Monthly Archives: July 2011

Evidence, Wednesday, 6:00AM

Here’s what my Wednesday mornings are like these days:

You can see “the rock” behind our heads. That’s 1/4-mile away, making for a nice half-mile swim. Nowadays, I usually swim with the group that heads off to the right making our way parallel to the shore for a half-mile to a private beach, where we turn around. Some mornings I wish we went a little farther.

BTW, I’m the guy in the wetsuit standing just behind the super-fast 10 year-old girl. The Irish dude to my right is about my speed, and occasionally races me back to the finish. Good craic!

Posted in I am Rembrandt, Reluctant Triathlete, Swimming | 2 Comments

Write This Down

A key aspect of athletic training is mindfulness. For the most part, you don’t just go at it willy-nilly. You need a well thought out plan in order to progress, and any activity that involves technique or correct form requires paying attention to what you’re doing. [1] So why would I expect that managing my diabetes during exercise, which involves a lot of thinking about where my blood glucose is and where it might go, should be any different?

I’ve never been very good at BG journaling, though. Like many people with diabetes, I’ve started multiple times to write everything down only to quit after a few days. But I’ve been very motivated following the BAA 10K to try for more consistently awesome BGs before, during, and after exercising. Journaling, I suspected, was the only thing that was really going to work.

Having less than stellar BG logging experiences before, I went into the process with my eyes open and my mind working on how to make it successful. The result was that I gave myself four guidelines:

  1. Be focused on what I want to change.
  2. Be free-form.
  3. Record it on the day it happened
  4. Don’t spend too much time (i.e., less than 5 min/day)

So, since June 26th I’ve been writing down all about my BG, insulin, and food during (and before and immediately after) exercise. Each swim, bike, run, and hike gets its own page in a small notepad. Even though they aren’t entered into a form and don’t conform to a rigid pattern, they have the same basic structure:

  • What happened earlier in the day? One or two sentences about BGs and whether I did anything crazy like eating a big-ass burrito for lunch leading me to go wicked high and leading me to decide that this bike ride is going to be all about driving that as close to a perfect 104 as I can in 45 minutes. (Not that such a thing has ever happened . . . within the last few days.)
  • What I set my temp basal rate to and when I did it.
  • Whether I had a snack before going out and how much.
  • A sloppy looking timeline of what my BGs were, when I ate, when I exercised, and whether I bolused at all, etc.

If I’m feeling really ambitious, I might add a “compare/contrast with these dates” section. I’ve really only done that for swimming, when I was making some serious attempts at testing the right time to eat my energy gel before getting in the water.

But that’s it. While I might record a middle of the night BG that I took before an AM run, I try to stay really focused on the period lasting from an hour or two before I start to no more than an hour after my training is over. Anything else is (a) going to take too long to record and (b) isn’t really going to help me look at what’s happening with the exercise.

So far it’s been working well. I’m coming close to nailing down the things that I do a lot: swimming before work, running or biking after work, and long bike rides on weekend mornings. [2]

What do you do to keep track of your diabetes data when you’re trying to improve something that’s not to your liking?

1 — Technique is currently the tricky thing about swimming. Being mindful about how to effeciently move through the water is where I’m putting my mental energy now (instead of worrying about whether I’m going to stay afloat or how long it’s going to take to get back to the beach). Progress! [Back . . .]

2 — Except that today my endocrinologist and I decided we’re going to make lots of changes to my basal rates and bolus ratios to get me to a happier A1c—my last one was 8.3—so I might not have those so well nailed down in a couple weeks. [Back . . .]

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

The Essential Swimmer

Now reading: The Essential Swimmer by Steve Tarpinian.

I need to convince myself to go back to the pool one of these mornings so that I have a nice environment for working on my technique. (The lake is definitely more fun, though.)

More about that after it happens.

Posted in Reluctant Triathlete, Swimming | Leave a comment

Be Right Back

Hey, loyal readers!

The Tour de France is over, which means three things:

  1. Congratulations to Cadel Evans. I was kind of pulling for Andy Schleck at the outset, but then Thomas Voeckler won me over, and I was sad to see him lose the yellow jersey on the 19th stage. But Cadel threw down and rode the most consistent race and really deserved to win. So, well done there.
  2. I finally can make some real progress on reading what those of y’all with blogs have been writing. I confess that I’m a bit afraid of the Internet during the 23 days of the TdF, lest my evening of watching be spoiled by a stray post or headline. But now that it’s over I can read up. Only 1,712 unread posts left to go.
  3. I now have a bit more free time to write here. You’d think that there would be plenty of time to write every day during the three to five hours of Tour coverage, but no.

