Step 6

Step 6: Ask for help. Nobody knows my diabetes experience better than me, but that doesn’t mean I’m the only one with ideas. Other people can help, too, by providing insight into diabetes, information about what’s in the food I eat, tips for exercise, and encouragement.

Lisa’s been asking me for a while how she can pitch in. I really don’t know what to suggest—she already gives me a lot of support and encouragement—but I love that she’s willing to help.

Today I met with my endocrinologist’s nurse practitioner. We discussed how to improve my A1c, attenuate the wild swings in my blood glucose when I exercise in the afternoon, and generally get me more confident in my own diabetes self-management plan. We were on the same page from the beginning of my appointment, when he asked me what I wanted to focus on. Me: “Well, I slide into lunch almost low, then I feel like I have to go very high before exercise, when I often drop 100-200 mg/dL in an hour. So, I was hoping to focus on noon to 7PM.” Him: “Great! That’s the part of the day I wanted to start with, too.”

I mentioned that I was unhappy with where I’ve ended up—with my A1c, not my accomplishments—so we talked a bit about how I got here. “Last year, training for the Ironman was so important that I tolerated a lot of highs that I didn’t really like just to make sure that I could get the work done. I think I got too used to being high—and had so many large drops—that I started to feel comfortable in the 200s. I feel like I need to reset a bunch of things.”

So that’s what we’ll be doing: getting back to basics while accommodating my training. We’re starting with an afternoon basal test soon. I considered trying today, but my pre-lunch BG was only 78 mg/dL (4.3 mmol/L). We will also be reviewing my data online, which is kind of exciting.

For the first time in a while, I’m hopeful that I can make some positive changes that stick. As I told my NP, if doing an Ironman taught me any lessons, it’s that putting my head down and just doing the work everyday eventually makes an impossible task achievable.

Posted in Baby Steps, Diabetes, Life Lessons | Leave a comment

First Thoughts on the Dexcom G5

Blip 2016-03-28

I’m coming up on the end of my first Dexcom G5 sensor, which is to say six days. (Yes, I’ll be trying to restart it and see how good zombie sensors can be.) So far I’m really pleased. It largely tracks my blood glucose, often to within a few mg/dL, which is pretty impressive. It hasn’t had any unexpected dips and bounces where it showed my BG changing in absurd ways.

As for exercise, my experience has been mostly positive.

After swimming with it twice—this morning and five days ago—the sensor still seems firmly attached. Following some advice from a few online peeps, I did cut a hole in a piece of Tegaderm and place that over the site of the sensor. (Covering the entire thing is not recommended.) I put the receiver inside two Ziploc bags and kept it at the end of the pool to see what happened. As expected, I lost reception while swimming, but when I stopped between swim sets with my sensor just out of the water, it picked up the signal and gave me a value on the receiver. Nice!

When I went for a bike ride, the sensor gave extremely accurate results. It was encouraging to see a smoothly changing curve, rather than the (incorrect) massive downward swings from the Minimed Enlite. Running has been a mixed bag. On Friday (day 3), during my treadmill run, I had yet another smooth graph with readings that matched at each endpoint. Yesterday (day 5), my CGM reading started to drop quickly right after I started before leveling off after I ate a bunch of food. My fingerstick readings at the end show there wasn’t the massive dip, and the CGM graph more-or-less caught back up with reality after about 20 minutes. (You can see the craziness on the left of the picture above.) I’ll be keeping my eye on this, but I’m still pretty impressed.

My big challenge is figuring out where to put the receiver when I’m sleeping. I need a nightstand.


p.s. — I’ve been playing around with Tidepool’s Blip app. I like it! It made the snazzy chart above.

Posted in CGM, Data-betes, Diabetes, Fodder for Techno-weenies | Leave a comment

Step 5

Step 5: Use CGM. Once upon a time I used a continuous glucose monitor, and it was helpful . . . when it worked. It didn’t work often enough for me to trust it, though, so I stopped using it. As a result, I slept better, but I lost insight into my blood sugar. My A1c went up. My confidence went down.

