is why we do our best to ignore it most of the time. Seeing someone struggle is difficult, especially when you want to help them and can’t and when it causes you to think about all the “what ifs?”

All this lead up for a very short story . . .

Glucagon at the ready


Yesterday afternoon I ate delicious cookies from the café. I love these cookies, but I still have trouble accepting (and acting on) the fact that they have in excess of 25 grams of carbohydrate each. It doesn’t seem possible that something so small can be so potent, so I usually under-dose the amount of insulin I truly need.

Consequently, at dinner time my blood sugar was 281 mg/dL (15.6 mmol/L). Which sucked. I was hungry and grumpy. Lisa had gotten delicious ice cream treats at Dairy Queen for dessert, and I didn’t want to wait to eat them. But I did, because 281. The plan was to give insulin for the full amount of dinner plus the correction, wait about an hour for my blood sugar to come down, eat dinner, and then go on like nothing had happened. And that’s what I did until everything went wrong.

As we were watching the Bruins-Canadiens hockey game, the announcer started to sound odd, and my body felt wrong. I was hyper-aware of everything and able to concentrate on very little. (People with diabetes will know what I’m talking about.) I checked my blood sugar: 44 (2.5). This is the lowest I’ve been in a long, long time. And I still had over 8 units of insulin flowing around my bloodstream, taking care of the carbs from dinner and trying to lower my BGs even more.

The combination of low blood sugar, lots of active insulin, and my fuzzy-headedness triggered us to get ready for the “just in case” scenario. As I was eating glucose tablets and holding on to the world, Lisa got the glucagon emergency kit. Fifteen years ago, when I got my first kit, Lisa let me know her feelings about it. “So help me. If I ever have to use this to save your life, I’ll probably kill you afterward.” Or something like that. 15 minutes later I was still at 49 (2.7). We discussed where to give the shot: thigh, arm, or butt. We settled on the upper arm.

Fortunately, I didn’t pass out. No one had to use the glucagon. Crisis averted.

But this is diabetes: 99% banal. It’s just that last 1% . . .

Posted in Diabetes | 1 Comment

Workout Power Mix… Not!

Pool Guy has started to play music in the mornings over a loudspeaker on the pool deck. This is why last week I heard Katy Perry and other pop singers whenever I pushed off the wall. (Plus the beep-beep-beep of my Finis Tempo Trainer.)

The high school swim coach/lifeguard/guy who is nice enough to open the pool at 5:30-ish AM has switched up the music during my last couple of trips to the pool. Smooth jazz now serenades me as I recover in the shallow end between sets. While it does make the rest period extra chill, I found myself wishing for something a little more up-tempo. “Maybe a little Public Enemy or Ministry or Rage Against the Machine. Yeah! ‘Killing in the name of . . . UNGH! Yeah!’ That’s the stuff! Of course, most of those songs drop an F-bomb every measure or two, so maybe not. Still . . . Fuck yeah!” And then the lap clock hit the top of the minute and I was off again.

That, of course, got me thinking about the “Workout Power Mix” that I play when I go to the gym or hop on the bike trainer or treadmill. Just for you, I put the playlist on shuffle and recorded it below. What’s your go-to genre when you’re exercising? Anything that always gets you instantly into your workout?

