Category Archives: Diabetes

Siri, Tell Me about the Ultimate Diabetes Device

Posted on May 20, 2013 by Jeff Mather


Diabetes Blog Week is technically over, but I still want to write about one of the topics: my dream diabetes device.

I — In the past I’ve written about wanting an application that integrates all my current diabetes paraphernalia, my Carelink account, and my mobile phone iPod. The goal was to have total diabetes awareness by tagging “interesting” events so that I can go back to the historical record the next time that thing occurs. “When I was sick how much extra insulin did I need to give?” “When I ate Indian food, what was an appropriate amount of insulin and how did I deliver it?” “What basal rates and carb amounts worked well for a triathlon?” Ask one of these questions, and see the BG values, bolus wizard details, and CGM traces for all of the events tagged with those keywords. It wouldn’t be a perfect solution to preventing all lows and highs, but it would surely be better than my own faulty memory.

I actually started writing the application and got all of the data into a MacOS application, but I got frustrated that I wasn’t going to be able to easily get the data from my computer onto my mobile device. So, as usual, I set it aside and got distracted by something else. That was a couple years ago. Since then iCloud came along and makes sharing this kind of data between devices much easier. Maybe someday—after I win the PowerBall lottery, perhaps—when I have limitless time and ambition, I will pick it back up. Or (better yet) I’ll become a venture capitalist whose first project is to fund the development of such an app. That way I can travel the world while other people do most of the coding for me. I’ll show up for design reviews to give insightful commentary and gather information for my TED talks.

II — Recently I’ve started working on another diabetes data project. Now that I have a newer Mac, I can run MATLAB again. Yay! It occurred to me, after reading a coworker’s at-work blog about telling stories with MATLAB, that it should be possible to integrate a lot of the disparate sources of data into one application (MATLAB) and try to reconstruct a day with diabetes and try to figure out a partial model for some of the stuff that currently requires a lot of trial and error. It’s not a perfect solution, but it’s a start.

The thing that makes this all possible is the fact that so many of the devices I use every day record and export data. My cycling GPS and Garmin running watch tell when I exercise, for how long, and at what intensity. My CGM records my blood sugar patterns, while my BG meters record the ground truth. My insulin pump tracks my basal insulin usage and all of my bolus wizard details, along with a host of other details. There’s a lot of data there that I can potentially synthesize and display in one view. And, because it’s MATLAB, I can define every last little thing about how I want the information displayed, what details I want to filter out, and what I want to try to highlight or search for.

III — But even with all of this data there are missing parts of the picture. Diabetes is a difficult disease to manage, in large part, because it’s integrated with almost every other part of life. Unfortunately, daily life is messy. There’s a lot of it that just isn’t easily tracked by devices—well, not yet. I’ve toyed with the idea of getting a FitBit device to keep track of some additional things, such as overall activity and sleep, but that still leaves a lot of things untracked, especially food: food that I don’t bolus for, such as glucose tablets, food during exercise, “just in case” snacks, the things that seem too small to worry about, etc. And then there’s swimming, stress, pain, illness, hydration, weight, and so on. I wish there were a way to keep track of all of that. (At least for a few days or a couple weeks while trying to figure out appropriate baselines or when changing my training load. Paying attention to all of that data every day could be a bit overwhelming.)

So I asked one of my bildr/maker-type friends if there were good hardware or software solutions for keeping track of any of this stuff, especially the food-related bits. There are hundred (if not thousands) of nutrition apps, but all of them I’ve seen are much more heavyweight than I want. Don’t make me select something that says which food I ate in order to give me all of the nutrition info or calorie count when all I really want to record is “At 11:25AM (give or take) I ate 15 grams of carbs that I didn’t bolus for.” The best that we could come up with at the time is a small notepad and pen to record stuff before transferring it manually into whatever computerized, MATLAB-based system that holds all of the other diabetes events.

Thinking about it on a bike ride a couple days later, it seems like it should be possible to have a little nanny app that pops up a few times a day asking questions. How is everything going? What time did you wake up this morning? How much sleep did you get? Feeling stressed? Eaten anything you didn’t bolus for in the last day that we haven’t already talked about? Do any swimming or yard work? How active have you been this afternoon? Any pain? Illness? Have you been drinking water?

Just a few judgment-free yes/no questions and easy-to-answer questions involving time and quantity, and voilà! instant context. I could probably make an iOS app to do that in a weekend (if I didn’t mind it looking crappy). But really that’s all of the data that my devices don’t give me now that I want to capture. Oh, and it should have a one-touch switch that turns it off so that I’m not bothered during the 95% of the year that I don’t want to keep track of all that stuff.

IV — As an aside, wouldn’t it be awesome if someday there were a Siri-like interface for diabetes?

“Hey, Siri. Remind what I did those times that I had barbecue at the office and everything went pretty well?”

“You estimated you ate 100 grams of carbs. You delivered ten units of insulin in a dual-wave pattern with two-thirds up-front and the remaining third over an hour. Here’s what your CGM trace looked like for the next six hours.”

“Thanks, Siri. I love you.”

“Hey, let’s keep things professional. I’m not that kind of robot.”

“Sorry, girl.”

“It’s cool.”

V — But all of this “Total Diabetes Awareness” and data fusion and mindfulness/memory apps got me thinking that the ideal diabetes device system is one that wraps all of this up. It automatically keeps track of activity and food and active insulin and BG/CGM values and all of the other emotional intangibles.