So . . . Try using a better CGM. Everyone seems to love Dexcom, and I’ve had my own since Tuesday. So far so good.

Posted in Baby Steps, Diabetes, Life Lessons | 1 Comment

Baking

The first bake

I like pastries. I love pain au chocolat, and I’ve wanted to make my own for a while. Last October, my mother- and father-in-law gave me a stand-mixer. My mom got me some supplies. Lisa got me a couple of books about bread. Mary and Adam got me a couple more plus some bread baking supplies, including a scale that has sub-gram accuracy! Since then I’ve baked about a half-dozen loafs of country bread (mostly with a poolish preferment). They’re tasty and imperfect . . . and surprisingly easy to make. I’m still getting used to working with dough.

Baking bread has taught me a lot in a short time, and I’m so happy to be making delicious things. But I really want to make pastries. My big goal is to make viennoisserie (delicious laminated pastries like croissants) but that’s some hardcore baking, so I’m starting with simpler things that will teach me about working with eggs, butter, flour, temperature, and time.

Pastry cream ingredients

For the most part everything is turning out well. (Except the chipas de paraguay, which we had in Patagonia but have proved to be my kryptonite.) I’ve been making 1-2 things each week, usually on Sunday: pretzel rolls, gougères gruyères, choux pastry, crème pâtissière, meringues, madelienes. The meringues were an afterthought, since I didn’t want to waste four egg whites. “Add sugar and cream of tartar, whip, and bake? Why not?!” I’m still baking bread, which Lisa and I usually eat entirely ourselves. A lot of the other things going to my office, where I share with my coworkers. They’re a bit bemused by my foray into baking, but they seem appreciative. Sadly—especially for them—the first batch of éclair shells were overbaked, so there weren’t enough to take to the office.

Here are pictures of the before, during, and after of baking over the last 4-5 months.

Posted in Getting Baked, Life Lessons | 3 Comments

Reading Diabetes Data from Tidepool into MATLAB

Here’s what I did over the weekend with the help of my awesome coworker Kelly.

email = 'your email address';
password = 'your password';
cmd = sprintf('curl -I -X POST -u %s:%s https://api.tidepool.org/auth/login', email, password);
[status, loginResult] = system(cmd);
result = regexp(loginResult, 'x-tidepool-session-token: (?<token>[a-z_A-Z0-9\.]*)\s', 'names');

opt = weboptions('KeyName', 'x-tidepool-session-token', 'KeyValue', result.token, 'MediaType', 'application/json');

query = sprintf('METAQUERY WHERE emails CONTAINS %s QUERY TYPE IN activity, basal, bloodKetone, bolus, cbg, cgmSettings, deviceEvent, deviceMeta, food, grabbag, note, pumpSettings, settings, smbg, upload, wizard', email);

data = webwrite('https://api.tidepool.org/query/data', query, opt);

Yup that’s (almost?) all of my diabetes data from Medtronic Carelink, which I uploaded to Tidepool. Yay!

Posted in Data-betes, Diabetes, Fodder for Techno-weenies, MATLAB | Leave a comment

Step 4

Step 4: Tolerate lower blood glucose. 120 mg/dL (6.7 mmol/L) isn’t low. 80 (4.4) isn’t low. Context matters, of course: 120 during exercise is time for action, and 80 before bed means it time for a snack. But right now, a lot of these numbers lead me to snack unnecessarily. So stop it. Wait a bit. Use that new CGM (which should arrive any day now) and watch what happens. Stop thinking “low” until I see the 70s (a.k.a., the low 4s). And stop thinking “OK” when I see 180 or higher.

(BTW, this is not what I expected step 4 to be. But I realized when listening to the Juicebox Podcast that other people have a much lower set-point when it comes to blood glucose, and they’re talking about kids. So, really, what’s my problem? It’s all tied into how my BG behaves when I exercise, I’m sure. That’s going to be hard to tease apart, of course, but it’s not a catch-22; any little bit of better is better.)