  • Huey Lewis & The News – Hip to Be Square
  • Prototypes – Je ne te connais pas
  • Guns N’ Roses – Welcome to the Jungle
  • Yeah Yeah Yeahs – Isis (listen…)
  • Capella – We Met at a Party (drums and best bike video ever!)
  • Tupac – California Love
  • Jedi Mind Tricks – Terror (NSFW listen…)
  • 50 Cent, Cashis, Eminem & Lloyd Banks – You Don’t Know
  • Vulgaire Machins – Petit patapon
  • The Osborne Brothers and Red Allen – Ruby, Are You Mad? (pretty sweet pickin’)
  • M.O.P. – Ante Up (with muppets)
  • Franz Ferdinand – Take Me Out
  • Motörhead – Ace of Spades (They totally ripped off Blünt Lancet on this one.)
  • New Order – True Faith
  • Timbaland feat. Nelly Furtado & SoShy – Morning After Dark
  • Lady Gaga – Bad Romance (How does anyone not love this song?!)
  • Les Cowboys Fringants – Tant qu’on aura de l’amour (écoutez…)
  • The Arcade Fire – (Antichrist Television Blues)
  • The Killers – When You Were Young
  • Glasvegas – Geraldine (listen…)
  • Dropkick Murphys – I’m Shipping up to Boston (I know, Lisa Mather. I know. He should be able to get one from the on-ship carpenter, but that wouldn’t make for a good song, would it?)
  • James – Laid
  • The Crystal Method – Name of the Game
  • Croftwork – Peatbog Faeries (listen…)
  • Boyz N Da Hood feat. Yung Joc – We Ready
  • Engrique Iglesias feat. Pitbull – I Like It (Don’t judge me!)
  • 22-20′s – Devil in Me (Unbelievably, I first heard this hard-rocking song in India.)
  • Bedrock feat. KYO – For What You Dream Of (If a workout starts with this song, it’s going to be a great one!)
  • Indigo Girls – Yield
  • L’Algérino, IAM, Pay 4 de la Rime, Chiens de Paille, Bouga, Said & Veust Lyricist – La ronde
  • Dixie Chicks – Goodbye Earl (A murder ballad for the ladies.)
  • Grim Skunk – Vive le Québec libre
  • DJ Khaled feat. Akon, T.I., Rick Ross, Fat Joe, Baby & Lil Wayne – We Takin’ Over
  • Donna Summer – I Feel Love
  • Sam & Dave – Hold On, I’m Comin’
  • Yeah Yeah Yeahs – Maps
  • Tots & The Maytals – 54-46 Was My Number (Et tu, Maggie?)
  • Wolfmother – Woman (Not to be confused with Woman!)
  • Snap! – The Power
  • Camper Van Beethoven – Pictures of Matchstick Men
  • Plasticines – Pas avec toi
  • Nelly Furtado – Powerless (Listen. I mean it; listen to the woman.)
  • Les Cowboys Fringants – Histoire de pêche (écoutez…)
  • Sum 41 – Underclass Hero (Not to be confused with this cheeky cover performed on live TV minutes after the original band sang it.)
  • Tomoyasu Hotei – Battle without Honor or Humanity
  • Wolfmother – Back Round
  • Cindy Lauper – Girls Just Want to Have Fun
  • U2 – Vertigo
  • Elvis Crespo – Suavamente
  • The Cranberries – I Can’t Be with You (Who said it all has to be happy?)
  • Destiny’s Child – Lose My Breath
  • Morrissey – Irish Blood, English Heart
  • The Duke Spirit – The Step and the Walk (listen…)
  • Jedi Mind Tricks – Heavy Metal Kings (I’m not sure I’ve ever heard a more paranoid song.)
  • Sean Kingston – Fire Burning
  • Timbuk 3 – The Future’s So Bright I Gotta Wear Shades
  • Jimmy Eat World – Big Casino
  • Public Enemy – Welcome to the Terrordome (Often I’ll just start the workout with this song and then shuffle the list.)
  • Asobi Seksu – New Years (聞く…)
  • The Killers – Somebody Told Me
  • Kaïn – Mexico (écoutez…)
  • A-Ha – The Sun Always Shines on TV
  • Bomba Estéreo – Fuego (¡Escucha!)
  • Weezer – (If You’re Wondering If I Want You To) I Want You To
  • Sherry Austin – Jolene
  • Van Halen – Why Can’t This Be Love?
  • Dick Dale – Misirlou (With the NSFW “Pulp Fiction” excerpt, natch’)
  • Depeche Mode – Never Let Me Down Again
  • Indochine – Alice & June
  • Belinda – Ni Freud Ni Tu Mama
  • Lenny Kravitz – Are You Gonna Go My Way
  • Rohff – La puissance (écoutez…)
  • Tech N9ne feat. T-Nutty & Sundae – Check Yo Temperature (NSFW listen…)
  • Taio Cruz & Ludacris – Break Your Heart
  • Lee Ann Womack – I’ll Think of Reason Later
Posted in Swimming | 1 Comment

