Today in Diabetes Blog Week is snapshot day. Last year I had a lot of fun with this when I was in DC. This year, I’m being a little more traditional.
Friends, I have been having the worst period of prolonged high blood glucose that I can remember. All the “rules” are wrong; nothing is working the way it should. Basal rate, bolus ratios, the effects of exercise—they’re all messed up. There could be any number of reasons: ineffective infusion set locations, lower training volume or intensity than before, no longer being overtrained and in glycogen debt, different eating choices, bad insulin, etc. Who knows? The result is that last night my 7-day average of all readings was 199 mg/dL (11 mmol/L). I don’t think it’s been this high since I was discharged from the hospital when I was diagnosed.
I’m working on figuring everything out again, almost from scratch. These snapshots are all from today, which was full of a lot of things that lowered (and occasionally raised) my blood sugar.
(You can click on any picture for a larger version.)
Today started with a interval workout on the track that actually raised my blood sugar. I’ve been using a foam roller to help keep my IT band in check, since it’s starting to feel a little injured.
After my run, a little stretching and the foam roller.
This is how Kitty spends the majority of his day.
Since I was still high, I decided to bolus and mow the lawn. I was wearing my heart rate monitor from my run, and I checked in from time to time. 120 BPM to mow the lawn. Ha!
After my run, it was time to mow the lawn.
Our irises are going gangbusters this year.
After lunch: housecleaning. It always lowers me a bit (supposing I bolused enough for lunch).
The carpets needed a good hoovering.
After vacuuming, it's time to clean the dining room.
Usually the vacuum cleaner makes him run for the hills.
Meanwhile, Lisa was doing battle with the shrubbery.
Lisa needed a tall person.
Different piece of furniture, same result.
Time to take the clippings to the transfer station
It was a warm day. That calls for ice cream before doing more housework! (Of course, we’ve also been known to go to the ice cream shop during a snowstorm.)
A Treat after all that yardwork
The office needs a good going through.
Lots of bike riding recently
I’ve been jonesing for a long bike ride for quite a while. Tomorrow is the day. We’ll see if that can’t knock these highs down a bit.
Tomorrow, I'm going for a little ride. Maybe that will help.
Long-time readers will know that last year around this time I did my first triathlon. I had been training for months, and I was extremely nervous about the open-water swim portion, which almost turned me off the sport before I even finished. But in the end, it was so much fun, and I’ve been looking forward to doing more of them since last summer.
This morning I competed in the same race, the NE Season Opener in Hopkinton. What a difference a year makes!
Last year I did the 1/4-ish mile of swimming, 10 miles of cycling, and 5K of running in 1:16:34, good enough for 171st of 366. This year: 1:08:57, or 131/438.
As a “newbie” registrant in 2011, we had our own special start time and apologized for bumping into each other during the craziness that was my first open-water swim. This year, in the biggest starting wave, it was all fists and kicks for the first 30 seconds until we got ourselves sorted out. (Next time: start farther out.) I found some feet to draft off through the 58ºF water, did a great job sighting with my optically-corrected goggles, and was surprised at how fast it was over. In fact, it wasn’t until I was about halfway through that I realized my form kinda sucked and that I needed to remember what I usually do in the pool. “Ah right! Less flailing more pulling.” Still, I was almost three minutes faster this year.
Ah, the bike! After a relatively fast transition, I hopped on Speed Junkie (my Cervélo P2) for my first race on it. I must confess that I was nervous in the days leading up to the race. How would I do around other people? Would I be able to spend most of the time in the aero position? Would I be as fast on the bike as I had hoped, or would it be an expensive ride? Could I hold on over the bumpy roads? Would I have trouble with the tight turns? Would I crash? Etc. Etc. Etc.
Let’s remember that last year during my two triathlons as a newbie, I did all of the passing on the bike (and almost all of it during the run, too). I wasn’t expecting that this year, since I was starting among faster people, and there were fewer people starting ahead of me. I’m sure I would pass people, and I’m sure others would return the favor.
