“Hey, Diabetes. Imma let you finish in a minute, but I just wanna say that Jeff has the most epic afterwork ride planned for tonight. So If you could just keep up, that would be the right thing to do. Peace.”

Thanks, Kanye! I’ll be seeing you.

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I’ve had some more time to contemplate yesterday’s stage of the Tour de France. We had some conversations about it at work, Facebook and Twitter; and I had a bit of a think on my ride this afternoon. (There were no “penalty laps” for me today, by the way.) Some of those people are probably reading this, and I invite them (and everyone else) to leave a comment.

Former carpool buddy Steve noted that if an auto racer has a mechanical problem, they don’t stop the race. True indeed. I do think the comparison falls apart when you consider that the car really is the thing that does all the work. Sure, it has to be driven well; but the car is the thing that’s tuned, and it’s the sine qua none of auto racing. Bikes matter in the Tour de France, of course; but the UCI tries to keep everything fair-ish between riders.

Meanwhile, all-around badass Alex simply says, “Cry me a river.” He has some interesting points. As an oh-so-close-to-elite runner — seriously, he ran a 2:27 Boston Marathon — I take what he says seriously from an athlete’s perspective, and he likes to think about the social aspects of sport. He professes great respect for the Tour and its riders, and I believe he’s sincere. His main points are thus:

1. If a runner trips, no one waits. Why should cycling be any different?
2. Europeans like to inject unnecessary ambiguity and drama into sporting events. Every World Cup or European championship has some event that lets the losing team argue that it should have won, that they lost because of bad officiating or bad luck. And these “unwritten rules” of cycling are just another way of perpetuating an inter-European or “us vs. them” rivalry and means never having to acknowledge someone else is better.
3. The structure of Grand Tour cycling teams is very 19th century, with expectations of deferring to your superiors and having some competitors there to serve team leaders.

All I can do is agree with Alex on these observations, but I don’t really think that some of them apply very much to cycling, which is a different kind of animal than running or footie. Running is all and only about pure talent: Anyone can do it; you don’t need much more than innate ability, a bit of tactics and self-awareness, and the time to train; and you can pretty easily rank people objectively on time over a given distance. These are some of the reasons that I love running almost as much as cycling.

But you also can’t really have a running race like the Tour de France, where you compete for 4-6 hours every day for three weeks. (I guess that means cycling is easier than running. :^) And if you’re going to have such a race, you need helpers for the people who can actually win it. And some of them have to be riders without a chance of winning the Tour. Alright, you could just have the 20 strongest cyclists in the world go out and ride every man for himself for 23 days, but it would be a very, very boring race. No amazing sprinters would show up. No mountain specialists either. It would be everybody getting their asses handed to them by two or three guys over and over again. Yawn.

What does all this have to do with Alberto Contador attacking Andy Schleck? Well, I can definitely see where people are coming from when they say, as Ryder Hesjdal did yesterday, “Hey, that’s bicycle racing.” If that’s how you want to race, it’s true that there are no actual rules against it. And I can see how if you’re inclined to see all sports events as a battle of wills and skills between completely autonomous actors that’s also seasoned by both good and bad luck, it would make sense that you’d see no problem whatsoever in what Contador did yesterday. I get that.

But cycling is a team sport that mixes contenders and helpers, however elitist or class-suffused that strikes you. And if that’s the way it’s going to be, there are consequences to crossing certain lines, even if they’re fuzzy, unwritten, nonbinding, “gentlemanly,” quaint lines. Crossing those lines — like attacking in the feed zone or trying take the lead on the final day — will alienate you from the public and your fellow riders, the people who you might need to help you control the pace someday or chase down a shared rival.

So was it wrong? Not in any kind of absolute right and wrong. It’s not in the same class as doping or cheating or knocking over a rival. Was it a smart move for Contador in the stage? We’ll see. Everyone says he’s a better time-trialist than Schleck and could certainly have taken the lead on the second to last day; but that’s cutting it a little close, to be sure. Frankly, I’m not sure that Schleck could have taken all that much time yesterday. Given the time Contador gained on the downhill, he might not have lost any time after the attack at all. Then again, maybe he would have, and they were only 31 seconds apart at the start of the day. We’ll never know the true impact.

(My objection yesterday was that Contador’s attack was a weaker rider taking advantage of a stronger rider’s technical malfunction to get an unfair advantage. I still feel that way, but since we can’t know what would have happened if Schleck’s initial attack would have succeeded, I’m going to just say that it’s more up in the air and debatable than I had suggested.)

But in the long run, it doesn’t matter what I think. It matters what Contador and Schleck’s peers think. If there are enough riders who feel like Hesjdal, then maybe Contador hasn’t done anything wrong. But if there are more riders like Armstrong who look at this with some suspicion or hostility, then maybe it was a chump move in the end.

We’ll see.

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First off, I went for my first ride since before we left for Australia. I know, it’s been a while. I have been running, but I think I was rather not looking forward to how slow I was going to be getting back in the saddle after a six week hiatus. It was a long enough time that I forgot a key turn on my new training route and had to take an extra penalty lap around the center of Upton. I was, as you might suspect, rather slower than before. But it wasn’t a total debacle, and my core muscles are still in pretty good shape. So yay for that! Tomorrow is another day, and the season isn’t even half over yet — well, maybe it’s about half over.

What I really want to do is to discuss today’s stage 15 of the Tour de France. Yes, it’s the one where Alberto Contador attacks Andy Schleck, the leader of the Tour, while he has mechanical issues. It was the subject of some “let’s try not to spoil the stage for Jeff, who has TiVo’d it” discussion at the office today, a spirited exchange between the Versus TV commentators, and a whole lot of 140-characters-or-fewer musings and arguments on Twitter.

I’ll give you my view, but first watch this:

Contador passes Schleck to take the yellow jersey. Schleck rides with anger and promises revenge.

