Monthly Archives: March 2011

Triathletes are Crazy

This post is part of March’s DSMA Blog Carnival, which is all about exercise.

I’m tired . . . all the time. I knew that training for a triathlon was going to be intense, but I hadn’t really expected it to be quite so tiring. Thank goodness I’m only doing the sprint distance. A short 1/4 mile swim, 20km bike ride, 5km run, and then it’s all over. I’ve seen 12-week training plans for Olympic distance events, which are double the distance, and I just can’t imagine how tiring all of the training must be.

Despite the fatigue and feeling like a slave to my training plan, I’m enjoying all of the swimming, running, and biking. It’s been light enough for me to ride outside after work a couple times this week, and I hadn’t realized just how much I missed being on my bike. (Or quite how much it had needed a tune-up. It’s so quiet now.) I’ve also been going to the pool at 5:45AM a couple times a week since October, building my endurance and working on my form. (Mostly I just flop around and try to copy what the fast people in neighboring lanes are doing.) And on the running front, I started a 10K plan last week, assuming that if I trained for the longer distance, I’d be able to feel good for the shorter one after about an hour of effort.

I’m just glad there isn’t a fourth discipline. I’m not sure I could find time to fit it into my schedule.

I still don’t feel like a “real” triathlete. I haven’t done all three events in succession. I’ve never swam long distances in open water. I still quake inside at the thought of the transition from swim to bike and from bike to run. I still don’t have a wetsuit or a swim cap or nutrition plan or any idea what to bring with me on the day of the race. Definitely not a true triathlete at all.

Specialized Trivent Expert shoes

But then today, as I was buying new cycling shoes designed for triathlons, the bike store guy and I were talking about how the Ironman-distance people were crazy. When he said, “All triathletes are crazy,” it hit me that I was buying something very tri-specific.

Nope. Still not a tri guy.

So why am I doing this? Rather, why am I taking this so seriously?

A bunch of reasons really. There’s something decidedly badass about triathlons. I can ride pretty well. I can run pretty well. I can swim — well, I can swim well enough. I like the idea of seeing how much I can do, finding out where my limits are. And — maybe this is a little immodest — but I’m also a bit thrilled by the idea of doing something that most people don’t do, that people think is a little crazy, that has a faint whiff of danger to it.

Plus, my innie has mostly turned itself into an outie. Trying to get into better shape (re)started these cycling, running, and swimming endeavors individually. And they worked pretty well, but taken together they’re über-formidable.

Finally, there’s me giving a big “suck it” to diabetes finally learning to handle exercise and diabetes. It’s definitely a challenge, and I know it makes several people nervous that something will happen when I’m competing, particularly when I’m swimming. But I wish those well-meaning people wouldn’t worry; beyond the positive effects that the training has on my blood sugar and insulin sensitivity, I’m also learning quite a lot about how to manage all the moving parts. It’s certainly a leap of faith to start a workout with a good BG — which makes me very happy — and trust that it will be in a good place when I’m done exercising, but it’s a leap I have to take. I know other people have done triathlons with diabetes, and I’ve seen my own skills improving to the point where I’m feeling very good about the different disciplines, especially the swim. (It’s ironic, I know.) I’m feeling more confident.

It took me a while to realize it, but triathlon training is actually helping me with more than just physical strength and conditioning. Something about the craziness — that is to say the hardcore, bat-shit craziness — of triathletes makes me want to up my game, even if it’s only so that I can fit in, so that I’m not “that guy” who does a triathlon and totally sucks at it. I want to be able to have the diabetes skills to go along with the physical conditioning. When the time comes I want to be able to throw down the gauntlet (to myself) without worrying (too much) about what it’s going to do to my BGs.

So I guess triathletes — even newbie triathletes with diabetes who may never do more than one — are kinda crazy. But that’s not so bad, is it?

Posted in Cycling, Diabetes, Reluctant Triathlete, Running | 4 Comments

Strike while the Iron is Hot

From the annual report of the diabetes management program of a Boston-area hospital:

Observationally, patients who had 3 visits each [with a diabetes educator or nutritionist] had greater decrease in HbA1c.* Those individuals with 1 visit only, [had an A1c that] remained the same or higher and often had no follow up from [their primary care physician] either. The demographics on those lost to follow up appeared to have barriers such as ESL, co-morbid conditions reflecting many [hospital] visits, psychological issues, and transportation issues. This is an area of opportunity to provide as much education and management as possible on this initial visit and offer outreach telephonically to help this population.