But then I thought, keeping track of all that data in order to make better insulin dosing decisions is 20th century thinking. What I really want is a system that automatically regulates BG levels using two hormones, one that lowers blood glucose (via insulin) and one that raises it (via glucagon). Then the system can reach homeostasis all on its own.

Of course, an artificial pancreas that integrates everything together in a closed loop system needs believable inputs. BG meters and (especially) CGM sensors need to be much more accurate so that the system is given the right data to make the right decisions. It’s a bad thing when my CGM says I’m 40 mg/dL (2.2 mmol/L) when I’m really 140 (7.8) or, worse, vice versa. So obviously, an artificial pancreas that’s actually implanted and uses a semi-permeable membrane that lets more insulin seep out when it’s needed is the way to go.

And that’s when I realized the basic truth of diabetes technology: The ultimate diabetes device is a new pancreas.

Posted in Data-betes, Diabetes, Diabetes Blog Week, Fodder for Techno-weenies, Life Lessons | Leave a comment

Gran Fondo

Posted on May 19, 2013 by Jeff Mather

I was hanging out in the middle of the pack about 85 miles into the North Shore Tour de Cure “gran fondo” feeling a bit out of it. I was hanging on to the rider’s wheel ahead of me, but it felt harder than before, and I could hear the world buzzing around me.

Losing my background noise filter frequently is a sign that my blood sugar is going low. I had been hanging out around 200 most of the ride, but I gave myself a minuscule amount of insulin at the previous rest stop since I hit that magic number where, even on a ride, I feel like I need a little something extra to help my body use the food that I’m giving it. Actually being low seemed unlikely, but I’ve seen my blood sugar move a lot in a short amount of time before. If we weren’t going so fast and riding so close together, I would have checked my BGs, but I worried about popping off the back of the pack and being caught in no-man’s-land. Plus, I didn’t really think I was low.

It was also entirely possible that I was at my limit, with or without diabetes. We had already gone 25+ miles farther than my previous longest ride of the year. I’m a firm believer that if you can ride sixty miles, you can ride 100 miles; it’s just a matter of how fast you can go and how you feel at the end of the day. I could go 100 miles for sure, but how was it going to feel? Early on, I realized today was going to be different than my Tour de Cure century last June, which was a leisurely gabfest and sightseeing jaunt with Scully. Unlike that ride, at the eighth mile of this ride there was a two-mile time trial that showed that the people I was riding with weren’t afraid to throw down. In fact, it felt just like triathlon, except faster and without my tri bike. (I kept thinking, “Well, there’s a drafting violation,” before remembering that it was okay today.) About a half-hour later, when heading out of the first rest stop, I managed to get on to the front of the pack and drag everyone five miles to the start of the timed hill climb. Needless to say, it wasn’t my best effort.

That categorized climb was 55 miles earlier. Since then, we had ridden almost another three hours, averaging just under 20 miles per hour (32 km/h). I spent those three-ish hours watching the rider ahead of me—taking care to stay close (but not too close) to his wheel—and checking the road for hazards and turns, which I pointed out like a good pack rider. During those 55 miles I worked on using just the right amount of energy to stay close to the person ahead of me without overdoing it and needing to move out of their slipstream to slow down or (horror!) touch the brakes and then pushing hard to stay on their wheel when I relaxed too much. Power up; power down; power up; power down. And then throw in a hill to cause a ripple through the pack as we all stood up and seared our quads to keep up with the person driving the pace. [1]

I was struggling a bit, but I didn’t want to be that guy. This was a Tour de Cure—which nominally meant that it was a ride to help people with diabetes—but most of the people in the gran fondo were treating it as just another organized ride. Unlike last year’s ride, there were many fewer Red Riders on the long ride, and most of the people we passed didn’t give the typical “Go, Red Rider!” cheer. No one asked anything about diabetes, and when I asked what people’s connections were to diabetes, the answers were vague and almost apologetic. [2] I was torn between wanting people to understand how difficult diabetes can be sometimes and how much people without diabetes take for granted and not wanting to use diabetes as any kind of excuse for anything unless I’m actually in a hypo-induced stupor. I was determined to be the strongest guy with diabetes on the ride and to challenge any lingering misconceptions about our abilities.

So when we rolled into the last rest stop fifteen miles from the finish, I tested my blood sugar, saw that it had dropped more than 80 mg/dL (4.5 mmol/L), ate four glucose tablets and a PB&J sandwich, and mixed some Skratch mix into my water bottle. I wasn’t hypoglycemic, but I had dropped enough (as I had suspected) to feel it and to need to prevent falling at the same rate for much longer. I put another banana into my back pocket to replace the one that I had bobbled and almost caught before losing it at 30 mph earlier in the ride. I took a quick picture with my camera for posterity and then headed out with my adopted group.

A few miles later I was feeling back to my perky self. All of the work I had put in so far was still dragging on me, but I noticed that the miles seemed to tick down a lot faster than just a bit earlier. We also started passing a whole bunch of Red Riders now that all of the routes were sharing the same road near the finish. One of the guys from the small Blue Cross Blue Shield team rolled along side me.

“Hey, Jeff. How would you like to lead us all in when we cross the finish? I mean you’re a Red Rider, and it just seems right.” I was genuinely touched, and the message rippled through our now much smaller group of about a dozen riders.