The first 45 seconds show all the important events, beginning with Andy Schleck attacking and almost immediately having a bad shift that (all but certainly) jams his chain between the front derailleur and the chainring, forcing him to dismount. While he’s slowing, he’s caught by Alexei Vinoukorov, the Astana rider chasing him down for Alberto Contador, who was in second place overall at the time. (You can debate whether those two actually play that nicely and if Vino was going off on his own.) Vino knew something was up as El Pistolero passed them both and never looked back. Schleck eventually got back into the mix of it — with, I must say, some truly impressive uphill riding — but those 40 seconds he lost to the chain problem turned into an 8-second deficit in the competition.

So what do I think? Well, I hope you watched the rest of the video past the first 45 seconds, because that was some truly possessed climbing by Andy Schleck to be only 12-13 seconds behind at the top of the climb and some really daredevil descending by Contador, et al., to extend that margin to 39 seconds at the end of the day’s stage.

As for the propriety of Contador’s actions — attacking a rider who is in mechanical distress — that’s trickier.

I can’t fault Contador for riding hard and for wanting to win the Tour. After stage 14, when Schleck countered his every move, he clearly knew that it was going to be hard to take time out of the Luxemburger. And the Spaniard was racing to catch up after his rival caught him out. It seems like Contador knew that the only way that he could win was if he got very lucky and pushed on whatever fortuitous breaks came his way. Cycling is a very difficult sport — and this is perhaps the most difficult and prestigious sporting event in the world — so I can see doing what you have to do.

But during the last few stages, Contador has looked like the weaker rider. (Still a very capable rider, perhaps even very nearly the best in the world.) And both he and Contador are equally smart racers. Contador’s Astana team does look to be stronger than Schleck’s Saxo Bank riders, though.

Now, if there’s one thing I can’t abide it’s a Tour de France won by a weaker rider who got where he did through happenstance.

As for whether Contador should have waited, just as Jan Ullrich did when Lance Armstrong fell in the mountains during the 2003 Tour, that’s open to debate. I certainly would have, had I known that he had fallen and been able to do it without sacrificing my position to challengers. (Of course my racing career only extends as far as two amateur road races in high school when I finished well off the back.)

Armstrong crashes on an attack and then has mechanical problems.

But that was 2003. Today Contador couldn’t match the attack and wasn’t able to keep up with Vino who might have pulled him up to Schleck. (That Astana team is strong, but they certainly have teamwork issues.) When the Kazakh slowed down while marking Schleck, Contador blew past them both. It’s debatable whether Vinokouraov could have told his teammate about the leader’s mechanical issues. As a domestique, maybe it wasn’t even really his place to rein in the putative leader of the team. At any rate, I can’t believe that Contador wouldn’t have sensed something was up when he sailed past the almost stationary yellow jersey. And Menchov or Sanchez surely knew and could have relayed the information to him.

Contador doesn’t seem to be the kind of rider who honors traditions or team dynamics or teammates, so I’m not surprised that he didn’t hold up. And as the defending champion he would have had the clout to keep his rivals Menchov and Sanchez from going on ahead without him and the Tour leader. Now, it all happened very quickly, but I just don’t think Contador is built that way in the sportsmanship/fair-play department.

So was it wrong to counterattack the yellow jersey during a short mechanical crisis of Schleck’s own unfortunate and unintentional making? Maybe, maybe not. But I respect those in the crowd who booed Contador at the podium ceremony when he put on the leader’s jersey — just as I respect those who cheered him. And I’m reminded of Paul Sherwen’s words in the second clip above: “You know, in the sport of professional cycling, there’s always payback time. You can never burn your bridges. Don’t ever make enemies.”

I’m hoping that Tuesday’s stage 16 has a bit of payback time in it.

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We’re back from Australia — have been for about 30 hours. That, coincidentally, is about how long our Friday was. As always, the first night we slept soundly due to being completely wiped out by the trip home; but the second night (last night) the jet lag hit. Usually, I have a loud soundtrack going through my head the moment that I wake up too early after a trans-oceanic flight; but this morning it was a small murder of crows that woke me up, and then the soundtrack kicked in once they moved on:

As I write these lines, I’m “watching” the Tour de France prologue and waiting for my temporary basal insulin rate to kick in, since I’m going to go for a run in a few minutes. This will be my first since Alice Springs about three weeks ago. That morning was cold! So cold — 3ºC — that I could see my breath, shivered whenever I stopped to photograph birds or whatnot, and wished that I’d brought a long-sleeve running shirt. (Today we’re supposed to have big-time summer heat at home. Lisa is already out for a walk, not having slept at all overnight.) Despite the lack of running, I managed to lose weight on vacation — though I was quite surprised to see the number of the scale. We’ll see how much all of that hiking and walking has helped with my muscle tone and how much “outback lunch” has hurt.*

Time passes . . . Running went well. No jiggly-ness in places where there shouldn’t be. No gasping for breath. No sluggishness. No hypos or high blood glucose readings. Those are all good signs. I guess we did manage to keep active on our trip, probably more throughout each day than we typically would have been sitting in front of our computers at work.

All that activity wasn’t enough to reach blood-sugar nirvana right off the bat, though. In fact, it was kind of a weird diabetes trip, all things considered.

First off, I’ll get a confession out of the way. I’m pretty obsessive when it comes to traveling with diabetes. I carry almost twice as many supplies as I’m going to need, and I worry that I’m going to forget stuff.

I bring more supplies (even though they take up a ridiculous amount of space) because I almost ran out of infusion sets in Chicago in 2003 when I got a bunch that I just couldn’t get to work and had to keep changing them until on the morning of my return I was contemplating how to give small amounts of insulin by syringe for the next ten hours.