Posted in Baby Steps, Diabetes, Life Lessons | 2 Comments

Step 3

Step 3: Bolus more insulin. More than sixteen years after I started using insulin, it still freaks me out. There . . . I said it. It’s not the insulin itself but the potential for hypoglycemic events. They feel terrible, get in the way of my exercise plans, and can even be life-threatening. Despite trying almost everything last year during Ironman training, I saw a lot of episodes of massive blood sugar drops when exercising after work, often while riding my bike home. It was frustrating, and eventually I stopped giving as much insulin as I knew I needed at lunch. At the same time, my carbohydrate intake increased. When you put it all together, my blood sugars were higher than I would like, my tolerance for those values went up, and my desire to take full doses of insulin decreased.

So . . . This one is going to be hard work and has multiple facets. I need to take more insulin but not always. I need more insulin when I know that I won’t be exercising right away: with breakfast and dinner, for example, or overnight when my 6AM workouts are still hours away. I need to look at the recommendation from my bolus calculator which seems big—OMG! 12 units!—and start to feel confident that it’s actually the right amount if I’m not heading into exercise. But even before I feel confident, I need to JFDI and take the insulin. Fake it ’til you make it. (All this assumes that the carb inputs to the calculator are correct. See Step 2.)

It’s possible to make this step easier if I also add in some future steps, like eating fewer carbs and journaling more, but let’s talk about those later. Baby steps.

Posted in Baby Steps, Diabetes, Life Lessons | 2 Comments

Step 2

Step 2: Try harder to know or estimate carbs. Knowing the number of carbs in things makes bolusing decisions (somewhat) easier, so why not do it? Taking the right amount of insulin is a separate issue, so let’s leave that till next time.

Posted in Baby Steps, Diabetes, Life Lessons | Leave a comment

Step 1

Step 1: Test my BGs more often. Whether it’s high, low, or in that happy 80-150 range, not knowing what it is doesn’t change the number. It only means it takes longer for me to react to it. So . . . test.

Posted in Baby Steps, Diabetes, Life Lessons | Leave a comment

The Big Picture

It’s going to take me a while to get through all of the photos from our trip, but I thought I’d give you the big picture, so to speak. Here are eleven panoramas from different parts of our Patagonian adventure. Click any of them for a more detailed view.

Los Torres

Los Cuernos and Lago Nordenskjöld

Lago Nordenskjöld

Valle Frances

Glaciar Grey

Glaciar Grey and Lago Grey

Rio Serrano

Glaciar Perito Moreno

El Chaltén (or Mont FitzRoy)

El Chaltén and Lago de los Tres

On the way to Mirador Pliegue Tumbado

Be back soon .  .

Posted in Patagonia, Photography, Travel | 2 Comments

Sí, Se Puede

After more than two years, I’m finally done.

Duolingo-small

Whew! That was a lot of work.

Posted in 101 in 1001, Patagonia, Travel | 1 Comment

In Praise of Getting It Off Your Chest

A couple of days ago, Christopher Snider wrote a very important post defending My Diabetes Secret (as well as the other “My Chronic Disease Secret” sites he has created). This is my “+1″ to his response.

I don’t read My Diabetes Secret very often, but I am so happy it exists. It’s a safety valve for the diabetes online community and its advocates. We all have secrets or things that we want to get off our chest without changing how others view us. (This is such a part of the human condition that people have made films where secret-keeping and -sharing are central themes.) Within the community, people gain notoriety for their advocacy or their accomplishments, and it can be hard for some of us to feel okay with showing our imperfections, especially when others are looking up to us. I’m not arguing that this is a reasonable burden to put on oneself; sometimes it’s better in the long run to let others see us stumble. However, some people are contractually prohibited for saying some of the things that other people with diabetes would feel free expressing. I’m not one of those people, but I’m also a bit proud from time to time.