I knew that if I was going to lead people in I was going to make sure that I did a pull on the front so that it wasn’t just a ceremonial gesture. The last three miles were great! I put my head down and churned out a consistent 20 mph pace, just slightly faster than our 19 mph (31 km/h) pace for the entire ride. My body felt the best that it had all day. When we were stopped at the intersection just before the finish line waiting on the police officer to stop traffic for us, there were compliments and handshakes all around. I like to think it was because I survived their out-for-blood, keep-up-or-ride-by-yourself club ride, instead of just having a really good pull for a guy with diabetes.


1 — I need to more of these hardcore training rides. I think it would make me a much stronger rider. [back . . .]

2 — There was a whole lot of “My mother-in-law/father/aunt had diabetes.” Always in the past tense. Some of the people I talked to were (admittedly) a bit older, but many were my age or younger. Clearly, there’s a need for much better information about diabetes and how to live with it successfully so that there’s less past-tense and more present-tense. And there’s also a tremendous need for research funding and advocacy so that there are more people living without diabetes. And that, dear readers, is why I was at today’s ride. [back . . .]

Posted in Cycling, Diabetes | 2 Comments

I Want that other Kind of “Diabetes”

Posted on May 17, 2013 by Jeff Mather


Diabetes Blog Week gets a little freaky this Friday . .  and frankly a little uncomfortable if taken seriously. “If you could switch chronic diseases, which one would you choose to deal with instead of diabetes?”

Comparing chronic illnesses and wishing that you had a different one is a fool’s bet. At worst, you show yourself as failing to understand how difficult another person’s illness is. At best, you still have a chronic illness! You will still need to take medication or be watchful and worry about when your illness will turn more serious.

Instead, I’d rather have the kind of diabetes that some people think I have. No, I don’t mean the diabetes that people believe means I can’t eat delicious things with sugar. Nor do I mean the one that leads people to think there are things in my life I can’t or shouldn’t do. And it’s certainly not the kind of diabetes that somebody’s aunt “who didn’t take care of herself” had before she went blind, lost her feet, became impotent, had a heart attack while on dialysis, and died. (All of those things are no laughing matter, of course, and can happen to anyone, no matter their A1c.)

No, I wish I had the “easy” diabetes. That’s the kind of diabetes where insulin is a cure, where having a pump means that I can do and eat whatever I want without worrying about anything, where using CGM lets me test my blood just once a day, and where “following the rules” puts my A1c instantly into the non-diabetic range. It’s the kind where following a low-carb diet, making out with Halle Berry, or eating cinnamon makes your symptoms completely disappear. It’s the kind of diabetes where simply preparing a few recipes from a “diabetic cookbook” is enough to ensure perfect glycemic control. It’s the same kind that is already cured in mice, and the same cure would be ready for me in less than five years. This diabetes uses technology and medication which are so inexpensive, easy-to-use, and reliable that the artificial pancreas is a flawless cure. It the kind of diabetes where islet cells are readily available for transplantation, anti-rejection drugs are foolproof, and medical professionals and drug companies provide everything pro-bono.

Obviously, this “diabetes” doesn’t exist at all, but, believe it or not, I’ve actually heard or read all of these things before. It sure would be nice if any of these were true, though. Some of them may eventually come to pass; I really do hope so. Others—like making out with an Oscar winner—probably will be just as mythical as any kind of “easy diabetes.”

So, I’ll be keeping this chronic illness instead of trading it for another. Besides, I have plenty of work left yet to figure out this one.


p.s. — Just in case you missed it, when talking about a mythical, nonexistent “easy diabetes,” I certainly don’t mean type-2 diabetes. That variety is just as hard in its own way as any other chronic illness. Don’t forget what I said in the first paragraph.

Posted in Diabetes, Diabetes Blog Week | 1 Comment

Biggest accomplishment? No big deal.

Posted on May 16, 2013 by Jeff Mather


Today’s Diabetes Blog Week posts encourage us to “share the greatest accomplishment you’ve made in terms of dealing with your (or your loved one’s) diabetes.”

I won’t lie, my biggest accomplishment with diabetes is still a work in progress. It’s taken a long time to get where I am with being comfortable with insulin, and I could be even more comfortable with seeing a bolus wizard suggestion and just saying, “Okay. I can handle that amount of insulin without worrying.” Nevertheless, where I am now is much better than where I was a year ago . . . or even six months ago.

The results of “doing what I’m supposed to do” are encouraging. My A1c is the lowest I’ve had in quite a while, and I’m seeing fewer big spikes than in the past. I’m snacking less at times when I really don’t want to. Cycling with “normal” BGs is happening more often. Even eating Indian food is easier.

I am, however, having more lows than in the past and needing more (legit) snacks to prevent them, so I have some fine-tuning left to do. However, unlike in the past, I’m not treating those lows as a frustrating justification to do whatever. The changes I need to make are all do-able (By the way, I wasn’t simply flailing in the past; I was actually trying to make things better, but it was just a little hard to do that when I was adding so many other variables into the mix.)

Basically, this accomplishment is all about gaining the confidence I had needed to empower myself to do “scary” things (like taking insulin) and to enable doing more exciting things (like getting CGM no-hitters and doing half-Ironman triathlons).

Posted in Diabetes, Diabetes Blog Week, Life Lessons | Leave a comment

Remembering the Desert

Posted on May 15, 2013 by Jeff Mather


Memories are the focus of today’s Diabetes Blog Week posts.

Until recently, my most memorable day with diabetes would have been the day of my diagnosis 13+ years ago. It was such a life-changing event—cleanly separating my memories into before and after—that it’s going to be hard to ever truly forget much of it. But recently more and more exciting/interesting/unusual things come to mind first when I think about diabetes and my life. On the bizarre side, I called Minimed from a pay-phone in the middle of the outback in Australia when my pump died. Later on that month-long trip, Lisa and I had a fabulous time snorkeling (sans pump), and I barely worried about diabetes at all.