And I worry about forgetting supplies because in the past I (a) left my meter at home at the beginning of a two-week road trip and had to buy a new one in Milford, CT, (b) I left my insulin in the minibar fridge in Shimla, India and was lucky enough to have one of the hotel staff track me down on my way to the railway station, and (c) I didn’t bring a quite enough insulin with me on an unexpected trip to Kansas last year.

So I obsessively carry lots of stuff with me. On this trip that really came through for me.

See, my pump broke in the middle of nowhere in the Northern Territory of Australia about three weeks ago. Yup that’s right: dead. A button on he controller got stuck, and that was enough to cause the pump to give up the ghost.

This isn’t the first time this particular error — “Button Error” — has happened to me. In fact, it happened about a year ago. In the US, this is an annoyance: Call Minimed, explain the problem, have a new pump the next day. In the interim, I’ve used my older Minimed 511 pump. (It uses all of the same supplies and is mine to keep because my health insurance system lets me get a new one every five years or so; and Minimed is eager to help me get the latest model.) It’s a pain, but it could be much worse.

But in the Outback in Australia. In a campervan. Without a fixed itinerary, without my own phone, without the Internet. It’s a bit more difficult. I had my backup plan, but it was now only one failure away from EPIC failure. My safety net needed me to do something. Fortunately, I had three things going for me:

1. I brought a backup pump.
2. I had the foresight to bring the list of Medtronic Minimed distributor phone numbers that comes in every box of supplies.
3. I have a naturally sunny and charming disposition. Okay, that’s a bit of a stretch, but I wait to freak out until after I’ve taken charge of the situation.

Getting a replacement pump in Australia is not the same 24-hour experience as it is in the USA. First, dial Medtronic Minimed from a pay phone. Hang up. Deposit 50 cents. Dial Medtronic Minimed. Tell them in the Northern Territory. Hang up. Dial the free call number (1800 777 808). Listen to crappy hold music. Get connected to US Minimed tech support. Explain the problem. Tell them I’m in the Northern Territory. Get put on hold. Listen to more crappy hold music. Give them the location of my next fixed address in Alice Springs in a week. Tell them to have the Australian office leave a message on my home voice mail (which we were checking via Skype when we had Internet access) if they need to.

A week later, show up in Alice Springs. Find no pump at the hotel. Get on Skype with the Aussie office of Minimed. “Your pump left Hawaii this morning. It should be there in a few days when you return to the same hotel after going to Watarrka and Uluṟu.” Go to Watarrka and Uluṟu. Pick up new pump about two weeks after it failed. Program all of the settings that I had (fortunately) written down on an index card I keep with my meter… you know, just in case. E-mail nice dude at Aussie Minimed to ask what to do with the broken pump. Put the pump in my luggage as a souvenir until I get home.

So what did we learn for the next time?

• Assume that a pump is going to fail at some point. Over the last decade, I’ve had at least two fail with the “Button Error” locking failure and one fail with a motor sensor problem.**
• Carrying a backup pump is a necessity (if you have one).
• When leaving the country, bring along Lantus or some other kind of long-acting insulin as the backup plan for the backup plan.
• Carry manufacturer contact info.
• Wait until you get to the US (or home) before contacting Minimed about getting a replacement pump. I suspect supplies would be easier to get if they got lost, etc.

Other than that, diabetes didn’t really affect my trip any more than normal. Hiking and swimming are things we do frequently, and I managed the trip to the Great Barrier Reef pretty well. I probably could have used a little more insulin before disconnecting pump before I put on my wetsuit; that’s good to know for next time, but this was the first time, and I feel it was a good trade-off.

Not exercising and changing my diet and eating schedule exposed a few problems with my basals . . . or at least required some changes. After those changes, I did pretty well for the rest of the trip. Sitting on a plane for long periods of time is going to suck for so many reasons, so just increase every bolus insulin dose 10% and hope for the best.

Now it’s late, and I’m hoping for a bit more sleep tonight. Wish me luck!

* — Remember, “outback lunch” = ice cream + chips/crisps + Diet Coke + optional Oreo cookies.

** — I suspect, but cannot prove, that this is related to water getting into microscopic fractures in the pump casing. I try to keep the pump dry, but I’ve noticed it twice after steamy summer exercise sessions. So I’m trying harder to keep the new one in a less humid environment, putting it in a plastic zippy bag when I run or ride and keeping it out of the steamy bathroom when I shower. We’ll see. Let’s hope the FDA takes notice.

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Just FYI, I went for a ride this afternoon. Nothing special — just my typical 16-mile, hour-long route up and down the hills of Milford and Upton. My bike seems to be fine and not sluggish at all, strongly suggesting that my problems on Saturday were, in fact related to nutrition and conditioning and just not having a good day.

I think part of my problem might be that I’m bored with my training route. I’m very, very accustomed to it. Perhaps it’s time to make a few changes.

Oh, and I feel very close to having my insulin and food worked out for an afternoon ride with happy BG readings beforehand and afterward. :^)

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There’s a bumper-sticker out there — you’ve probably seen it — that says “A bad day golfing is better than a good day working.”* Variants of “golfing” include “fishing,” “shopping,” whatever. What you can’t replace it with is “cycling.”

A great day of cycling can’t be beat, but a bad day sucks. Because a bad day of cycling is work. Hard work. Possibly even work in the rain.

No rain today, but I was just not feeling it. I had intended to ride 90 miles, leisurely going over some mountains on a beautiful day.** Long but doable, I thought. After all, a month ago I did an 80-mile loop from my house to the top of Mount Wachusett and back, and that felt really good. But I ended up turning around after 25 miles.

Click for larger

Don’t get me wrong, the ride had its good parts. Hardly anyone was driving up or down the mountain. It didn’t take as long to ascend as last time, when there was snow and ice on the road. And the descent down Notch Road was smooth and fast. (I learned that if you run into a bumblebee while descending at close to 40mph***, you can see it coming and it kinda stings hurts as it thuds off your chest.) And — even though it killed me a little to see it — I smiled when I saw someone had painted “HILL 1/2 WAY ” on the shoulder of the big climb a little before where I turned around to trade the last 65 miles of my ride for 15. And at the Mount Greylock SP visitor center, I saw a fellow rider with a Team Type 1 jersey.