* — HbA1c is diabetes self-management metric. Lower is (generally) better.

Posted in Diabetes, Health Care | 1 Comment

What’s on My Pump’s Mind?

Sorry for the geeky/nerdy digression, but I’m just so pleased that I’ve been able to start to parse through the data from my pump. It’s nice to make some progress.

According to the CSV file generated from my Medtronic CareLink data, this is what my Minimed Paradigm pump thinks about. The number is how many times the keyword appears in the log.

carelink_parser_2 - There are 14121 items in the array.
1 AlarmPump
154 AlarmSensor
99 BGReceived
393 BolusNormal
35 BolusSquare
391 BolusWizardBolusEstimate
315 CalBGForGH
502 CalBGForPH
4 ChangeBGTargetRange
4 ChangeBGTargetRangePattern
18 ChangeBatteryEnable
18 ChangeBatteryEnableGH
2 ChangeBolusWizardSetup
4 ChangeBolusWizardSetupConfig
12 ChangeCarbRatio
4 ChangeCarbRatioPattern
8 ChangeInsulinSensitivity
4 ChangeInsulinSensitivityPattern
1 ChangeMaxBolus
1 ChangeParadigmLinkID
35 ChangeSensorSetup
70 ChangeSensorSetupConfig
15 ChangeSuspendEnable
7 ChangeTempBasal
2 ChangeTempBasalPercent
1 ChangeTempBasalType
1 ClearAlarm
3 CurrentActiveBasalProfilePattern
3 CurrentAlarmClockEnable
3 CurrentAlarmNotifyMode
3 CurrentAudioBolusStep
3 CurrentAutoOffDuration
3 CurrentBGReminderEnable
3 CurrentBGTargetRange
3 CurrentBGTargetRangePattern
21 CurrentBasalProfile
9 CurrentBasalProfilePattern
3 CurrentBatteryStatus
3 CurrentBeepVolume
3 CurrentBolusReminderEnable
3 CurrentBolusWizardBGUnits
3 CurrentBolusWizardCarbUnits
3 CurrentBolusWizardEnable
3 CurrentBolusWizardSetupStatus
9 CurrentCarbRatio
3 CurrentCarbRatioPattern
3 CurrentChildBlockEnable
3 CurrentDisplayLanguage
3 CurrentErrorStatus
3 CurrentGlucoseHistoryPageNumber
3 CurrentHistoryPageNumber
3 CurrentInsulinActionCurve
6 CurrentInsulinSensitivity
3 CurrentInsulinSensitivityPattern
3 CurrentKeypadLockedEnable
3 CurrentMaxBasal
3 CurrentMaxBolus
3 CurrentParadigmLinkEnable
9 CurrentParadigmLinkID
3 CurrentPumpModelNumber
3 CurrentPumpStatus
3 CurrentRFEnable
9 CurrentRemoteControlID
3 CurrentReservoirWarningUnits
3 CurrentReservoirWarningValueInsulin
3 CurrentSensorAlarmSnoozeTime
3 CurrentSensorBGUnits
2 CurrentSensorCalFactor
3 CurrentSensorCalReminderEnable
3 CurrentSensorCalReminderTime
3 CurrentSensorEnable
3 CurrentSensorHighGlucoseAlarmEnable
3 CurrentSensorHighGlucoseLimit
3 CurrentSensorHighGlucoseSnoozeTime
3 CurrentSensorLowGlucoseAlarmEnable
3 CurrentSensorLowGlucoseLimit
3 CurrentSensorLowGlucoseSnoozeTime
3 CurrentSensorMissedDataTime
3 CurrentSensorTransmitterID
3 CurrentTempBasal
3 CurrentTempBasalType
3 CurrentTimeDisplayFormat
3 CurrentTotalRemaining
3 CurrentTotalToday
3 CurrentTotalYesterday
3 CurrentVariableBasalProfilePatternEnable
3 CurrentVariableBolusEnable
9427 GlucoseSensorData
3 GlucoseSensorDataHigh
2 JournalEntryPumpLowBattery
35 JournalEntryPumpLowReservoir
39 Prime
48 ResultDailyTotal
20 Rewind
2 SelfTest
57 SensorCal
200 SensorCalFactor
10 SensorError
130 SensorPacket
34 SensorStatus
26 SensorSync
60 SensorTimestamp
20 SensorWeakSignal
1669 UnabsorbedInsulin