Perhaps my most memorable diabetes event (at least for now) is last year’s JDRF Ride to Cure Diabetes in Death Valley. Diabetes was everywhere on this ride (including some of my favorite people with diabetes) and yet my diabetes was remarkably well behaved. The more time that passes from this event, the more special it becomes. I mean, I rode 105 miles in the desert Death Valley! It was hot and difficult and so meaningful. It’s something I couldn’t have done on my own, and all of the help from the volunteers and donors meant so much to me. That particular ride is not necessarily something I’ll ever do again, but the memory changes how I think about diabetes and what I can do with it.

Posted in Cycling, Diabetes, Diabetes Blog Week | 2 Comments

Cats: The Perfect Diabetes Service Animal

Posted on May 14, 2013 by Jeff Mather


Today, the second day of Diabetes Blog Week, prompts us to think about petitions for diabetes. (For some context on why this is relevant to the community, read the DiabetesMine article.) I’m not really a big fan of petitions, so I’m going to do one of the wildcard topics: “What is the ideal diabetes service animal?”

I’m going to have to go all-in here and say, “Cat.”

Let’s look at all of the reasons:

  • Cats are furry . . . and warm . . . and affectionate. It’s hard to do better than a warm, furry, affectionate critter that wants to be around you.
  • Cats—like diabetes—interrupt what you’re doing to remind you of their existence. This presents a very convenient reminder to test . . . especially at 3:30 in the morning when they pounce on your feet or walk all over your face.
  • They don’t really care what the hell you do as long as you feed them. They give you that look which says, “Hey. That thing looks bolus-worthy. I’m not going to judge you if you eat it.” Or maybe it’s a look of disapproval. Or ennui. It could definitely be ennui. Cats are an emotional Rorschach test.
  • With their constant desire for food, cats provide a reminder to eat that food you pre-bolused for.
  • Cats don’t bark or need baths. They’re pretty self-sufficient.
  • Cats are easily distracted by empty boxes. Need a diabetes break? Just set out an empty box, and voilà!

Well, that’s pretty much it.

Posted in Diabetes, Diabetes Blog Week, Photography | 5 Comments

The Truth Comes Out

Posted on May 13, 2013 by Jeff Mather


It’s here! Diabetes Blog Week has arrived again, and it’s time to let someone else help me figure out what to write about here. Today, we pretend that our health care providers are reading what we write. What would we want them to know (or not know) about our lives with diabetes?

Hey there, Awesome Endo and Awesome CDEs! I think y’all are pretty great. You have a really good sense of what people with diabetes are going through, and I believe you really treat this as a calling to help make our lives better and not just a job. I’ve shared links with you in the past, so there’s an outside chance that you are, in fact, actually reading this right now. But you’re all very busy people with lives outside of the office, so I kinda doubt that you actually are. Anyway.

What I hope you do see is also what kinda wish you wouldn’t see: People with diabetes are constantly doing things and making choices that are contrary to what we talked about in your office. We present you data that often doesn’t have all of the context. “What happened here?” Well, it’s a long complicated story that started earlier in the day . . . or the day before . . . or all of those years ago when I was on NPH. But really, that’s a lot more detail that I suspect you really want—or that I can remember—so I’m going to make an educated guess. (This probably isn’t surprising to you.) So many of the choices we make are “messy” and nothing like the ones that we talk about in the office.

Neither of us is doing anything “wrong”—whether it’s making suggestions based on limited data or living in a way that leads to such choices—but it makes it hard to feel completely honest during the conversations we have where we’re trying to make things better. This is part of the reason why I’m glad that you look the other way at the occasional highs and lows in my logbook. Don’t get me wrong; I’m doing my best to make the right decisions, gather the right data, and do the things we talked about. I’m just really glad that you don’t see the imperfections as failures, because I do enough of that on my own. (Although, I’m getting much better at being okay with those misses.

So, thanks for reading and for helping me be the best human pancreas I can be.

Oh! And I wish I could always show you CGM reports like the first picture below; but, really, they’re more often like the second one.

 


If you are a health care provider, be sure to read Céline’s post today.

Posted in Diabetes, Diabetes Blog Week | 1 Comment

Swim. Swim. Run.

Posted on May 12, 2013 by Jeff Mather

There’s just no getting around it: Today’s NE Season Opener triathlon was wet. After what felt like the longest time away from triathlon—August’s 70.3 was my most recent—I had been looking forward to this race for quite a while. It didn’t occur to me until yesterday evening, when we were watching the weather forecast on TV, that it was possible that we would get rain during the event. But rain it did. Sprinkles at first and then a full downpour during the bike portion. There were rivers running down the highway, and Lisa said there were several crashes on the big hill leading to the transition area. Fortunately, the rain ended right as I started my bike-run transition, and I finished with a time that was just off my best time from last year: 1:09:47.

I made a couple of good decisions today. First, I decided to bring Tommy V (my road bike) instead of Chrissie (my tri bike). Over open ground, Chrissie is a couple of miles per hour faster, but I’m a lot smoother and much more agile when out for a ride with Tommy. Given that I could barely see through the rain today and that some of the corners were tight, it was the right choice to pick conservatively. And yet I still was passing lots of people. In fact, my bike split felt good and was the strongest part of the event for me. I started to wonder whether I was pushing too hard given how many people I reeled in, but I had more than enough in the tank for the run. My other good decision was bringing a plastic bag to put my running shoes and socks into to keep them (mostly) dry until I needed them.