But something about today just didn’t work. Maybe it’s because I started by climbing a mountain. Maybe it’s because the route was either all uphill or all downhill with few flat sections. Maybe I got too warm on the way up. Maybe I should have had more breakfast before heading out. Maybe something mechanical was wrong. (I even stopped on the way up the mountain to adjust my brakes, since I thought I could feel them rubbing the rear tire.)

Maybe it was one of those things. Maybe it was nothing but my overall lack of skills. Maybe it was all in my head. Whatever the reason, I felt like I had an anchor dragging behind my bike. It felt like the energy I was putting into the bike didn’t move it forward as much as it should, and when I was going slowly (which was often) the bike seemed to slow down on its own.

If the bike was misbehaving — and I’m not saying that it was, although it definitely needs a tune-up — it was mostly me. I just had no energy. I ate and drank, but it didn’t seem to matter. I had cracked. In fact, I contemplated walking my bike the last half mile up the 10% stretch back to the car. I’ve never walked a bike since I first got one with multiple gears. Like I said, it was a tough outing; and I consoled myself with a strawberry shake.

Tomorrow is another day. And since I didn’t go very far today, it might just be tomorrow.

* — This bolsters my (admittedly very biased) assertion that golf is not a sport. At least not any more than billiards or darts. And yet golf is going to be an Olympic sport in 2016, while cricket continues to be excluded. Hmm.

** — I think this ride is jinxed. Two weeks ago, there was a gale/nor’easter that kept me at home. Last week I forgot about a dinner date. And then today. But I declare this: “Taconic Range, I will make you my bitch successfully cross over you.”

*** — I know, I know. The speed limit was only 25. I don’t have a computer/speedometer, so I’m guesstimating. BTW, I’m sure the bee was fine. . . .

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Yesterday was day #6 of Diabetes Blog Week. I managed to miss it because we were kinda busy. So I’m gonna make up for it today with two posts. First, some diabetes snapshots.

Before the pictures, a little story. Remember that on Friday I wrote that I was going to do 90 mile ride in the Taconic Range today? Turns out, I forgot about an evening obligation, so I decided to delay the ride until next weekend and do a similarly sized ride starting at home but without any mountains.

About two hours into my ride through Massachusetts, Rhode Island and Connecticut — before I really even had a chance to get bored — I got a flat. After a year of riding, I was due, but it could have happened in a more convenient place, instead of halfway across the West Thompson Dam. My first thought was a hope that I could just raise my hand like they do in professional races and summon the neutral service vehicle for a quick wheel change. Oh, delusions!

After walking myself back to a place with a shoulder, I made a rookie mistake, breaking the head off the valve of my flat tube as I took it off the wheel. Had I been wiser, I would have also brought an extra tube with me. Like I said: rookie mistakes. Nothing to do after that but pack it in and call Lisa to pick me up. She’s a sweetheart, that girl.

Next week, I’ll be more sensible when I finally do that ride in the mountains.

Here are some pictures from the past couple days:

Lunch of palak paneer and chicken korma

What?!

How did we do SWAGging lunch? Uh . . . coulda been better.

Reading all y’all’s blogs

A movable feast

Stopping by the cemetery in Burrillville, Rhode Island

Lots of Joslins in this part of Rhode Island and Connecticut

I thought at first this might be the guy we PWDs owe a debt of gratitude, but he seems to be an uncle of some distance.

Waiting for the cavalry in Thompson, CT

I barely worked hard enough to muss my hair

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It’s day #5 of Diabetes Blog Week. Today we’re talking exercise.

I have a bike. I like love to ride it all over.*

Is that exercise? I guess that depends on whether you think it’s “exercise” to do the thing that you love.

On one level, the answer is undeniable: Yes. I have to carve out time from my daily schedule to do it. Sometimes I have to convince myself to get going, especially when I’ve had a tough day and I want to veg out. And it burns a lot of calories, which was part of my initial motivation. According to the computerized bean-counters at MapMyRide.com, I’ve burned more than 130,000 Calories over the last 10 months by running, bicycling, and swimming,** which helps explain why I lost about 25 pounds over the same period.

I don’t think about it as exercise, though. In fact, what I do after work feels more like training. I “train” on weekdays so that I can ride longer distances with more ease on the weekends. I wear myself out repeatedly riding up long hills so that I can feel badass when it comes time to ride up an actual mountain. I go out in the winter and in the rain to put the miles in the bank, so that they’re there when I need to draw on them in the fourth or fifth hour of a ride. While I’m out training I have mental image of my idealized self. “I’m climbing like Andy Schleck. I’m grinding away on the flats like Fabian Cancellara. I’m spinning easily like all those other people in the peloton, waiting for the breakaway to wear itself out.”***

Whatever I call it, cycling is something that I love and that I think about way too much while I’m at work. I live for the long ride on the weekend. This Sunday, I hope to do the 90-mile ride that I was going to do last weekend before the jet stream shifted and changed my plans: Up and over Mt. Greylock in western Mass. before heading into the Taconic Range that divides New York from New England.

View Larger Map

As with all things diabetes, it’s not as easy as just putting in the miles and showing up. There’s day-to-day planning that has to happen, too. I find it easiest to ride in the morning before the day’s first bolus: Just lower the basal about 50% an hour or two before starting and eat frequently along the way, testing every hour or so. I put Clif bars, bananas and string cheese in my jersey pockets and fill up my bottles with Gatorade. And on the weekends that’s what I do.