For many of us, family members and friends get uncomfortable seeing us struggle occasionally, although it is a regular part of living with any chronic illness. Even though many of us have long periods where we’re more-or-less pleased with our diabetes self-management, there are times when it sucks, and it helps to have a place where we can vent and let go just a little bit. Don’t get me wrong; I don’t partake in the kind of self-loathing that leads me to deny who I am, but sometimes it’s just easier to say things in a safe space.

As for whether it’s advocacy or not, I have to respectfully disagree with both the anonymous detractor and Christopher. To me, My Diabetes Secret is a form of advocacy. Posting there affirms to the patient community that it’s okay to have things to share that make oneself or others feel uncomfortable. It’s okay not to be okay from time to time. I wish it were more accepted by society that being good doesn’t mean being perfect and that sharing our pain and frustration and disappointment doesn’t make what the rest of what we say subject to extra scrutiny. Maybe we’ll get there someday. Until then, having this secret-sharing site makes us better advocates, because it allows us to focus on the message we want others to know about diabetes through our regular social media outlets without the distractions.

Keep up the good work, Christopher!

Posted in Diabetes | 2 Comments

Twenty Minutes

Aww...

Yesterday was Thanksgiving. In recent years Lisa and I have headed north to Montréal for the holiday, but we stayed home this year since we’re going on vacation soon.

As a result, we could do our town’s Turkey Trot 5K!

Since Ironman Wisconsin, I set a 5K trail PR, ran a tough 8.5-mile trail race, took almost three minutes of my half-marathon PR, and ran a wicked hard 10.5K trail race. I’ve been thankful for how good my body has felt and that I’ve had the chance to do so many fun local races. I’m actually starting to recognize people at events. Weird!

With all of the racing, I was interested to see if I would be able to achieve my long-time goal of going under 20 minutes at a 5K. I’ve learned a lot about how to push myself way beyond what feels comfortable when running, but my body has its limits. Plus, I would need to drop a lot of time off my previous (post-high school) best of 20:52.

As Lisa and I were walking the half-mile to the start of the race from our house, we talked a little bit about my plan. First, we noted that this hilly course might not necessarily be the best for breaking 20; a flatter 3.1 miles would definitely be less challenging. Also, I knew that two things would have to happen: (1) I would need to push myself so hard that I might not finish anywhere near 20 minutes, and (2) I was going to have to be very uncomfortable for the whole race. No easy trot for me. I needed to average 6:27/mile to make my goal.

Lisa, who is looking pretty fit, hasn’t run much recently—usually opting for a bike ride or walk instead—didn’t express any similarly lofty goals, but I suspected that she would do well.

We got to the start at the high school, shed some of our warmer outer layers, and got ourselves ready. I hoped for a nice 10-15 minute warmup, but time was tight, so I didn’t stray too far. I got back to Lisa, removed my jacket, and had a little smooch before we both headed to the start. We were among the last ones.

The start line was quite crowded with lots and lots of high school students, so I found the fastest looking adult woman and lined up next to her. (The fastest women usually finish just ahead or just behind me.) We started almost before we knew it. No national anthem was sung. No race directions were delivered. No “Thanks everybody for showing up” speeches were given. At 7:30 promptly, the race director said something to the effect of “Let’s get going. On your marks, get set, go!”

I love the start of local 5K races. There are middle school and high school kids who line up a the front and could conceivably be wicked fast or just have delusions of grandeur. And the fast ones might go out too fast and then flame out anywhere from 100 meters from the start to a couple of miles in. (You can get a sense of what distances the kids race.) Then again, the cross country runners tend to stay strong throughout the whole distance, so you never know. With adults, it’s easier; usually when someone runs away from me at the start, I don’t see them again until the finish.

This race was no different in this respect. I started at a fast pace—thankfully I was warmed up—and proceeded to pass a number of teenagers over the first mile. By this time we had left the flat early part and were on the 3/4-mile hill that I go up almost every time I run in my town. It was starting to feel pretty tough when I looked at my time for the first mile: 6:27. “Gah!” I thought. “The next mile contains even more uphill. How am I going to break 20 minutes?” Then I told my brain to shut up and just keep going as hard as I could, since I would have to go downhill again eventually.

