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.

Monday, September 2, 2013

New Paradigm - and success: and a bunch of details that are probably only important to me.

I'll be honest.  I have a few unpublished blogs that I'll be saving for myself.  It's been a tricky summer with the management of my diabetes.  I had things well figured out - as I had it with both my riding with HHH and my birthday ride.  But as I'm learning as a diabetic novice - things change.

The paradigm-shift:  I must have been honeymooning.

Turns out that I likely was 'honeymooning', meaning that my body was still making a trace amount of insulin.  Likely, but not proven.  Ideally I could get all the necessary tests done to measure the levels of endogenous insulin production vs what my pump provides - but in reality I could not convince my health care provider to pay for additional tests.  I look back at my initial test of my insulin levels and I guess it seems fair to assume that I held onto my ability to produce a very slight amount of insulin.  And this makes sense when I consider my ability to ride and swim for long workouts with my basal pump rate set to zero.

I am always open to learning more.  I have been doing well on my high fat, moderate protein, low carb nutrition.  But despite that my stability took a nose dive at the start of July - it took me a while to figure it out.  I questioned whether it could have been my choice of the ketogenic diet, whether it was something specific I ate, stress or lack of rest, etc.  In restrospect I really can't be sure.  But regardless of the cause I've got the train back on the tracks.  And honest confession, I feel some guilt believing that my instability was a result of an overindulgence of chocolates and sweets - but whatever the cause the result is what it is.  My body now seems to make absolutely no insulin.  (Again, I'd like to get this tested but that request is denied).

I make this assumption because of the changes which I've had to make to level things back out.  Previously I would set my daily basal rate to 0.2U/hr.  During my period of instability I had to get to 10x that - it was crazy.  But now I've been settled for over a month at a rate of 0.8U/hr.  And I'm stable.  My insulin sensitivity has lowered a bit, and that could be due to my low carb diet - something I just read about on Mark's Daily Apple.  But assigning reasons is really just educated guessing without the ability to test myself.  All I can really say is that 1U of insulin does not seem to go as far as it used to.  (It used to be 1U:40grams).  I don't really know what it is now since I don't plan to test - since I don't really ever eat that many carbs anymore - but I'd guess I'm about 1U:25g judging by my corrective use.  I guess I could do those tests at some point.

Lets get to the success:

But back to my successes - it's always fun to talk about what works.  Running has been the biggest challenge for me.  I attribute it to my size.  There is no way around the fact that I'm 6'5 and 225#, although my weight ranges lately and I was much leaner a few months ago.  I don't put too much stock in my body-weight but that is a topic for another day.  Running more so than swimming and biking has a greater physical demand due to gravity.  Swimming can be done at very low intensities and lots of breaks at the walls, cycling provides a range of gears.  Plus I'm much more efficient mechanically as a swimmer and a cyclist.

Running has always been my favorite discipline, but for those reasons above, also one of my more challenging.  I was just starting to build confidence in my abilities.  I had broken into the 19:3X's for my 5k, gotten my mile time to 5:20.  Most of that progress I made without doing much for actual speed work.  I was focused on running economy and ultra distance running - not only was it a low injury risk for me to run the trails in Vancouver at slower than 12min/mile pace, it was great fun.  It was supposed to be NOW that I was planning on increasing my intensity, hitting hard track workouts and finally building to long set goals such as a sub-40 10k, hoping that those increases would translate into faster marathon times.

But running has been the discipline that my diabetic diagnosis affects the most.  Most of my runs have caused me to destabilize.  At first my runs would cause the expected drop in blood sugar values, but now that I've become very fat adapted the reverse has actually been the issue.  Due to the greater physical demands of running my body, through whatever mechanism, would actually produce more blood sugar than it needed.  Total mind bender on that one - and the only way around that would have been to head out running with my full basal rate flowing - not something I wanted to get wrong alone... so I put those trials off until now.

But as I said, there has been success.  I've had to relegate myself to the safety of the treadmill, but it's been working.  Right now I'm doing a lot of walking, which provides opportunities to test my sugars as I go, as well as let my body's fat metabolism catch up to the demand.  And I'm just running slowly for now.  Logged a total of 16 miles today!  That's on top of 10 miles last night, and a few shorter runs of 3-6 miles earlier this week.  I don't want to ramp too fast, but I'm on a cushioned treadmill running very slowly so I'm not too concerned about doing too much too soon - but I do know better.


What worked today in case anyone is interested, but more for my own record, was:

Started running at the same time I turned my basal down from 0.7U/hr to 0.35U/hr.  Kept repeating segments of walking 5 minutes at 3mph and running 10 minutes at 6mph.   Like I said, not fast but I'm focusing on building the base right now and need to be very patient - stability is way more important.

What I was hoping for was that by started to run at the same time I turned my insulin down, the insulin that was in my system would cover the BG spike that I'd been seeing when my body adapts to the demand.  And it worked, perhaps a little too well.  My body's response (spike in BG) seems to increase when I start running too fast too soon.  So this 5 min walk - 10 min run seemed to mitigate that.

I figured it would take about an hour for the reduced basal rate to start to balance out, so I wasn't too shocked to see that after 30 minutes my BG was down to 71. I was feeling fine so I kept on going in hopes of figuring out where my bottoming out point would be.  This is assuming that my fat metabolism would kick in at some point as my insulin level reduced.  I tested my BG during every walking break.

I noticed a few other things worth recording.  My heart rate while walking at 3mph would drop to 120bpm after one minute and would be down to about 100bpm after 5 minutes.  My HR while running at 6mph would stay between 148 and 150.  The longer I kept running, the lower it would actually be (which I'm contributing to fat adaptation.   As for nutrition:  My breakfast was 6 slices of bacon, 2 eggs (4 yolks) served over a bed of lettuce 4 hours prior to running.  No calories were consumed during my run, just 3 bottles of water.

After my initial drop to 70mg/dL each successive test was steady in the mid-60's.  After about 90 minutes I had a reading of 62, but since I felt very good I decided to turn my insulin down further from 0.35U/hr to 0.10/hr and keep going.  Sure enough I kept repeating my 10 minute miles and despite no calorie input my numbers started to balance out closer to 70.  Luckily I find this whole process entertaining since I did spend upwards of 3 hours on the treadmill - thank goodness for podcasts too.

It was a fun experiment.  3 hours of running without carbs sounds rather crazy - and not something I recommend, but I never got hungry.  I actually spent the entire run breathing through my nose as well - which has become my fun way of ensuring that I'm training at an aerobic level.  I counted my breathing rate to be about 24 breaths per minute - too bad I couldn't quantify my 02 vs C02, as I'm confident that my fat adapted state is much more efficient on that front (RQ).

I'm still not all that hungry afterwards.  Normally I'd be ravenous after a long run.  Normally I'd be much more sore as well.  I've been trying a new treat which fills my chocolate cravings and fills me up very well.

4 spoonfuls of chia seeds (30g)
1 cup of water
microwave for 2 minutes
mix in 4 heaping tablespoons of cocoa powder
1 pat of grass-fed butter.

It makes for a chocolate oatmeal sort of thing - hey I know it's not normal, but I like it.  I've had it pre-run too and it sits very well.

This time I added a little bit of raw green leaf stevia, but have also sweetened it with some almond butter and or sprinkled a bunch of powdered pecans or walnuts in with it.  This is my new treat now that I've been trying to limit my usage of dairy, specifically the heavy whipping cream - another experiment for another day.
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