On the other hand, I should have started farther forward in the swim. Evidently, I got faster over the winter, and I was constantly swimming onto people, slowing my forward progress. I could easily have been about 10% faster if I’d had fewer people elbowing me in the face or slowing down in front of me. On the plus side, I drafted on the swim! That was a first, and it was pretty cool.

My diabetes mojo is a bit rusty. I decided to try something different today, so that I could eat a bit more before the event. I was doing pretty well keeping my BGs down until just before the start when it started to go higher. Unfortunately, I went all the way up to 274 mg/dL (15.2 mmol/L) by the finish. Something to work on for next time.

It’s good to be back!

Posted in Cycling, Diabetes, I am Rembrandt, Photography, Reluctant Triathlete, Running | 1 Comment

Crash and Burn

Posted on May 10, 2013 by Jeff Mather

Like a Sunburn: Two Mondays ago I had this conversation with my general practitioner.

“A few weeks ago I was sick, and then, a week after feeling better, I started having some pain in my leg. It felt as if all of my hairs were going the wrong way. Or as if my thigh had been scrubbed with steel wool. Everything on the left side of my body from my tailbone around my hip to just above my knee feels raw.”

“Kind of like a sunburn?” my doctor asked.

“Exactly, except that when I touch it or apply pressure it feels better. In fact, I feel best when I’m wearing bike shorts or swimming or running . . . or when my clothes can’t even brush against my skin.” By mid-week I was walking around holding my hip, which made the discomfort bearable. I could also be heard exhaling deeply from time to time to take my mind off the pain.

“But just on one side?”

“Yes,” I said. “That lasted all week, so it wasn’t just a run of the mill irritation. Then on Friday I noticed that I had a very swollen lymph node on the same side. At first I could feel it, but now I can actually see it, too.”

My doctor was starting to look like he knew what was wrong with me. What I didn’t say was that, after I found the lymph node, it was too late to get into the doctor’s office on Friday, and I kinda had a little freak out over the weekend. What was wrong with me? I didn’t have most of the symptoms of the few things I could think of. If it was a hernia, would my season be over before it started? What if it was more serious than that?

“And then I noticed a cluster of bumps on my back. They don’t really hurt, but they started around the same time. Now I have a few on the front of my thigh, too.”

“You have shingles. You’re the fifth person in the last week that I’ve seen with it. That’s really unusual.” And then he pointed to the poster from the CDC behind him on the door. It was the poster I had started to look at before he came into the exam room. On it, sad-looking, line-drawn people had shaded swaths on one side of their bodies. Then he gave me a prescription for the drug you get if you have herpes.

I was starting to feel much better a few days after starting to take the valaciclovir. I still feel a little pain just below the skin in my hip, and I’ve read that the neuralgia—which is what this kind of nerve pain is called—can last months. Yet I still feel fortunate that my shingles wasn’t as bad as some of the pictures I’ve seen or stories I’d heard.


BG Crash: Meanwhile, I was still swimming, cycling, and running. Swimming was going well, and I felt like I was getting back to my pre-illness form and speed. Running was . . . amazing! I’m still not super speedy or anything, but I noticed that at some point over the interminable winter my form improved, and as a consequence I seem to be able to run faster with the same amount of effort. Cycling is another story, since I found myself a bit off my form the end of last season. What I needed was time in the saddle. So about a month ago, I switched from mostly running to mostly cycling. I want to say that it’s been slow, but really I’m progressing pretty quickly, getting in a couple of 60-mile rides over the last two weekends. Hopefully, I’ll be speedy on Sunday for the first tri of the season and ready for the 100-mile Tour de Cure gran fondo next weekend.

One thing that has been completely different—and very frustrating!—compared to last year is my diabetes abilities in the afternoon. Almost every workout for a couple of weeks ended with me either 100+ mg/dL (5.5+ mmol/L) lower than where I started. That’s quite a drop, especially given that I had been working hard to keep my BGs in a “better” range. As a result, I was having a bunch of lows (or near misses) while exercising. No amount of pre-emptive eating seemed to fix anything. The worst was a span of three days where I had to stop cycling and running in order to treat hypos. I hate stopping.

It occurred to me that a few things were different. As I already mentioned, my BGs are bit better throughout the day, which (unfortunately) gives me less room for a drop like this. My training volume is also higher now, which means I’m more likely to use blood sugar, since my muscle glycogen might be slightly lower. And—this probably is the key—I had ever-so-slightly more active insulin in my system than last year. I remember being hungry in the afternoon everyday last summer and not eating because it would mess up my afternoon running or riding. Surely, there’s got to be a better way to balance the need to eat and the need to exercise. I should go back to my TeamWILD notes from last year to remember how much to lower a bolus for food depending on how far in advance of riding it is. Stay tuned.


An Actual Crash: Last Sunday, I went out for a little ride. It was a beautiful day; Chrissie (my tri-bike) and I hadn’t been out for a long ride together for a while; and I was feeling pretty energetic. About 20 miles in, I decided to stop at the same park I did the weekend before to take a little “nature break.” The previous time, I accidentally punched myself in the face taking off my arm-warmers. This time I didn’t even make it into the park before starting the mayhem.

