Category Archives: Data-betes

Diabetes Mind Palace

Posted on May 17, 2012 by Jeff Mather


“Stuff” is one of the evergreen topics of diabetes. What we use, the features we would like from pharma, and why we don’t have the amazing toys yet—we never seem to get tired of discussing it. Today in Diabetes Blog Week is the day that we talk tech, in particular our “fantasy diabetes devices.”

I think you can divide fantasy devices into (at least) two broad categories: (1) things like what we have now, and (2) things that act like an endocrine system. I’d love the latter, with its promise of a system or implant that behaves like a pancreas and gives us back normal glycemic response without any work. It’s going to take a while before we have replacement beta cells that don’t die . . . or CGM sensors that are accurate enough to make life and death decisions without our input . . . or control system algorithms that can handle all of the crazy variables that go into blood glucose.

So I think we’re on our own for a while longer, and we will need devices that help us make better decisions. I’ve said it before: we generate so much data that never gets used, and I’m sure that device manufacturers could build more decision-support, trend-spotting, and CDE-like functionality into our devices. And these devices should all talk to each other using standard, open protocols (like ANT+) so that they can integrate with all kinds of other devices—like my Garmin bike computer or running watch—and third-party software, which I would totally write if it were easier to get at the data.

Ideally, these decision-support systems would remember what’s happened over a long, ever-growing history, know what’s happened earlier in the day, and give suggestions about what to do next. The less work that I have to do the better.

Posted in Data-betes, Diabetes, Diabetes Blog Week | 3 Comments

A Nice Day for a Ride

Posted on April 21, 2012 by Jeff Mather

Another week. Another two-part long bike ride. Another additional 10 miles.


It’s a little hilly where I live.

I’m getting a lot more confident on my tri-bike. In fact, I feel good enough to eat a bit while riding . . . and play drinking games. Okay, it’s actually a technique I’m using to remember to drink more water. Every time I get out of aero, I drink. It seems to be working, except that it’s at odds with my effort to stay in aero more. (Clearly, I need to get one of those bottles that mount between the aero bars and let you drink via straw without using your hands.)

Diabetes is playing well on these early morning rides. (Not so much during my after-work outings . . . or much of the rest of the time over the last couple weeks, but it is what it is, and I’m trying to make it better.) Today I turned down my basal to 60% of normal, ate a carton of Greek yoghurt before heading out, ate 25-35g of carb every 35-45 minutes, and sipped on Gatorade during the second part of my ride. Last week was almost perfect, ending almost exactly where I started and being consistent throughout. Today, my first two hours were very even at 150 mg/dL (8.3 mmol/L), and then I dropped to 110 over the next 1.5 hours.

Next week: more practice, more distance, and more tweaking.

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

Long Run

Posted on March 12, 2012 by Jeff Mather

Yesterday, I did my last long run before I run Around The Bay (ATB) on the 25th. I think I’m as ready as I can be.

What a difference a week can make. Last Sunday I headed out to do the same 14-mile route, but I didn’t make it the whole way. After running five miles on the increasingly snow- and ice-covered trail, I was tired and starting to feel a new pain. [1] After another four or five miles of slower running and a few unsuccessful attempts to stretch it out, I decided that discretion was the better part of valor and just packed it in.

By contrast, my run yesterday started with me wearing shorts and being helped along the trail thanks to a decent tail wind. I had a plan, too. My goal was to run in the neighborhood of 8:30-9:00 per mile and keep my heart rate right around 150 BPM. Every few minutes I told myself, “We are going to take this easy. We are not going to be speeding up to catch people.” And for the most part that worked. When I got to the high point of the route at mile six, I was still feeling really fresh. In fact the first 10 miles were pretty easy.

When I turned into the wind in the 10th mile, I started thinking about ATB even more. Scully told me about how the hills on the course are packed into the last 10+K. I slowed down because of the wind and then a bit more as I started going back uphill toward home. I figured this is how ATB would be as well.

