Insights into my personal life.

This blog includes the personal details of my experiences as a recently diagnosed Type I diabetic and the impact of that diagnosis on my endurance athletic pursuits.

Please understand that I consider myself to be a work in progress. I am willing to share both my successes and failures, so please do not take my words to be professional dietary or medical advice. This is a blog, this is only a blog. I research my choices carefully, and take my health very seriously. The choices I make are my own, I am doing the best with the resources and support that I have. If you have questions or concerns feel free to comment, but please be constructive and understand that this is my life. I value it dearly.

My goal is to live a happy, healthy and active life where I can balance my internal drive to push my physical limits and the challenge of safely maintaining stability despite the challenges of Type I diabetes.

Tuesday, December 24, 2013

Favorite Christmas memories.


I remember coming home from the school bus and decorating the pine trees in the front yard with lights.  Walking circles around the trees, using a pole I devised with a wire hook to hold the string and reach an extra 10 feet.  These trees were probably 20-25ft tall so I also got to play around and learn how to safely lean a ladder on a tree, while on a hill.  One year Dad got extra into the decorating with me and suggested we do the 40 ft pine tree.  Man that took forever! A 30 ft extension ladder, my lanky frame reaching with a pole, barely getting the top, and then figuring out how to circle around.  It was so much work coming down each time and moving the ladder!  At one point I remember balancing on the ladder, and then our cat Patches climbed the ladder and jumped on my shoulder while I'm trying to work.  That cat had serious skills.

Giant snow mouse.

When I was a little kid I loved the mouse Fievel from American Tail.  Pretty cool character back then.  So what.  I also liked seagulls, my teddy bear and a stuffed puppy.  You got a problem with that?  Didn't think so.

Somehow this fondness for Fievel manifest into building a 12 foot tall snow Fievel in our front yard.  What would you have made if your goal was to make something 12 feet tall?

Certain ornaments and decorations.

I admit I'm a sucker here too.  There was a white porcelain figurine that wound up and spun slowly as it played Silent Night.  My favorite Christmas Song.

As for ornaments, I didn't know the full story behind most of them but as the 5th and youngest child in a family with a 20 year head start before I entered the equation, there were a lot of odd shaped ornaments.  Now most people would consider them gaudy, but several were hand made. Nothing really matched but all came with a story.

The Living Room.

We had so many gift opening in that same living room, but it was great that I can remember so many of my family members fitting into the seats and couches.  With a big family and some very generous parents the room was always knee deep in presents.  I was seriously spoiled, but both of my parents really enjoyed giving gifts.

Extended family cameos.

Not that I have a cousin Eddy (Christmas Vacation movie reference), but Uncle Bob would make a pretty solid substitute.  Many of these relatives wouldn't be seen that often, especially now with everyone either getting older or just spreading their own way, but both of my parents have 5 siblings as well so there was always a fairly large extended family on these occasions.

Aunt Rosies cherry cheesecake.

As a kid I didn't like cherries, but this was an exception.  This treat was always at my Dad's brother Randy's and Aunt Rosie's party.  Randy could always be counted on to provide the punch with sherbert.  I don't think our punch ever got spiked, but my cousin Steve will never outlive his puking in the chex-mix after consuming too many whiskey-balls (cookies).

Wooded Hills luminary display.

After church we always took our time to driving the entire subdivision display of streets and drive ways lined with candles burning inside of white paper bags. This is also when Santa would time his arrival at our house.

Monday, December 16, 2013

No one is perfect. Mistakes are part of the learning process.

Well I wouldn't be honest if I all I wrote about were my successes.  So here's a little bad news, just to remind me not to make that mistake again.

I've slipped up on my diet before.  To remain in nutritional ketosis it's usually recommended to consumer fewer than 50 grams of carbohydrates per day.  This value varies depending on the individual, the amount of exercise done during a day and excess protein certainly has an effect on this as well.  I learned to not overindulge with protein earlier this Spring after an all-you-can (but probably shouldn't) meal at Samba Brazilian Grill.

Six weeks prior to IMAZ I got into a bag of Halloween treats, but that was a rather minor slip-up.  This time my slip up was more agregeous.  I found myself on the UW campus near the lab where I used to work.  That lab just happens to be across from the Babcock Dairy Store.

For a variety of reasons, the primary one being that I am human and prone to mistakes and poor judgments - but there are a few others that I won't get into now - I'll just say that it's been the most stress filled week of my life and leave it at that for now.   But for a variety of reasons I slipped.  Slipped and fell face first into a bucket of Chocolate Peanut Butter Ice-cream.  This used to be treat I would indulge in a couple of times per week.  Triple scoops on my lunch breaks after a nice swim workout - Michael Phelps style!  (I didn't know better at the time - it's not like it ever made me feel sick).

So I walked in, bought a half gallon and by the middle of the next day I ate the whole damn thing.  It was like crack to me, I knew better, but you know what? - I didn't care. I tried to cover the massive amount of sugar with the right amount of insulin - which was probably more than I use in a normal week.

My numbers only peaked in the mid-200's.  For me that's unbelievably high.  The last time I had numbers that high was in February when my my insulin had expired while and I was sick - well before my foray into ketosis. Blood glucose in the mid 200's is bad, but not hospital bad or anything. I'm actually curious whether I'm still at as high of a risk of DKA, seeing as my body and brain are able to use ketones I doubt they would build up high enough to cause acidosis.  The one blood ketone test I did actually showed my ketones to be very low at 0.3mM.
 Knowing that I've made similar mistakes in the past I adjusted my basal insulin to a higher level and eventually I've stabilized.  But wow!  It's amazing how long lasting the metabolic changes from that one day of gluttony last.

For the entire week my basal insulin level has been increased from 0.3U/hr all the way up to 2.0U/hr.  On top of that I also need to increase the amount of insulin to bolus and cover meal-time carbs.  Suddenly I'm quite insulin resistant.  I knew this is what would happen.

Like any mistake it is a learning experience.  These are the same adjustments that I would need to make if I ever come down with the flu.  Side note:  I haven't been sick at all this year.  Although doing this during flu season might have been reckless as this leaves my immune system impaired.

Other negative results of this: poor sleep, goobery eyes when I wake up, headaches, lethargy, inability to concentrate (compared to the great focus I have while solidly in ketosis - but still doing better than before my diagnosis), I think I even have some funky body odor, an increase in ear wax (sexy, right?!), cramping in my calves and feet, aching joints, neuropathy in my arms where they arm numb/asleep when I wake up - which I also experienced a lot of pre-diagnosis, , nerve pain in my feet while working in the cold - another symptom I remember experiencing as far back as 2011, and my appetite was rampant! One week later and I'm 15 lbs heavier, from 215 lbs all the way to 230 lbs - talk about inflammation!

But I'm not going to dwell on this mistake.  Like I said, it was a hell of a week.  I'll definitely learn from it.  As a result of the lethargy and instability (and the damn cold weather) I hadn't been exercising very much, I imagine exercise would have mediated some of those negative effect.  I'm back on track now.

Did some yoga yesterday (inflammation has had a negative effect on my flexibility), and got in an hour long swim today.  The swim actually felt very good.  My goal will be to swim as often as possible as swimming seems to have the greatest positive influence of reducing my insulin requirements back to where they should be.  It will likely take me another 2 or 3 weeks to get my basal insulin level back down to below 0.8U/hr - hopefully all the way back to 0.3U/hr - we'll see.  This will be a good test for how well swimming actually will work for that.  Plus it will give me something to focus on during the holidays.

One thing is for sure - I won't be tempted to indulge in any more sweets and treats.  Lesson learned.

Saturday, November 23, 2013

Race Report Follow-up: What about Bernice?

Seems like everyone enjoyed the cliff hanger to my race report.  So lets get back to Bernice.

When we parted ways I left Bernice with my bib number in hopes that we'd be able to connect in some way.  I assumed she wasn't on Facebook so with a bib number she'd be able to track down my full name.  I'm pretty easy to find in google due to the unique spelling of my first name (thanks parents!).

Bernice's story was a bit of a cliff hanger to me as well.  A large part of me hoped to stick around until midnight and catch her finish.  However, the reality was that asking Michael and Merri had a dog at home that needed to be let out and my Vancouver friends who had finished hours earlier than me needed to leave.  I learned that they had to be back to the race site early the next morning.  Victoria had placed 2nd in her age-group and could not miss the podium ceremony, nor did she want to miss her opportunity to sign up for Kona.