Turning the corner from the highway to the park at about 10 MPH, my wheels hit sand, and I slid to a stop on my right side. Two women walking down the street saw the crash and asked if I was okay. As I stood up, nothing felt broken, although I could already feel some pain on my right leg despite the adrenaline. I’m fine. The ladies seemed dubious. So I looked at my bike and saw everything was (thankfully) exactly as it was supposed to be. My insulin pump seemed unharmed. And then I looked at my knee and shin. Blood and scrapes, but nothing that wouldn’t heal or keep me from finishing the next 40 miles. Yes, I’m okay. Thanks. All things considered, I wasn’t badly hurt—just a little road rash—although I was bleeding pretty well.

I headed into the park to do what I’d gone there to do, and then I spent a few minutes cleaning out my wounds. The bleeding from my knee wouldn’t really stop in the 30 seconds that I was willing to give it, so I used my beanie (which I no longer needed on this ride) to blot the blood and headed back out. I think I scared a few people I saw on the remainder of my loop. When I got home, Lisa didn’t believe me that it was a wolverine attack, so I had to fess up that the blood was, in fact, my own and convince her that I was, in fact, okay. After a shower it looked much better. Now, about a week later, the scabs look a bit gruesome, but the injuries they cover feel fine.


It’s been the strangest two months since the New Bedford Half Marathon, and hopefully nothing else happens between now and Sunday.

Posted in Cycling, Diabetes, Life Lessons, Reluctant Triathlete | 4 Comments

Patient-centered Care Works Better

Posted on May 1, 2013 by Jeff Mather

Here’s some shocking news, as reported in the Reuters article “Patient-centered care linked to better outcomes.”

Patients tend to do better when their doctors pay attention to their individual needs and circumstances, according to a new study.

“In a sense that sounds sort of obvious, but no one has ever showed that before,” said Dr. Saul Weiner, the study’s lead researcher.


Updated 6 May 2013: Lisa asked, “Why is this research necessary? I mean, it’s obvious isn’t it?” To which I responded, “Without the research, doctors can dismiss intuition and keep doing whatever it is they do now.”

Posted in Diabetes, Health Care | 1 Comment

7.3

Posted on May 1, 2013 by Jeff Mather

When I was at my general practitioner’s office on Monday getting diagnosed with a case of shingles—more about that another time—I asked if I could get my A1c drawn in anticipation of my endo appointment on Thursday. My GP and endocrinologist are in the same health network, so they both use the same electronic health record (EHR) system, and it would save me a trip to the hospital lab before work. “No problem. We’ll check your electrolytes and whatnot while we’re at it.”

Whenever I don’t expect good things from my A1c, I’m often pleasantly surprised. After a few months that included being ill, traveling, and having some bat-shit crazy BG readings, I was expecting something closer to 7.7 (where I was in January) or even 8.0.

Fast-forward one day to yesterday when I checked my EHR and saw my spiffy new A1c of 7.3. I know we “strive for 6.5,” but I was really happy to see the lowest A1c in the last six years.

Posted in Diabetes | 3 Comments

Cold

Posted on April 14, 2013 by Jeff Mather

It all started a few days after the half-marathon. I had already decided to take a couple days off running following the race, although I’m not sure I could have actually gone for an easy run on those days without hurting myself. That very cold but fast-ish race really beat me up. On the Monday and Tuesday of the conference I was hobbling around, and sitting still comfortably for long periods of time was a challenge. But by Wednesday I was feeling fine, so I went for a short run around downtown San Jose.

It was colder than I had expected, and I had only packed a couple of short-sleeve running shirts—it’s California, right?—so I was a little chilled for the first ten minutes or so. The same thing happened Saturday morning, when I put in seven flat miles from my hotel to the airport and back along the excellent Guadalupe River Trail. In the days between those runs, I got a case of the sniffles and a sore throat, but it went (mostly) away, even after a nice (but chilly) hike with friends along the coast at Half Moon Bay.

I could hear on the other end of the phone line that Lisa had a bit of a cold, too. I assumed that we both got chilled in New Bedford—me running and her waiting around for me to finish—and then compounded it with a cold outdoor run or bike ride (in Lisa’s case). The day I returned home from California—a week after the race—Lisa was flying to Oregon, and we passed somewhere over the middle of the country. When she returned home the next weekend, her cough had progressed to something more menacing.

While she was gone I did my usual thing. Swim in the mornings three times a week. Run after work a few times. Ride my bike a few times. The weather was gradually warming up, but these workouts were all a bit cool. The bicycling and the swimming felt difficult, which I attributed to not having done much of them recently, but the running was good . . . almost easy. The day before Lisa arrived home I went for a decidedly difficult seven-mile run. It was hard partly because it was chilly and the route I picked had a 2.5-mile hill in the middle of it. But really it was tough because I had given blood the evening before.

Last week the temperatures finally warmed up a bit. I was still coming home from a ride with a runny nose, but at least the temperatures were in the sixties and seventies. Monday and Wednesday I did some incredibly hard (for me) swim sets and was coughing a bit afterward, but I didn’t think anything of it. My swim paces were still off my best times, but I was feeling strong. Wednesday I went for a run.

All last week my BG readings had been terrible. Terrible as in: high all day except immediately after I exercised, during which they dropped 150+ mg/dL (8.5+ mmol/L). In general, I seemed to be insulin resistant. I loaded myself up with insulin and my blood glucose barely moved. 180 (10) was the “new normal” where my body seemed to want to stay. Except that I had finally gotten myself down to 130 (7.2) on Wednesday before my run, which had me feeling incredibly nervous. Because I’m stubborn, I went running anyway, and ended up walking the third of four miles in a bit of a stupor. When I finally started running again, my hypo sweat had me almost shivering. That evening Jess had to talk me down—which I admit was quite easy—when I expressed feeling that I totally sucked at diabetes.