Yesterday was something of a practice run for ATB. I wanted to see how my muscles and joints felt after a few difficult months of injury and rebuilding: Everything felt fine. I hoped to get a sense of where I was with my conditioning: I’m not the fastest I’ve been in the last couple of years, but I’m pretty sure I can go do the distance. I wanted to work on my pace: I held back and averaged 8:50/mile and 150 BPM over the 2:02 of running 14 miles. Diabetes? I started at 118 mg/dL and ended at 113. Woot! [2]

My fourteen miles yesterday were also the longest I’ve run. Ever. I had hoped to be running closer to the 18.6 miles of the race by this time, but this is as close as I’m going to get before race day. I know I can do the distance, but I wouldn’t mind knowing what those last 4.6 miles are going to feel like when I’m already tired. I’m excited to find out.

I’m also very, very eager to meet Céline and Scully. They talked me into doing this race, and to be honest, meeting them was a much bigger draw for me than the race itself.

Next stop: Hamilton, Ontario.


1 — The butt bone connected to the hamstring bone connected to the calf bone connected to the foot bone. Or something like that. Suffice it to say, they all hurt last week . . . except (ironically) my foot. I suspect I need to work on strengthening my stabilizing muscles.

2 — Temp basal of 80% starting an hour before I started. A Greek yoghurt (20g of carbs) about 10 minutes before I started. A couple of glucose tablets to give me an initial bump. An energy gel every 40 minutes. And 16 oz. of water every hour. Let’s see if I can bottle the magic of yesterday’s run.

Posted in Data-betes, Diabetes, Running | 3 Comments

Logging for Lent

Posted on March 7, 2012 by Jeff Mather

I’m not Catholic. Well, not anymore. I was once—briefly—but that’s a long story for another time. Nevertheless, I like Lent.

A major aspect of Lent is becoming a better person, which doesn’t necessarily mean giving something up. (I did give up TV for Lent in 1991 and ended up missing the entire ground portion of the First Gulf War. True story.) Instead I see it more as a chance to make or break habits.

This year, after many years of not observing Lent, I decided to record my blood glucose readings, boluses, and other major diabetes events for the 46 days from Ash Wednesday to Easter. I hesitated to mention my goal here earlier when it would be possible to bail, but today is the 15th day, and I feel like I might be able to keep it going.

Tomorrow, my endocrinologist and I will discuss my recent 7.3 A1c—Yay!—along with rest of my diabetes self-management. She likes to see my BG readings in a particular format; it isn’t my preferred style, but having all of the data recorded on paper will certainly help me tonight as I prepare for tomorrow.

Personally, I feel motivated to use this data to spot (and fix) some trends using the data. I don’t really enjoy journaling much at all, and if I’m going to take the time to do this, I’m going to make the most of the experience.

Only 31 days left!

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

7.3

Posted on March 3, 2012 by Jeff Mather

Let’s cut to the chase. My most recent A1c—7.3—is the lowest I’ve had since 2007. That’s fourteen blood draws.

Yay!!

Posted in Data-betes, Diabetes | 3 Comments

Closing the Books on November

Posted on November 30, 2011 by Jeff Mather

Here we are: November 30th. The last day of November. The last day of post-something-everyday month. I feel this year’s NaBloPoMo has gone better than last year’s, and I’m thinking about some possible tweaks for next year. Maybe I will take a little hiatus starting tomorrow, using the time to read books on my reading list and further purge the office of mental baggage. We’ll see when I’m moved to post write something new next.

One thing I had hoped to do a month ago was to clear out a bunch of the things I had in mind to post. I posted roughly half of them. Yay! This dispatch aims to tidy up some loose ends. It will probably be long, and it might be rambling. Beware! If anything turns out to be just a bit too long or important, I’ll break it out into its own post.

