Category Archives: Diabetes

In Love with the World (and my BGs)

Posted on April 4, 2012 by Jeff Mather

OMG! When I exercise my ability to move my blood glucose values closer to where I want them is so, so much easier!

This isn’t news, of course. In fact, it’s super-duper obvious. I crafted my mostly working basal and bolus rates based on a certain level of insulin sensitivity, and that level depends on me working out at least five times a week. Change a little thing and those rates all go to hell.

Why am I telling you this? Well, in an effort to recover adequately after Around the Bay, I hadn’t run a single mile or ridden my bike at all since the race. And for one reason or another, I also hadn’t done any laps at the pool, either. That equals ten days without a workout. This has been good for my muscles, but not for my mental health—I was starting to get really antsy—or for my BG readings. Starting late last week, I started running a 24-hour temp basal of 120%, and that helped a bit, but not enough.

Then yesterday afternoon, after getting my free Ben & Jerry’s cone, I went for a semi-leisurely, vaguely hilly, 17-mile ride. Almost as soon as I hopped on the bike, I had that particular feeling of clarity, contentment, ease, and freedom that I only get when I’m riding. Immediately afterward, my BG-wrangling skills came back as if I hadn’t taken any time off at all.

This morning I swam some laps—which were plentiful but slow—and I’ve been planking all day since then.

The sun is shining. It’s a beautiful 60F outside. My friends are wonderful. I finally made something work that I’ve been struggling with at the office. I went to an informative and entertaining presentation about the MATLAB Cody game platform. I had a nice lunch with my coworkers outside. My life has purpose and direction. My BGs are where I want them. I have another date with the bike after work.

And, most importantly of all, Lisa is on her way home from Philly!!

It’s a good day.

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

Your “Property”

Posted on March 30, 2012 by Jeff Mather

Iberia was running late. When we checked in, our flight from Barcelona to Madrid was already close enough that we had “Short Connection” stickers on our luggage. And now they were running late. We arrived in Madrid with less than a half-hour to make our flight to Boston. We didn’t know which part of the terminal we had to go to make the connection, but we knew that it was in another building and that we had to take a train to get there. The signs directing us said to expect to take 21-28 minutes.We would have run to and from the train, but Lisa was carrying the ceramic vase we bought, so we fast-marched through the airport.

When we arrived at E.U. exit control there were no other passengers there—thanks to the fast march—but I decided to use the “connections with less than 1/2 hour” lanes out of principle. The border guards looked at my passport, (maybe) looked at me, used his big stamp, and waved us through. Fortunately, we didn’t have to go through security again, and we just had one small stop before our gate where they double-checked people with American passports to make sure that we had them and were on the up-and-up.

Simple. And appropriate. If we had looked suspicious or acted oddly or not been running through the airport to catch our flight, I’m sure we might have gotten a little extra scrutiny. And that makes sense.

Furthermore, when we were going through security at Barcelona’s airport it was an easy and relaxed experience. Here’s what it was like. First, after waiting in almost no line, someone who looks an ordinary civil servant looks at your passport and boarding pass to make sure you’re going the right place and have the documentation to get there. Next, you take all of the metal out of your pockets, take off your jacket, watch and belt, and go through the magnetometer, to meet your items on the other side of the X-ray machine. The security guard sees your pump, points at it, gives you the thumbs up, and goes about his business. Your pants may hang low; they may wobble to and fro; but you can throw your bags over your shoulder and saunter over to a nice collection of tables to reassemble yourself. The trays aren’t deep, decaying, table-busing tubs; instead, they’re shallow, smooth, and easy to take things out of. Your Euros slide nicely back into your hand and into your pocket without you needing to scrape your fingers along the bottom of the tray to retrieve them.

Notice that at no time did you have to (a) take off your shoes, (b) get an aggressive pat-down, (c) let go of your wallet, (d) explain your medical device, or (e) feel rushed or under suspicion.

Let’s compare and contrast this with going through security at Boston’s Logan International Airport—with which I am quite familiar—the last three or four times.