But weekdays I ride after work, so it’s more challenging. I hate seeing the high numbers, but I build up a bit of a blood sugar cushion by snacking without bolusing along with lowering my basal. And I drink Gatorade throughout my hour-long workout. I’ll keep tweaking everything until I get it right — until my BG levels don’t drop 50-100 mg/dL in an hour — and then I’ll lock it in until diabetes decides to change how my rules work (again).

Thanks to diabetes, I always carry three things with me when I ride****. (1) A tube of glucose tablets, which I occasionally need to use. (2) My phone, which I fortunately have not had to use except to snap the occasional picture. And (3) about $15 dollars in small bills in case I need to stop for an emergency snack or to bribe someone.

But to paraphrase Lance Armstrong, it’s not about the diabetes. I love to ride, and diabetes can come along if it promises to keep up. When I actually get on the bike to ride, that’s the time when I feel like I’m beyond diabetes. I put my pump in the pocket of my Team Type 1 jersey to represent for my PWDs and because I’m so damn proud and inspired by what that professional team does; but cycling connects me to a time before I had diabetes, and it’s my way of being as free from it as possible.

* — I’ve also been known to run, walk, hike, and backpack. And, yes, I’ve even started to enjoy swimming — though, I still suck at it.

** — Seriously, I’m not thinking about competing in a triathlon. I’m not.

*** — I have no delusions about my abilities, though. I’m just a guy with diabetes on a bike, after all.

**** — That’s in addition to the Boy Scout stuff that always stays with the bike: fix-it tools, patch kit, tire levers, etc.

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It was beautiful outside this afternoon, and I felt a bit chagrined about not going for a ride or a run. But it’s my rest day, and the only thing worse than not going for a ride in beautiful weather is being injured and knowing that you can’t get back on the bike tomorrow.

And I did need the day off. I rode 60 miles on Saturday — I was rather amazed seeing how much flooding there still is out there — and then ran almost 9 miles yesterday. Even though I’d been telling myself all day that I was going to rest my legs, I didn’t really believe I would be able to resist getting back in the saddle until I bolused the full amount for my afternoon snack. That extra bit of insulin sealed the deal for me. I would probably have had hypoglycemia if I’d gone.

I think I’m finally getting a hold on how to balance exercise, food, and insulin. Everybody’s diabetes is different, of course — talk to your doctor, and don’t simply copy what I’m doing — but here’s what tends to work for me.

• First off, active insulin really drives down blood glucose. On weekdays I exercise after work, so I usually have somewhere between one and two units of insulin on board; that usually guarantees a sizable drop that I have to compensate for with extra carbohydrates. But exercising first thing in the morning makes this moot. Of course, I do have to eat something first thing in the day, but I try to eat a small enough meal (<40g carbs) that I'm not going to send my blood glucose up a bunch without extra insulin. (Eventually, I'll figure out the right carb:insulin ratio for eating before exercise.)
• During exercise, a couple of things happen that make insulin more efficient — as long as there’s some basal insulin present. More blood flow causes insulin to get to the cells where it’s used more quickly. (Remember, insulin is the metabolic “key” that moves glucose into certain kinds of cells, like muscles.) And the action of muscles expanding and contracting during exercise actually pumps glucose into cells with less insulin than when the muscles are at rest. So, I have to bring my basal insulin down a bunch (roughly 60-75% less than “normal”) about an hour before I head out.
• Of course, just like people without diabetes, I have to get energy to my muscles; and that means eating. Over the four hours of my ride on Saturday, that translated into about 60g of fast-acting carbs (in the form of Gatorade) and 80g of more complex carbohydrates (Clif Bars . . . yum).
• After exercise, it’s not quite like my type 1 diabetes is “cured” but I certainly don’t need as much insulin for my food. Exercise depletes muscle glycogen, which has to be replaced, drawing down blood glucose levels. I find that sometimes — but certainly not every time — I need to take off about 20-30% of my meal boluses, much less if I only go for an hour or so.

As always, I’ll keep fine-tuning and sharing what I know. What works for you?

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I wanna model.

No, not that kind of modeling. And I don’t want one of those other kinds of models, either. (Although it’s certainly nice to watch Heidi Klum every week on Project Runway.)

I want to develop a model that helps me figure out how to balance exercise, insulin, and food — a model that helps me have a pretty good idea what to do before and during exercise so that I can start exercising in a healthy range and end within it, too. It doesn’t matter to me whether it’s a set of more-or-less repeatable actions that are loose and fuzzy but get me to my goal or a table of values where I put in starting values and how much exercise I’ll be doing to end up with an action plan. Either one would work for me, and I suspect it’s going to require both. But consistency (and safety) are my goals.

I know this is possible. When I exercise in the morning — before giving myself any bolus insulin — I just have to lower my basal insulin rate to about 30% of normal and I can go for hours and hours. Of course, I usually eat a little something beforehand; and I need to eat about 30-40 grams of carbohydrate every hour from the second hour onward. But that’s easy enough to do.

But I know that it’s possible to do even better. Olympic nordic skier Kris Freeman seems to have developed something that works most of the time. (His hypo during the 15 kilometer pursuit notwithstanding.) I’m no Olympian, but I know that with the appropriate amount of personalization, I can have the same level of predictability, too.

And do I ever want the ability to predict better! And I don’t mean, “I predict that I’m going to have a low blood sugar event during tonight’s swim.” (That’s what happened tonight, when I started out at a very respectable 156 mg/dL a couple hours after dinner and ended at a very thin 47 mg/dL, complete with shiny spots in my vision provided by my glucose starved brain.) No I mean the ability to more accurately and precisely target all of my BG readings at all parts of the day.

Modeling isn’t always easy. It depends on the problem, how well it generalizes, how sensitive the phenomena are to small perturbations, how many variables there are, whether the relationships between variables are simple (e.g. linearly related) or complex, etc. But I work at a company that develops modeling software. The expertise I need is just down the hallway.

But first I need data. I need to identify the relevant independent variables and collect them. To that end, starting today I’m keeping track of much more data and being much more diligent at recording it. I hate experimenting on myself, but that’s diabetes. Soon, I’ll share more data and maybe ask for your help, too.