It’s a good time to clear the decks. Lisa is out for the evening, I’m streaming a concert by Cœur de Pirate (mp3), and I’m in the mood to write. In fact, I’m in the mood to do just about anything to take my mind off the fact that I’m basal testing and have to skip dinner. Fortunately, at lunch I had some of the very delicious Comté cheese that we bought in Montréal last weekend; I hope that it will fortify me for another four-or-so hours when I can eat a very late (10PM) dinner.

Oh, one more thing before I get going with the things I had intended to write about. I’ve been listening to (and loving) the new album by Caracol. Unfortunately, it isn’t available in the US yet. (Next year, she hopes.) But you can stream the tracks from the web site. It’s so good! In my book, it’s one of my Top 5 for 2011. Go check it out and tell me what you think and what albums/CDs/whatever you really liked this year.

On with the show.


Basal Testing: I hate basal testing. I don’t think anybody who uses an insulin pump likes to do it. Why would we? It involves eating a normal meal, waiting at least three hours since the last insulin bolus, skipping the next meal, waiting 4-6 hours after the normal meal time to eat again, and recording blood glucose every two hours (or so). And that’s just during the daytime. At night, the requirement is to go to bed without a snack and then wake up at 1:00 and 4:00 (for example) to test.

Ideally, you see an awesome, tight range of numbers that make you feel confident that your basal (background) insulin rates are correct. But if there’s too much movement one way or another, you have to stop. This means you get to eat early, but it also means that you have to make an adjustment in the pattern and then run the test again on another day. Plus, who actually does a basal test when everything is going right? No one except crazy people. No, you only do a test to figure out what is going wrong.

But in October I decided to bit the bullet and get my all my basal rates as correct as they can be. I was noticing a lot of trends in my CGM graphs and decided against just making changes willy-nilly. I still suspect that most of my problem is under-bolusing for meals, but I can never know without checking that the basals are correct first.

One big problem with basal testing is each day is a big ole cycle that leads straight into the next. Where do you start? Some people say, “Overnight. Get that right and then you can start your march through the day.” Maybe for them. My evenings are cray-cray, going high after my after-work training and then bouncing around after dinner before I give myself my final “well, I’ve messed up today pretty good” insulin and/or snack before bedtime. That makes overnight testing difficult.

For me, it’s been easiest to find a few mornings that seemed designed for testing—in-range BGs, flat/normal CGM graphs overnight—and skip breakfast. Then I tested my breakfast bolus ratio and timing. Then I skipped lunch for an afternoon basal test, followed by the lunch bolus test. And now here we are at dinnertime without dinner. Once I’m done here I can figure out a rubric for my afternoon/evening workouts and test that before taking a stab at dinner and (finally) the overnight basal.

One hard question I’ve had to answer is whether to exercise on days when I do basal testing. Since I train 5-6 days each week, I feel okay skipping one for the greater good. But then there’s the admonition that you should do what you normally do, which for me means exercise. Today I skipped a bike session in the basement, which is “okay” since I swam this morning, but it’s also torture because I really, really want to ride my new bike. Greater good.

By the way, to any CDEs, endos, etc., who might be reading this, please note: I’ve been on the pump for over ten years, and this will (hopefully) be the first time that my basal rates and bolus ratios are correct/proven. If you’re going to put someone on the pump, you need to (a) make sure y’all work together to get the settings locked down from the start, and (b) work on all of the behavioral issues that come along with multiple daily injection (MDI) therapy. Just saying.

I just hope that when I get through with this process, I’ll be able to translate all of this hunger into a baseline for making amazing observations about exercise+insulin+food.


Three hours to go.


Organized Bike Touring: I was asked several times right after my trip (photos) whether I would do another organized bicycle trip. Most of the people on the tour had done several already and were talking about which one they would do next. I always played coy. “Maybe.”

I enjoyed myself quite a lot. The scenery was great. I really enjoyed spending time with Mom in France. My fellow travelers were wonderful. The tour leaders were fantastic people. It was terrific having so many details taken care of; all I had to do was get on my bike and ride. And there was plenty of time to do things other than cycling.