Turns out, I’m fast on a bike. And the roads were very well controlled. There was very little traffic, and I was able to ride where I wanted on the road. I spent 85-90% of the ride in aero, worked hard, and only got passed by a half-dozen people, including one woman from BU with longer hair than anyone I’d ever seen on a bike and two of my Landry’s teammates. (That reminds me: must get a Landry’s tri-top so that I can represent . . . unless/until TT1 wants me to wear their colors.) I caught one of the Landry guys when an ambulance was attending to him along the side of the road near a rather rough patch of road. Poor guy.
All things considered, I did very well over the whole course. Small, wiry guys like me do well on hills, and I’m getting better at riding this little bike over open ground. (Almost 5 mph better.) I like passing people.
Finally, the run. I was feeling good today, but I was trying to be smart. I’ve had some IT band pain recently—which I’m watching closely—and over the last few days my right arch started getting cranky, too. Stretching, ice, the foam-roller on my hip and thigh, and self-massage for my foot should (hopefully) do the trick. I’m happy that this coming week is an easy one in my training plan.
So I decided to run hard but hold back a little, try to hold a good pace throughout the whole run, and not feel (too) bad about being passed. It was what it was, which was consistent but just okay . . . the only part of the event (including transitions) that was slower than last year, actually. Strangely, I’m okay with this. I had enough at the end for a nice finishing sprint.
My diabetes strategy most certainly did not work out well. Not well at all. In fact, I’m mystified by how bad it was. Diabetes is what it is, but I was hoping for something better.
In a perfect world, I would eat some breakfast before leaving the house, take some insulin for it, adjust my insulin before the start, and then take nutrition during the event (almost) like I didn’t have diabetes. Unfortunately, I don’t know how much insulin to take before a triathlon—because Insulin + water = scary—so I don’t really eat much, except a Greek yoghurt right beforehand. I don’t even usually need to eat before I swim at 5:45 in the morning, but when starting at 9:15, it seems completely different. It was also different than my normal multi-hour rides and long runs.
Perhaps it was the adrenaline from the anticipation of the event. Perhaps there’s something going on with my basal rate. Perhaps it was just sun spots. Who knows? What I do know is that I need to make it better. And I will.
At any rate, I had to take about a half-unit of insulin before the swim, and I didn’t come down much when I was in the water. Or during the ride. Or the run. Fortunately, I didn’t have much of that high BG pain in my legs that I sometimes get, but I could tell that I was high throughout the run. Next time will be better, I hope.
So, all things considered, it was a major confidence booster with some great experiences and a few obvious things to improve. Onward!
Today is Patriots’ Day. Marathon Monday. The best day of the year!
I’ve been making the half-hour walk from my office to Natick Centre to watch the marathon every year since 1998 (except 2009, when I was hiking in Utah). It’s a wonderful workday diversion during a usually beautiful time of year in New England. The blue skies, new-green leaves, flowering trees, and warming temperatures all remind me that the last thing I typically want to be during spring is inside. And the marathon is a perfect excuse to get outside for a few hours.
I love watching all of the athletes, and I like showing up early to find an unobstructed spot and to be inspired by the push-rim wheelchair, handcycle, and mobility impaired athletes who start before the main field. By the time the elite athletes come through, I’ve remembered what I need to do to photograph runners and am really into the spirit of the day. Frequently I stick around to see someone I know run through before I feel the guilt of being away finally drag me back to the office.
One of the great things about the Boston Marathon is that it’s more than a sporting event. It’s one of the main social occasions of the year. It seems to have the same atmosphere as the great one-day cycling events, like Paris-Roubaix, that I love to watch on TV. It draws so many spectators, not just neighbors coming out of their homes along the course. And the route is totally lined from at least the 10th mile (where I watch it) all the way in to Copley Square.
Often I go with my coworkers, but for some reason I was by myself this year. So I found an open spot, between a family with small children and a couple of twenty-something young women. I was prepared to mind my own business for a couple hours and just immerse myself in what was happening on the course, but the two women were talking about running and asking each other questions that I knew the answer to and generally doing their best to crack me up with their banter. Eventually they asked an important question they couldn’t answer by themselves—when would the elite women and men go through?—and we casually got into a conversation. (It probably helped that I asked them whether they were students. I meant grad students, but they seemed to think that was just the nicest thing ever. I’m really not a flirt. Honest.)