As far as I can tell:

  • UnabsorbedInsulin is metadata that’s used to compute active insulin for the bolus wizard.
  • SensorPacket is data from the sensor during the warm-up period before it starts streaming GlucoseSensorData.
  • BGReceived is data that comes from a paired meter, which always updates the sensor calibration (for my pump) since they’re paired with CalBGForPH. (I guess that’s why you’re supposed to turn that feature off.)
  • I have no idea (yet) what the difference is between CalBGForPH and CalBGForGH.

Don’t worry. I’m not going to flood users with most of this data. I just needed to know what it is possible to show.

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

MTV Pimps My Diabetes

MTV is planning to highlight diabetes in its True Life show next season. Here’s an excerpt from the casting call request for people to share their stories.

Does your diabetes hold you back from living the life the way you want? Do you have an extreme form of the disease which requires you to constantly inject yourself with insulin? Or are you stuck monitoring your diet and exercise when you would rather just live a more regular life? Does it make you feel different from your peers? How is your situation more difficult than your friends’ at school? Are you embarrassed by your diabetes? How often do you visit doctors and how much effort do you put into your health? Have you had any scares relating to your diabetes recently? Are your parents always on your case about your medication, diet, doctor’s appointments, and exercise? Are you planning on taking a new approach to handling your health in the near future?

If your diabetes causes you major difficulty in your life and you appear between the ages of 16 and 28, email us at and tell us your story. We want to know how living with diabetes makes your life complicated. Please include your name, location, phone number, and a recent photo of yourself.

Yo, MTV! I know that you specialize in playing up adolescent anxieties, but this is a little too far. Diabetes is hard enough for people who have it without being exploited. Why not show the young people with diabetes — not to mention your non-diabetic viewers — that it’s much, much more likely that they will live happy, productive lives with diabetes?

Maybe that’s what you’re after. (No, no. You could have a soul down deep somewhere.) But because I suspect that when I send this message to, you won’t actually share my message with your viewers, I’ll answer your questions here, too.

Does your diabetes hold you back from living the life the way you want? Everybody’s diabetes prevents them from living the life the way they want. That’s the nature of a disease. We would all prefer to be healthy people living lives without the constant activities we have to undertake to keep ourselves well. We could also do without the mental baggage of diabetes. Is your show going to present that this is the normal state of anyone living with a chronic illness?

Do you have an extreme form of the disease which requires you to constantly inject yourself with insulin? There is really no such thing as an extreme form of diabetes. Every kind of diabetes — type 1, type 1.5, type 2, gestational — requires vigilance and takes a mental, physical, and social toll on the person who has it. I wear an insulin pump that continuously gives me insulin, but I don’t take injections. I know that takes away some cringe-inducing video, but are we still cool?

Or are you stuck monitoring your diet and exercise when you would rather just live a more regular life? Of course, I would like to be able to eat what I want without worry. And I would really, really love to be able to exercise whenever I want. Life is choices, and I try to make the best ones I can. Diabetes and the way we have to treat it makes the consequences of our choices more obvious and immediate. Maybe you could show me checking my blood sugar in the middle of a 12-mile run or show me forgoing a big ice cream cone so that I can avoid wildly out-of-balance blood glucose and insulin levels three hours later when I want to go for a long bike ride.

Does it make you feel different from your peers? Of course it does. We’ve all got our issues. Does being a reality television show producer make you feel different from your entertainment industry peers when you go to parties? Do you tell them that you play on people’s anxieties and exploit people who need support?

How is your situation more difficult than your friends’ at school? Let’s talk about work instead of school. I worry about experiencing hypoglycemia when giving presentations or talking to customers, but most people have performance anxiety. Oh, you know what would be awesome? You could start a shot by showing me testing my blood sugar in a meeting and then pull back to show one of my (non-diabetic) coworkers totally bombing during a presentation. You ought to get a hell of a rating out of that. 50 share, easy.