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Dear readers, it’s time for a roundup of topics that just aren’t big enough for their own posts. I’m just going to jumble them all together. Enjoy!

It’s Olympics time. Woo! I don’t understand people who profess not to love the games. You may not like every event — bobsled, ice dancing, whatever — but how can anyone not love the whole Olympic ideal? Me, I particularly enjoy the nordic events, especially biathlon.

DiabetesMine interviewed skier Kris Freeman, the first type-1 Olympian in an endurance sport before the 30km cross-country race and afterward — I think he’s my new role model. They’re both great reads for any athlete with diabetes.

Freeman was “pissed” about going hypo during the 30km race, but he was “really, really pissed” about a bad ski choice during the 15km. I’m sure he will rock the 50km on Sunday!

Thinking of Canada, Lisa and I went to Montréal early in January. It was sooo cold (-14ºC for a high). How do people live that way? We went to see a J. W. Waterhouse exhibit at the Musée des Beaux Arts. While there, we ate some great food — check out Paris Crêpes on the corner of Ste. Catherine and Crescent — and I enjoyed the city’s polyglot lifestyle.

(And as for art: Last week the MFA installed its first painting in the new Americas wing. I can hardly wait!)

While we were in Montréal, I procured a bit of Francophone music. 90% of Canada’s population may live within 100 miles of the border that sees the most commerce between any two nations; but it’s almost as if there’s a Mounty-patrolled iron curtain separating the US from bootleggers French music. You can find a little bit on iTunes, but it’s hit or miss. Here are some names to look for: A.D.N., Amadou & Mariam, Marie-Luce Béland, Daniel Bélanger, Carla Bruni, Cali, Camille, Caracol, Les Charbonniers de l’Enfer, Cœur de Pirate, Les Cowboys Fringant, Étienne Drapeau, Dumas, Mylène Farmer, Grimskunk, Indochine, Kaïn, Karkwa, MC Solaar, Prototypes, Mara Tremblay, etc., etc., etc. The CBC nominated the top 50 Canadian francophone bands from this decade if you need more choices.

We also saw “Up in the Air” a month or two ago. Definitely recommended. It stars George Clooney, opens with a fabulous sequence of arial footage, uses a version of “This Land Was Made for You and Me” by Sharon Jones and the Dap Kings, and has a really strong story line. From time to time, I feel a bit like intern George’s character — at least I share his attitude toward flying, but certainly not his brand loyalty (though I do have my preferences). But I’m not very savvy when it comes to getting the most of my air travel dollar, which is why I’ve been reading the Cranky Flier’s web log.

Are you going on a trip anytime soon? Need reviews of places to eat, stay, visit? The Times gives a rundown of where to go online and in-print to figure where to go in real life. They mention TripAdvisor.com, IgoUgo.com, Oyster.com, and printed guidebooks. I’m starting to use TripAdvisor for hotel reviews, but books and magazines are still my destination for where to go and how to get there. Give me glossy pictures, a travelogue, and a map or two and I’ll be ready to pack my bags.

But my travel dance card is kinda full for a little while. I actually can’t believe how much I know about where I’m going in the coming years. Australia in just over three months. Bicycling in Provence, France sometime next year. England (and maybe Paris) in 2012. It’s not what I usually do . . . but I’ll take it.

More substance to come soon, I promise.

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The last time I rode my bike up a mountain was almost twenty years ago. That is, until today when I took on the eight miles of Mount Greylock.

I have to admit that I was a little nervous before setting off on my ride, since hills have been my nemesis this year. But I’ve been wondering what it might be like to do some mountain riding in a few of the national parks in the West. So I decided to give into Greylock’s siren call.

When I arrived at the state park visitors’ center in Lanesborough, I found the road over the mountain closed due to Friday’s snow. The volunteer at the center told me I could go up — “We’re probably going to open the road at noon, anyway” — and he showed me the “tricky” spots on the map. Evidently it hadn’t snowed very much, but the concessioners closing the lodge at the summit packed the little bit which did fall, turning it into small icy patches. Yesterday was warm, and today was supposed to be even warmer, so I decided to try it out.

An hour later, I arrived at the top and had the summit all to myself — except for the dozen-or-so University of Rhode Island students who were on a weekend backpacking trip, as well as a few concessioners who passed me on the way up in a U-Haul truck at the slushiest part of the climb (of course). I wish that every ride could be on closed roads, since it’s fun to ride down the middle of the road and even cross-over to the “oncoming” lane to avoid a “tricky” spot.

The ride really wasn’t that bad. There were about a half-dozen icy spots in thin strips that I could almost completely avoid. In fact, there was no snow anywhere, except at the very tippy-top. And I had plenty of energy, and it felt easy, although I spent a lot of time in my wussy lowest gear just because I could.

(I couldn’t help thinking of Errol Morris’s recent series of articles about a controversial photo of the dust bowl when I took this picture.)

There was one other guy at the top: the mayor of NIMBY-town. I passed him as he ran up, and at the summit he told all of the URI students to oppose the “Wind Energy Siting Reform Act.” It (allegedly) would change the law to make it easier for the Commonwealth to permit wind power, making it not subject (they say) to the by-laws of local jurisdictions. (We have 351 of these, you might recall.) And on the way down, as I passed him again, he ran to catch up with me while I negotiated the trickiest icy patch. I told him I would look at his group’s grassroots website. Personally, I’m with the URI kid who, when the runner had gone out of ear-shot, said, “I like windmills.”

Free of distractions, I picked my way down over the terrain I just covered. One of the best things about riding up a mountain is riding down it again. Preferably at a fast pace. Because of the slushy parts, I couldn’t really do that for the first half. But, even though I’m certain that I didn’t touch 50 MPH like the last time I rode down a mountain, those last four miles didn’t take very long at all.