As I left the race site, I saw that she had actually sped up a bit - probably running a few sections.  This left her with a good cushion.  As I got home after a long drive I was able to confirm that she had indeed finished her race!  She finished in 16:35 with 25 minutes to spare.  Her marathon pace was a steady 15:45 per mile.  25 minutes to spare!  That's a difference of less than one minute per mile over the distance.

A couple of days following the race I was contact via email by Bernice's daughter, who eventually got my email address to Bernice.  On the Tuesday evening following the race I received one of the greatest emails I've ever read:


Hello Kory!!!!
Thrilled I got your email. I have a debit of gratitude to give to you. I've been telling everyone that I had a guardian angel with me for 13 miles of the run. How you kept me focused on the positive when the pain kept clouding my focus. How kind and gentle you were with me... How we did a mile of quiet (well most of it I kept) in dedication to your friend. How you calculated my time of arrival to the finish line. On and on and on.
I am a FIRM believer that when the " student is ready the teacher arrives" I have many examples in my life of the "teacher". I'm not sure I would have crossed the line before midnight with our your help. I trained real hard to succeed and help me accomplish that personal goal. By the way I took your last bit of advise, drank the flat coke and my stomach nausea left!!!....

...One last thing my daughter Courtney is friends with one of your friends, Mike McLean....she said he's a great guy. Isn't it a small world?
How was your finish???



Too read this words made my heart swell.  The gratitude goes both ways between us.  I am grateful to have had someone to keep me company.  I was honored to have been able to do what I loved most during the race.  While I easily could have become frustrated that I wasn't 'racing', I was doing something that I enjoy even more.  I was coaching!  To be able to coach someone from within a race is an experience that I will never forget - especially a first timer.  I remember the joy of my first finish, there is nothing to compare it to.  I am honored to have been a part of her day.

I hadn't thought to ask if there was any chance Bernice knew Mike McLean, although I knew they both resided in St. Louis.  To bring this story full circle you can read back to my November 16th Diabetes Awareness Post.  When I was diagnosed with Type I, I was riding in a fundraiser for Mike's non-profit, L.I.F.E.  My emergency identification tag that I wore during the Ironman Arizona and nearly every day since diagnosis is an orange L.I.F.E. bracelet.

While I was doing my best to motivate Bernice during her race - I was silently remembering words spoken by Mike's brother Eric in his last interview posted before his passing.  Eric's courage and strength have been my inspiration for a while now, and he's bravery will continue to inspire.

Friday, November 22, 2013

My Ironman Arizona 2013 Race Report. PART ONE.

To many people finishing an Ironman distance triathlon is a lifetime accomplishment.  Each year thousands of people sign up for these events for a variety of reasons.  Among the masses, the participants can be viewed in a few major groups.  For my purposes here I'm going to speak in generalities.  I fully understand what is lost by oversimplifying and generalizing, but this post will be long enough so allow me to try to keep this argument as simple as possible.

There are two types of participants at an Ironman:  Those who are racing the clock and those whose goal is to finish.

The group racing the clock doesn't only include the professionals athletes and elite age groupers.  There are athletes in all time ranges from the 8hr finisher to those crossing near midnight that still have the goal of a finish time in mind.  Often their success on the day is measured by what that clock says.  A few minutes one way versus another means the world to this group.  This group sees the event as a race, and I agree that it is.

The second group of participants isn't motivated by the clock, other than making sure they meet the 17 hour cut-off.  They are still aware of the existence of time, but their success isn't defined by it.  You can assume that many of the people in this group are novices that aren't yet confident enough to 'race' the event (and you might be right).  However, there is more to this group of athletes than just novices.  Some of these folks are just as fast as the aforementioned group, however their experience can be totally different.

Again I'm speaking in generalities so this argument is easy to pick apart, but you get the point.  I've had this topic on my mind because while I was staying in Arizona, I was hosted by my godmother Merri and her partner Michael.  It was both of their first times spectating a triathlon - this two group hypothesis was actually Michael's observation.

This is going to be a very long post.  I'm not only going to discuss my experiences on the day, but also my experiences over the entire last year of managing my diagnosis as a type I diabetic, how that affected my training and how it's all come together.  I'll get back to my earlier discussion of how Ironman can be experienced differently but my reason for introducing the topic is that I've always identified myself as the athlete racing the clock.  This year however has been so tumultuous, that I've found myself resigned to joining this second group.

Here's the back story:

When I signed up for Ironman Arizona, I did so from the lobby of the Dean Health Clinic.  I had been diagnosed with type I diabetes less than a week prior.  I believe I've discussed this topic before, but I bring it up again to make this story complete.  When I was diagnosed with diabetes I was initially miss-diagnosed as a Type II diabetic.  I had been taking the oral medications prescribed and despite eating very few carbs had absolutely no reduction in my 300+ blood glucose level for the entire week.

I am aggressive when it comes to advocating for my health.  I was confident that I had been wrongly diagnosed and over the course of that first week probably called 5 different doctors and nurses hoping for an accurate diagnosis which would enable me to begin insulin therapy, which was required to get my blood sugar under control.  I had even taken myself to the emergency clinic at St. Mary's with my BG at 350+ one evening, only to be discharged an hour later after receiving nothing more than the administration of IV fluids. By the end of the week test results would confirm my type I diagnosis, but I was still not provided a means to bring down my blood sugar.

Over the weekend I took myself into Urgent Care (during a Packer game).  It was dead quiet in the clinic, I was one of two people there.  I remember begging, pleading and eventually arguing to the point of tears with the doctor on call that I desperately wanted him to administer insulin to bring my levels down.  The argument was that they wanted me to wait for the proper training and that an appointment for that wasn't set until next Tuesday. I still do not understand the delay and why I was ever released from emergency care.  Not only would I have to suffer with extremely high blood sugar for several more days, but I had also learned that it would likely be 3 months before I could get in to schedule an appointment with an endocrinologist.

I didn't take my frustration out on doctors and nurses, I knew their personal limitations and that my issue was with the flawed system.  So I continued to contact those doctors and nurses in hopes that they could advocate for me and somehow expedite the process.  You catch more flies with honey than vinegar because on that Monday morning I got a call that my endocrinologist could see me that day!- and the appointment was ironically set at the exact time that IMAZ registration went live online.  The odds of the race selling out quickly were high (and it did in a record time of 5 minutes).

I guess its fair to wonder why IMAZ was still so important to me.  I had committed to a close group of friends and training partners from Canada that I would compete in the event.  In a way the experience of diagnosis was so overwhelming that it didn't sink in how naive it was for me to consider such grand adventures.  I refused to accept diabetes as a limiter from the beginning.  I knew there were diabetic Ironman athletes, hell, I had just finished IMWI in September of 2012 already unknowingly suffering from diabetic complications.  But truthfully - I signed up because it provided me with hope and a sense of normalcy. I am an endurance athlete.  It is what I do.

To the training:

I've discussed this to a high level of detail in my previous blogs, so the nitty-gritty of how I managed my diabetes can be found there.  But I want to discuss my training in a general sense.

I am not just and endurance athlete.  I am an Endurance Coach.  I know what I'm doing when it comes to training athletes to achieve their goals.  I treat my clients as individuals and tailor their training to suit each ones specific needs.  I've used a variety of strategies and understand there is more than just one way.  However, consistency is a common strategy.  It was the consistency that would be my greatest challenge.

My training involved teasing out more variables related to diabetic control than focusing on any specific training volume or intensity.  I had to accept my physical limitations with regards to diabetes.  Training alone presents some serious safety obstacles.  So this obviously had an impact on the amount of volume I could do.

As a result of how I set up my metabolism with a high fat diet, my body would handle effort of low intensity for a very long duration quite well.  It was actually the shorter more intense efforts that had to be cut from my training.  In a perfect world I would just train 5 hours every workout, but the reality is that I have a job - admittedly an awesome job.  I have commitments to the athletes that I coach, I have classes to lead and a life outside of training just like everyone else.  My coaching job keeps me very busy in late summer.  Many of my athletes are training for marathons, triathlons and Ironman races themselves.  I need to be there for them - as they are my highest priority above and beyond my own performance.