I’ve queued up a few topics. Stay tuned!

Oh, by the way, I rode out to Sharon today to recon the triathlon bike course. The whole ride was great—even though it did rain for about two of the four hours—and I have a good feeling about the triathlon.

Posted in Cycling, MetaBlogging, Reluctant Triathlete | 2 Comments

Whatever Works: “The Diabetic Athlete’s Handbook”

“When it comes to diabetes, don’t let the perfect be the enemy of the good enough.” That—or something like it— is what the exercise physiologist at Joslin said. And I agree.

Except that I don’t want perfect. I just want better. Better than where I have been. Better than where I am now. [1]

And where am I now? I exercise/train a lot, but I start out with higher blood glucose levels than I would like—sometimes very high—and I tend to drop a bit more than I’d like, too. (For a while that was about the only predictable thing about exercise.) During a couple of races it brought me to a walk, sucking up major time. I haven’t been able to figure out how much insulin (if any) to give when I eat during multi-hour bike rides. And then, of course, I have really good days, too.

I don’t expect perfection. I’d settle for predictability, though I’d really like something closer to “normal” BGs for two main reasons: Better BGs mean better performance, and higher BGs mean a greater risk of long-term complications. I know I have a disease, but I also know that I’ve had great experiences with it. I want more of those. Figuring out how to do that will keep me safer, healthier, and happier.

So I finally got around to reading a book that’s been on my shelf for about 18 months: the second edition of The Diabetic Athlete’s Handbook by Sheri Colberg. (I’d started it multiple times, but I’m a champ at getting distracted.) It’s a shame that it took me so long, because it’s full of great information.

The book has two parts. The first provides some general background on the physiology of exercise—how our bodies use energy—along with how diabetes alters this and the main ways that we can work it. The latter chapters of the book give some recommendations for specific athletic activities: from cycling to kickboxing and everything else.

I found the physiology parts really interesting. [2] The body is a mysterious thing, and I like learning how to make it work well. Here’s a bit of useful information from the book:

  • There are three energy systems that get used by muscles. The shortest duration system only lasts about ten seconds. The lactic acid system can go for a minute or so. Then there’s the aerobic system that powers endurance activity and can last for hours.
  • Consequently, the intensity and duration of activity impact what energy sources your body uses: muscle glycogen, blood sugar, glycogen stored in the liver, fat, etc. Knowing what kind you’re going to use can help you plan how to approach an activity.
  • There’s a hormonal response to intense activity—such as sprinting or hill climbing or power-lifting—that reduces the effect of insulin. This can make blood sugar go up and (paradoxically) suggests that brief, four-second bouts of sprinting can help keep BGs from dipping as much during endurance events.
  • People with diabetes have almost exactly the same physiological response to exercise and competition as people with functioning beta cells except that we add our own insulin. The rest is quite similar: the amount of calories burned for the same duration and intensity, how long it takes food to hit our blood stream and muscles, the effects of adrenaline and other stress hormones, etc. We (mostly) need the same amount and kind of food to fuel our activities; we have the same hydration needs; we have to prevent the same injuries; and we can benefit from the same mental preparation.
  • The lack of our own insulin production (for Type 1 folks) and insulin resistance (for Type 2s) are the tricky bits. (Duh! Those are defining characteristics of diabetes.) There’s an optimal plasma insulin level—usually lower than normal for aerobic activity— that stimulates glucose production in the liver and that enables muscle uptake. Too little insulin, and the liver continues to produce glucose but the muscles can’t take it. (BGs go up a lot.) Too much insulin, and the liver reduces its contribution while the muscles soak up lots of the available blood glucose. (BGs go down a lot.) If you can find the (ahem) sweet spot, BGs should stay pretty stable and cause the body to use the energy source(s) as in a person without diabetes.
  • Exercising in the morning is frequently easier for most people because of the lack of recently bolused insulin and because of all those happy wake-up (stress) hormones.
  • Aerobic (endurance) activities make insulin more potent, both during exercise and for 12-48 hours afterward, as it moves glucose out of your bloodstream to replenish your muscle glycogen stores.
  • Hypoglycemia begets more hypoglycemia. If you’ve been low in the last 24 hours or so, the stress hormones that would help prevent it during exercise are inhibited. Your chances are much higher that you’ll be hypoglycemic again.
  • Evidently, having girlie parts also makes a difference with diabetes and exercise.