You arrive at the airport, check in, and go to a long security queue where a uniformed representative of the U.S. government looks at your documents under a black light and then back at you skeptically, considers the situation, and then writes something inscrutable on your boarding pass which might translate into “Bonne Voyage!” or “Send this man directly to Gitmo.” You go through another queue where you jostle with other people who are taking everything out of their pockets—wallet, coins, keys, glucose tablets, Kleenex, scraps of paper, chapstick, the random Stop & Shop card, etc.—and putting it into a bin along with their belt, shoes, jacket, and watch. You walk (in your socks with a hole near the big toe) to another uniformed officer, point at your pump and say, “I’m not supposed to take this through the back-scatter X-ray imager.” To which he replies, “It’s okay. You weren’t supposed to take them through the magnetometers.” Uh-huh. Okay. You’re the boss, chief.

You stand, holding your pump facing a device that showers you with X-rays. They say it’s safe, but radiologists who have looked at the images suggest it actually does penetrate the skin and sinus cavities and have called it “the biggest low-dose radiation clinical trial without informed consent ever performed” (or something like that). Another TSA agent somewhere else can see that you don’t have any weapons, but then you will still get an extra-thorough pat-down.

After a few seconds, you step out of the machine so a guy (for me) can ask, “What side is your property on?” Do you mean my pump? “No. Your property.” Oh. My junk. The one thing I didn’t take out of my pants. Uh huh. And then comes the very thorough going over. Up one leg. Down the other. All the way around the inside of my waistband of my pants. Down both arms (since they were less visible because I was instructed to hold my pump in my hand.

Going to Buffalo last week, after the TSA agent who swabbed my pump and hands walked away to test for explosive residue, the woman behind me said quietly, “Makes you want to go through again, huh?” We New Englanders have dry cynicism down cold.

Eventually, once it’s clear to The Man that you’re not a terrorist, you get to go collect all of your stuff that’s been sitting unattended on the X-ray belt: wallet, fancy watch, coins, glucose tablets, Stop & Shop card, hand luggage, etc. Plus, oh yeah, your shoes and belt. Good luck finding a nice, out-of-the-way place to put everything back on. You’re going to be in the way and feel rushed.

And don’t get me started about coming back into the U.S. from another country. Getting into Canada is easy: “Are you transporting anything to sell or give away in Canada? Do you have any guns?” The UK and E.U. don’t care about anything as long as you’re not trying to stay for an extended period of time. Australians (and Californians) just want to make sure you aren’t bringing any microbes in that might destroy the local flora and fauna.

But coming back into the U.S. lately has involved a whole bunch of suspicious questions and needless queuing, especially to declare that I have nothing to declare. Just put an “OK” stamp on the duty card and let us walk out of the airport already. Jebus.

Is this really the right way to make us safe? Has this actually stopped anything? (I doubt it. And you know if it had, the TSA would be crowing about all of the Mega-Badness they prevented.) So why treat passengers like criminals? (BTW, I get less intense scrutiny when I visit my brother in the pokey.) Why subject us to extra-thorough screening because we have medical devices? (It’s not like they haven’t seen insulin pumps or CGM transmitters before.) Why, more than ten years after 9/11, do we still have a ridiculous system for getting through airport security and customs?

I have my suspicions, but I’ll just keep them to myself so that I don’t get branded as anti-American and put on a “no fly” list.

Hint, it’s part of the “fortress mentality.” (Which is also the reason why architecture from the 1960s and 1970s sucked so bad.)

Posted in Canada, Diabetes, Europe, This is who we are, Travel | 2 Comments

If You Have to Ask the Price… Canadian Edition

Posted on March 28, 2012 by Jeff Mather

One of the best things about last weekend—and there were so many—was the conversation. Scully let me crash at her cute little house, and we talked. A lot. In fact, I was a bit worried that I was boring her by the end of the weekend. But evidently not, because she kept the conversation going.

What did we talk about? There was the usual stuff you would expect: diabetes and running and bicycling; races we’ve run; people we know in common; Canada and the United States; what we do for a living; and Lisa. We also talked about India, movies, photography, food and our issues about it, English, French, Montréal, relationships, and the Ontario building code. Not to mention a whole bunch of personal stuff that we’ll just keep to ourselves, m’kay?