But the training season slows down in Wisconsin following our local Ironman in September and I finally found some time to figure out a few details that enabled me to begin training in earnest.  Yes you are reading that right.  I didn't really start my training until September.  It's a little bit of  "do what I say, not what I do" from the coach.  I know my body incredibly well.  I not only know my weaknesses, but I know my strengths as well.

I had figured out the details of swimming early on in the year as I trained in earnest for a 5 mile open water Gildas Club Fundraising swim across Lake Mendota that never happened.  But I completed the 2.4 mile swim distance in open water a couple of times in training, and for my goals in Arizona I decided that was enough swimming until the race approached.

Most of my cycling was either easy commuting miles or low intensity effort with the cycling classes that I lead.  I usually log 5-7000 miles a year on the bike, this year I doubt I rode 2000, and none of it was on my triathlon bike since I find it difficult to coach from a time-trial position.  I didn't even log my mileage.  I have reached my capacity for logging anything beyond blood glucose for a while here.

Running was my biggest challenge.  Running was the most destabilizing influence on my blood sugar out of the three disciplines.  Each time a workout destabilize me (usually spiking my bloodsugar, which seems counter-intuitive) I feared I would lose the protective benefits of my ketoadaptation which protected me from the dangers of lows - I'm not sure that this is true since I never had the displeasure of suffering any major lows, but the highs (anything over 130) never felt good.  Eventually in the first week of September I resigned myself to the glory of the treadmill and started hammering out the details.  I set the pace to 10 min/mile and experimented with different insulin strategies until I found a pattern which worked.

For about 6 weeks I put in consistent running volume, eventually peaking at 50 miles in one week.  Again, slow your roll coach!  To build from nothing to 50 that quickly can't be smart - yes, it wasn't.  It was slow and low intensity on a soft surface, but I indeed suffered some lower back pain which might (although I'm not certain) have been a result of the bounce of the treadmill.

That back pain also coincided with an untimely staph (or cellulite) infection in my elbow which needed to be treated with antibiotics.  I was very unhappy with this setback.  During a time when I would normally be peaking in training volume for a race, I found myself side-lined.  But I had to listen to my body, infections like these don't happen to healthy individuals - I though it wise to take a step back.

In a way that break was a blessing.  5 weeks out and I took 2 weeks off.  Not your traditional time for taper, but considering my goals it actually worked for me.  I am more stable when my body is consistently training.  The break gave me time to think about how I wanted to set up my body for the final 3 weeks.  Instead of a traditional taper, I figured that it would actually be best to build into the race.  Figuring that my goal wasn't to push myself to a personal best performance, going into the race slightly fatigued would have little consequence on my overall result.

The finally two weeks of training involved knocking out a couple more long runs just to make sure I knew what my body was doing, but it focused primarily on low impact swimming again.  I needed a great deal of confidence in my levels going into the race in order to be able to relax enough in the water to maintain control.  I consider myself very blessed as an athlete to have a swimming background.  In the week prior to the race I swam 3 sets of 4200 yards on alternating days to confirm my insulin strategy.  The first set I swam the distance in 1:20 and took breaks every 20 minutes to check my levels.  The next two sets I swam in 1:15 without breaks and felt strong.  I was confident.

Now for the actual race report I'll have you continue to Part Two.

My Ironman Arizona 2013 Race Report - PART TWO

I'll finally get to the race report part.  I couldn't do the telling of my race justice if I hadn't included the prior post, but hopefully this part will be more entertaining.

Remember back to Part One where I described the difference in participants.  Normally when I'm racing I'm focused narrowly on the clock, I've never stopped at special needs, I've only briefly stopped to hug my mother during my first Ironman.  I usually finish in the low 11 or high 10 hour range.  I feel my potential is to finish in the low 10 hour range - of course that was before diabetes.  I'm starting all over now.

My goal for this race was set a baseline.  I need to prove to myself that my choice to pursue a ketogenic diet was not a mistake.  My priorities on blood sugar management out ranked any interest I had in a fast time.  I am an endurance athlete for my health.  I'm not going to harm myself in the process of racing - it just doesn't make sense.  Previously I enjoyed pushing myself to the limit, although I never found a limit, I really don't want to find one now.  My goal was to finish comfortably and conservatively.  Conservative means smart and safe.

It was a lot of extra work setting up for this Ironman compared to previous efforts.  I'm an OmniPod Insulin Pump user.  I stashed extra pods, insulin, emergency glucose tablets and testing supplies in each special needs bag, as well as specific supplies for each transition bag.  I had to write out the plan several times.  I had a program built into my control unit for my insulin pump.

I had to fine tune my insulin levels for the event.  I knew the pattern it would follow, but found it interesting that my swim focus taper was doing wonders for increasing my insulin sensitivity.  This is a great sign for overall health and my blood sugar for the entire week was amazingly stable and my diet was delicious but also perfectly balance with my goals - even with the travel.  It was interesting trying to get my Wholly Guacamole past TSA in Chicago, but I managed.  The downside of the increased insulin sensitivity was that if I didn't adjust my plan, the insulin levels that had been successful in the workouts leading up to the event may now be too high, which could cause my blood sugar to go dangerously low during the event.  Things needed to be tested again.

The Friday before the race I did a 30 minute swim the rates that worked the week before.  I started the swim with my BG in the 90s and I tested post swim on the pool-side and it said 56!  Ah, that was only 30 minutes - Warning Danger!!  But then I realized something.  I felt 100 percent fine.  When I entered the locker room and dried off and tested again.  73.  Phew.  The culprit was wet fingers.  The moisture on my figures pool-side had diluted my blood and caused an inaccurate reading.  73 was still lower than I'd hoped so I made two decisions.  I was going to reduce my insulin a full one hour before the race rather than just 30 minutes, and instead of lowering it to 0.15U/hr I would err on the side of safety and set it to 0.1U/hr.

As for the rest of my insulin program I figured out that instead of setting up a Temp Basal program - which limits me to setting only one flat level for up to 12 hours I would personally build a basal program specific for the day.  My fear was that if a Temp Basal expired after 12 hours, my insulin flow rate would default to a level higher than what I'd handle.  Smart choice.  I also set that base level to 0.05.  The plan was to turn it back up to 0.1 for the run, but I enjoyed the safety of knowing that if things took longer than planned my pump would default to a safer low rate.

The night before the race I felt the best I've felt all year.  It had been so much fun to visit with my godmother and to catch-up with my UBC Tri Club friends.  It's been a challenging year and it was a gift to be able to spend this week with such wonderful people.

Before bed I took a nice bath in epsom salts and was asleep by 9pm.  The alarm was set for 3:30 am - I didn't want to rush in the morning.  I was awoken randomly around midnight by an Amber Alert of all things on my phone, but eventually fell back asleep.  The brief midnight wakeup was good for one thing.  I used it as an opportunity to turn on the basal insulin program that I mentioned above.

I woke up before my alarm at 3am feeling wide awake and ready for the day.  I tip toed to the kitchen and made my breakfast of 4 eggs and 1/2 an avocado, gathered my special needs bags. I ingested a little carbohydrate in the form of half of a serving of Generation UCAN, applied sunscreen, taped up my nipples, donned my timing chip and pinned it in place for safety. Everything on my morning checklist was addressed and I had time to spare. Merri had woken up to send me off - she's a very calming presence that I will forever be grateful for.  I even had time to do 10 minutes of yoga while I waited for Brendan, Winston and Victoria to pick me up.

Once on the race site I had lots of time to drop off my special needs bags, attach my garmin to the bike and check everything over.  Nice and relaxed.  I made the realization that I had to wait until 6am until I could put my insulin controller unit into my T1 bag.  Again this was a bit of an audible, but I figured I'd wait until my hands were drier in transition before testing my BG out of the water - but the important realization that I made was that I still needed to be in proximity of the unit at 6am while the program sent the signal to change from my overnight 0.25U/hr setting to my swim setting of 0.1U/hr.  Once that was done I felt much better.  I still used the monitor I affixed with velcro onto my bike's stem to double check my blood sugar.  It was a reasonable 114 - just a little bump from that UCAN I consumed at 3:45am.

I found Winston near the dry clothes bags and we walked to where the line would form to get to the swim start.  There we found Brendan lined up with the pros.  Victoria was apparently a few feet away but neither of us found her.  She had her game face on so it's probably best she be left to focus anyways.  It was fun to see Brendan off with the Pro Start.  Once it came to Winston and my turn we were probably two of the first 20 people in the water.  I love swim starts, especially when I find people who enjoy getting in early with me.  We sang the anthem and joked around.  I didn't even pick on Winston for probably not knowing the words.