Three Rides

A few people have asked me some variant of this question, “Now that you’re done with tri season for the year how are you keeping?” I tell them that I love this time of the year because I can do whatever I want now that I’m free of the training plan. What they have a little harder time understanding is that I’ve been spending so much time in the saddle. But it’s all guilt-free. Want to ride 100 miles one day and 75 hilly more miles the next? Sure! It’s not going to mess up my focused training, since I’m not doing any. Plus it was fun! And that’s what this time of year is all about.


Ride #1: Charles River Wheelmen Fall Metric Century
Ride #1 - Metric century

Robyn, my college classmate and fellow triathlete (easily) talked me into riding a metric century (100 kilometers, or 62 miles) with her and some of her peeps a couple of weekends ago.

It was dark when I left the house around 6AM, and it never really got brighter on my half-hour drive to the start of the ride. In fact, I drove through light rain for most of the trip. My bike had just returned from Tahoe, and I was glad I remembered to put the blinking lights on it before leaving home. I was also glad to have grabbed my heavier, waterproof jacket.

The first hour of the ride was pretty soggy, alternating between a warm drizzle and a heavy downpour. Eventually, the sun came out and dried up all the rain—but not before I approached an unexpectedly tight corner too fast and went across someone’s front lawn rather than trying to see if my tires would hold in the rain. Lesson learned. :-)

The ride was fun. Robyn and I had roughly the same time at the Mass State Olympic-distance triathlon in July (which evidently I forgot to write about) so we rode together off the front of our little group for most of the day. I think I convinced her to ride in Burlington, Vermont, next year. (You can join us, too!) The 65 miles passed very quickly . . . except when we were reviewing the cue sheet after making the wrong turn which added three “bonus” miles to our ride. At the end, Robyn invited me to ride a century with her the next Saturday.


Ride #2: Nashoba Valley Pedaler’s Fall 2014 Century
Ride #2 - Century

On ride #1 we followed the yellow arrows on the pavement marking our route, but we saw a bunch of “N”s with arrows for a good portion of the course. On ride #2 Robyn, Matt, Katrina, and Kate followed each “N” from Sudbury, Mass., to Hollis, New Hampshire, and back via Stow, Harvard, Littleton, Ayer, Groton, Pepperell, Dustable, Westford, Carlisle, Acton, Concord, and Lincoln. With the exception of the previous weekend, this was new riding territory to me. But it shur was purdy. The New England leaves have started their annual fireworks show. It’s also the height of apple- and pumpkin-picking season, and the wild grapevines are laden with deliciously smelly fruit. Unlike the previous weekend, there wasn’t a cloud in the sky. As we rode through small towns and farm country, I felt like we were rolling through a postcard.

Although we were following the NVP’s route, we were a couple of weeks late to the organized ride. So it was just us. Our group of five would spread out into little clumps for most of the ride, stretching out on the flats, breaking apart on the climbs (yay, real hills!), and regrouping at turns and stop signs. We were all pretty strong riders, but it was on this ride that I was reminded others don’t like the hills as much as I do. Matt had arranged with some coworkers who lived ride on the route to let us use their house as impromptu rest stops. At one we used the water spigot on the outside of the house, and at the other we refilled our bottles and ate snacks Matt’s wife had dropped off earlier in the day. It was a great, easy-feeling hundred miles!