But two things brought me down. (1) I wish there had been more actual riding. I could easily have gone an extra 20-30 miles most days, and I wouldn’t have minded a slightly faster pace. I certainly wasn’t expecting a race or even a hard ride each day, but I think the tour company we used was aiming at a more casual riding experience . . . which is totally cool, if that’s what you’re after. No judgement from me. Honest. And (2) Lisa wasn’t with me. I was having a great time doing and seeing interesting things, eating delicious food, and going to beautiful places that she would have also loved . . . just without the bike.

If only there were a way to bring Lisa, a noncyclist, along on a trip that involves some (longer distance or more intense) bicycling. Oh wait, maybe there is! Clearly it involves bringing a larger group of friends to France, some of whom ride and some who don’t. We’ll see what happens in a couple years. :^)


Two and a half hours . . .


Occupy This! will be posted tomorrow.


Two hours to go.


iOS v. Android: I have an iPod Touch. It’s great. I have all sorts of useful apps, and I use it all the time. It syncs with my Mac apps, including iTunes. It doesn’t make phone calls.

I have a Google Nexus One phone. It has a nicer-than-the-iPod’s input editor coupled with its not-quite-as-nice touchscreen keyboard. It has a couple of apps that I used when I was in France, only one of which was not already on my iPod. It kind of plays music. It shares data with “useful” Google apps on the web. It makes phone calls, is unlocked, and accepts normal SIM cards like the one I bought in France that let me call home at 4¢/min. (No shit! 15€ gave Mom and me so much talk time over two weeks that we had a bunch left over when we returned home.)

I wish I had a mythical, nonexistent, unlocked iPhone that supports pay-as-you-go and takes regular SIM cards. That would be perfect.


Are we there yet?


Before There Was Facebook: A Short, Subjective, Incomplete Insider’s History of PlanetAll will be posted Friday.


Almost there! By the time I write one more and then proofread, it should be “dinner time.”


Cyclocross: Early in the month I had thought about writing about how I was considering cyclocross as an off-season pursuit. But then I saw one and decided that it looked painful (and not in a fun kind of way). Although this did make me laugh.


Yay! I made it! I did my proofreading, took one more BG test, and had dinner while chatting with Lisa, who just arrived home. The results are mostly good news: I was incredibly stable until 9:00, at which time I started to drop slowly but steadily. That happens to be just an hour after my basal rate kicks up from 0.4 u/hr to 0.7 u/hr. That hardly seems like a coincidence.

Posted in Cycling, Data-betes, Diabetes, General, MetaBlogging, NaBloPoMo, NaBloPoMo 2011, Travel | 2 Comments

Heart Rate Training?

Posted on November 29, 2011 by Jeff Mather

How do you get faster at any endurance activity? Ironically, you get faster by doing it faster than usual. If you run every run at one pace or do every ride at the same tempo, then you’ll never progress. You can only build up so much aerobic capacity, since you can only move so much blood and oxygen around. What you need to do is to work harder so that the muscles themselves are stronger and capable of giving more.

My running plan includes plenty of tempo running and interval sessions. And I’ve finally gotten to the point where there’s “normal swimming” and “harder swimming.” But how do I know how hard to work when cycling?

I think the answer is heart rate training, which is new to me. Have any of you had success doing this?

I’ve figured out several of the basic calculations based on my computed maximum heart rate (183 bpm) and resting heart rate (52 bpm). According to an online calculator, these are my target heart rate zones:

Zone 1: 118-131
Zone 2: 131-144
Zone 3: 144-157 (Aerobic)
Zone 4: 157-170 (Anaerobic)
Zone 5: 170-183 (Maximal)

Now, where do I go from here?