I covered the second mile in 7:02, about 35 seconds slower than I needed to go, but the last 1.1 miles were all downhill (almost). I ran like a man possessed. The high school kid I was running about 2-3 seconds behind kept trying to put some distance between us, and I pushed hard trying to pass him. With about a quarter of a mile left, I thought I might pass him, and I was getting ready to tell him not to give up and to work with me for the next minute. Seeing me just behind him as we rounded a corner was all the motivation he needed, though, and he found a new gear, finishing three seconds ahead of me. Staying with him really worked well, as it was extra motivation to push myself as hard as I could go.

In the end, I just wasn’t fast enough. For the first time ever, I saw 19-something on the clock at the finish, but I wasn’t able to make it to the finish before it ticked over to “20.” But I’m still really, really pleased with the 20:14 I ran. It’s almost 40 seconds better than my previous fastest, which also came on a very hilly course. Maybe next year, I’ll find myself a flat 5K somewhere and see what happens. Still, I’m very happy for finishing 15th out of 418th, and third in the very expansive “men 40-59″ age group.

My mind immediately turned to Lisa and her race. I grabbed my jacket and little camera from my bag and headed back out onto the run course, staying out of the way of the people finishing. About a half mile into this cool-down run, I saw Lisa. She was looking great! She was running well and seemed to be enjoying herself. We ran along for a little bit together before I peeled off to avoiding going through the finish twice.

Lisa took almost two minutes off her previous 5K best! What an excellent job! I’m so happy for her.

About a half-mile from the finish

Lisa is looking great!

Commitment

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The Halo Effect of Ironman

It’s fair to say that finishing Ironman Wisconsin changed me.

I know it sounds a bit cliché, but I think it’s actually true. In the first week after the event, I thought it was just the glow of the day illuminating everything else in my life, but now two months later the feeling is still there.

In particular my concept of what’s possible has expanded. An Ironman triathlon is the largest single thing I’ve ever achieved. I awoke at 4:30 AM, and I didn’t go to bed until after midnight the next day. In the meantime I swam, cycled, and ran for more than twelve hours. Just doing it wasn’t enough. I felt the need to race it as fast as I could. For a long time, I didn’t really understand just how enormous an undertaking it was going to be. It was just an abstract “really big thing.” Sure, I knew I would be working out for 50% longer than my typical workday at the office, all while covering a distance longer than the length of the Commonwealth of Massachusetts, but it took a long time for the enormity to sink in. I had raced five 70.3s before—and I still take a lot of pride in those accomplishments—but I couldn’t really extrapolate from those triathlons to the magnitude of a full Ironman.

Having done it, I know that it’s not impossible at all, though it certainly seemed that way the first time I thought about it. It helped not to think about the whole thing at once . . . ever . . . except in the most abstract, neutral terms. Thinking about 12 hours of anything while in the middle of it, is a bad idea. Instead, I divided the Ironman into its parts, and I divided each leg into smaller chunks, too. I had a cadence for my nutrition and hydration, but other than staying on schedule, I didn’t really look at my watch very often. And, crazy as this sounds, just simply doing something without thinking about it more than I needed to, well that really made the time pass quickly.

Ironman Wisconsin is also the largest single project I’ve ever executed. (I’ve been part of large, on-going projects at work for a long time, but the Ironman was definitely more focused and self-directed than any of those.) I had a six-month plan for this project, which borrowed liberally from Gale Barnhardt’s Training Plans for Multisport Athletes. I modified it to accommodate the other races I wanted to do and to match up with days that I could swim. Overall, the amount of time I spent swimming, biking, running, and recovering was unchanged. The plan was essential. I didn’t have to think about all six months at a time; I knew that I could focus on a single week and that the plan would get me where I needed to be in terms of fitness.