Ride #3: Impromptu JDRF ride through NW Connecticut
Ride #3 - Hilly 70

Hills are my friends. From my earliest days of teenage riding, I haven’t been bothered by them. People have called me “stoic” before—including a Russian student at Grinnell!—and this basically described my feelings toward hills for a long time. They were just part of the ride, not an obstacle in getting to my final destination. At the same time, I idolized the mountain climbers of the Tour de France. Those guys suffered and succeeded, and there was no doubt how difficult it was. I wanted to be like them.

Over time my attitude towards climbing has changed a little. I’ve discovered that hills and mountains treat me well, so I seek them out. It’s wrong to say that I find them easy. Pushing 160 pounds of bike and rider against the force of gravity for minutes upon end is never easy, but my mind is wired to seek the top of a hill and enjoy the process of getting there. It’s difficult, but I need that feeling of suffering for a ride to be truly complete. There’s something redemptive and transcendent about being able to shut off the part of your brain that says “No!” or “Why?” and just doing what needs to be done. Moreover, I take no small measure of pride in being able to do it well, which of course motivates me to try to do it even better, regardless of the difficulty.

I had this realization as I was pedaling up the last big climb of the day outside Hartland, Connecticut . . . for the second time.

Four other JDRF riders and I had rolled out of Windsor Locks, just north of Hartford, a few hours earlier on the morning after my century ride. All of them had done the Ride to Cure Diabetes in Burlington earlier in the summer. Steve and Erin, who rode with me around Lake Tahoe, were getting ready for Death Valley in a couple weeks. We chatted on the flat sections of rural road and when we stopped for breaks, but early into the big climb I had ridden well off the front.

Here’s what you should know about me: I am not a patient person when it comes to the bike. Waiting for a ride to start? Don’t like it. Waiting at stoplights? Don’t like it. Anytime I’m kitted up and not turning the pedals? Don’t like it. Not pushing a hard gear when I’m turning the pedals? Don’t like it (usually).

Don’t get me wrong. I like talking with people as we ride down the road, and I like hanging out before and after the ride. Plus, I don’t go into any ride intending to be first or to embarrass anyone. Furthermore, if I know that the ride is going to be a casual affair, I can get into the right mental space and enjoy the experience. On those outings, it’s just the appropriate thing to do: Look around, take pictures, socialize, relax every hour or so, eat pie, etc. Occasionally, I’ll let the bike run, but those are short and atypical.

But when I want to ride, I want to ride . . . especially when there are hills involved.

Which brings me to my dilemma and why I was riding my bike up the 2.4 mile-long hill for the second time after summitting it once, turning around to descend it, and then starting over at the bottom.

I had found myself unintentionally riding off the front all day whenever I came to a hill. One the first big climb of the day, I put myself into the easiest gear I had and hung out, keeping everybody with me. The back half of the ride was full of hills, though, and I found this strategy to be both unsatisfying and ineffective; despite my best efforts I was riding away from my group. As I was going up one particularly long climb, I realized that this would be a perfect road to chat with Erin about triathlon (since she had questions). When I got to the top, I turned around to catch her again on the uphill, and we talked for a while. She’s a very good rider, by the way, and we hung together for the majority of the rest of the day. This strategy seemed to work out pretty well: Hang with the group for most of the ride just enjoying the scenery and the company (as I did on ride #2) and then accept that the hills are my strength and indulge them.

All of that climbing meant some really wonderful descending. There was the big sweeping descent into New Hartford. Then the fast downhill to the start of the 2.4 mile climb. And of course, the 2.4 mile hill itself. The best was yet to come though. After the last big climb, we turned onto Mountain Road. With a name like that, I knew it was going to be steep. We went down one long stretch, with Steve the Coach blowing past me like a rocket. After that, I was checking the cue sheet to make sure I didn’t miss a turn, when I saw the “12% Grade” sign. I quickly put the sheet back into my pocket and prepared for the excitement.

The road was recently paved and beautifully smooth. There were no cracks or debris on the road whatsoever. Best of all, it had great sight lines. I quickly ran out of gears, got into a tuck, and hit 50 mph (80 km/h)! It was the best.