We spent a long time on Friday night talking about healthcare costs and insurance in the United States and Canada, who pays for what, how much things cost, how easy it is to get access to services, and so on. (I think this is the diabetic version of “How do you say        in your country?” BTW, the answer in Canada is “toque.” Isn’t that precious?)

Basically, it comes down to this: In both the U.S. and Canada, it’s fairly easy to get low-out-of-pocket-cost access to doctors and basic procedures if you have insurance, but prescription medications and diabetes supplies are wicked expensive in both countries. Some drugs cost consumers/patients less in Canada, but pump and CGM supplies have much lower copays (for some of us) in the U.S.

There’s a form of rationing in Canada by limiting how much various plans will pay for, as well as by de facto waiting lists for non-emergent procedures. While in the U.S. we let our employers and insurance companies ration our care by determining how much they’re willing to pay for. In the U.S. and Canada if you have more money, you have better access to helpful things (such as CGMS and all of the test strips you need.) And in both of our countries there are slow-moving regulatory systems that keep us from having access to the most exciting self-management devices and technologies.

I’ve been thinking about all of this in the context of the on-going debate over the U.S. healthcare law, which turned two last Friday, the day that I left for Canada. Happy birthday, Affordable Care Act! Monday, as I flew back, the U.S. Supreme Court was hearing arguments about whether it would survive to its third B-day. [1]

Leaving aside the politics of healthcare in the U.S., one thing is clear: Taking care of our diabetes costs too damn much for what we get. No one in any country should have to make choices about whether and how to manage the basic parts of their disease based on costs. The only way we’re going to fix the healthcare crisis in the U.S. and make it possible for people with chronic illnesses in any country to afford what they need is to lower the overall cost of healthcare so that money is free to go where it’s really needed.

Let’s spend less time thinking about how we pay for things and spend more time trying to make them more affordable.


1 — I’m sympathetic to the argument that it’s Constitutionally strange to compel a citizen to buy something from a private entity. Of course, I also completely buy the argument (a) that a citizen’s failure to have insurance has a significant detrimental impact on my ability to afford my insurance, doctors, and prescriptions and (b) that everyone needs to use the healthcare system, often at times that they don’t expect. Both of these make “buying” healthcare much different than buying a car or anything else “for the common good.” Finally, as much as any other part of the core American value system, I am a firm believer that being a nation that values the rule of law is part of what has helped the U.S. become the more-or-less equal, free, and prosperous society that it is now. If the “individual mandate” portion of the law is ultimately deemed unconstitutional, I wouldn’t be grievously disappointed if the Court overturned it (even though I like it).

Obviously, the answer is more radical—and likely much more legal—than the current system of forcing people to buy private health insurance. Get rid of the ineffective system of private insurance as the primary gatekeeper to healthcare, put everybody into a single-payer system, and pay for it via federal taxes.

Posted in Canada, Diabetes, Health Care, This is who we are | 3 Comments

All the Way Around the Bay

Posted on March 27, 2012 by Jeff Mather

Sunday, I ran Around the Bay, the 30K race in Hamilton and Burlington, Ontario, that I’ve been writing and worrying about here for many, many months. Let’s just cut to the chase.


I ran the 30K in 2:57:18. [1] That’s a PR for me, partly because I’ve never done a 30K (18.6 mile) race before. In fact, it’s the first time that I’ve run longer than 14 miles . . . ever. I’m happy with the time. I’m happy with how I managed my diabetes during the race. And I’m happiest that I finally met two of my diabetes best friends. (My “dia-besties,” if you will.)

I’ll write more about the fantastic weekend I had with Scully and Céline after this brief race report.

I’d been thinking about how to approach this unknown race during each of my training runs over the last couple months. My thinking involved this rough plan: Don’t run too hard for the first 20K, suffer through the 6K of hills, and then see what I had left for the final 4K to the finish. I was hoping for about 8:30-9:00/mile all while keeping my heart rate around 150 BPM. Several times on most of my recent training runs you could hear me saying (quietly) to myself, “Slow the fuck down!” (I seem to have a potty-mouth when I’m by myself or in similar company.)

