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, March 5, 2013

One giant leap.

This is a big week.  With the weather due to break at any moment (tapping fingers.... tapping...) clients are starting to plan our their race seasons - that means plenty of business for me.  I am very happy about that fact.  The work is rewarding - that makes all the difference.  But my job keeps me busy, odd hours and what not.

The challenge being (another) that my schedule doesn't line up with many other people's.  While this is perfectly in alignment with my disgust for traffic - it interferes with my ability to train.  As alluded to earlier I need to be careful when I workout out alone - frustrating.

So yesterday I said to hell with it.  I'm going to have to figure this out sooner or later.  I'm a fan of sooner, so I went to one of my favorite sections of Pheasant Branch trails in Middleton and did a nice 90 minute out & back run.  Almost a double out & back with the way the route loops so I wasn't ever more than 2 miles from my start point.


Nothing notable about the run really.  Just another 10 miles in the snow on trails.  I paced rather conservatively, and I wanted to fuel as aerobically as possible.  I've been seeing some interesting shifts in mood, hunger, and energy level.  They all connect into blood sugar values.  I test my blood sugar very often, 10 times a day,  some think that's crazy and are lucky to test twice.  Until you commit to testing often you don't know what you aren't seeing.  I'm learning glucose response curves, trends in my insulin activity, how illness & stress affect my levels, the list goes on and on.  It's like I now have a fuel gauge for life.  Unfortunately that comes with a severely choked off carburetor.

Okay, I'm not a car.  And while I'm great working on a bike, I don't know automotive mechanics nearly as well.  But the analogy is close.  Without my body in control of its own insulin requirement, the sugars in my bloodstream are left without a way to cross into the cells that need the energy stored in the bonds of its carbon, hydrogen and oxygen molecules.  Pretty simple molecules really.  But they have amazingly complicated influences over my life.  Jerks.

The highlight of the run was the end.  I enjoyed my run and would have kept going if that was my plan, but the end was definitely the highlight.  90 minutes of 70% heart rate and 53g of carbohydrates (C:H:O) and my blood sugar was dead level at 120mg/dL.  That is victory folks.

The story doesn't end there however.  This is the point where I would have destroyed a huge portion of homemade pizza with whole grain crust in the name of recovery.  But now that I'm free of that non-sense I was barely even hungry.  Normally when I run in the cold I would return craving something massively hearty.  Instead I had bacon, kale & cheese omelette plus greek yogurt and cantaloup.

However I was getting full before finishing the melon.  My numbers started to go low because I had dosed my insulin ahead of time to account for it.  I have to time the mealtime doses about 15 minutes ahead of the food for optimum stability.  So once I look at a food I have to decide how to dose for it, how to time it and then wait.  That's a pretty good system to follow to give your body time to catch up to the impulses of eating habitually.

I was slowly eating my delicious meal and started to feel my brow break into a sweat.  Some dizziness upon standing (my blood pressure has dropped back down to 110/70).  It's mostly a loss of clarity of thought that I'm aware of for symptoms of low blood sugar.  I guessed that I was at 60, but test at 50.  The lowest I've been.

Know that trained method to treat a significant low would be to consume high glycemic index simple carbs. A Snickers bar has sugars, but the fats and proteins will satisfy you.  They weren't kidding.  The glycemic index of a Snickers is actually low: GI 41.  Glucose is 100.  White Bread is 70.  The number is a measure of how reactive the sugar is.  There may be more energy in a snicker bar, but it is released much more slowly.

You're seeing why this could be hard to calculate when your experiencing low blood sugar.  But I'm trying to eliminate rapid swings, both down and UP.  Blood sugar swings cause swings in everything, my metabolism included.  Had I gone with the quick fix of 6 corrective dextrose pills (really just smarties) at 24g total sugar (CHO) I would have raised 2 points per gram- 48 points.  48+50 would get me to 100mg/dl in 5-10 minutes.  But I don't want to eat 24 grams of pure sugar.  I'll eat 24 grams of carbs, but there is going to be some value to them.

First thing I did was speed up my eating.  Finishing my cantaloupe   I could have had more cantaloupe, but more isn't always better.  Less is better?  Less of more things is - at times.  Follow?  Cantaloupe is a super choice for carbs, but I chose to pick up my 48 points with a small apple with 10-15g CHO and 10 large black grapes.  Each grape is 1g CHO.  Nailed it.  That's how you do it.



The glycemic index of my carbohydrate sources was lower, although grapes are pretty high at 60.  Notice that a raw apple has the same glycemic index as that Snicker bar.  Not what you'd expect.  It took me longer then 10 minutes, maybe 30-40 but my blood sugar responded as planned.

This drop in blood sugar was in response to 3 Units of Novolog insulin with my meal.  3 little units and I overshot.  It obvious why.  My body was pulling sugar from my blood to aid in the post workout rebuilding.  There is a receptor molecule that comes to the surface of cells to help transport glucose independent of insulin. If I remember correctly, these are same molecules in the signal cascade that allows insulin independent glucose utilization at higher intensities. That mechanism combined with my background long acting twice daily 6 Units of 16-18 hour Lantus.

Another concept I'm excited to dig into further is a side effect of our adrenal system linked to flight or fight response. Flight sounds good, right.  It's rumored that some short all-out sprints will be able to raise my blood sugars while I run - no aid station necessary.   I've already experienced this effect.  During the few more intense soccer games I've played in (once in my first fast paced Liga Latina game, and again during the President's Cup Tournament), the adrenaline coursing through my veins that keys my into 'the zone' also causes my liver produce glucose through good old gluconeogenesis-expialdoshis.

"If the current pace hurts, try a faster one!"  I've been racing with those thoughts of Jack Daniels in my mind my whole running career.  It works.

Just got off the phone with my Diabetic Nursing Specialist.  Pump training is set for Tuesday and we'll be putting in my application for a Dexcom 7 Plus, a continuous glucose monitor that has an embedded sensor that test many times per minute.  Complete with bells & whistles that alert to rapidly changing levels.  It's accuracy isn't as good as a finger prick test (fresher blood flow).

However, it is precise.  From what I hear it's manly a problem of a time delay by 5-10 minutes due to detector location.  Whatever it's issues it will be a huge leave forward from having to take of a glove, open the bottle of tiny test strips, load the strip, snap the container closed, wait for the meter to beep alerting that its ready to read.  Then wipe clean your finger (no residual sugars), poke finger, squeeze blood droplet (about 10uL), align droplet with appropriate point on test strip, record reading on Glucose Buddy app on my smart-phone, dose my carbs in response to reading, put everything away, put back on gloves, look up and hope that my bike is still going the right direction in traffic.... Okay, I'll pull off the road to test.

That unacceptable.



Think of the time-course responses to fuel sources that I can figure out!  Data!!

Have fun looking up stuff.  http://www.glycemicindex.com/

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