Do I ever love riding a bike!

Posted in Cycling | Leave a comment

Three Rides’ Data

Over the last eight days, I did three big rides of 65, 102, and 72 miles. I’ve been treating each of my rides as experiments, trying to figure out what the hell I’m doing with diabetes and exercise by the time I start Ironman training in the spring. I’ll write more about these rides soon, but I just wanted to share a little data.

Diabetes data

Ride #1


Ride 1:

Insulin-on-board (IOB) at the start = 0 units
Insulin during = 1.5 units
Carbs during = 250-270 grams
BG @ start = 240 mg/dL
BG during = 175 @ 2.5 hrs, 155 @ 5 hrs
BG @ end = 138

Ride 2:

Insulin-on-board (IOB) at the start = 0 units
Insulin during = 1.3 units
Carbs during = 280-300 grams
BG @ start = 220 mg/dL
BG during = 358 @ 1.5 hrs, 377 @ 2.5 hrs, 204 @ 4 hrs, 240 @ 6 hrs
BG @ end = 274

Ride 3:

Insulin-on-board (IOB) at the start = 2.0 units
Insulin during = 0 units
Carbs during = 325-350 grams
BG @ start = 226 mg/dL
BG during = 169 @ 1 hr, 132 @ 2 hrs, 162 @ 2.5 hrs, 128 @ 3.5 hrs, 157 @ 5.5 hrs
BG @ end = 213

Every day a little closer . . .

Posted in Cycling, Data-betes, Diabetes | Leave a comment

Fourth Grade Math to the Rescue!

Earlier today, I found myself trapped in a “knowledge forum.” The meeting’s content wasn’t right for me, but I had picked a chair where I couldn’t easily leave. Worse, after returning home late from last night’s Emmylou Harris concert, I was starting to feel a little sleepy. What to do? What to do?

Fourth grade math to the rescue!

“Writing things down keeps me awake. Doing math keeps me awake. So handwritten long division and multiplication should keep me awake,” I thought. “What shall I compute? I often think about Ironman, so why not compute something related to that?”

My swim speed has been improving recently, and I was curious how those and future improvements might impact my Ironman swim times.

Swimmers measure speed by talking about the time it takes to swim 100 yards (or 100 meters depending on your pool). Swimming an Ironman’s 2.4 miles? Great! You still talk about time per 100.

For a long time I had plateaued at almost exactly 2:00/100. At that rate, it takes 1:24:29 to complete the iron-distance swim.

Lately my long swims have improved to right around 1:48/100. Those 12 seconds per 100 yards don’t sound like much—it’s only 10% faster—but over 2.4 miles, that’s almost eight and a half minutes! 1:16:02.

Between now and next September, I’d like to try to take another 10% off. Maybe it’s possible; maybe it’s not. If I can get my swim pace down to 1:40/100 yards, I should be able to swim the distance in 1:10:24. I would be extremely happy to see that.

Now that I think about it, that was exactly my pace in the Gulf of Maine during last month’s Rev3 half. Hmm . . .

For your consideration, here are the results of my in-meeting calculations:

Pace (/100 yards) Time to swim 4,224 yards
2:00 1:24:29
1:48 1:16:02
1:45 1:13:55
1:40 1:10:24
1:35 1:06:53
1:30 1:03:22

How do you stay awake in meetings?

Posted in Reluctant Triathlete, Swimming | Leave a comment

Revisiting the Medtronic Enlite CGM Sensor

A couple months ago, I wrote about my frustration with the Medtronic Enlite CGM sensor. It was the follow up to my first impressions post, which was actually my view four months in. Those dispatches, along with the one about what I’ve learned while using the Sof-Sensor are among the most popular articles here. (At least if you look at the number of comments.)