The only “awkward” moment came while I was waiting for Team Type 1 runner Marcus Grimm, whom I gave a hearty cheer when he arrived around 11:30. As I looked at the runners streaming by to see if they were wearing a TT1 singlet or had a name that I could shout out for encouragement, I saw a familiar name: my name.
Me: “Hey, I bet that woman’s last name is ‘Mather.’ That’s mine, too!”
Nice woman, probably joking: “You should totally run with her for a while.”
Me: “I could say, ‘Hey there. I saw that you had my last name written on your bare midriff. So I thought I’d just jump in here and say hi and run with you.’”
Woman: “I guess that might be awkward.”
Me: “Definitely.”
Sadly I have no pictures of anyone mentioned in this post—the lawyer, her friend getting an M.Ed., Marcus, the running Ms. Mather, or myself—but here are a bunch of photographs of the rest of the action.
I remember seeing the photographer and thinking, “I’m going to try to look good when he takes the picture. Nothing to betray the hurt I’m in right now.”
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 . . .]
Hi, dear readers. The big post about our recent trip to Barcelona is going to need to wait a little bit longer. I’m still a bit jet-lagged, and I’ve just barely started going through the 1,700+ photos from our trip. But I have a lot to say, and I’m eager to get it down. Especially since I leave for Canada tomorrow to run Around the Bay and meet some wonderful people. I seem only to be able to think about one thing at a time, so it’s best to get it out of the way before embarking on a new adventure.
Speaking of tying up loose ends, here are a few follow-ups to recent posts.
I.What to listen to next? I wanted to listen to something new, but I wasn’t sure where to go next. Then yesterday on the way home, I heard an NPR segment on U.K. reggae. (It’s okay. You can admit that you listened to it to, and that you occasionally discover new music via public radio. Your sense of being special and nonconformist is safe here, friends.) One of my earliest memories of music that made me sit up and take notice was hearing a bit of calypso, so it feels a bit like diving back into the music of my early youth. Years later, when I first started listening to some early 80s British music, I was amazed at how much reggae and ska influence there was in it. (And then there’s this.) So why not dig into reggae for a while?
II.No hablo español. Turns out, you don’t need to know Spanish to have a good time in Barcelona; most of the shop clerks, hotel folks, and wait staff knew enough English for us to communicate. And the locals are at least as friendly as the French to people who try to speak a few words of the local language before asking if they know English. (I will grudgingly say the Spaniards are perhaps even a little friendlier.)
Often people could tell after my first few words of Spanish that I wasn’t very proficient, and they just switched to English. Evidently, Lisa and I don’t look Spanish either. One woman at the Madrid airport tried to say something to me in Spanish, which I didn’t understand, so then she asked, “Nicht verstehen?” (“You don’t understand?”) After I answered, “No,” she proceeded to try to speak to me in German. She could have also said one of the two or three things in Arabic I remember—”لا أفهم؟”—and my answer would have been the same. (I was telling Lisa how bizarre it is that I can say “I don’t understand” in Arabic and German but not Spanish.) So I countered with “¿Habla ingles?” and “Parlez-vous français?” with the same result. My helping her was not meant to be. Anyway, I guess that we look more German than Spanish.
Thanks to “Sesame Street” and my mom teaching me a few words as a preschooler, I can count to twenty and be on the look out for “entradas” and “salidas” and “peligro.” When we had to use Spanish, we were still able to buy things and order food, and I even gave directions to a woman looking for the street she was walking on. By the time we left I had the simplest of conversations with the check-in agent at the Iberia desk in Barcelona, which only broke down when she asked what kind of seats we wanted for the flight back to Boston. I laughed when she said that I speak Spanish very well, and she seemed amused when I said that I don’t speak Spanish at all.