That night and the one before I slept in the guest bedroom because Lisa’s coughing prevented me from sleeping. Even the cat abandoned the poor girl.

Thursday, I finally started to put things together. The ineffective 115-120% basal rates, the slow swimming, the coughing, the sniffles, the copious amounts of Mucinex D that I was taking to loosen up my congested chest, . . . I didn’t suck at swimming or diabetes. I was getting sick. Not (hopefully) the same bronchitis crud that I had last year (and that Lisa seems to have now) but definitely something. I went to bed early.

Friday, I skipped the pool. It was tough for me to do. The coming week is spring break for the town’s kiddos. And as Pool Lady used to say, “No school. No pool.” I didn’t want to take an extra day off swimming before a full week hiatus. But I needed the rest, and I think the chlorine was messing with my already fragile sinuses. Midmorning, I felt like I was in a haze. “I think I’m going to go home early,” I told Lisa, who had been given an antibiotic prescription by her doctor the previous afternoon. By noon I canceled my afternoon meetings and went home to lie on my sofa. I watched a fascinating episode of “Nova” about Australia before falling asleep to wake up more than an hour later with the cat asleep atop me.

Lisa and I had planned to go to New York on Saturday to see “Impressionism, Fashion, and Modernity,” which are three of my favorite things. But Friday evening, as I was laying around sounding pathetic, Lisa (easily) convinced me that we should go another weekend and concentrate on getting well. Which is what we did.

I concentrated—I really did—but the jury is still out on how well I am. I did the dishes yesterday, and we shopped for groceries today, and that was about it. Well, I did read 150 pages to finish The Romantic Revolution: A History. But mostly I slept and sat around. And coughed. And sniffled. And coughed a bit more.

The good news is that I slept better last night than the previous. My head also isn’t pounding the way it has been the last couple of days, nor is my skin quite so crawly. And while I’m still coughing and sniffling, it’s a little better than before (I think).

The hardest part—perhaps worse than actually feeling like crap—is knowing that my first race is only a month away and that I haven’t been training much recently. But I’m trying not to worry, because usually when I come back from an illness, I end up doing better than before.

Anyway, tomorrow is Patriot’s Day, the best day of the year. I just need to make sure that I dress overly warmly so that I don’t get chilled again.

Posted in Cycling, Diabetes, Running, Swimming | 2 Comments

1:42:42

Posted on March 25, 2013 by Jeff Mather


Editor’s note: I wrote most of this post on the plane ride to California mere hours after my race, and it turned out a bit longer than I intended. Here’s a summary. I ran 13.1 miles in 1:42:42, a personal best and more than ten minutes better than my previous fastest. The race had its up and down moments, starting with a 44:00-ish 10K split before I unexpectedly ran out of gas in the last four miles. While I’m not disappointed with my results, I had hoped for a little better, and I have a decent idea where to go from here, which is good because the racing season has now officially started.


The New Bedford half marathon and I have unfinished business. Still.

I first ran this race two years ago, and I had a really tough blood sugar day, going hypo for the last five miles or so. Today was better, and there are whole sections of the course I remember for the first time. (Those were the parts I walked in a stupor back in 2011.) In fact, my 1:42:42 time today was my best ever at this distance. It’s just that my race was very uneven.

So what happened? First, here’s a little story.

Some of you probably noticed that I haven’t written much here recently. There are a lot of reasons—I’m definitely prone to going through periods of intense activity followed by droughts in many areas—but this time two factors stand out. First, I’m trying to get more stuff done during my days: at work, around the house, on the bike, on the sofa with a book in hand, with my head fast-asleep on a pillow, etc. Last triathlon season I was pretty sure that I didn’t help out enough with the housework, and it caused me a good deal of anxiety. This year, I’m trying to build up a reserve of goodwill (and good habits) that will get me through to October. Life is choices, and in an effort to get all of my stuff done, the dozen-or-so dispatches that I wanted to post here kinda shuffled to the bottom of the list.

But perhaps an even bigger reason for being quiet here is that I really only had one thing I wanted to talk about, and it seemed a bit neurotic to say, over and over, “Hey y’all, there’s this race I’m doing on Saint Patrick’s Day, and I’ve never been more unsure about how an event is going to turn out in my life . . . or even how I should approach it.” Beyond neurotic. Perhaps even a bit needy and insecure. But there it is: I spent most of the last 2-3 months thinking about today’s race and not wanting to talk about it.

Let’s head back toward the main part of our story.

It’s been a snowy, snowy winter. Last year, when I trained for Around the Bay, we had almost no snow all winter. Finding a place to train was so simple; just head up the bone-dry trail and out onto the suburban roads. This winter started like last year, but after Christmas all frozen hell broke loose. Before the New Year I was already doing speedwork on a snow-covered track or on the treadmill in the basement. I was moving my long run day around to get it in before the next snowstorm hit.

Then came January. And February. And early March. It snowed and snowed but never really melted—mostly because it was ridiculously cold. When the snow wasn’t too icy or rotten, I would put some miles in on the snowy trails; otherwise I did snowy loops and dodged snowplows on the state highway. Not only were these outings difficult, they kinda sapped my confidence.