Are you embarrassed by your diabetes? No. You should show people that there’s no reason to be embarrassed by any disease or disability. And the only way you can do that and have any credibility with your demographic is to show us being bad-ass.

How often do you visit doctors and how much effort do you put into your health? I visit doctors seven or eight times per year. Staying healthy with diabetes is a 24/7 thing. Most people actively managing their diabetes probably have better health literacy than you do.

Have you had any scares relating to your diabetes recently? No. But one time last year I had a routine lab result that made me think there was something wrong with my kidneys. Turns out if you exercise too hard — say by riding 60 miles one day and running 10 miles the next — most people’s bodies are going to spill a bit of extra protein related to rebuilding muscle tissue. Does this make me compelling enough?

Are your parents always on your case about your medication, diet, doctor’s appointments, and exercise? No. My mom is really sweet.

Are you planning on taking a new approach to handling your health in the near future? I’m always trying to be the best-informed, most-engaged patient. I work with my medical team as a peer, and I have a fabulous support community online. You should seriously plug the positive role that Twitter can play for people with diabetes. I hear that lots of your viewers love Twitter.

p.s. — When I’m clean shaven, I can pass for 32 28. Here’s a recent photo.

Posted in Cycling, Diabetes, Running, This is who we are | 13 Comments

Health Care Law Turns One

Happy first birthday, Patient Protection and Affordable Care Act (né health care reform bill)!

You’re not perfect and are kinda responsible for getting your birth parents kicked out of the house. I don’t blame you per se; the Democrats were occasionally timid, frequently disorganized, and fundamentally incapable of articulating a message that could be heard loud and clear above the din of the opposition’s bullshit. Be that as it may, you’re here and making my life better.

I no longer have trouble falling asleep or break into a momentary panic — like I occasionally used to do — at the thought that my good health is tied to having the particular job I have now. While it’s true that, unlike your cousins in most other highly developed countries, you don’t do much to reduce the cost that I would have to pay if I lost my job, at least I can count on you (eventually) to prevent me from losing my access to that expensive health care.

What you need now is a sibling. A little law that will help lower the cost of medical care. A bossy, nosy, thrifty, little brother or sister. An enfant terrible, if you will. Don’t worry, no matter how successful she or he is, you’ll always be the one we love more. You’ll be the prodigal son.

If only I could make laws the way my cousins make babies. . . .

Posted in Diabetes, General, Health Care, This is who we are | 1 Comment

Prefontaine Never Had the GUTS to Run a Half-Marathon with Diabetes

Yesterday I ran my first half-marathon.

I started training for it (officially) fourteen weeks ago using a plan I built online from Runner’s World. Over those weeks, I ran approximately 230 miles, progressing from long runs of about six miles to running the full half-marathon distance a couple times. Despite logging 3/4 of my workouts on the treadmill — it was really snowy this winter — I never really developed a good sense of pacing. But that didn’t bothered me, because running the distance was my goal. As long as I was getting closer to 13.1 miles, I didn’t care how long it took me to get there.

Well, I did care a little. Having run a 10K at 7:15/mile pace in 2001, I was shocked that eight years later when I began running again, I could barely run two miles at a time and then only completed a mile in 11 minutes. My pride was hurt a bit, but I decided that the past was behind me. This was a new normal; I would adapt to it and maybe claw my way back up to a place not quite as awesome as where I’d previously been . . . but nowhere terrible either. Besides, I was swimming, putting in big miles on the bike, and becoming the leaner version of myself that I had always remembered. Time mattered on a certain level, but enjoying each run while getting stronger was the thing.

So I was apprehensive when I took my place in the starting corral of the New Bedford Half Marathon yesterday next to the 8:00/mile pace sign. I had run that pace (and faster) during some of my speedwork sessions. Occasionally, I ran faster just because it felt right. I finished most of my long Sunday outings between 8:30 and 9:00 per mile. So it was a gamble, but one that I wanted to wager. Most of the people around me were chatting it up with their fellow team members, probably to take their minds off the chilly, 40ºF temperature. If I could keep my blood glucose where I wanted, I knew I could finish. Maybe I could even achieve my stretch goal of finishing in 1:45:00.