On Sunday, the first 20K were actually pretty good. According to my Garmin, I was doing about 8:30/mile but at a slightly higher exertion than I was hoping: about 155-160 BPM. Unfortunately, my Garmin lies, and I did the first 20K at a very, very consistent 9:25/mile. Oh well, I still felt really good. Then the hills arrived, as I knew they would. The first couple weren’t so bad, but by the end of the second kilometer of hills I was hurting. I kept going, but the last four kilometers of hills were just plain brutal. In fact, they were bad enough that the 4K (allegedly) downhill run into the finish was an ongoing dialogue between my brain—which knew that the finish was drawing ever nearer—and my body, which just wanted to walk for a little bit. The last 10K took exactly an hour—which is only 20 seconds per mile slower than my earlier pace—and I made it to the finish with enough left for a good kick. See, always listen to your brain. “Shut up, legs!”

I survived. My joints didn’t fall apart. My conditioning wasn’t as bad as I had feared. And my diabetes regimen was on-track. (I was 200 mg/dL at the start, 180 at 12K, 140 at 24K, and 125 at the finish. That’s 11.1 mmol/L, 10.0, 7.8, and 6.9 for my Canadian friends. Yay!)

That was the race. Now for the good stuff!

Céline and Scully convinced me last year to do this race last October, and I had been super-excited about it since then. I love going to Canada. Heck, let’s just say that I love Canada. Period. It’s the people and point-of-view mostly. So I had hoped this trip was going to be a great mix of fantastic people, beautiful scenery, tasty food, a fun race, a whiff of international intrigue, and—what’s this?—curling.


After a very short flight to Buffalo and a short drive, I was viewing Niagara Falls, a beautiful and impressive force of nature. So much water. So much spray. So much noise. Unfortunately, the short flight messed with my already messed up sinuses, and my hearing was off all weekend. I guess I’ll just have to go back another time (with Lisa, of course) to hear the full rumble of all of the water going over.


I was a little late getting to the curling rink to meet with Scully and Céline because I had to sit in the rental car for a little while waiting for my blood sugar to come up after it went over the falls in a barrel. [2] I knew next to nothing about curling on Friday morning, except that Céline does it and that I would meet her and hang out with Scully while she did her slippy shuffleboard-thing with stones and brooms. Fortunately, one of their common friends came along to explain the whole thing.


Afterward Céline’s Doug posed an innocent question: “Would you like to throw a stone?” (He might not have said “throw.” I made up a lot of descriptions about what was going on, to everyone’s amusement.) When in Canada, do as the Canadians do, eh? Yes.


Let me tell you, it’s a lot more difficult than it looks. Coordination and balance are not my best attributes. Plus, curling ice is literally more slippery than a hockey rink because it’s all bumpy and stuff. And it’s all because of this guy:


Anyway. The rock stone weighs 20 kilos (44 pounds) and takes a bit of work to get moving. Well, not so much work if you know what you’re doing. Then you can make it look easy. Eventually, I actually got one all the way down into the box on the other end of the ice. Before going out on that high note, though, Doug had to chase one down before it went into a neighboring lane. And I looked like this a lot:


But look! I think I’m ready, Céline. Just don’t ask me to go out and scrub sweep.


The rest of the weekend I spent with my Dia-besties. After picking up our race numbers and swanky “Older Than Boston” shirts, we set out to do two very important things: buy chocolate and buy cheese. We drove all over the Niagara region, chatting the whole time as if we’d known each other for years.

Even though I’m home now—and it’s time to give my passport a bit of a rest for a while—I think it’s worth saying again: I had such a great time this weekend!

Stay cool, Canada.


1 — Fortunately I’m mostly fluent in converting between metric and ‘merican for all the important measurements: temperature, distance, weight, diabetes, etc. [Back . . .]

2 — Plus, I got a little confused getting back to the QEW. [Back . . .]

Posted in Canada, Diabetes, I am Rembrandt, Running, Travel | 4 Comments

Fear

Posted on March 13, 2012 by Jeff Mather

Age v. Fear graph

Don't fear insulin (or the reaper)

Posted in Diabetes, Life Lessons | 2 Comments

Diabetesville

Posted on March 12, 2012 by Jeff Mather


FarmVille image from Best FarmVille Farms blog *snicker*.