I built my training plan around the 21:11 5K I ran last September to close out the season. That plan, which seemed aggressive to me, relied on a fairly normal set of distances each week run at some rather aggressive times: a 4-mile tempo run at 7:05/mile (4:24/km) pace, 4x1600m in 6:48 (4:13) each, 13 miles at 8:30 (5:17) pace. Ironically, I didn’t have much trouble hitting my marks at the shorter, more intense distances. But over the snowy, slushy, or icy roads, I quickly learned that I was going too hard on the early parts before getting to the dry roads, where I was a bit worn out. (I was very well-hydrated though, since I carried and drank lots of water.) Having one difficult long run after another kinda dragged me down and left me wondering if I had peaked too early in the season or if I would be capable of transferring my track speed to the roads over longer distances. Would I be able to run 13.1 miles at the 7:08/mile pace my plan said I could do?

Today proved that the answer was, in a word, No.

There was no real snow accumulation in the forecast for the week before the race—which of course didn’t stop us from getting a half-inch overnight on Friday—and the bike/run path taunted me by being invitingly snow-free for the first Sunday since the middle of January.

On the other hand, it was still a chilly 30F (-1C) when we left the house race morning. What to wear . . . Pants? Probably a good idea. Jacket? Probably not necessary, although I did put on a base layer below my long-sleeve shirt. By the time I was done with my warm-up, I knew I should have opted for shorts and short-sleeves. It was perfect running weather. (Although not perfect spectating temperatures. Poor Lisa.)

I got a good luck kiss from my sweetheart, settled myself into the starting corral by the 8:00/mile (4:58/km) sign, and tested my blood glucose during the national anthem. 252 mg/dL (14 mmol/L). My best efforts at having a quality BG race were derailed around 7:30PM Saturday by a low that caused a high rebound and an early morning bolus, a pre-run snack, and an 11AM race start that had me wondering how much to eat for breakfast and what insulin-on-board was appropriate for my high. I decided that the 0.8 units IOB was probably okay, but my nutrition plan of eating every 30 minutes needed modification. Basically, I was going to be a bit hungry.

The first half of the race were good. Everyone around me was running decidedly faster than I was, and I felt no qualms about watching a stream of people slowly run past me through the first few miles. I was watching my pace closely, so I wasn’t surprised to see a 6:45 show up after the first mile. By the third mile I was cruising along at 7:30/mile (4:40/km), which had been my plan coming into the race: run slower than the “official” plan called for and hope for a negative split, running the second half stronger than the first.

My (unofficial) 10K split was a new personal best just upward of 44:00. I was feeling good. A run at this pace is never easy, but it didn’t feel bad.

Then around the ninth mile, when we got to the seawall, I hit the wall. I had been battling a side stitch that felt like a collapsed lung—I imagine—for the last couple miles so I decided to walk for a minute to catch my breath and check my BGs: 152 (8.4). Much better than before. Knowing that I didn’t have low or high blood sugar gave me a bit of a second wind. The big hill for the last mile was cruel—just like last time—but the crowds were huge and so supportive.

I was so happy with my time and to be done. All things considered, it was a good race: a solid, relaxed 10K followed by a tough part that I pushed through leading to a PR. I told Lisa that it’s good that I signed up for the Baystate Marathon (in mid-October) on Friday rather than waiting until afterward, because I’m not sure I would do it if I hadn’t. But that was pre-shower. It’s amazing what some hot water and soap will do for your point-of-view.

Between now and my first marathon there’s a lot of running and swim/bike/running to do. I have new training paces and a clear need to work on hills. (I think trail running will help with pacing and strength more than anything, not to mention being lots of fun! :^) And . . . I wonder how close to 1:42 I can get during a half-Ironman. I’ll also come back to New Bedford someday to get the satisfaction I deserve.

Now if only spring would get here.

Posted in Diabetes, Life Lessons, Running | 6 Comments

Tin Ear

Posted on March 25, 2013 by Jeff Mather


(Image from Eknath Gomphotherium)

This post is for the hypochondriacs out there. You’re welcome.

Lisa says the high-pitched, continuous ringing in my ears that I mostly hear in quiet environments (or like right now when I listen for it) isn’t normal. She says it’s tinnitus.

I had always assumed everyone filled the usual background with some sound, but evidently that’s just something that I do. Well, me and 50 million other Americans. It’s not like it’s new—it’s just new to Lisa. As long as I can remember, that’s the way the world has been, and (thankfully) it doesn’t really bother me. I hear perfectly well—touch wood—although it is a really unfortunate pitch.

Oh well.

What causes tinnitus? WebMD gives a laundry list of causes that range from the obvious to the mundane: everything from having a loud profession, listening to loud music, aging, and head trauma to aspirin, ear infections or blockages, and something called “ostosclerosis,” which I can only assume is caused by putting fatty, cholesterol-rich foods in your ears.

Oh, and it’s associated with a whole host of other medical conditions, including a couple that I have: allergies, anemia, and (you guessed it) diabetes.

What a crazy thing is this human body.


p.s. — I promise I’ll tell you about the half-marathon I ran a week ago really, really soon. Promise.

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

The BiUD

Posted on March 12, 2013 by Jeff Mather

After last week’s bungled pre-launch of BioHub, the proposed anti-diabetic sponge, the DRI has decided to rebrand and re-prelaunch with another pre-announcement. The new BiUD will be available for pre-order sometime in the next 5-7 years, after which it will undergo a rigorous FDA approvals process. There is no word yet on the rumor that the DRI is also developing the “Biaphragm,” a diabetes cure that people with diabetes can use without the aid of a physician.

(“What the what?” you ask. Don’t worry; Jacquie explains all in the best possible way.)

Posted in Diabetes | Leave a comment