The first few miles were really pleasant. Sure, I was continually getting passed by people who hadn’t muscled their way up to the front of the corral, but I did the first few miles in 7:29, 7:43, and 8:01. I was trying to back off the fast pace so that I could be fresh for the second half. I spent a lot of time looking around at New Bedford’s post-industrial landscape, watching my fellow runners, and smiling at the much-larger-than-I-expected crowds lining the streets. I ran the next five miles between 7:58 and 8:27/mile. I was falling off the pace needed to finish in 1:45, but that was okay, because I still felt pretty fresh and thought I might be able to gain back some time near the end.

Midway through the ninth mile something happened. I was slowing down a lot. I didn’t feel weak so much as drained of momentum. I knew this feeling. I moved over to the side of the course, pulling my blood glucose meter and lancing device out of my pocket on the way to a convenient traffic barrel where I stopped to test. I started my race at 176 mg/dL, a bit high by “healthy” people standards but okay for me when running. If this were like last week, I could do what I did then and finish at almost exactly the same level.

Although I was snacking just like last Sunday, four big things were different. I forgot to set the temporary basal rate on my pump to 50% three hours before the start, only “turning down my pancreas” 20-30 minutes ahead of the gun. The race started a couple hours later than I typically run on a Sunday morning; that’s good since I might have frozen before the race otherwise, but it’s another blood sugar variable. Because of the late start time, I also had a little bit of breakfast very early, hoping that the insulin’s blood glucose-lowering action would be cleared from my body before the event; usually I forgo a meal before my long run and just have a pre-run snack without insulin (which I also had). I was also running a bit harder than normal.

The 80 mg/dL reading on my meter — which I had hoped not to use during the race — was not at all what I wanted to see. It was likely a bit lower, since I probably had some diluted energy gel on my finger that I couldn’t rub off. That number would certainly explain the “blood sugar spot” I was seeing, the one that usually appears right in front of my eyes when I’m very low and outdoors. I ate a tube of glucose tablets and an energy gel and shuffled on a bit slowly. The spot continued to pace me as I ran on the leeward side of the sea wall and past the hurricane barriers. I slowed to a walk for a full minute as I ate another gel, hoping that by not running I would give my body a chance to rebound a bit. I walked past the clock at mile 10, noticing that it took me 20 minutes to go two miles.

During those miles, I wondered what my threshold would be. When would I know it was time to give up? If I tested again and saw a number still in the double digits? If I stumbled? If I felt obliged to sit down? I was out of snacks and glucose tablets. How would I get back to Lisa at the finish line? Would I walk the last three miles? Would I try to beg something off the folks at the water station? If I asked, would they try to stop me from continuing? Eventually I started to feel a bit more confident that I wouldn’t have to drop out of the race.

Late in the eleventh mile I decided I was going to pick up the pace a bit. I didn’t want to push too hard and risk reentering the doldrums, but I wanted to finish strong. If I couldn’t break 1:45, I could still manage two hours; I could still do better than the 13-mile training run I did the weekend before. I was actually passing people on the mile-long hill that marks the end of the course, and I had a strong kick that I could have started a half-mile earlier.

I crossed the finish line in 1:52:41, feeling good but a bit chagrined . . . not to mention guilty for feeling ambivalent. I achieved my main goal: I finished a half-marathon. I left New Bedford with a T-shirt and a race number and a finisher’s medal and a PR time. I completed something that I trained hard for three months to do. I did it all despite diabetes. And yet diabetes made this particular day difficult, robbing me of at least five minutes and leaving me wondering what might have been.

There’s only one thing to do: I have to run another half-marathon race and find out!

But first there’s this little sprint triathlon in seven weeks that I’m going to start stressing over.

Posted in 101 in 1001, Diabetes, Life Lessons, Reluctant Triathlete, Running | 11 Comments

Seriously Now. Let’s Start Coding.

Okay, I’ve picked up a smattering of Objective-C, learned about a few of the frameworks, and sketched some of the interface. I’ve contemplated the data model, and I’ve worked out a few of the interactions.

Isn’t it about time to put aside my “iPhone developer impostor” feelings and just start coding? Yes it is. I’m not going to build this app unless I start writing it.

ABC: Always Be Coding.

Posted in Data-betes, Life Lessons, Software Engineering | Leave a comment