I lined up for the start a bit more aggressively than I planned.  I had planned a 1:15, but since swimming has been going so well, combined with the narrow and overcrowded course I decided it would be better to start up front and go a bit faster.  The 1:15 crowd is usually a cat-fight complete with finger nails.  Once the cannon fired it was pretty easy.  Still crowded considering I was swimming with 3000 people, but I eventually settled in on a manageable pace.  Nothing eventful.  It's and out and back.  The out portion is directly into the sunrise but we were blessed with low clouds blocking the sun.  Plus I found a guy who was a right breather (I breath left).  We used one another to set a straight course just 10 yards off the buoy line.  I thought we were friends, but at about the 15 minute mark when someone squeezed me on my right my friend had no problem clobbering me in the face for a few strokes as I crowded into him.  I can take a punch, no harm done.

The water temp was great at 65.  The water didn't taste bad, but it was too murky to see my hands, nor the feet I wished to follow.  This created a little problem on the backstretch when a guy have me 5 consecutive ankle grabs.  My limit is 3 before I set off some rather thunderous kicks.  I used them to bridge up to the next set of feet, but suddenly everyone was also 5 yards wide of me.  Message received.  I didn't kick to hurt anyone,  I just wanted a little space.  I knew I was swimming a bit faster than planned and didn't have much training so my shoulders eventually felt a little tired, but not bad.  I didn't look at a clock as I climbed the ladder.  I make it a rule to avoid the swim out clock in all races.

In transition I tested at 99.  My volunteer asked if that was good.  "[Explitive] Yeah! That's good!"  T1 was slow as I had to put on a deep pocketed cycling jersey.  I had my nutrition and backup nutrition in my pockets and I had to put my pump controller away in a protective race belt.  I needed it accessible if I needed to make any changes to my insulin rates, and also for it to make it's programmed change to 0.05U/hr for the remainder of the day.

For testing on the bike I configured a clever system with a smaller meter on my stem with a stabber jabber and test strips in my bento box.  I knew there was a chance of dropping these items during the race so I wisely attached them to elastic tethers which actually worked to save me at least once that I remember - a little trick I learned from reading mountaineering books.

The bike ride is a 3 loop out and back course.  My plan was to go very easy on loop one and wait for my metabolism to kick in.  I'm still not sure why it takes so long for my body to reach that point but I know the pattern and respect it.  I felt a slight twinge of hunger at the 5 mile point so took one of my 200 calorie packets of Almond Butter.  At about mile 10 I decided to test my levels.  I eased to the right and sat up, tested and as soon as I saw a 102 I was happy.  And then I realized I had just flatted.  Turns out I pulled to the far right along a stretch of median with lots of cacti, definitely a cactus thorn puncture.  It only took about 3 or 4 minutes to change. Between the slow transition, my easy pace and now the flat I had just let the bulk of the main field catch up to me.  The course was now miserably crowded with huge draft packs as the bulk of the field had caught up to me.  Everyone was going much faster than they should.

I was patient and waited.  I talked to a few of the amoral souls and discussed the ethics of their choice to sit in a group and draft, but I knew my kind advice fell on deaf ears.  It really is a shame.  Sure it was crowded, but I was able to ride clean.  So could everyone else if they chose to.  Shameful indeed.

I reached the turn-around on the bike just in time to see Michael and Merri walking to the course.  Without that flat tire they never would have seen me.  Another blessing in disguise.  After the turn it was downhill.  I made a big pass on pack of about 50 riders and settled in to a comfortably easy pace again, it only took a minute for that entire pack to pass me back.  There were 100lb women in the group... passing me at 215lbs... on a downhill?!  Arggh.

My plan was to take the downhills easy and use them as an opportunity for my metabolism to catch up.  As much as I wanted to drop the packs I restrained myself.  Midway back I tested again at 109.  Took a stinging insect to the face, but took stock that I was lucky it wasn't the eye.  I dislike wearing sunglasses, but after that I put them back on.

I started loop two feeling stronger, I hadn't spent much time training in aero so I stretched as often as possible, but held my position well. I tested at about the same point on the course again.  98!  I wasn't hungry but figured if I was going to eat anything sooner is better than later. I had a second packet of almond butter.  This packet had a maple flavor (the store was out of plain) so I bumped up again to 115, but that's the highest I'd be on the bike all day.

Lap 3 things finally spread out.  I was getting sick of riding the same flat course, but my body actually felt it's best at this point.  I started the lap with a BG of 95, feeling the diesel now!  Finally all those people who had gone out too hard (or had drafted their way ahead of me) started to get reeled in.  I felt superhuman.  I didn't even get stiff.  Everything was working well.  I was passing masses of people on the final uphill portion.  Saw Micheal and Merri one last time at the turn around and then eased it back towards home.

As per my plan I pulled over to the side at the mile 100 marker.  There I rested my blood sugar with my pump meter, 93.  Knowing that the transition to running spikes me by about 30 points, I took a bolus of 0.5U of insulin at this point (presumably 45 minutes from the finish of the ride).  This is the trickiest decision to make because I feel that adding insulin at intensity is akin to playing with fire.  If I got another flat and was delayed it could backfire - although I knew I had backup carbs on hand (in every possible location), my goal was to not have to rely on them.  My goal was to manage my blood glucose with my insulin rates, not with corrective carbs.  That is how I trained and that is how I planned to execute this day as well.

I entered the transition to the bike and my blood-sugar was now down to 66.  That might sound low but that's exactly what I wanted.  Technically I wanted 70, but that's damn close.  I had a great T2 volunteer who laid everything out and really knew what he was doing.  That's so nice.  I already had my insulin controller on the belt around my waste.  The volunteer handed me my race number, hand water bottle, helped me with my shoes and my change of shirt.  Again another slow transition due to the full change, but I wasn't going to bounce around with all the gear in my cycling jersey.

I always enjoy the hands of the sunscreen volunteers as well.  With their help and that of my wonderful cowboy hat I was safe from the sun all day.

I ran the first 2 miles at 10 minute pace as planned.  They did not feel good.  I wasn't expecting them to, but I had a little bit of discomfort in what I could only described as my kidneys.  Danger Warning!!  I stopped at mile 2 to test.  BG now 90!  Bingo again, I nailed that part of the plan, but I did not feel good.  My heart-rate was higher than I planned.

Looking back this is probably a result of a combination of factors.  I was a bit undertrained.  I probably should have been more conservative on that last loop of the bike, but I was having fun.  I have spent almost no training on my tri-bike this summer so I definitely used different muscle group than I had trained with and I knew I was gambling with the bike choice, however I just couldn't bring myself to sit up on a road bike on such a flat course.  My triathlon bike definitely is a more quad dominated pedal stroke.  Another factor is that I hate to admit I probably let myself get dehydrated.  Without taking in my usual volume of liquid calories on the bike, combined with the dry desert air I had a likely cause for the heart rate increase.  I had consumed about 7 bottles of water on the bike, but this may not have been enough.

Since there was some concern about the ache in my kidneys I decided to walk until that went away and to let my heart rate reduce to a point where my body could catch up.  While I was walking I realized something.  I liked the view.  I've never really slowed down in an Ironman before.  I can still walk plenty fast and my garmin read 15 minutes/mile - but without pushing myself I was able to take in the full experience.

This is where I connect the early part of Part One of my race report to my experience.  As I walked and once I settled in I really began to enjoy myself.  I ran a few more sections and they started to feel better, but I made a decision to give myself a break and enjoy the marathon.  I knew I wasn't going to meet any long standing goals.  (I still want to run a 3:40 Ironman Marathon).  So even if I did run and manage a 4:30, I've already done that or better several times.  I saw no harm in the change of my mindset.  I really enjoyed being able to catch views of all my friends on the course, and even stop and chat with a few.

I believe I finished the first lap of the marathon in 2:50. When I reached the 2nd loop the temp was starting to cool, my body felt much better and I was ready to run - however just as I was about to run I stumbled across a woman who was walking just as fast as me.  She was just starting her first lap.  I believe I started a conversation with her about her wonderful walking pace (most walkers are incredibly inefficient shufflers / aka death march).  As we were talking a girl I met earlier in the week passed with her insulin pump on her waist - she asked about my blood sugar.