And then there’s Catalan, which was everywhere in Barcelona. It’s a beautiful, funny thing that sounds not quite French and not quite Spanish. At any rate, I found the Catalan menus easier to read than the Spanish ones. Boy oh boy, did I want to speak French a lot on this trip. . . .
III.City Running. I have decided that big cities are not easy places to run in unless you’re willing to make a commitment to travel to a nice place to run: along the Seine or Thames, Central Park in New York, the Domain in Sydney, the waterfront in any city lucky enough to have one, etc. Suburbs are easy enough to manage, but if you’re staying in the city where all the action is, there’s just so much stopping and starting.
Except Boston. Somehow Boston has been blessed with plenty of long streets with minor side streets, meaning you usually don’t have to stop at every corner. And these streets take you quickly to the Charles River trails or to the Emerald Necklace and its parks. I’m trying not to sound parochial—especially since I don’t run in Boston often—but the number of people running all over Boston at any time of day just helps prove the point that Boston might be one of the best running cities in the world.
Nevertheless, I needed to run on our trip. This vacation was a perfect time to taper, but I still had to put a few miles in every other day just to keep my legs fresh and ready. (My orange New Balance shirt and I have now run in five countries on three continents.) So if you’re staying in the L’Eixample neighborhood of Barcelona and you need to run a few miles, what to do? First, use the Passeig de Gràcia or the Rambla Catalunya to head to La Rambla, the super-touristy pedestrian area. If you finish your run before 9:00AM, you don’t have to dodge many people. Also—and this seems true for most European cities—head to the old city where the streets are one-way, windy, narrow, and designed for pedestrians. You’ll often get lucky and an early-morning delivery vehicle will block traffic, letting you run in the street without too much worry.
Just have a good idea where you’re going and don’t get lost.
IV.Pool ladies. Honestly, it would be easier if the four of them weren’t trying to swim in my lane.
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.
Do any runners with diabetes out there know how to help me with a wee, tiny, almost insignificant problem?
I met with my endocrinologist today, who is awesome and was really happy with my spiffy 7.3 A1c. But she was not happy with the black callous on the end of one of my toes. This toe—the one next to my big toe on my left foot—frequently gets bruised or calloused. It doesn’t bother me—even if it blisters it doesn’t seem to hurt—and it’s been worse-looking in the past. (This was the toe that lost its toenail around this time last year before I got shoe inserts and learned how to take better care of my tootsies.) But I understand where my endo is coming from, even if I don’t agree that it’s a problem.
Does anyone have suggestions for things that I might try to keep my toes looking dainty and endo-approved?
I — I finished off the bottle of sugar-free Robitussin DM yesterday. That must mean I’m well now, right?
II — Yesterday morning, I went for a long run around Milford, Hopkinton, and Holliston. The 12.5 miles were a bit slower than they might have been if I hadn’t been sick and/or injured for the better part of the last two months, but I don’t care. I’m looking forward to running Around the Bay in just under five weeks. I have goals for the race, but mostly I’m excited about just doing it.
III — Victoria invited me to join her on a JDRF Ride to Cure Diabetes. More details about the 100+ mile Death Valley bike ride in October and how you can help are on the way . . .
IV — The consensus at the bike store this afternoon is that twelve years is “a very full life” for an indoor trainer. I was surprised myself to realize that we’d had it that long, but I remember riding on it while watching the summer olympics in 2000. A couple weeks ago, forty-five minutes into a nice ride to nowhere, the riding got very difficult very quickly, and I could hear a horrible grinding sound. Fortunately, my awesome new bike was not the source of the sound. Unfortunately, the bearings in the trainer seem to have seized. Sadness. The upside is that now I have a new, very quiet trainer for the basement.
V — Lisa and I have been watching lots of films recently. I like “good” movies, so we made our way through eight of the nine Oscar-nominees for “Best Picture.” (You can’t make me watch “Incredibly Loud and Extremely Close” or whatever it’s called.) I’ve also watched a number of foreign films, popcorn movies, and documentaries. By the way, my three favorite nominated films of the year were “The Artist,” “The Descendants,” and “Midnight in Paris.” Lisa and I also both liked Miyazaki’s new Studio Ghibli film “The Secret World of Arrietty.”