I have often wished there were a really convenient way to convey to people without diabetes how it takes over parts of your brain life. I think I’ve figured it out: FarmVille.

You know Facebook, right? Of course, you do. So, you probably know FarmVille, too.

Just in case you don’t, here it is, as I understand it. It’s a game that I don’t want to play but it taints whatever I’m doing in Facebook. Consider this typical in-head conversation I might have while perusing Facebook: “Oh look, James is starting another amusing political rant. . . . Oh! Miriam is having a baby! That’s exciting. . . . Kittehs! . . . Cute baby pictures! . . . Nina is in London. Again. There’s no “Jealous” button. . . . Poor puppy is wearing the cone of shame . . . Jeanne found a fancy duck on her farm, and wants my help?! WTF is this? . . . Oh! A YouTube video! I love videos! . . . Heidi needs my help to plow her wheat field?! Make it stop! Make it STOP!! . . .”

At least, that’s how it was until Mary taught me that I could ignore all of the FarmVille notifications. Now I only think about it when I visit my mother-in-law’s Facebook page.

But that’s diabetes. If you have it, it takes over your mental timeline (to use the Facebook lingo).

“Well, here I am at work, getting ready to do all kinds of awesome stuff. . . . I wonder what my blood sugar is. . . . I’ve been working for an hour or so and making great progress. . . .” BEEP BEEP BEEP!! “My CGM tells me that my blood sugar is rising. Should I do something about that or wait for the insulin to kick in? I’ll wait and get back to work. . . . I wonder what my blood sugar is.”

If only there were a safe way to “hide all notifications from diabetes.” *sigh*.

Posted in Diabetes | 3 Comments

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

JDRF Ride to Cure Diabetes

Posted on February 28, 2012 by Jeff Mather

Friends, I’m bicycling the 105-mile Ride to Cure Diabetes in Death Valley this October. It’s a fundraiser for JDRF to support diabetes research, therapies, and patient advocacy. Won’t you please help me meet my fund-raising goal?

Thanks!


Here I am testing my blood sugar on the bike. Help make this a thing of the past—the testing, not the cycling. :^)

Posted in Cycling, Diabetes | Leave a comment

Real People Sick

Posted on February 16, 2012 by Jeff Mather

The ironic thing about me having diabetes is that I’m really bad at being sick.

I come about it honestly. My father is a bit of a hypochondriac, so I’ve always been a bit skeptical of illness. My mother is usually way too busy to ever be sick, seeming to save it all up until—from time to time—something big knocked her out. As a paramedic, my stepfather was around illness and injury all day long, and in those pre-HIPPA days it was okay to talk about the things that happened in the emergency rooms and on the accident-prone highways of Wyoming.

As a result, I have a rather high bar for being sick. “Do I have hemorrhagic fever?” No. “Do I need surgery?” No. “Did I bring the rattlesnake that bit me into the E.R. in a pillowcase . . . after finishing digging all of the new post holes?” No. “Then I must not be too sick.” Don’t get me wrong; I don’t believe in going to work and exposing my coworkers to whatever contagious thing I have, but it takes a lot to keep me home. Fever mainly. Or the inability to stay awake. Or pain. Or not being able to keep things that belong on the inside on the inside. Or hemorrhagic fever . . . which might combine all of those together—though I’ve never had it. (*touch wood*)

I do what I can to stay healthy. I get a flu shot annually. I avoid people who are sick. I wash my hands. I avoid the finger-food that randomly shows up around the office printer. I tell myself that I feel well, even if I’m a bit marginal. And, for the most part, I stay very healthy.

Except that every year around this time, I get a respiratory infection that slows me down. I blame winter—and children—for the sniffle and headache that eventually turns into a sore throat, cough, and malaise as it moves its way from my sinuses to my chest.

It’s going around, and I don’t really feel bad at all. Except, yesterday when I got home it hit me. In the span of five minutes my mind switched from “It’s beautiful; I should run outside” to “I still feel a bit wimpy; I should run on the treadmill” to “I think I could vom; I’m should lie here on the coach under a blanket.”