I reported back that I was starting to peak at about 130.  I had previously consumed another half serving of Generation UCAN in hopes of running this second loop.  And although my blood sugar tested at 118 when I consumed it I was curious if some carbs would make me feel any better.  That's how things used to work before I was diabetic.

Meeting this fast walking woman was when my goal changed.  I started talking with Bernice.  She's a 60 year old retired nurse from St. Louis.  She was adorable, complete with a Boston Accent.  She signed up with her husband and a small group of friends also racing.  This was to be her one and only Ironman.  She was incredibly nervous that she wouldn't make the midnight cutoff.  She was one of the last few riders off the bike course and her stomach was killing her after following her trainers advice of consuming 300 calories per hour on the bike.  Yikes.

But she was walking a great pace.  15:30's per mile. We started talking.  She shared her experiences and I shared mine.  We bonded pretty quick.  There was no way I was leaving her.  It was much more fun to have company.  Plus it gave me an opportunity to do what I love from within the race.  I am a coach after all.

I helped her keep an eye on her posture while walking.  She was worried about the pain in her feet so I had her focus on the tempo of her arms.  She couldn't take in any more nutrition and had a stomach ache.  I waited for her at the potty stops and did what I could to distract her from the discomfort.  Before long she was at mile 8.  She was worried that she should be running, but I told her she could always choose to run later, and that if she ran too soon she might not be able to even walk later.  We did the math together and calculated that if she held pace she'd finish with 20 minutes to spare.  She could always run at the end if she needed to.  Her goal was to finish - and I had the pleasure of helping her.

It was a bit sad that we had to eventually part ways.  Over nearly 3 hours we had a lot of fun.  I had finally gotten her to eat a few bites of solid food near mile 10 for her and 23 for me.  We discussed how she'd manage the rest of the race on her own.  We did a few Yeehaws under the acoustics of the underpass.  Shared a mile 23 in silence to honor Jesse Alswager.  I advised her to try to get some food in once her stomach settled, and that some flat coke could actually help her stomach near the end.  I was confident that if she stuck with what we discussed she'd do just fine.  I had even debated walking an extra third lap with her, but Merri was too excited to see me at the finish line to do that.

When we parted ways I finally started to run.  It probably was upsetting to those around me as I felt great running that last half mile.  I was so well rested from my nice long walk that I comfortably holding 8 minute pace.  Not a single ache in my body, and I was feeling very good about how I had chosen to spend my day.

I had no expectations for the clock.  Before I left for the race I told my friends to expect me in the 13 to 14 hour group.  But while I was carefully calculating Bernice's paces and finish times I hadn't actually thought about mine at all.  I was a bit surprised to realize that I still managed to finish in 13:07 despite walking nearly the entire marathon.

When I crossed I found Merri, got a chance to call my mother and let her know I was safe and hear my father's voice, which always makes emotional.

I was surprised I couldn't find any water at the finish line. only muscle milk?!  I walked through the food tent to get water.  I didn't see any food I would choose to eat there either.  Surprisingly, I wasn't hungry anyways.  I had just gone 140.6 miles and consumed only 450 calories and I wasn't hungry?  It's a strange new world.

Now to repeat myself.  I choose my management strategy for my own personal reasons and I do not advise anyone out there to try to follow my plan.  The calories that I burned on the day were the ones stored in my cell, primarily my body fat, my own glycogen reserves and other intrinsic sources.  I still likely burned 6000 or more calories.  My ability to perform for 13 hours on less than 20 grams of carbohydrates is only because of how I've adapted my body to function on ketones.

I realize that my walking leaves questions unanswered.  Could I have ran with this nutrition strategy?  I think so had I managed to train better and avoided getting dehydrated.  My blood sugar while on the marathon course was between 90 and 130 which is actually a bit higher than had it been while I was training.  I have a theory that I actually run best when my blood sugar is in the 70-80 range.  Higher blood sugar seems to have an inhibitory effect on the liberation of ketones for fuel, although I'm not sure how to prove this beyond what I feel and how my heart rate in training and perceived exertion is lower when my blood sugar is in that lower range.  Perhaps I should have adjusted my temp basal level for the run to 0.15U/hr.  Questions for another day...

I'll aim to slay those demons at my next event which will be a 50k ultramarathon on some very challenging mountain trails on February 2nd at Orca's Island.  But for IMAZ I achieve all I had set out to do.  Sure I look back and see the success I had and it's tempting for me to be greedy and think, what if I actually ran?  But I'm not really concerned with 'what ifs'.  What I am concerned with is what I consider amazing blood sugar control over the course of 140.6 miles by someone who has only just begun their journey as a type I diabetic endurance athlete.

I will be able to race more in the future with confidence that I can build on this success.  I know what worked best in my training and I learned a ton about my body.  I'm excited for the future but I don't care to rush things.  I have the goal of competing in Ironman Wisconsin again in 2015 which should give me time to really dial things in and perhaps then I will have the confidence to push myself hard.

Below I will include a few notes as far as my basal rates leading into the race as well as my blood glucose tests during.

10/6 Basal rate: 0.4 (0.3 from 10pm to 6am) - Normal
10/12 Basal rate: 0.8 - I had gotten into some Halloween candy- hey, I'm human.
11/4 Basal rate: 0.6
11/6 Basal rate: 0.4 (0.3 from 10pm to 6am) - Back to normal
11/14 Basal 0.3  - Swimming really seems helps
11/17 Basal Program:
          Midnight to 6am: 0.25
          6am to 8am: 0.10
          8am to midnight: 0.05.
                   1pm Temp Basal set to 0.10 for run.
Blood Glucose History for the day:
Midnight- 86
3:20am- 90
5:15am- 107
6:00am- 115
8:11am- 99 (T1)
8:27am- 102 *consumed Justin's Almond Butter (and flatted)
9:13am- 109
9:52am- 98 * consumed maple flavored Justin's Almond Butter
10:38am- 107
11:15am- 115
12:09pm- 95
12:42pm- 93
1:28pm- 66 (T2)
1:58pm- 90
2:29pm- 90 (consumed 1 serving of UCAN)
3:09pm- 119
3:40pm- 118
4:27pm- 131
4:45pm- 131 (bolused 0.2U)
5:10pm- 115
5:45pm- 101
6:35pm- 98
7:02pm- 92
8:17pm- 102 (Finish Line.  The increase is due to running)
9:30pm- 109 (Bolus 0.25 for a gyro sans pita)
11:15pm - 116

4 eggs scrambled in 1T coconut oil. Half an avocado.  1/2 serving of UCAN

Race nutrition:
8:20am: Justin's Almond Butter:
10:00am: Justin's Maple Almond Butter
2:30pm: 1 serving of Generation UCAN.

Post Race Food:
4oz of PHD brand protein drink (0g CHO) * I may want to consider protein during the race)
Naked Gyro:  Meat, lettuce, onion, tomato and dill cream

Dinner:  Guacamole and cheese.

Recovery Basal Rate:  12:45am- 7:45am Temp Basal set to 0.15.
Woke up at 98.

One week of diabetes awareness posts.

The post below are from my Facebook wall.  I've decided to preserve them on my blog as well in hopes that this information will reach as many people as possible.  I've received a great response from people in regards to these posts.  Diabetes can be a complicated topic to discuss, but the discussion is important.  Diabetes affects a significant and rapidly expanding portion of the population.  These facts are important so please feel free to read, share and discuss!

Diabetes Awareness Fact of the Day - November 9th, 2013

November 14th is World Diabetes Day. It will also be exactly one year from my diagnosis with Type I - Latent Autoimmune Diabetes of Adults (LADA). In one year I have lowered my hemoglobin A1C from 11.2% to 5.6%. A1C is a test measuring your red blood cells average blood glucose exposure during the past 3 months. 11.2% correlated with a average blood sugar of 285. 5.6% correlates with 114. Each day this week I will post some basic information about diabetes. 

The goal is to raise awareness of this increasingly prevalent disease. Admittedly and despite having family members living with both type I and type II diabetes, I knew very little a year ago. 

Type I is a condition where the body no longer produces it's own insulin requiring either insulin injection with syringes or in my case an insulin pump. Type II is a condition where your body produces insulin but your cells no longer respond to it. Type I account for only about 5% of diabetes cases - but both types are on the rise. 