I did my best to follow the plan. Occasionally, my body or schedule just wouldn’t cooperate, and I was okay with that, knowing that extra recovery wouldn’t really derail me. Doing the work was (usually) enjoyable, too. By the fourth month, all of the training did start to wear me out quite a lot, but I knew it was in service of my big goal. Keeping that in mind made it easier to get up early in the morning to swim or to head outside to ride or run in bad weather.

Despite figuring out how to compartmentalize, having a plan, and just doing all the hard work, success still wasn’t guaranteed. There were dozens of things that could have gone wrong: a freak-out in the swim, dehydration, dangerously high or low blood glucose, bike crashes, twisted ankles, cramps, illness, injury, food poisoning, lost timing chips, drafting penalties, missing the time cut-offs, insufficient nutrition, over-hydration, GI issues, bad weather, hypothermia, heat exhaustion, lost bags in transition, mechanical issues on the bike, lost goggles, being too conservative or aggressive on the bike, poor pacing on the run, not sleeping the night before, oversleeping and missing the start, etc., etc., etc. Failure to finish was a real possibility; I just had to trust in all of the training and past race experience.

And everything did go well, probably as well as it possibly could have. That fact is very empowering.

The funny thing is that (objectively) I wasn’t any less capable of achieving that result on the Saturday before the event than I was on that day or as I am now. Nevertheless, I do feel differently about what I think I can do now that I’ve done it. If I had to do it again—and I certainly plan to someday—I still won’t underestimate the effort, but I’ll certainly have more confidence going in.

This feeling has carried over to other things in the last month, especially the big and scary stuff that might have overwhelmed me earlier. Finishing the Duolingo Spanish course before our Patagonia trip next month? Just take the lessons one day at a time. Lots of big unknown things about the re-org at work? Keep focusing on the big picture and trust in the plan. Getting my diabetes where I want it? Treat it like training for an Ironman.

It’s not that I feel invincible, but I definitely feel capable of trying more things and believing in the probability of success.

To be continued . . .

Posted in Life Lessons, Reluctant Triathlete | Leave a comment

Rookie

I haven’t ridden my bike very much since the Ironman. Just 8 times between the 14th of September and the 16th of November. I’ve enjoyed all of the cycling I have done, but for one reason or another I just haven’t really given the bike much love. I mean, I hadn’t even put the pedals back on Chrissie, my tri bike, until last night.

I was feeling a little manic yesterday evening, and Lisa suggested that maybe I needed a workout. I had skipped my run earlier in the day because my right calf is pretty tight after last weekend’s trail race. [1] So I took Chrissie downstairs to the love dungeon, set up the bike in the trainer, put on the pedals, and fired up TrainerRoad with a SufferFest video (“The Rookie“).

The title of the video always reminds me of this scene from “Training Day.”

With so long away from the bike and no structured training in over two months, I did seem a bit like a rookie. The workout felt harder than it probably should have, and I didn’t do the whole thing, since it was already starting to get a bit late in the evening. I did do enough to take the edge off my mania and keep Lisa from getting annoyed with me, though.

Tonight I’m heading back down to the basement to do another workout. It will probably be an FTP test to find out where I should set my training effort. *whimper*

The Rookie in the Love Dungeon


1 — Sunday I raced the 10.5K Durtyfeets trail race in the Upton State Forest. It’s my backyard race, and I knew most of the trails well. “Oh look! That’s where I fell on the ice.” And “Hey! This is that little bit extra I tacked on to get a full 13.1 miles when I ran from the forest to the lake and back.” I didn’t pace the beginning well, and by the time that I got to the uphill single-track sections that were too narrow for passing, I was already gassed but felt like I needed to go that speed for the benefit of the people behind me. Of course, when I got to the downhill sections I had to dial it way back because the two guys directly ahead of me were being super cautious. Grr! Then again, I almost bought it when I hopped over a rock to take a shortcut through the woods to pass them. Tee hee!

I finished in 55:26, good enough for 22nd of 111 (male and female) and third in my age group. It was a tough race! [back...]

Posted in Cycling | Leave a comment