Posted in Cycling, Data-betes, Fodder for Techno-weenies, NaBloPoMo, NaBloPoMo 2011 | Leave a comment

Titration

Posted on November 20, 2011 by Jeff Mather

titration: (noun) the process of gradually adjusting the dose of a medication until optimal results are reached.

I remember doing titration in high school chemistry class and not really enjoying it. You wait and wait and wait for something to happen while adding more and more and more reagent to a flask in the hopes that it will turn a pretty color. Or rather, after a game of rock-paper-scissors, your lab partner adds the reagent to the flask while you write down measurements and try to stay awake. Even though I loved learning about chemical reactions and trying to recreate some of them at home—how did I not burn the house down playing with purloined magnesium tape?—I think the titration lab was the one where I realized higher-level studies in chemistry weren’t for me.

It feels so similar now as I try to titrate the correct dosage of insulin to give when I exercise. It’s still the process of running multiple experiments involving adding a known amount of chemicals—in this case food and insulin—coupled with a lot of record-keeping. The big differences of course being that (a) I’m the flask to which the chemicals are added, (b) I have to wait a week between experiments, and (c) there are reagent strips I use with my blood glucose meter that together tell me the values and keep track of them for me. And, of course, the really big difference: If I mess up the experiment too badly I can’t just poor the contents of the flask down the lab desk’s drain.

After all this time, I still don’t really like titrating—it’s scarier to mess with insulin than it is to burn magnesium tape—but I also don’t like these other things when I’m training:

  • being hungry
  • running out of energy
  • experiencing hypoglycemia
  • having high blood glucose
  • not knowing what’s going to happen

Unfortunately, in this lab experiment, each apparatus person with diabetes is different. Otherwise I would just ask my awesome internet friends. Even I probably won’t give the same results from one week to the next. That being said, last week’s experience of going way up during the first 45 minutes of my long run and then holding steady for the next 45 minutes (eating beforehand and along the way) was the same as today’s.

Next long run (in two weeks) I’m going to add some bolus insulin and see what happens. I’m going to start minutely small and go from there. I have about sixteen weeks until Around the Bay, and I don’t feel any particular need to approach the problem via bisection. I’ll just use the normal titration method, starting small and gradually adding more until I find the “right answer. . .” or something near it.

Today’s run was actually quite good, elevated BGs notwithstanding. The weather was beautiful in the Bay State this weekend, and I got up early enough that I didn’t feel rushed to get home before we went to see the film “Martha Marcy May Marlene.” (It’s good, but bleak. Wicked bleak. “Winter’s Bone” bleak. Life lesson: stay away from John Hawkes.) I picked the 10-mile loop with three mile-or-longer hills, and I threw about fifteen minutes of tempo running into the middle of it. I figure I’ll gradually keep adding longer stretches of high intensity as I add more distance.

And Tuesday I’m going to see a guy about a bike.

Posted in Data-betes, Diabetes, NaBloPoMo, NaBloPoMo 2011, Running | 1 Comment

3600 Yards

Posted on October 24, 2011 by Jeff Mather

Here’s a quick update about yesterday’s race: I’m a bit sore.

Was it the lack of arch support in my spikes? The dehydration? Maybe the exertion of running three miles before digging deep to find a kick that helped me pass five or six people in the last tenth of a mile? (I forgot to put that into my “Snap out of it! You should feel good about your race” calculus last night.) Who knows for sure? Not me. Whatever the cause, it’s here—slight, but here.

When I got out of bed today, my first thought was (as always) “OMG, it’s early!” The second was that I’m glad today is a swimming day instead of a running day. There was the aforementioned (mild) soreness, and also I knew I wasn’t going to run after work, since we have a customer visiting from 6:15 to 8:15.

When I realized on Friday that I was going to work later, I decided that I would also go to work later. This presented me with an opportunity: swim extra long. Most Monday, Wednesday, and/or Friday mornings, I swim for about thirty to forty minutes, starting at 5:45. Despite my early departure, the pool is open until 7:15. The longest that I had ever swam before was back when Lisa and I would swim for an hour on Saturday afternoons, but that was a while ago. I decided to see how far I could swim in an hour and a half.