If you have any questions about diabetes, please ask.
How did you know something was wrong at first?
I finally figured out something was wrong when I felt really ill after WCRC. I was starting to cramp often on the bike that week (I never cramp). Of course, I went home after my race and thought I had the flu and was craving sugar... so chocolate milk, o.j., and coke to try to settle my stomach. Oops. Then by mid week I realized I couldn't read the projector at SBR, but assumed the projector was out of focus, so I finally set a Dr.'s appt. There were so many subtle clues that I had been looking past. And some not so subtle. I had 'passed out' after drinking 3 or 4 beers earlier in the day. I passed out a 2nd time at Lindsey's after eating half a plate of caramel brownie deliciousness - along with a few aforementioned Mai Tais. I had been waking up at night thirsty and chugging milk only to wake up later to have to use the bathroom. Craving sweets like never before! I had horrible allergies all summer, along with random eye and sinus infections. I even had been waking up with numbness in my arms but assumed I had just been sleeping on my arms funny. I can probably even attribute my weakened ankles which easily sprained a few times playing soccer, as well as tendon pain at the bottom of my forefoot. All of those symptoms have since cleared. I can't believe I didn't put it together earlier, but I use the analogy of boiling a frog, the water temp raises slowly enough that the frog never jumps out of the pot. (not that I've ever cooked a frog, but it would fit my low carb diet).

Diabetes Awareness Fact of the Day - November 10th, 2013

Blood sugar is a measure of the amount of glucose in a person's blood. If blood sugar is too high, the condition is called hyperglycemia, and lOw blood sugar is called hypO-glycemia. Get it? hypO = lOw. A healthy fasting range is 70-100 mg/dL. That's milligrams per decilter, or about 1 gram per Liter. The average person has about 5 liters of blood. 4-5 grams in an average body, which equates to just over 1 teaspoon. 

If a diabetic is hyperglycemic, they have too much sugar. Moderately high blood sugars of 125-180 are not immediately dangerous, but chronic exposure to these levels increase risk of many degenerative disease. The higher the level the more serious the risk. 

Hypoglycemia (low blood sugar) can be more immediately dangerous, which may lead to loss of consciousness and death. Lows can be treated with glucose pills, sugary juice and other fast acting sugars or in severe cases, with an emergency injection of a hormone called Glucagon. Glucagon stimulates the person's own liver to dump it's stored glycogen (the body's storage form of glucose) into the blood stream. 

Either way, if you come across an unconscious diabetic, treat them with sugar first. Even if you're wrong, it won't do any more harm.

If someone is unconscious, the FIRST thing you must do is call 911 and get the EMT on their way to the unconscious person. NOW ... how will a stranger know if you may be a unconscious diabetic? Wear a medical alert bracelet!! Your RoadID is not just for when your training or racing.

Diabetes Awareness Fact of the Day - November 11th, 2013

Insulin is a hormone produced by the pancreas. Insulin serves many roles within the body, but the primary role with concern to diabetes is that it's proper functioning enables glucose from the blood stream to enter cells of muscles and the brain. Once inside the cell, the glucose can either be used, or if the supply of glucose exceeds demand, it is stored as body fat. 

In type I diabetes insulin in absent, in type II diabetes insulin is produced (often at a high level) however the bodies cells are desensitized (insulin resistant) and don't respond to it's presence. 

Insulin resistance can be caused by poor diet, a sedentary lifestyle, obesity, inflammation, illness, stress, sleep deprivation along with genetic factors. The more insulin resistant a person become, the more insulin is required to achieve the job of getting glucose into the cells. 

Since insulin is also a fat storage hormone, the high levels of insulin required in an insulin resistant person cause the metabolism to shift towards storing more energy as fat. In fact, if a type I diabetic were to chronically inject large amounts of insulin into the same part of their body they can develop a localized fat deposit at the injection site. This same fat storage occurs in the body of an insulin resistant person with high levels of insulin through-out the body.

·    Not bad but a couple of corrections needed. Many T2's take insulin too because the beta cells just wear out and don't produce enough or any insulin. Although T2 is connected to obesity, (We're seeing T2 in children now because of sedentary lifestyles and poor dietary habits), genetics plays a major role in T2 development and should be emphasized more than it is.

·    Thanks again Ed. I appreciate it, I'm trying to be informative enough that someone with little previous knowledge can learn enough without overly complicating and confusing things, but it's great to have another set of eyes out there making sure I don't miss any pertinent details.

Diabetes Awareness Fact of the Day - November 12th, 2013

Diabetes is much more prevalent than many would ever imagine. At the bottom of this post I will share a link to the statistics from the American Diabetes Association website. It can be difficult to put numbers into perspective, but as of 2011, 23 million Americans are diabetic - 8.3% of the population. The scarier number is that another 79 million Americans are Pre-diabetic, that another quarter of the population! 1 in 4 people!

Pre-diabetes – At least 50 percent of people with impaired glucose tolerance eventually develop type 2 diabetes, and there is an increased risk of heart disease even if diabetes does not develop. 

Impaired fasting glucose is defined as a fasting blood sugar level between 100 and 125 mg/dL. Impaired glucose tolerance is defined as a blood sugar level of 140 to 199 mg/dL two hours after an oral glucose tolerance test.

When is the last time you had a fasting glucose tested? This test is usually done when you get your fasting cholesterol test. I've often wondered if that statistics really project that 1 in 4 Americans are pre-diabetic, then why aren't glucose levels tested at every doctors appointment similar to blood pressure? Why not ask your physician to check? 

You can take matters into your own hands and get your own meter and test yourself and your family. Meters are often less than $20 and a test strips are usually about $0.50 a piece, which is cheap compared to the chronic expense of diabetes.

Another scary fact is that 25% of those who have diabetes don't know it.

Diabetes Awareness Fact of the Day - November 13th, 2013

Since yesterdays post focused on the statistics of diabetes, today I'd like to focus on why those statistics matter so much. The complications of diabetes are serious. There are dangers of hypoglycemia among those treating their diabetes with insulin, but there are also numerous consequences resulting from the high blood sugars experienced in the millions of people that are either un-diagnosed or not managing to control their high blood sugars.

From the NIH website: "If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can cause problems with other body functions, such as your kidneys, nerves, feet, and eyes. Having diabetes can also put you at a higher risk for heart disease and bone and joint disorders. Other long-term complications of diabetes include skin problems, digestive problems, sexual dysfunction, and problems with your teeth and gums.

Very high or very low blood sugar levels can also lead to emergencies in people with diabetes. The cause can be an underlying infection, certain medicines, or even the medicines you take to control your diabetes." 

While this sounds like any simple disclaimer you might hear at the end of a prescription drug ad, these risks are serious. When they say kidneys think dialysis, when they say nerves think loss of feeling in limbs and neurological disorders such as alzheimers as you age. When they say feet, think wounds that may never heal, gangrene and possible amputation. These can be serious - but because they are a result of long term exposure it can be very easy to not take the risks seriously until it is too late. And beyond your own personal health, the management of these problems will have a crippling effect on our entire healthcare system. I don't want to dwell on the negative, but this cannot be ignored. It's the unlucky 13th today, tomorrow I'll focus on the positive.

Diabetes Awareness Fact of the Day - November 14th, 2013

Thank you for following along with my posts all week. I could continue with information for the entire month and if there is anything you'd like to ask please do so, but today I want to shift the focus. 

Hopefully everyone is aware of the story of 5 year old Miles,who is in remission from Leukemia. Through the Make-a-wish foundation along with 11,000 people in the San Fransisco area, Miles lived his wish yesterday to save the city as Batman.

This amazing victory for a new generation of Batman reminds me of another heroic batman near and dear to my heart - Eric McLean. Eric passed way on August 23rd of 2012 after a 10 year battle with Leukemia. His brother, a Wisconsin Triathlon Team alumni and friend founded the organization L.I.F.E. on his brother's behalf. L.I.F.E. is the Leukemia Ironman Fundraiser for Eric. L.I.F.E. carries on as a successful 501(c)(3) charity.

L.I.F.E. is the charity that we at Sbr Coaching were raising funds for one year ago at our annual Wisconsin Cycling Relay Challenge (WCRC) when I first realized that something was wrong with me following my leg of the relay, leading me to the doctor's office to investigate the reason for my blurry vision, constant thirst, and frequent urination. 