VI — Saturday evening we went to the Providence cheese shop beloved by our friends. We bought a lovely Napfkäse, which is a delicious Swiss cheese somewhere in the neighborhood of Comté (my favorite cheese) and Gruyère, with grainy hints of Parmigiano-Reggiano. If you can get your hands on some, give it a try.
VII — It’s been almost a decade since I decided to stay in software engineering and not go to grad school, but I still miss history. Turns out, I can be a software engineer by day and read history at night. My current choice is Fred Anderson’s Crucible of War: The Seven Years’ War and the Face of Empire in British North America, 1754-1766. This book has been on my reading list forever, and I wish I had gotten around to it earlier. If all goes well, I’ll share details with you about this long war that destroyed France’s North American empire, seemed to bind American colonials more closely to the British empire and each other, and then ultimately set in place many of the precursors to the American Revolution. I’m having such a good time reading it.
VIII — I also signed up for one of the history listservs that were so popular a decade ago (academically speaking). It’s like a little bit of early American history enlivening my inbox everyday.
IX — I’ve been doing strength training at the office gym a couple times a week. While I don’t particularly enjoy it, I believe it will make me a better athlete. Strength training reminds me of this ad:
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.
Coworker: You can sign up to be a zombie or a normal person. If you’re a normal person, you wear a flag-football belt, and if the zombies chasing you grab two of the flags, you’re done.
Me: And if you hit one of the zombies in the head with a bat?
Starting around Christmas time I start to feel a bit overwhelmed. New prezzies (usually) means new books to add to my reading list. Extra time off work means more opportunities to clean up the detritus of the previous year (or longer). That’s a mixed blessing: freeing up space in my brain to concentrate on the right things without actually getting to spend the time doing those things. I’m being much more ruthless about just chucking stuff this year than in the past, and I think I’ll be done soon.
Almost being done is very good, because I have goals. (I don’t go in for New Year’s resolutions. Anything worth doing is worth starting at any point in the year. Why wait for a particular date to have a clean slate?) I tend to keep my goals to myself, but I’m willing to say that one of them involves trying to pimp-slap my out-of-control bookshelf by reading a certain number of pages each week. I figure that even an incredibly slow reader such as myself should be able to average 15 pages/day.
This goal-thinking was (is?) getting me a little down this year. So much of what I want to do in 2012 involves feats of athletic prowess, but my feet were threatening to get in the way of those feats. Lisa, the awesome exercise psychologist of my dreams, is (slowly) helping me see that I am more than my goals and accomplishments, but I still missed running because I really like it.
The week before my injury, I had a wonderful 12+ mile run that took me to the end of one branch of our local rail-trail and then past it into the exurban farmland and acreages of the neighboring towns before picking up the start of the other branch of the trail and following it home. I am eager to get back to that.
For sure, I was was also stressing that not doing these long training runs might leave me ill-prepared for the Around the Bay 30K in late March . . . or possibly incapable of running it at all. Eventually I told myself that I had to stop worrying about whether or not I would be able to do ATB—or the NYC Tri in July or the half-Ironman in August—and just concentrate on getting well. I could still ride my shiny new bike in the basement, there’s always plenty of swimming to do, and on the last day of work in 2011 I got a personalized weight-training program, which I started last week.
Sometimes I need to be reminded to look at the “big picture.”
By the middle of last week my foot didn’t really hurt very much, although I noticed twinges now and again, especially when I moved my foot in particular ways. It kinda sounded like plantar fasciitis, and it kinda didn’t. Everyone I talked to about it had horror stories about how PF messed up a fellow runner for months or years on end, so I was determined to find out what was actually wrong with me before doing anything stupid. I also wanted to find out the right way to start back up when the time was right. I didn’t want to rush into anything, but I could feel myself losing the exercise-every-day-after-work-and-go-to-the-pool-a-few-mornings-each-week habit that I had developed by the beginning of December.