Actually, my goal was to see if I could swim two miles. I had swam about 1.25 miles before, but most of my swims are about a mile. One day at the reservoir, somebody sprang the idea of swimming an extra mile, doubling our normal route. I really wanted to take them up on the offer, but I wasn’t ready. Physically I knew I could probably do it, but I was worried about the diabetes part. I didn’t have extra snacks with me—though I usually carry a gel or two in the ankle of my wetsuit—and I didn’t know what my blood sugar was going to do on a swim that long. I declined; September came around; it got colder, darker, and rainier; and I thought my chances were gone until next summer. Then today came along!

I was also going to use this swim to see what happens to my blood sugar on long swims. I brought a small chamois towel to dry my hands and my “exercise” meter with me onto the pool deck, along with a bottle of water. (Swimming is thirsty business.) A half hour earlier I had turned my pump down to 0% and eaten an obscenely large banana. At the time, my BG was 121. (Yay!) Half an hour in, Lisa had to leave to go to work. I took a break, gave her a goodbye smooch, drank some water, and tested: 161. (Yay!) Another half hour later, at around 1.25 miles, I tested again: 115. (A bit of a drop, but . . . Yay!) Finally, at 7:15 I stopped, looked around, saw that I was the last person in the pool, and tested: 120. (Woo-fucking-hoo!) When you take out the time when I was testing, I swam 2 miles in 1:21. And I did it all while rocking the happy BGs.

What a difference a day makes!

I’m still not a very graceful or efficient swimmer. I’ve swallowed my pride and started doing a few drills from the Total Immersion system, and I can start to feel a few changes coming on. In particular, I’m trying to be more of a “front quadrant” swimmer. Instead of being a whirligig-like wind-up swimmer with windmilling arms, I should try to keep one hand out in front of me longer. Lengthening out my body should help keep me streamlined and tilted correctly in the water, and I can already feel it starting to change where my power is coming from, as it moves from just my shoulders to include my core. It’s slow going, making these changes. I’m glad I have the rest of the winter to work on my form.


p.s. — My Internet-friend—hopefully one day my have-met-in-real-life-friend—Céline has been swimming a lot lately. It’s fun to watch someone have many of the same experiences that I’ve had.

Posted in Data-betes, Diabetes, Life Lessons, Running, Swimming | 3 Comments

Things You Should Be Reading

Posted on August 12, 2011 by Jeff Mather

Hey, everybody. It’s that time again. The time to clean out a bunch of links that I’ve read and share them with you because I think you might find them interesting.

Posted in Computing, Cycling, Data-betes, Diabetes, Software Engineering, Worthy Feeds | 1 Comment

My Insulin Pump Hacker Name is “Glux0se”

Posted on August 10, 2011 by Jeff Mather

Victoria wrote an excellent piece on her site about what’s become known as “pumphackingate.” In it, she gives a brief recap of the facts and some of the reactions that have appeared on other blogs. Here’s an even briefer recap, in case you don’t know anything about it: Some hacker/builder dude created a device that can control some insulin pumps remotely along with gathering data from them. Based on a comment I left over on Victoria’s site, here’s my take on the issue.

First off, I’m not surprised. Like any device that transmits and receives wirelessly, the signals from pumps and CGMs are interceptable. Furthermore, like any other device that communicates with limited access control—you just need to know (or sniff out or be able to guess) the six or seven digit code that’s used to connect with another device—they’re essentially open. From there it’s all just figuring out the protocols and the format of the data as it’s passed around. As someone who spent about ten years working with and occasionally reverse-engineering formats, I can tell you, it’s all just a matter of trial and error and careful observation. (If I were a hacker, my handle would be “gluX0se.”)