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We just got back from the pool. You can find Lisa and me there almost every Tuesday, Thursday and Saturday. I’m still not a very accomplished swimmer, but I’ve come a long way since that first time a couple months ago when I had my ass handed to me by the pool. Last week I was feeling very energetic and swam a full half-mile; but usually (like today) I swim a bit less (about 750 meters).

My first time to the pool swimming, I was slow but not surprised. Starting back in March, when I did a bit of running to get ready for my Utah backpacking tip, I discovered that I had squandered all of the conditioning I had built up over the years. I was slow. I wasn’t just slow; I couldn’t run a full mile, which really did surprise me. Endurance activities had always been easy for me, and this was quite humbling.

Months later I was still struggling. Running wasn’t going anywhere — literally — so I took a chance and bought a bike so that I could at least feel like I was going somewhere. I loved it, even though the hills were killing me and my head still felt like it was going to pop. And on top of it all, the world was a bit bright and sparkly after my long weekend rides.

Vitamin B12 deficiency anemia. That diagnosis in August explained a lot: the weakness, the head-popping, the post-ride wooziness, the inability to run. Daily mega-doses of B12 seem to have fixed me . . . although we still don’t know for sure, since my doctor has been really blasé about getting my follow test results back to me . . . grrr.

But all of those months exercising with anemia, combined with my diabetes, provided me some real perspective. I don’t need to be as fast as those other riders I see on Sunday mornings. I’m never going to be as fast as my coworker who ran a 2:28:44 marathon last month. I may never even be as fast as I was six or seven years ago when I ran a sub-48 minute 10K. And Lisa may always be faster than me at swimming, doing five laps for every three of mine.

And I’m alright with those things.

One day earlier in the summer when I was out riding, a guy not much faster than I was passed me. He never got too far ahead of me, and over the next five minutes, he kept looking back to ensure that I wasn’t gaining on him. I couldn’t stop smirking. My internal monologue went something like this: “Dude, I’m just a guy with diabetes on a bike out for a forty mile ride.” He eventually got the distance he needed when I stopped in the center of Dover to check my blood sugar.

And that’s where I am now. I’m just an anemic guy with diabetes who loves to run and ride. (I don’t love to swim, but I do it because I want to be able to do it well when we go to Australia. And on the rare occasions when my form and breathing are working for me, it’s almost fun.)

Despite just wanting to have fun, I do have a few goals, which I’ll mostly keep to myself. But I’ll let you in on a couple of them: I’m working on my endurance and learning to manage my diabetes well enough to run a half-marathon in the spring. (Tomorrow is long run day, by the way). And on Sunday I plan to drag my diabetic self over Mount Greylock on a 40-mile loop before going to a museum or two in Williamstown and North Adams. And I wouldn’t mind setting out on another backpacking trip, preferably free of the near-disasters of the last one. Stay tuned!

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Lisa and I recently booked our tickets to Wyoming for the week of Thanksgiving. We hadn’t expected this trip — we had thought we would be hosting holiday festivities — but I’m very happy that we’ll be in the Cowboy State again so soon. Then, a month later, we’ll be in Oregon for Christmas.

It seems like we’ve been traveling a lot this year. If you’d asked me after our western adventure last year, I wouldn’t have expected any of this (except maybe Christmas and the cruise in February). Here’s what we’ve done this year so far.

Denver International Airport (January 2009)	Downtown San Jose (January 2009)
Aboard the Carnival Destiny (February 2009)	Can you find me?
Notre Dame – Paris (March 2009)	Paris from the Arc de Triomphe
The Champs Elysees – Paris	At the Louvre – Paris
Place de la Concorde – Paris	Monmartre – Paris
View from the Eiffel Tower – Paris	Musee d’Orsay – Paris
View of the Seine – Paris	View of the Pont Neuf – Paris
Notre Dame – Paris	Inside Notre Dame – Paris
Place des Vosges – Paris	Jardins des Tuilleries – Paris
Parisian sunset	Crocuses (March 2009)
National Gallery of Art – DC (April 2009)	Cherry Blossoms – DC
Cherry Blossoms – DC	National Air and Space Museum – DC
Temple Square – Salt Lake City (April 2009)	Salt Lake City Temple
Packing in Moab – UT	Arches NP – UT
Canyonlands – UT	Canyonlands – UT
Canyonlands – UT	The Hobos – UT
Looking out over Canyonlands – UT	Our friends’ baby (April 2009)
Courtney – Boston (May 2009)	Hitting on proto-feminists – Boston
Walk for Hunger – Cambridge (May 2009)	Kerry and Lisa – Worcester (May 2009)
My father’s apartment – Des Moines (May 2009)	Humboldt – IA
Great-aunt and uncle’s farm – IA	Family reunion – IA
My cousin and her cutie – IA	Hiking Mount Monadnock – NH (May 2009)
Hiking Mount Monadnock – NH (May 2009)	Hiking Mount Greylock – MA (July 2009)
Norma and Kerry – Boston (July 2009)	At Fenway Park – Boston (July 2009)
Happy Tooth Day – Boston	Kitty (July 2009)
At Sail Boston (July 2009)	Aboard the U.S.S. Eagle – Boston
National Gallery of Art – DC (August 2009)	Farmer Jeff’s meager haul of beans (August 2009)
Hiking in the Great Blue Hills (August 2009)	Taking a break from riding – Medfield (August 2009)
Toilet repair (September 2009)	Setting off from Salisbury, CT (September 2009)
Rendez-vous in Pittsfield – MA	Too much traveling? – Winfield, KS (October 2009)
Relatives’ shoes – KS	Lisa’s new BFF – KS
Steve, Lisa’s brother – KS	Lisa and her dad – KS
Family portrait – KS	At the Sonic – KS
Checking in for another flight – Tucson, AZ (October 2009)	Tucson Mountain Park – AZ
Ocotillo = Ouch – AZ	A brief respite – AZ
At the reception with Mary – AZ	Adam, the groom – AZ
Heading out to ride around the Quabbin (October 2009)	In New Salem, MA
Taking a break in Hardwick, MA	Quabbin Hill Road – MA
Our traveling tires out Kitty (October 2009)	Metropolitan Museum of Art – NYC (November 2009)

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This post is inspired by Anna in Montréal, who is adjusting her basal rates.