On Friday, I went to my podiatrist, who said (again), “Boy, your feet are eff’ed the fuck up . . all loosey-goosey and flat and shit.” And then he went on to say, “You don’t have plantar fasciitis, but you’ve gone and slightly fucked up the long tendon that connects your calf to your big toe via your heel. It’s amazing you’ve been able to get way without this kind of shit for so long. You need expensive orthotic shoe-inserts to keep this from happening again. Now, let me teach you some calf stretches and recovery techniques. You should start popping Aleve like a fiend, too. I’ll tape up your foot, and you can go running tonight if you want. But don’t go for any PRs or bullshit like that for a little while.” (I’m paraphrasing just a wee bit here.)
So I’m quite relieved. I’ve gone running twice since visiting my not-at-all-potty-mouthed podiatrist. Each run felt good, foot-wise. The left one isn’t 100% in the hours afterward, but it’s 10x better than the days after I injured myself. The runs also felt shorter and more difficult than I remember them being a month ago. Even so, these short, difficult runs were awesome.
Speaking of amazing things. I’ve been out on my road bike twice this new year already, and each time I wore shorts. New Years Day was the first time I’d been out since early October, and the lingering chill on the thawing roads couldn’t bring me down. Saturday morning’s sunny, 50°F, 25-mile ride had no chill at all. By way of contrast, at this point last year we had more than 30 inches of snow on the ground, and we were in for 60 more.
So I guess there’s that, too.
Oh, and there’s swimming! The Friday before Christmas I got up super-early despite not needing to go to the office. The pool was open, and I had the chance to get a full hour-and-a-half swim, instead of my typical 40-or-so minutes. The last time I had this opportunity, I swam two miles, and I wanted to give it another go, testing my blood glucose along the way. The results were very much like last time—better actually. My BG stayed almost constant; my 250-yard split times were fairly consistent throughout; and I swam a quarter mile farther in the same amount of time.
Now that I’ve written this, I’m reminded how fickle I can be. Yes, winter can be a cold, dark, lonely, depressing, snowy, stir-crazy-making time of the year. But it seems that all I need is a good report from the doctor, a run or two, an outdoor bike ride, a nice swim, and the constant loving support of Lisa for me to feel like a good spring is just around the corner.
p.s. I guess I should add that last night Lisa and I watched a documentary about U.S. athletes in the Beijing Olympics. It wasn’t the best thing ever, but it sure looked beautiful on our new high-def TV. I can barely wait to see this year’s games. Hurry summer don’t be late.
I went for a run today on the treadmill. (I like watching “The Walking Dead” while I run and go nowhere. It seems appropriate for the brainlessness of the treadmill.) It was my first run since I felt the pain of plantar fasciitis appear six miles into my easy, seven mile, recovery-week run on Sunday. Even though I didn’t feel any pain this morning when I got out of bed (the time when it’s usually worst) I only ran three easy miles. I don’t want to push my recovery.
And tomorrow morning, I’m going back to the pool for the first time since last Friday. I had such a great swim a week ago that I planned to write that evening about how awesome it was. Except, by the time the evening rolled around, I couldn’t raise my left arm high enough without pain to use the computer. After five days off, I probably could have gone back yesterday, but I didn’t want to push that either.
Being injured was hard. Being doubly injured was ten times worse. I’m so happy to be well enough to get back to training. *touch wood*
(I’m not a superstitious or magical-thinking thinking kind of person, though I am known to indulge in two things. When things are going really well, I don’t like to talk about it. Everything could suddenly change. Why? Hubris, of course. It’s best to just keep going quietly as long as things are going well, all the while expecting that bad things could happen at any moment. . . . I also throw salt over my shoulder when I spill some, because throwing salt is fun.)
Friends, I am not good at being injured. The first few days were the most difficult. On Monday, I definitely had my cranky pants on. I tend to arrive at the worst possible conclusions: I’ll be injured for a long time; I won’t be able to do the events that I’ve signed up for; I won’t be able to achieve my goals; I won’t be able to be who I want to be. I’m a very goal-oriented person, and I derive a lot of my self-worth from setting and meeting them. (Lisa and I debate whether or not this is not a good way of thinking. At any rate, I need to remember to take the long view.)
