Catching Up, Part 2: Active Insulin

This is the second half of the “What has Jeff been up to?” post. In the first part I had a couple of difficult bike rides.

III. “You really should stop doing all of that cycling and running.” Jen, one of the fastest swimmers at the pool, had a mischievous look. “All that muscle development is making your legs too heavy.”

I had passed her the previous morning at the end of my miserable three-state tour. She was running up the hill near my house as I was coasting home. The pool was crowded, and all of the lane dividers were still up from a swim meet over the weekend. So we doubled-up, keeping to our respective sides of the black line on the bottom of the pool. A few lanes were packed enough to require circle-swimming.

“I don’t think those muscles are the problem,” I said, patting my core. “But seriously. Am I dropping my legs?”

“Every single stroke.”

I had been doing one-arm drills to work on my catch, a high-elbow pull, and a strong, propulsive finish. The “Month of Drills” had been going pretty well—even if I felt a bit awkward doing drills instead of “real swimming”—and I noticed that when I went to the lake for a swim, my power was moving me through the water more effectively than in the past. It’s not often that I get free advice at the pool, so I decided to make the most of it. “Keep your hips and legs up!” I told myself on my next set of 50s.

“That’s looking better!” Jen said, the next time we were both stopped at the wall resting before the clock sent us off again for another set.

Slow, steady progress.

IV. After a couple weeks of getting passed by a couple guys going up a particularly nasty hill like I was standing still (before jumping on and letting them pace me the rest of the way, I should add), barely making it up that same hill the next week, having some really awful-feeling runs around the neighborhood, and being really tired and sore all the time, I was starting to doubt: Maybe I just suck. Part of the reason that I did the really hard ride and then the long outing was that I was looking to have a little fun after some very structured workouts that felt difficult. I needed to prove that I could go fast, and I wanted to take my mind off training. Instead, my recent difficulties focused my mind on how soon my next triathlon is (Sunday!) and how unsure I was about my abilities to do well there.

I was trying hard last week to snap myself out of the funk and self-doubt, but my diabetes wasn’t cooperating at all. It got very warm here a couple weeks ago and never really cooled down. (Tuesday night, the house finally dropped below 80F for the first time in a week.) For whatever reason, my blood sugars shot up and never really came down for more than an hour or so. Perhaps I was under-hydrated. Maybe my insulin got a little baked and lost its potency. It’s quite possible that the heat itself, which is a form of stress, made my body a bit insulin resistant. I’ll probably never know.

What I did know is that I was starting to feel something like despair. At first I blamed myself, assuming I made mistakes in my self-management. Then, when some rage-bolusing didn’t have much of an effect, I knew that it wasn’t my fault. If I can’t even make myself go low with extra insulin, I can’t really be held responsible for the highs. I did everything I was supposed to do: I changed infusion sets and opened a new bottle of insulin. Of course, knowing it was out of my control didn’t make the highs go away or help me feel better. Even worse, high blood glucose can mess with mood. Prolonged, high BGs makes feel a bit manic and depressed, particularly because it amplifies all of the feelings of self-doubt and grumpiness that I have from time to time. I’m sure I must have been a pain in the ass to Lisa.

I noticed a few things that helped me “solve” the problem. (1) My pump was getting hot, probably cooking my insulin. And (2) when I changed my insulin every few days I felt some pretty impressive “pump bumps.” For whatever reason, my body didn’t really like having the infusion set in there for 3-4 days. Both things pointed toward changing my insulin more often. It feels like a lot of waste to change sites every 50-60 hours, but you do what you’ve got to do, right?

My BGs have come down, and my mood has improved greatly.

V. The only thing that would bring my BGs down was cycling or running in the afternoons. I was starting high and dropping 100-150 mg/dL (6-8 mmol/L) over the course of an hour. Sometimes I bolused a small amount of insulin before the ride. Other times I decided to forgo my usual practice of reducing my basal insulin rate. And I rarely needed to do any snacking before or during these afternoon outings. I was happy for the effect of the exercise, but I knew that drops like that are unsustainable if I start to exercise with “normal” BGs.

On Wednesday, the third—the day before the start of a four-day weekend for me—I decided to go for an extra long bike ride. My blood sugar was in a really good place when I left the office, and was still pretty good (for pre-exercise anyway, 187 mg/dL, or 10.4 mmol/L) before I headed out for an enjoyable 25 miles. I ate a banana and loaded my pockets with glucose tablets and a few energy gels. I also mixed a bottle of SkratchLabs drink mix that I planned to drink on the second half of the ride. About 40 minutes in—just after eating a gel—I pulled my meter out my back pocket and placed it between my teeth; fished out a test strip with one hand and put it in the meter; and pricked my index finger, milked some blood out, and transferred the drop onto the waiting test test strip.