I feel odd admitting this, but when I learned that I had Type I diabetes, I thought to myself, at least it's not cancer. I am blessed to have begun my journey with diabetes with the great physical strength of an endurance athlete and a background in biochemistry that allowed me to understand the physiology, as well as an interest in food and nutrition- as well as a passion for cooking. I am an incredibly lucky person. Diabetes will not hold me back in L.I.F.E. Eric has played his role as well, inspiring me along the way.

If perhaps I have inspired you, please feel free to donate on my behalf to L.I.F.E. 

You can learn more here:

Miles story further reinforces that the world is full of amazing people. We may get distracted at times along the way, but we are all this world together. We are all connected and it's easy to see. 

Tomorrow I will be taking the 23rd mile in silence out of respect Jess Alswager, another hero linked to my favorite number, 23. If you wish to donate to support diabetes or learn more about Jesse, follow along here: 

Thank you Jesse, Eric and Miles.

Friday, November 15, 2013

Improved insulin sensitivity and a bit of my TSS plan for IMAZ.

Quick one this time.  I'm in Arizona tying up all the loose ends before competing in Ironman Arizona on Sunday.  My training has been atypical in comparison to any Ironman races I've done before.

With the importance of setting up my metabolism, along with dealing with a few bumps in the road in the lead up my approach will be non-traditional.  Normally when I would have been building peak training, I rested and then past 2-3 weeks when I would normally be tapering I have been doing base training.  

I've come to this through listening very carefully to my body and understanding the importance of a what I'm doing metabolically.  First off, I'm not out to set a personal best at this race so the gains from being fully tapered and rested really aren't important to me.  I will not be racing at the intensity where that should affect me.  

What has been interesting is that while I've really put my focus on prioritizing consistency in training, and especially due to the increased focus on swimming I've noticed a dramatic improvement in my insulin sensitivity.  Along with that I've also reduced the inflammation in my body.  My face is less squishy, my and body weight is a few pounds down - this is not due to me burning more calories as my energy consumption has more than matched my output.  

The most significant improvement has been my insulin sensitivity.  I have had to reduce my basal insulin rate back down to 0.3U/hr, which is very near the level it was at when I was assuming that I was 'honeymooning'.  This is great news to me, however there is only one downside.  As a result of this improvement I need to re-evaluate the insulin rates that I plan to use during Sunday's event.  To err on the side of safety I plan to reduce the temp basal rates from 0.15U/hr down to 0.1U/hr.  

Technically, and probably only of interest to other OmniPod users I'm not setting a temp basal, but creating my own basal program for the event day.  The race starts at 7am.  My overnight basal will be set to 0.3U/hr until 6:30am at which point it will change to 0.15U/hr until 8:30am.  The plan is to target a BG of 80-100 at the start of the race - there will likely be a spike due to adrenaline as well.  (I will also have emergency carbs taped inside my wetsuit since you never know.).  

Without an adrenaline spike my blood sugar should settle to about 70-90 as I excite the water.  Then run into transition will likely spike this up again by a minimum of 10 points putting me in a great range on the bike.

At 8:30am I should be just settling in on the bike at which point my basal program will further reduce to 0.1U/hr when it will remain for the rest of the day.  I had the ability to ride part of the course with a PowerTap yesterday.  I'm comfortable targeting 210-230 watt average on the course depending on the level of incline.  This effort should keep my heartrate in the mid 140's at (for me) is a nice aerobic level.

For power geeks my FTP is usually 360.  Yes that is a big number but factoring that I'm 215 pounds that's 3.6 watts/kg which is a much more humbling way to look at it.  I haven't done an FTP test lately since I've been intentionally avoiding them due to their potential for instability.  I have been able to comfortably hold 320 watts at what felt like 90% effort for 40 minutes so I'm sure my FTP hasn't changed too much from season's past.  For safety sake I'll enter a conservative 340 watts for my FTP into the calculator.

I should do just fine on this flattish course.  Three laps with a gentle uphill on the way out and a gentle downhill on the return.  I'll be riding the uphills near 250 watts and likely be able to drop that to 180 watts on the downhill and still hold speed just fine.  This will likely net me about 18 mph average (judging from yesterday's 2 hour simulation ride on the course, which leads to about a 6 hour total ride.  I'll be spending slightly more time on the uphills than the downs.  My numbers are still loose calculations but these efforts should put me at a conservative 270 TSS points for the entire ride.  Plus or minus a loose twenty points and I should feel nice and fresh coming of the bike, especially since the finish is after a downhill leg and I'll be able to recover.

In addition to these theoretical estimations, I'll be relying on the bike computer between my ears that has served me so well during my many years of cycling.  I'll definitely have the option to back off and play it even safer than that.  This is the first Ironman in which I'll be recording my power output.  This will be incredibly useful for figuring out the details of future races.  I'm interested to see how the PowerTap and the computer between the ears compare.  

Eventually I'd like to get some metabolic efficiency test done and then together with a power meter I will be capable of developing an incredibly detailed nutrition plan to suite my new requirements.  I won't be basing my race on the power numbers but it will be fun to look at the data once the dust settles.  

It helps me to write these things down.  Normally I'm a notebook person, but now that I've taken to blogging I'll likely be including more of those details here.

Friday, November 8, 2013

Birthday Challenge Update.

Hmm.  I wrote this post on June 26th, but just now realized that it's been sitting as a draft.  Whoops.


June 23rd has come and gone.  I have a tradition of treating that date as an opportunity of challenge myself.  This year is no exception, however I had a new idea.  My original idea for my birthday challenge was to train to race a 200 Butterfly.

Actually, the whole goal was to train a total distance of 10,000 yards of butterfly (in small sets and then I'd be ready for the 200).  I have to admit that I wasn't able to get the full training in.  No regrets however, I'm at about 40% of the way and I'm enjoying my butterfly training so much that I plan to continue it through the remainder of the season.  The butterfly sets have been making me a much better swimmer overall - but I've only been able to make it to a total of 100 yards consecutively.  200 Butterfly is going to be a challenge.

A 200 butterfly should take me somewhere around 3 minutes.  That's 3 minutes of high intensity (despite trying to relax as much as possible).  The anaerobic demands are currently beyond what I'm able to tap into.  I'm not providing an excuse, but it's a challenge with my current fueling strategy.  Aside from my 2 or 3 sets of butterfly per week the bigger priority in my life has been optimizing my aerobic endurance.  This side of my training has improved greatly - so I modified my birthday challenge to indulge in what I enjoy most.

Following up on my successful ride at the 200km HHH - I knew I'd be safe to head out for my first big solo ride in a long time.  I love long rides - they've never failed to make me feel good.  For my birthday I decided to check out a few roads I haven't ridden in a while.  I let nature choose my course.  Starting out into the wind (always makes for a better ride home).

Down to Paoli, I start to feel really good as I watch my CGM numbers drop from 120 to 60.  This steady drop seems to be the trend during my warmup period and lasts about 45 minutes.  I climb Observatory feeling strong - my GCM numbers level out - once I recover from the hill I feel the stronger than before.  I head out Hwy A with the goal of heading west.

I wasn't in the mood for Blue Mounds, but perhaps Blanchardville?  I really enjoy the large roller in that area.  On Hwy A I found very smooth new pavement, caught a bit of a downpour, but really started to feel good.  As the rollers grew bigger, my body responded with more energy.  And despite the headwind and hills and drinking only water and not consuming any carbs, I got to Gratiot in 5 hours, feeling strong.  I've been to Gratiot before and randomly found my way here again.  I had hopped onto 39 to Mineral Point and then had to take 23 south considering the number!  Beautiful roads.  At the convenience store in Gratiot  did my blood sugar test. 70- I ate some salted cashews and bought some hard peppermint candies just in case.

I recently stumbled upon an old blood-work from 2003 and my way back fasting blood sugar was 80.  And a reminder than my meter reports 8 points falsely low (compared to whole blood draw).  Riding my bike with a BG of 70 isn't as careless as it seems.  To the traditional diabetic rider it probably sounds like a level at which one would have absolutely no energy.  But I was humming along.  Long climbs of 4-5 minutes at a time - plenty of time out of the saddle, really putting the burn into my legs.

I could build up to a rather high level of work.  My legs seem to wake up the longer I went.  10 hours round trip.  156 miles.  Wind, rain, hills.  My CGM had me at 60's, my meter had me in the 70s.  To compare this to last week's HHH, I chose not to drink any UCAN this ride.  That difference explains the 30 point difference in the level of bloodsugar my body can keep up while I'm riding.  What's not clear is whether I felt stronger with or without the higher bloodsugar.