So, in a world where relatively few people have these medical devices—unlike, say, mobile phones or bluetooth devices—the device manufacturers essentially did the easy thing, which was to assume we use our medical devices in a trustable world where people don’t mess with medical devices. (BTW, who knew there was a free Vulnerability Management for Dummies e-book?)

There’s been a lot of unease in the community about the way that the information was presented to the press and the way that some outlets sensationalized it (e.g., “Black Hat: Lethal Hack and wireless attack on insulin pumps to kill people”). It’s hard not to agree with a lot of the criticism there. But I can’t criticize looking for security holes in medical devices. Nor can I fault the impulse to hack into own’s own medical device—even one that keeps people alive—or to help other people hack their devices. Not all hacking is scary villainy, but this incident certainly exposes some problems.

Using the AP to share this information leaves a bad taste in my mouth, but presenting the findings at the Black Hat Conference seems like the most appropriate way to publicly disclose this research. (And it is, in my mind, legitimate personal security research that should be shared openly.) I would have preferred that Radcliffe work more closely with the device manufacturers leading up to the announcement. (I’m assuming that he did not.)

On the other hand, just presenting the findings to the device manufacturers—as some would have liked—violates the hacker ethos, both the black hat and white hat versions. Part of hacking—the part that I can get down with—is when motivated hobbyists exploit technology to solve a problem (real or imagined). I have thought many times how great it would be to sniff the unprotected data that’s transmitted by my pump/CGM and skip the middleman of uploading data to a web site. I’ve even gone so far as to seek out the information that Radcliffe presented, but it wasn’t available at the time.

Device manufacturers limit our access to our own medical data and tightly control the way that we can interact with our devices. It’s understandable given the limitations put on them by the FDA, their own desire to help (not harm) customers/patients, and their lawyers’ desire to limit risk exposure. It does mean, though, that the enormous potential for third-party, patient-focused tools goes untapped. Those tools could benefit so much from being able to present data the way that their users want to see them: A dashboard light in a car, a desktop computer widget that display CGM values, a mobile app that records all of the data for later use, a device that calls parents of children with diabetes when something happens, an awesome mood ring displaying BG, etc.

I suspect (and once again I’m assuming here) that Radcliffe was intrigued by the rather obvious possibilities of unprotected communication, and that’s getting lost in the whole “malicious people ruining diabetics’ lives” reporting. I fear the notoriety this incident is garnering is going to scare manufacturers into closing exploitable security holes without providing a secure, replacement method for getting at all of that data. And that’s a shame.

Posted in Computing, Data-betes, Diabetes, File Formats, Fodder for Techno-weenies | Leave a comment

Exercise Data

Posted on August 4, 2011 by Jeff Mather

I mentioned last week that I’ve been journaling about exercise for over a month now. With all of that data—over forty events—it’s finally time to sift through it for patterns, to see what worked and what didn’t, and to come up with a new round of “experiments” to do as I swim, bike, and run.

So, into Microsoft Excel it went. After sorting and grouping the data, here it is:

Diabetes Exercise Data

Believe it or not, I am really more of a narrative person than a numbers person, and I already worry that looking at the data this way will obscure other important details or magnify the importance of data over context. (That’s actually why I hate the way many endocrinologists approach diabetes management, though I understand why they do it that way.) Nevertheless, I hope this different view into the last five weeks will illuminate trends. We shall see what comes from all of this.

Posted in Data-betes, Diabetes, From the Yellow Notepad, Life Lessons, Reluctant Triathlete | Leave a comment

Write This Down

Posted on July 27, 2011 by Jeff Mather

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

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

Posted on July 5, 2011 by Jeff Mather

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

The Test Strip Rebellion

Posted on April 6, 2011 by Jeff Mather

The “test strip rebellion” is a grass-roots movement to access our health data from our diabetes self-management devices: meters, pumps, CGMS, online apps, etc. It’s our data, and we’re going to take it back . . . one way or another.

Stay tuned.

Posted in Data-betes, Diabetes | 1 Comment