When I last wrote, I was quite disappointed with the accuracy of the readings I was seeing and decided to call my endo to get a new prescription for Sof-sensor sensors. (Man, “Sof-sensor sensor” feels awkwardly “corporate” to write . . . like writing “MiniMed® 530G with Enlite®.” But I digress™.) Anyway, I called to start the process of getting a new prescription and then went on vacation to do RAGBRAI. [1]

And do you know happened? Of course, you do.

The accuracy got better. For the most part, it’s been believable enough that I forgot about going back to the Sof-sensor. Two months later, I still have wonky sensors about 10-15% of the time, some incorrect readings during exercise, and the occasional buyer’s regret with the whole Minimed line—especially after talking with Céline in depth about her waterproof Animas Vibe with integrated Dexcom CGM—but the results are good enough that I feel much better about the 530G and Enlite.

What changed? What’s different now?

At first I thought it was because I wasn’t running or swimming as much during those two weeks. In fact, I only swam twice during that fortnight. And when I got home from vacation, the pool was closed, so I swam in the lake a couple extra times per week. Perhaps there was something about the chlorinated water or the twisting of my body that was throwing off the interstitial glucose (ISIG) values. Perhaps the sensors didn’t like being in the water for 60-80 minutes. Perhaps being under my wetsuit prevented the tape from getting loose, which is the death knell for these little guys in my experience.

But no. I’ve been back at the pool for a few weeks now, and the sensor accuracy is just as good as when I was on vacation (which is to say, pretty good).

Another thought I had on vacation is that my hydration is better or more consistent, but I’ve decided that’s not the case.

The two thoughts that haven’t yet been disproved are these:

  1. I’m inserting the sensor in almost exactly the same place each time. For the last two months I’ve been placing the sensor within a 2-by-2 inch patch of real estate on my left hip just above my belt line. Someone will probably tell me this is a bad idea, but there’s something magical about this location. There isn’t much scar tissue there; it’s not near “gusher” territory; that place has just the right amount of flab; I don’t tend to sleep on it; and it doesn’t seem to move very much along with the rest of me when I twist, sit, etc. It will be a shame if I’m forever bound to this one spot, but whatever works. [2]
  2. I’ve stopped using extra tape, except as a last resort. I used to cover Sof-sensor sites with Tegaderm™. That locked them in good and tight and seemed to be just what that sensor needed. The Enlite sensor appears to be much more of a free spirit. If I put any extra tape on it to keep it from moving around, I find that the sensor filament gets kinked more easily. (Remember: “kinky = bad” when it comes to sensors.) For the most part, the Enlite tape and overtape stay attached well, although it took me a while to feel confident that it wasn’t just going to pop out when I went swimming.

I also calibrate less now than before. This is partly because the readings are closer to my actual blood sugar. Plus, calibration doesn’t have any impact on the ISIG readings from the sensor. So I’m inclined not to think this is part of the solution, even if it is good practice.

My problems with the Enlite were real but not widely shared. At the JDRF ride in Tahoe a few other Minimed users I talked with rarely had problems with bad readings. One of them even cuts IV-3000 to add extra staying power to her sensor. She also talked about getting 3-4 weeks of good readings from them. (Lately I’ve been getting 10-14 days from the good ones.) Whatever works, right?

I’m just glad that things are working.

How about you? Do you use the Enlite sensor? How is it working for you? I’d love to hear your experiences.


1 — My local Medtronic trainer/rep called while I was on vacation to see how she could help me get the sensors working better. This is really great, and I should probably call her back. Now that everything is working pretty well, it keeps falling off my list of things to do. [Back . . .]

2 — One of the JDRF coaches at Tahoe was talking about how she places her Enlite sensors in the same place each time, too. I happened to walk into that conversation at the exact moment she said, “I always stick it in my butt.” Good times with diabetes. Good times. [Back . . .]

Posted in Data-betes, Diabetes, Life Lessons | 2 Comments

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

Wheels

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 | 1 Comment

Elevation

Oooh!

JDRF Lake Tahoe Ride

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

Posted in Uncategorized | Leave a comment

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

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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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