I’m trying to be better at handling the occasional injury, and I feel grateful that each of my recent issues were very minor in the great scheme of things. And I need to start working on my injury prevention.
So what was I going to write on Friday? Given that I already injured myself, there’s no fate to tempt by talking about how great my swim on Friday was.
I’m not very fast yet, but I’m consistent during my workouts. I also think I’m improving my technique: I have started to feel my catch more, and I’m starting to see how to generate power during my stroke. Despite these improvements—which may or may not have caused my shoulder problem—I was starting to wonder whether I was actually getting faster or not. After all, the whole point of working on technique is to reduce my times, and I was much faster in the open-water over the summer than I ever have been at the pool. But what about my times just at the pool?
I went back to the historical record (a.k.a., mapmyrun.com). Turns out, I am swimming faster—and not just a little. Last Friday, I swam a bit over a mile at 36:12/mile pace. That’s two minutes faster than on Halloween and more than three minutes faster than just before my first triathlon. At this time last year, I swam at a 43:00/mile pace . . . and I wasn’t even going a full mile. This is a great trend, and I hope to keep it going. (And for the record, the first time I went to the pool, I swam six lengths in twenty-five minutes. That’s 277 minutes per mile.)
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.
titration: (noun) the process of gradually adjusting the dose of a medication until optimal results are reached.
I remember doing titration in high school chemistry class and not really enjoying it. You wait and wait and wait for something to happen while adding more and more and more reagent to a flask in the hopes that it will turn a pretty color. Or rather, after a game of rock-paper-scissors, your lab partner adds the reagent to the flask while you write down measurements and try to stay awake. Even though I loved learning about chemical reactions and trying to recreate some of them at home—how did I not burn the house down playing with purloined magnesium tape?—I think the titration lab was the one where I realized higher-level studies in chemistry weren’t for me.
It feels so similar now as I try to titrate the correct dosage of insulin to give when I exercise. It’s still the process of running multiple experiments involving adding a known amount of chemicals—in this case food and insulin—coupled with a lot of record-keeping. The big differences of course being that (a) I’m the flask to which the chemicals are added, (b) I have to wait a week between experiments, and (c) there are reagent strips I use with my blood glucose meter that together tell me the values and keep track of them for me. And, of course, the really big difference: If I mess up the experiment too badly I can’t just poor the contents of the flask down the lab desk’s drain.
After all this time, I still don’t really like titrating—it’s scarier to mess with insulin than it is to burn magnesium tape—but I also don’t like these other things when I’m training:
being hungry
running out of energy
experiencing hypoglycemia
having high blood glucose
not knowing what’s going to happen
Unfortunately, in this lab experiment, each apparatus person with diabetes is different. Otherwise I would just ask my awesome internet friends. Even I probably won’t give the same results from one week to the next. That being said, last week’s experience of going way up during the first 45 minutes of my long run and then holding steady for the next 45 minutes (eating beforehand and along the way) was the same as today’s.
Next long run (in two weeks) I’m going to add some bolus insulin and see what happens. I’m going to start minutely small and go from there. I have about sixteen weeks until Around the Bay, and I don’t feel any particular need to approach the problem via bisection. I’ll just use the normal titration method, starting small and gradually adding more until I find the “right answer. . .” or something near it.
Today’s run was actually quite good, elevated BGs notwithstanding. The weather was beautiful in the Bay State this weekend, and I got up early enough that I didn’t feel rushed to get home before we went to see the film “Martha Marcy May Marlene.” (It’s good, but bleak. Wicked bleak. “Winter’s Bone” bleak. Life lesson: stay away from John Hawkes.) I picked the 10-mile loop with three mile-or-longer hills, and I threw about fifteen minutes of tempo running into the middle of it. I figure I’ll gradually keep adding longer stretches of high intensity as I add more distance.
I am not a doctor and do not have any medical training. Your diabetes may vary. You should always check with your health care team before making any changes to your diabetes self-management or exercise regimen.
