Management and Measurement

As with many things in life, if you are hoping to manage something you better have a way of measuring it.  Whether it's watts of power on a bike, the food you take in - or in this case the management of my blood sugar.

It's been a bit over a month since I've switched from multiple daily injections of insulin which I calculated based on the blood-sugar reading of my Accuchek Nano Blood Glucose meter.  While I was using I was pretty good at holding steady at 100 mg/dL... according to that meter.

Then I switched to my OmniPod for my insulin pump.  The PDM (personal diabetes manager) works both as the controller for my pump, and also as a manual blood glucose monitor.  Right when I switched, the scientist in me knew well enough to check the consistency of the readings between meters.  

I would use the same drop of blood and test it on both meters.  Different meters have different margins of accuracy at different ranges.  Some are more accurate for measuring high values, etc.  I guess that's handy for those people who want precision in their poor control - not really my goal.

There has been a consistent off-set between these two meters.  The difference was usually as much as 25 points.  The Accuchek always read higher. That's a significant margin of error.  70 or 100 won't kill me, but 40 vs 70 is a big deal.  And it's tricky to guess which one was actually right.

Functionally what this means is that I wasn't sure whether all my work of the past month with the OmniPod in which I've been able to hold a steady monthly average of 105mg/dL, may have been in fact a less than stellar* 130mg/dL  (by my standards which are higher than most).

So after all this worry I finally got some blood labs done with a meter check.  They drew about 20mL out of my finger tip in the lab.  I was amazed at how well the lab tech milked that much blood so easily from a fingerstick - it actually hurt less than my stabber-jabber although upon further inspection her lancet cut a bigger slice.

The results came back.  The omnipod read 92 mg/dL.  The Accuchek read 124mg/dL.  The lab values were 100 mg/dL (BULLSEYE!).

Implications.  Accuchek should rebrand as in-accucheck.  The OmniPod is much more accurate and it will measure me as slightly lower than what my bloodsugar actually is.  So my avg of 105 might be more like 113 mg/dL.  

Looking back.  Makes sense why I was feeling gassed trying to workout with my Accucheck - similar to the fuel gauge on my Firebird which always showed 1/4 tank left when I really only had only enough to get me 20 miles.

Looking forward.  I'd like to target my actual blood values when resting to be 90 mg/dL - so I'll play around with lowering my set-point to the low 80's (which will be a real world value of 90).

What a relief.

Crazylegs Race Report

I used to love writing race reports.  Some of them are hopefully still archived on the UW Triathlon Team forum.  I've fallen out of the habit over the last few seasons and have only written reports on a handful of races.  However, they are a useful tool for tracking progress.  Great insight for what went right, and where to improve.

Crazylegs is a big event.  It's an 8k and pretty early in the season, but it's a huge fundraising event for the UW athletic department.  Hey, those obelisks aren't going to build themselves.

It seems like all the run events in Madison follow a very similar course due to limitation of traffic flow on the isthmus.  The variation to Crazylegs is that you get to run up a little hill about 1/4 mile in.  Then at mile 1 you get to do the switchbacks up Bascom Hill by Helen C.  Despite the early uphill, the first mile overall is net descent.  I'm always amazed at how fast people take out the start of this race.

These couple of early hills aren't something that I'd normally be concerned about - but they sure are now.  Technically this was actually my first race.  Sure I jogged the Burbee Derby, but I wanted to try to race this one.  But for me to perform I need to try to stay as aerobic as possible.  Part of this is related to the limitation due diabetes, and part of it is due to the fact that I haven't been training the anaerobic component of my running and biking.

I'm currently tweaking a few things that should allow me to raise the aerobic component of my fitness.  I'll get into those details in the future, but for the time being I'm pretty much locked into training the low aerobic component of my fitness.  Doing a race with early hills doesn't really fit into this goal.  But it's Crazylegs!  It's an institution of its own.  I'll get to why I love it so much at the end of this post.

The race itself.

Fighting weight: 214.  Halfway between where I've been bouncing between.  The trend has been on the way down over the last few days so that along with the way in which my wedding band and gummy bracelet fits indicates that the inflammation I'd encountered has been on the way down.

Strategy:  I needed to get a good aerobic warmup.  Travel logistics are tricky in a 20,000+ person race.  I don't know the official count, but it's on the huge side.  To get around this I planned to ride my bike in.  Seeing as it's a point-to-point run I planned to park near Camp Randall.  I rolled up to the Police station across the street (complete with patrolling officer - safest bike rack in the city).  But I forgot my lock which I was going to use to lock my bike and backpack together.

Backpacks.  Whoa.  Now every backpack is a security threat.  I'm gaining frustration with the little things in life that have become non-sense.  But that's the world I live in (unless I defect).  For the race's website I knew I couldn't bring my bag into the stadium.  I didn't think it would be a problem to leave it by the police station, but go figure - it's a problem.  I eventually figured out to leave it in the SHELL locker room.