I guess I looked pathetic when Lisa came home from work an hour later. By that time, I didn’t feel quite so bad, just worn out.

Which brings me back to my initial observation: I am not a good sickie. I do what I should to help me get well as quickly as possible—I take it easy and follow the widely held “Don’t exercise if you’re sick from the throat down or have a fever” philosophy—but it makes me unhappy in a way that the actual illness usually doesn’t. When I miss a workout—much less actual work—for things that don’t even remotely resemble hemorrhagic fever, I feel like a slacker, a loafer, a shirker.

I missed a few workouts last week before I started feeling better over the weekend, just to relapse over the last few days. Monday, when I thought I was feeling well, I went for a surprisingly slow swim in the morning and a short but surprisingly slow run in the afternoon. Then Tuesday I went to the gym to pick things up and put them down, which was surprisingly difficult. And that was the last time I worked out this week. Tuesday afternoon workout? Nope. Wednesday morning swim? Nope. Wednesday afternoon run? Nope. Thursday morning weight training? Nope. And since I’ve been coughing and downing sugar-free Robitussin DM all day, it’s likely that I’ll take this afternoon off, too.

And this, my friends is the difference between having diabetes and being Real People Sick™: When I just have diabetes, I can do whatever I want. Actually being sick sucks.

Posted in Diabetes, Running | 2 Comments

Advertising

Posted on February 8, 2012 by Jeff Mather

Lisa makes the best T-shirts! This Christmas gift might just be perfect.

Bad-Ass Diabetic Motherfucker

Posted in Diabetes, General, I am Rembrandt | 3 Comments

To Paula Deen

Posted on January 18, 2012 by Jeff Mather

Hey Paula!

It’s true I’ve never watched any of your shows or tried any of your recipes, but I saw your picture on a magazine cover or two at the supermarket. Now that you’ve announced that you have type-2 diabetes, I feel like we’re definitely on a first-name basis.

Type-1, type-2, LADA, gestational—no matter the kind, diabetes sucks. I’m sad to hear that you joined our club. It’s a bummer, but there’s a really big supportive group of people online and in real life who are here for you.

I know there’s a brouhaha brewing about the how/why/when of your announcement, but I frankly don’t care. . . .

Except I will say this: You owe us.

You have a high profile because of your pre-diabetes life. And you have partnered with Novo Nordisk to promote pharmaceuticals, putting you squarely in the diabetes community. You best be using your influence to help people with diabetes. Here are some ways:

  • Promote understanding of the differences between type-2 (which you have) and type-1 (which I have), since so many people in the US think there’s just one kind.
  • Encourage healthy lifestyle choices for everyone, whether touched by diabetes or not. T-2 is more than diet and exercise, but we have to be honest about their role. There’s no guarantee one way or the other, but every little thing we do (within reason) makes a difference.
  • Help people with diabetes in your audience understand that they are more than their disease, that there will be better days and worse days, and that they can do this.
  • Work with CDEs (at Novo and elsewhere) to develop a message of empowerment that people with diabetes can use to improve their own self-management as they make choices and work with their family and healthcare providers.
  • Stress that there’s more to diabetes than Novo’s drug-of-the-day. Be holistic.

Remember that a bunch of people are watching you. The diabetes online community is watching, too. We’re nice people, but we look out for our own. Based on what I’ve seen in the past, we will cut you like a piece of pecan pie if we think you’re using diabetes for your own benefit and aren’t giving back.

Diabetically yours!

Posted in Diabetes | 4 Comments

What (Kinda) Works Now

Posted on December 5, 2011 by Jeff Mather

Chris sent me a message saying that someone might ask me about running with type-1 diabetes. I haven’t yet heard from him/her, but it got me thinking about what I’m doing now and how it’s going. It’s not perfect, of course, but I’m actually in a pretty good place.

Let’s start with the big disclaimers. First, this is what (kinda) works for me. Your diabetes may vary; it likely will. Second, this has only recently started working for me; it could all change tomorrow. Third, it assumes that you use an insulin pump and that your basal and bolus rates are correct-ish; mine are getting there. Finally, I can’t consistently reproduce what I do in training when I’m racing; something always seems to happen.