“Shit shit shit!” I muttered upon seeing an 85 (4.7) staring back at me. I had dropped over 100 mg/dL in the last 40 minutes. Based on how I was already feeling, I could tell that I was going to go low, so I looked for a shady part of the highway shoulder to wait it out.

You should know that I can be impatient when I’m on a bike. If I have an expectation that I’m going to go a particular intensity or speed, I’m going to do it. Of course, if my expectations are that I’m going to go have a nice leisurely ride with friends, then I can totally chill and have a great time just being on a bike. And if someone I’m with has a hypo, I have no problem waiting until everyone’s BGs are back to a happy place, mostly because I’m a big, worried mother-hen when it comes right down to it. But if I’m by myself, sitting around on the side of the road is torture. Time passes slowly in the BG penalty box.

Six minutes after eating some glucose tablets and another gel I tested again: 71 (3.9). “Looks like it’s a major penalty,” I thought while eating a few more glucose tablets and washing them down with Skratch mix. Nine minutes later: 81 (4.5). I was moving in the right direction but still a little too low to start again. Seventeen minutes after the first test, my BG had recovered to 97 (5.4) and I was ready to head out. Unfortunately, I had eaten all of my food, so I had to make a quick stop at a convenience store a few minutes later to restock on carbs.

My second wind was fantastic, and I went on to put the hammer down on my “nemesis hill” (Milford Road in Grafton). Later that evening, Lisa and I had a great time watching fireworks, and the next day we did a two-ish-hour ride on the Minuteman Bikeway, which was very enjoyable and took my mind off thoughts like “Do I suck?” A couple mornings later—that would be last Sunday, the 7th—I went for a short, leisurely 35-mile ride and felt really great. That ride included a new-to-me hill, which was completely ridiculous. 17% grade?! Are you kidding me?

It’s nice to have my mojo back.

VI. Continuing on with the theme of trying not to take training too seriously during this taper/recovery week, I did something completely new this week: I combined exercise and errands.

On Wednesday I needed to refill a few prescriptions at CVS. I also wanted to run about four easy miles with just a bit of intensity in the middle. I knew I was going to be a little late leaving the office, and I didn’t want to be even later starting out my run by driving to the pharmacy first. That’s about when the idea to hit me to run to CVS, pick up my stuff, and then run a slightly longer route home.

I can hear you out there, because I had these same thoughts myself: “But, Jeff, it’s been hot and humid in Massachusetts. Won’t you be all gross and nasty standing in line?” Somehow I rationalized it this away. “Well, it’s 1.6 miles there, and they’re all downhill, so it will be easy, right? And it’s the first part of the run, so I might not even be warmed up yet. And it’s only 80F (27C) out there, so it’s almost cool.” And that’s what led me to put on my running gear, strap on my hydration pack, pick a perspiration-wicking cap, and run to CVS, where I stood sweating all over the place while I waited for them to fill the test strips part of my prescription.

“I was reading the other day about a woman with Type-1 who runs all summer long. She has some fancy way of keeping her insulin pump cool in the hot summer heat.” The pharmacy clerk has Type-2 diabetes, and somehow knew that I had been running. It was probably the running clothes . . . and the sweat. “Are you going straight home? Because sometimes people don’t know, and they think they can go do more shopping elsewhere, and their insulin goes bad.” I assured her that I was going straight home—I didn’t mention that it would be in a rather roundabout way—and then stuffed two vials of insulin and a bunch of test strips into my pack.

As I ran home, the test strips clicked like little maracas with every stride. Hearing the insulin bopping around inside their boxes brought a bunch of diabetes terms to mind: insulin on board, active insulin, running on insulin, etc. I did the math: “2 vials times 10 mL per vial times 100 units per mL. Let’s see, that’s 2,000 units of insulin. Plus about 0.3 units of active insulin from lunch. 2,000.3 units of insulin. I’ve never run with that much insulin on board before. I hope I don’t go low.”

This entry was posted in Cycling, Diabetes, Life Lessons, Running, Swimming. Bookmark the permalink.

2 Responses to Catching Up, Part 2: Active Insulin

  1. StephenS says:

    Ha! Love that last bit. Also love the “BG Penalty Box” term. Never heard it before, and it’s so true.
    Good luck on Sunday. I’ll be doing a seemingly-leisurely 5K.

  2. I can totally hear the test strip maracas in my head! And I love the deal about running with so much insulin on board – haha! :-)

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