There’s so much information in the book—including some charts that might help you determine how much to change your insulin dosages before exercise and events—that it’s really worth getting your own copy and going through the first 125-or-so pages.

I’m going to sum up the remaining 140-ish pages, which are also very useful, this way: Whatever Works. Colberg divides more than 60 different sports and activities into five general categories, gives some guidelines about how to approach them diabetes-wise, and then provides a bunch of information from different athletes about what works for them.

That last part of each section was the most instructive aspect of the book for me. Technically, it didn’t teach me much new, but it let me know that there’s no best way—much less one right way—to approach exercise and sport with diabetes. In one paragraph an athlete describes what works for him or her, while the next shows someone doing something that seems almost 180-degrees opposite. There may be a half-dozen “right ways” to exercise or compete in an event with diabetes. Not only may your diabetes vary from mine, but it might be possible for the same person to get to the same outcome (more or less) consistently using different techniques.

Whatever works. The key then becomes finding what works for you. This book can help get you there by understanding what your body is likely to do for different activities and then providing you some suggested starting points and anecdotes about what has worked for others.

From there it’s all trial and error . . . and note-taking. But that’s something to take on next time.

1 — And by “now,” of course, I mean a couple weeks ago when I started writing this post. [Back . . .]

2 — Full disclosure: The year-long course in anatomy and physiology was my favorite high school class. [Back . . .]

Posted in 101 in 1001, Book Notes, Cycling, Diabetes | 2 Comments

Learner’s Permit, Friday, 6:00AM

Trying to be a BA-D-Mofo isn’t always as awesome as a basket of kittens. In fact, some days, I think whoever it is that licenses bad-assery is going to take my learner’s permit away. I carry that permit around in this wallet, of course:

Monday, I couldn’t get excited about going to the pool to swim laps at 5:45AM and didn’t drag myself out of bed. While Wednesday’s swim was really great, today’s was anything but.

Since Wednesday morning I’ve had an internal dialog about whether and when I would swim sans wetsuit. Almost everyone in my triathlon club was swimming without on Wednesday, but I had just gotten a new sleeveless one in the prior day’s mail and was anxious to try it out. “Next time,” I told myself.

This morning—Friday, that is—I had almost convinced myself that I was going to wear the wetsuit again despite what I told myself two days earlier; the main source of my backsliding being a worry that the tape covering my CGM transmitter might come lose and that it would be sleeping with the fishes. I put my wetsuit in the car trunk this morning, but by the time I got to the boat launch, I was finishing up my internal dialogue.

“‘I might lose my CGM’ is the best excuse I can come up with to cover what’s actually, down deep, just a fear that I’m not going to do well? Really?”

Before getting out of the car, I applied another piece of tape to my sensor. Then I walked over to the water, made some pleasantries with some new people and with the regulars, walked into the rather warm water until it was up to my bare knees, watched a couple other swimmers head out for the half-mile swim, and decided to do it.

Here’s the thing about swimming in a wetsuit: the neoprene makes you very buoyant. That’s why wetsuits are great even when the water is really warm. It raises your hips, helping to keep you near the surface, which makes swimming easier. Their smoothness also makes swimming faster. Plus, with all that buoyancy, you really can’t drown. Run into trouble? Just roll over onto your back, collect yourself, catch your breath, and keep going.

A few minutes into what should be an eight or nine minute swim to a big rock on the opposite side of the lake (1/4 mile), I was feeling a bit tired. When I slowed my pace a bit and took some extra time to breathe more deeply, I started to hear the defeatist voices in my head. A few moments later, I breathed a bit of lake water and needed to take a break to collect myself. Treading water, I looked around and watched the people ahead of me swim away confidently.

Treading water. Not something I enjoy. Easy enough, but still work. Work that wasn’t getting me any closer to either shore. Should I swim on? That would be another five or six minutes (at best) to get there and then another nine or ten to get back. I wasn’t feeling 100% confident. Physically I’m sure I could (probably) do it, but the hesitation before starting meant I would be by myself the whole way. Should I turn back? There’s no harm in going back. Unlike during the triathlon, when I had a bit of a freak out at the beginning of the swim, there’s not much on the line if I cut it short . . . just my pride . . . and a regret bordering on shame that I know I’ll feel if I do. What to do? What to do?

The morning was beautiful. The water was beautiful. The feeling of moving through the water—that feeling I had been craving since the end of Wednesday morning’s swam—was beautiful. I swam on, heading toward the rock on the opposite shore. A minute later the sun shone over the trees, bathing my part of the lake in its golden light.