Considering it's not the carbs that are fueling my mind and muscle, I'm not sure how important worrying about bloodsugar really is.  I'm really growing in my confidence.  If my body can keep up for 150 miles already, as I continue to train and follow this diet I'm only going to improve at the level of intensity that I can maintain for that duration.

A very cool feature that I'm figuring out. Once I start to do a cooldown from my workouts, when I reach a point where my heart-rate is in the 120's, my blood sugar (according to my CGM) begins to raise naturally.  Over the twenty minutes of cooldown and 40 minutes of standing around the house, my numbers rose from the low 60's to mid 90's. All on it's own.  It didn't even overshoot this time.  My dinner was totally carb free.  There was meat.

Now for the part I'm quite excited to announce.  I spent the entire day of June 23rd free from insulin.  Not a drop for the entire 24 hours.  Within that time, my numbers according to my meter were between 70 and 130.

Not every day is perfect, but June 23rd was pretty close.

World's Longest Slowtwitch Post.

So I don't read Slowtwitch as much as I used to.  Okay, I used to read it a lot when I had free time between experiments in my previous lab job.  These days I rarely read it, and if so it's for the articles and no longer the forum.  But today I stumbled across a thread titled, The Official Diabetic Triathlete Thread. Talk about great timing!  I was looking for info on IMAZ water temps - but instead being able to communicate with a bunch of other diabetic triathletes, including another diabetic coach who authored this article on a low carbs strategy for IM. Talk about a gold mine.  I ended up posting my 'intro' which turned into a manifesto, which I figured I may as well share as a blog post.  So here it is:

I'm 34. Was diagnosed almost exactly a year ago, type I - LADA. I've raced 3 IM in the past, more HIM than I can count, tons of endurance cycling etc. I'm racing my first diabetic IM next week in AZ and planning to use it as a learning experience. 

I think it's great that resources such as this thread allow us all to find another and discuss these topics. It really is amazing the progress. I'm am incredible grateful for those who have tested the boundaries and been brave enough to achieve the success that they have had. Every diabetic is different, physically and mentally. Hell, I'm different depending on the day - but that said I'm also going to vouch for Vinnie and the benefits of being low carb and ketogenic adapted. 

I have also been pursuing this strategy, admitted I'm new to the scene so I know my place. However, how I choose to care for myself is my decision. I'm not here to pressure anyone else to do things my way, but it works for me. My goal is to try to preserve my beta cells - hell I'll openly admit that I'd love to reverse this thing. Even if that's an unrealistic or unobtainable goal it still leaves me with my health. 

I'm not saying it's unhealthy to treat your diabetes in the traditional manner, but for me I want to pay due respects to the 80 year old future me. I don't want to (in my opinion) risk my long-term healthy by exercising with BG's in the 140's. I am able to train in the 80-100 range very well. I do not experience any rapid hypos, and if I do ever go low I can just stop or slow down and my body will auto-correct. Vinnie's comments about the law of small numbers is only part of the benefit. The real benefit in my view is that being adapted to burning ketones as a primary fuel source means that my body can handle them and actually use them. 

There is more to it than just 'low carb'. I've trained by body to burn fat (in the form beta-hydroxybutyrate). So not only do I not get high BGs from food, although high intensity intervals do cause a bump, I'm protected from lows. I guess I can't prove this, but I am putting my life on the line that I am more protected from lows. I haven't ever been low to a point where I haven't been able to think clearly and care for myself (again, this is year 1 so knock on wood) It's not a hypo unawareness issue, it's that my brain and body aren't choked off from their only fuel source. There was an interesting study I read about in "Good Calories, Bad Calories" where they took patients who they ketoadapted through starvation for a couple weeks and then administered enough insulin to take their BG's below 20, and they apparently suffered no neurological deficit - I think this was in the 1930's since you can't fund that study these days! Not that it's my goal to ever go that low, but if I do I'd rather not go into a coma. 

My blood ketones are consistently in the 0.5-2.5mM range, no where near the 15mM DKA risk category. I feel better and perform better at 80 than over 140. I get stronger as a workout duration increases - I feel like a big diesel engine. Admittedly I'm probably a small portion of my anaerobic metabolism, but I've also upregulated my aerobic (just through diet!). I should do a VO2 max test and measure my respiratory quotient - been waiting on that since the first year of diagnosis is $$$. But I can tell I'm more aerobic while swimming and require less air, etc. 

A note about CGM's. I use a dexcom G4, but it doesn't seem to tell me much. My theory is that this could be unique to the whole ketoadapted thing. It's great when sedentary, but once I'm 40 minutes into cycling workout the CGM shows that I've dropped below 50 while blood values show me still in the 100's. This could be related to my ketoadaptation, either way it doesn't tell me what I need to know for it to be a reliable tool during exercise. Maybe my interstitial glucose values really are 40's, but I was knocking out killer hill repeats feeling very strong the last time that occurred. 

Other benefits beyond and up-regulated aerobic capacity is that I'm noticeably less inflamed now. No more allergies - I can breath though both nostrils at the same time! My flexibility increased which I thought was crazy (I got better at yoga while not actually practicing?! ), my energy is very steady - I can miss a meal and not be hungry and have stable BG values, I could fast for a day and train just fine. 

Now again, I'm not forgetting that I'm still new at this. I was likely honeymooning a bit, and hopefully I still am and will continue to for the rest of my life. Right now I'm using an OmniPod (no tubes!) and run a 0.4U/hr basal. I set a temp basal of 0.15u/hr for aerobic efforts. I turn that temp basal on 30-45 minutes pre-workout before swim and bike, but time it at the start for runs. I experience similar BG effect that I quoted from Vinnie above. For high intensity workouts or short runs I don't reduce a temp basal. 

With my first diabetic ironman next week I did 4400 swim yesterday. By swimming a comfortable easy pace my BG dropped from 90 to 70 and my splits where nice and consistent. Normally I'd do that distance in about 65 minutes - but yesterday's pace time was 75 minutes. Then for shits and giggles I did a hard anaerobict 200yd effort to finish my workout. By the time I was dressed I was back up to 90 from the intensity. That's pretty cool in my mind. (using my own glucagon rather than injecting). 

As for losing 10 minutes in my swim - I don't care. I'll be stopping to test on the bike. I'll be happy with a 6hr+ split (where as I know I could probably ride sub 5:15, at least I could pre-diagnosis). And I'll just be happy to finish the run. 

Its funny how I feel a little pressure to prove that this strategy works by actually going all out, but it's not worth the risk to me. I have a much longer term vision. Maybe I'll go harder in IMWI'15. There is hopefully going to be a big group participating. 

Oh, and more details. My A1C after my first year is down to 5.6%. I eat mostly fat. Typical meals: Breakfast is either bacon and eggs with kale in coconut oil or lard. Lunch (if I need it) is a salad with olive oil and vinegar dressing perhaps with avocado and sardines on top. Dinner is usually a home-made soup from bone broth with non starchy veggies, maybe 6-8oz of pork, fish, or steak (sometime liver). Snacks are almonds, macademia nuts, or a spoonful of coconut oil with nutbutter and/or chia. Dessert is coconut milk chia seed pudding with cinnamon and cocoa powder mixed in. And I admit to putting kerry gold butter in my coffee if I'm in a hurry. 

Sorry for the length of my post. Again, I think it's amazing that we can all share this info. I'm so happy to read what Vinnie has posted because it reflects what I too have learned and experienced. We all have a choice in how we care for ourselves. And even if you choose the HCLF strategy, your better off than someone who chooses no strategy and doesn't exercise. We are all doing the best we can. I'm just glad to have the choice. It was hard for me to find info on choosing this method so hopefully my words (and Vinnie's) will help explain this option to anyone else that might be interested. 

If you sadistically want to read more about me I do write a blog at I think I'm just going to post this as a blog as well - wholly manifesto! 

I'm not on ST much anymore, just happened to check in for info on AZ (water temps, etc), but I'll follow this thread - good timing I guess! And from my blog address I'm easy to find on FB. Good luck everyone! I know how afraid I was a year ago - and it's due to the work of all of you that I have the confidence to continue on in the sport that I love, hopefully for a long time to come.