Remember, three big things impact BGs during exercise: insulin, food, and intensity. (There are other things, but these are the big ones that you can control.)

Active Insulin: I tend to workout when I have no (or, at least, minimal) insulin on board. For example, I swim and do my long running/cycling first thing in the morning before any boluses. And when I workout in the afternoon, it’s been 4-5 hours since my lunch bolus. This means that there’s very little extra insulin to bring down my blood sugar. When I do have rather high BGs (but no ketones) because I misjudged a meal, for example, I will sometimes give myself a little insulin. I’m really conservative doing this, though, since it usually brings me down more than I think it will.

Basal Insulin: I am starting to think that changing my basal insulin has less of an effect (for me) than I had originally suspected. This might be because my basal rates are fairly low now, or it could be that my body is better at using fat and carbs together than it was in the past. Who knows? Anyway, when I run or ride my bike, I set a 30% reduction 1-2 hours before I start. Usually longer in the afternoon and shorter in the morning, since I like sleeping. When I swim, I set a 0% basal rate (i.e., no insulin) starting 45-or-so minutes before I hop in the water. There are three reasons: (1) I’m skittish when it comes to insulin and water, (2) it’s similar to what happens during triathlons, where I need to detach from my pump to leave it in transition before hopping in the water, and (3) it seems to work.

Food Before: Food is not the best part of the three for me. I want to eat more before I train, because food is fuel, and I hate running out of steam. (We’re remarkably like people without diabetes in this respect.) Food normally means insulin, which violates that whole “minimal insulin on board” thing. But I’m working on getting myself in a mindset where I can experiment with small amounts of insulin to cover pre-athletic carbs. High glycemic foods still spike my BGs when I’m working out, often more than I would like. Lower glycemic things do better, but quantity counts; 20g of carbs from Greek yoghurt about 10 minutes before I did a two-hour run worked well yesterday, the first time I tried it. Be careful here.

Food During: I tend to eat like I don’t have diabetes when I bike or run. It’s just how it works for me. I eat an energy gel every 45 minutes to keep up my energy. I also carry a full tube of glucose tablets with me, just in case. And I drink water. Water is important.

Food and Insulin After: I find that I always need to give myself insulin after I’m done exercising. I haven’t yet figured out how much to give, but I usually bolus the full amount of any correction I would need (or enough to bring me down 25 mg/dL [1.5 mmol] if my BGs are in range). After really hard workouts, I like a protein-rich snack with carbs. (Odwalla’s Chocolate Protein Monster is my favorite.) These carbs and protein are important for recovery, and I find it necessary to bolus the full amount for this snack, even though I will eventually be more insulin sensitive for the next 24 hours after big workouts.

Frequency: It helps to have a regular frequency, usually three or four times per week (or more). If I workout at least this often—although I can’t remember the last time I did less—my insulin sensitivity stays much more “normal” than if I don’t. Consistency is key.

Supplies: I bring these things with me on my workouts.

  • A full tube of glucose tablets
  • My pump (enclosed in a Zip-Lock bag to keep perspiration from killing it)
  • My BG meter when I go on longer runs or when I’m curious about what’s happening on shorter outings. I use the OneTouch Ultra Mini just for exercise.
  • Energy gels. I’m not very brand-loyal; I like vanilla and chocolate Gu and Clif Shots and just about any Hammer Gel flavor.
  • Water (in a FuelBelt Sprint Palm Holder)
  • I also carry about $10-15 with me in case I need to buy some extra food.

There are some other things I like, but they don’t have anything to do with diabetes preparedness. I have a Petzl Tikka headlamp, which is great for running on these dark afternoon; I’ve never had a jacket as nice as my Asics one; and I need shorts and pants with pockets . . . and a drawstring. (Without the drawstring, all of the extra stuff in my pockets makes ‘em fall right off.)

Good luck! And just remember, do whatever works; there’s no single right way.

Posted in Cycling, Diabetes, General, Life Lessons, Reluctant Triathlete, Running, Swimming | 7 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