And I couldn’t see. Even though I’ve had this experience before, this morning it amplified the panic I was already feeling.

I turned around and swam back to the near shore. As I had suspected it would be, the swim back was easy. My muscles and breathing and posture in the water felt right. I sighted very well and held a straight(ish) course. It was, in short, a perfect swim—except for the voices in my head that I was trying to outswim. I won’t lie: I was relieved when my hand dug into the pebbly bottom of the shore.

I’ve had some time to think about it. [1] Turning back was the safest thing to do, given my mental state. No harm, no foul. But the disappointment afterward totally makes me want to try it again. Next time will be better.

1 — Gratuitous Patty Griffin reference. [back . . .]

Posted in Life Lessons, Swimming | 3 Comments

BA-D-Mofo, Or The One That’s Not Really About Swimming

Hi, y’all! It’s been a few days since I wrote here. In the meantime, Lisa has returned home from Oregon, and we have spent some time together hiking Mt. Holyoke, hanging out in the new backyard hammock, watching the new Woody Allen film, running a bit, and eating ice cream. [1] It’s been quite enjoyable!

I had briefly contemplated writing about swimming each day for a month. I’ve been doing a lot of it recently—and have even posted a little about it here—but, as Lisa said, “That’s a lot of swimming.” The problem with committing to writing daily on a particular subject being that it’s hard to find time to write about anything else. “Life is choices,” and all that.

Thinking of choices, last week was the first one in quite a while where I didn’t race or partake in a long run. Instead, on Sunday morning I started building up my cycling mileage again. Last year I was a riding fool, but this year I had been much more focused on swimming and running, almost to the exclusion of the bike. Why did I ever cut back? I was so glad to be back at it; a few times as I watched the world slide by during my 50-mile outing, I found exclaiming aloud, “This is fantastic!” You would think I hadn’t been riding in years. (Not coincidentally, about 35 miles into the ride, my sit bones let me know that they were going to need a bit more saddle time before they would be truly happy.)

So now I’ve switched over from training for a better run time to getting my cycling legs back. I will need them for the Sharon sprint triathlon in mid-August and for my trip to Provence a month later. Hopefully there’s a way to keep my running ability near where it is now without putting in the same amount of miles. I’m thinking that if I keep with my tempo and interval workouts and go for an easy run a couple times per week that could work. Who knows? Perhaps I should look at a triathlon training plan. [2]

The book I was reading in the hammock between bouts of cloud-watching was Sheri Colberg’s Diabetic Athlete’s Handbook. It’s been on my reading list far too long—so many books languish there—despite some pretty clear evidence that I need to learn from it. I’m pretty close to finishing it and will be sure to share some of its wisdom here soon.

The book is a nice complement to some observations that I’ve been making since last Sunday, the day of the BAA 10K. I don’t really like blood sugar journaling because it takes up so damn much time, but I really want to make this part of my diabetes experience better. My hope is that if I can limit the data and observations to one specific area (i.e., exercise) it should be an easier habit to keep. I’m a little intimidated by the prospect of sorting through the raw log data in order to determine what to do differently next time; surely it’s going to involve some guessing, but at least I’ll have something to compare against.

And that finally gets me around to something I’ve been ruminating on a lot recently: how to be a badass diabetic mofo, or BA-D-Mofo.

For the longest time I’ve only been making haphazard changes to my diabetes management for exercise. Now is the time, though, to treat diabetes like swimming. I have to jump into the deep end. Or rather, I have to jump into the open water where I can’t see the bottom and where I’m far away from land and where all that I have around me is the water and my insecurities and the hopeful knowledge that I can do this because I’ve done this before. I have to gather up my courage and take a risk, make the observations about insulin and food and exercise, bolus for things I eat before exercise, and eventually (hopefully) arrive at a place that’s more manageable (if not always comfortable).

To quote Mark Twain, who would totally have been a BA-D-Mofo: “Courage is resistance to fear, mastery of fear—not absence of fear.”

[1] — I know, I know! I used an Oxford comma there, even though Oxford says it’s no longer good style. I just can’t seem to break the habit. We become old-fashioned slowly and without really meaning to, by snickity. [back . . .]

[2] — I guess I am a triathlete after all. [back . . .]

Posted in 101 in 1001, Cycling, Data-betes, Diabetes, Life Lessons, NaBloPoMo, Reluctant Triathlete, Running, Swimming | 7 Comments