A Side-effect of Exercise

I have a bike. This shouldn’t be a big surprise, as I’ve written about my border-to-border and Quabbin Reservoir rides recently.

I love riding my bike, and during the warm months with lots of sunshine I rode it almost everyday. I like the sensation of rolling along, with the wind whistling in my ears and the scenery blurring by. I don’t even mind the hills anymore, even though the wind stops whistling as I crawl along.

All of that riding has been great at lowering my blood glucose reading. In fact, it’s worked a little too well. Insulin — the enzyme that helps transport glucose into your cells for energy — becomes much more effective when you exercise. And when your muscle cells slide past each other, they basically act as pumps and can work (almost) without insulin. (But not completely without.)

When I ride, I carry a waterbottle full of sports drink — Gatorade if you care to know — but I was still having hypoglycemia more often than I’d like. If you don’t have diabetes, this is commonly referred to as “cracking,” “bonking,” or “hitting the wall.” Your muscles have spent their glycogen (a form of glucose usually found inside of muscles), and your body can’t convert enough fatty acids into energy. You feel tired and find it hard to keep going.

If you have diabetes, hypoglycemia has all of these same attributes. Of course, for us it also means that our brains don’t get enough glucose either. So we’re not just tired, we can also pass out. And stopping for a little while doesn’t fix the problem. We have to replace it right away. So I try really hard not to have hypoglycemia. And as someone trying to take off a few pounds — which is going quite well, thank you very much — I want my body to turn fat into fatty acids and leave my blood glucose more or less alone. And I don’t like to drink a lot when I run, which I’m doing now that it’s dark in the evening. But, as I said on Halloween, hypos scare me.

Time to Fix the Basals

So I pulled out my copy of Smart Pumping. “Oh look! I should probably fix my basal rates as a first step.” Well, it was time to do that anyway.

For those of us with insulin pumps, basal insulin is the continuous trickle of background insulin that keeps our blood glucose in the happy/normal range of 80-150 mg/dL, counteracting the steady release of blood glucose from the liver. Why the liver does this, I don’t know. I read in my book that basal insulin should be about 40-50% of your average total daily dose (basal + food/correction boluses). Mine was about 55-60%. A sign of problems. Fixing these rates requires skipping meals and testing every couple hours. Skipping meals is hard. And if one reading is too much different than the one before, you have stop, make adjustments, and start another day.

But I wanted exercise to be easier (and last longer). And (more importantly) I was coming up on my 10-year anniversary with diabetes and had told myself that I wasn’t going to go five or ten more years just “getting by.” I was starting to be quite unhappy about all of my hypos and high readings. And I had a supportive, active new endocrinologist who wanted to help me improve my readings and my ability to predict them.

After figuring out my morning basal rates — which involved about four or five skipped breakfasts — I began my afternoon tests in late September. When I started, I was getting 22.0 units per day. (A unit is 1/100 of a mL. A vial of insulin has 1000 units.)

Four weeks, seven tests and seven adjustments later, I think I’ve figured it out. I have just one more afternoon test to go — I hope — but I think my new rates are correct. For the curious people with diabetes out there, here’s a bit of the data.

Numbers and stuff

On 26 September, my basal rates were

00:00 - 07:00 = 0.9 u/hr
07:00 - 09:00 = 1.0
09:00 - 20:00 = 0.9
20:00 - 00:00 = 1.0
(22 units per day)

The first or second test:

6 October 2009
Last basal: 4.0u at 7:42 (active insulin at 12:30 is 0.4u)
11:39 - 143
12:54 - 79
Stopped

8 October 2009 - Attempt #2 or 3
Last basal: 4.3u at 7:22
11:20 - 155
12:56 - 97
Stopped

I was checking more often than required in those early tests, because I could actually feel my blood sugar moving. I kid you not, and I had suspicious that I was going a scary place.

By 12 October, I had changed my rates to

00:00 - 0.9 u/hr
07:00 - 1.0
09:00 - 0.7
15:00 - 0.8
20:00 - 1.0

13 October 2009 - Attempt #4
11:38 - 133
13:00 - 93
14:00 - 78
Stopped

19 October 2009 - Attempt #5
11:27 - 216
12:54 - 188
14:45 - 138
15:47 - 111
Stopped

After this, I was feeling close to being there, and before my last test had already knocked off a lot of insulin.

00:00 - 0.9 u/hr
07:00 - 1.0
09:00 - 0.7
11:00 - 0.5
15:00 - 0.6

27 October 2009 - Attempt #7
Previous bolus - 07:51
10:44 - 256
11:53 - 234 (Active insulin 1.1u)
13:36 - 226
16:01 - 180
18:01 - 153

I know that last test started out with high readings, but I just wanted to get the damned thing done, and I knew that having higher readings would give me a good cushion for seven hours of testing.

Currently, here’s where I am:

00:00 - 0.9 u/hr
07:00 - 1.0
08:00 - 0.8
09:00 - 0.7
11:00 - 0.5
20:00 - 1.0
(18 units per day)

These basal tests are all about gradual refinements. If your BG readings change by more than 30 mg/dL up or down over any two hour period, adjust +/- 0.1 unit/hour starting 2-3 hours before the dip/bump. The Pumping Insulin authors also recommend redoing all of your basal tests (overnight, morning, afternoon, and evening) whenever you change exercise patterns, your weight changes 5-10%, or you suspect they’re wrong because of fasting highs or lows.

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