The trick here is that timing is everything.  For any athletic activity - even the bike commute I have to reduce my pumps flow of insulin.  It takes about 90 minutes for the reduction to have effect.  I've been getting better at balancing that - but it's tricky.

I need all my pump supplies with me.  No way in hell was I going to put that in a dry-clothes bag to trust others to transport to the finish line.  I also had my backup carbs if needed post race.  Maybe I need a purse - luckily no one has done a purse bomb.  The ladies would be livid.

With the warm weather I did't want to run in my jacket so no pockets.  And no fanny pack in the race swag this year... bummer.  But I got it figured out.  I'd run with my backup meter tucked in my tights, carry a couple kiwis with my as I run to the start line to get a good running warm-up.  That all went pretty well, except the kiwis were rock hard, under-ripe and inedible.  I also had tucked two hammer gels in my tights... which were getting a little too tight with the mobile science lab.  So I ate the gel.

I hate that.

Sure it works as fuel, but it's not in line with what I'm trying to do.  Maltodextrin isn't the worst thing for me, but it's on my watch list of items that have been causing my inflammation issues.  Not the maltodextrin per say, but there are other things in there that I'd prefer to avoid:  fruit juice, natural grain dextrins, natural flavors, they might be as benign as they sound but I've lost confidence in most 'nutritional products'.  Which they'd say which fruit, wtf is a natural grain dextrin, and natural flavor leaves me wondering which flavor.  I don't need flavor or color - I need clean fuel.

But I ate it.

A hammer gel usually takes about 40 minutes to peak in my system.  20 minutes before the start I consumed 1/2 a gel.  Not wanting to carry a gooey half a gel around I decided to err on the side of going high and finishing it off before the start.  

Side note: I can't wait until my continuous blood glucose monitor arrives.  I'd love to know what my glucose trends are rather than trying to guess.  In everyday life I'm very in tune with the sensations of different levels, but its tough while running.

Race starts:
Everyone goes so damn fast on the first mile - partly because the next downhill.  But mostly due to excitement at such a big event.  I started at the end of my starting group with the plan of taking it out as easy as possible.  I'm feeling that once I figure things out fuel wise I should be able to run a 32 here which is about 6:20 pace.  Back in 2008 I ran a 35 while sick and I'm a much better runner since then.

I wanted to take it easy for a 7 minute first mile - which I was close.  Even taking it easy and walking at the top of the first hill I managed a 6:48.  But my heartrate was higher than I want it to be still and had that damn switchback coming.  I crested the second hill with a 171 heartrate - not horrible, but I was only able to get it down to the low 160's during my sort walk break.

It was this point in the race that I had premeditated the decision to actually race or just have a hard workout.  It sort of became a hard workout at that point.  I didn't totally pull up since I wanted to find out if I could pull things together, but my expectations and pressure for a time were no longer a priority.

I held my HR at just about 170 for the rest of the run.  Took a few walking breaks when it reached 173.  Man I feel great when running when my HR is just a few beats lower, but I haven't trained to a point to hold that level of aerobic fitness.  I pretty much averaged 7:15's for the rest of the race - that's including the walk breaks.

Mile 4 was the hard part.  That section is usually hard for me.  It's a bit of no mans land going under University Avenue and back up a little hill that always feels bigger than it is.  This part of the course makes me reminisce about IMWI, but I started to feel rather awful.  And quiet honestly - strangely emotional.  Tough to tell what kind of awful.  And the emotional thing could be a blood sugar crashing cue as well. Not knowing whether I was feeling 'normal running fast awful' or 'low BG awful' or 'high'  and not wanting to take 2 minutes to stop and test I decided to err on the safe side again and take my last emergency gel

Mile 5 is my favorite.  I can always pass people on this part.  I've always had the ability to finish a race hard.  I good at burying myself.  Unfortunately, that's much easier to do when burying is metaphorical and not a realistic possibility.  It's hard to run with doubt in your mind.

I shook off the doubt knowing I was only a few minutes from the finish.  A little rocky music and some fun people drinking beer and tossing footballs brought me back to the state of mind I normally race this section with.  I picked up the pace and the legs felt good... for about a minute.  But then the reality started to kick in.  Yes I'm strong, but my muscles couldn't fuel to keep up.  Normally I'm the other way around.  This is the limit I have to deal with right now.  Shitty.

Still a great day and a great event.  I still finished in 36 something, but I sure didn't race.  I ran.  It's a step up from my jog at Burbee Derby and it lets me know where I'm at - but unfortunately it lets me know that I'm not where I was hoping to be yet. I always preach patience - it's time for me to do just that.

Breaking point.

I feel like I'm on the verge of a breakthrough here.  So very close.  During the past 2 weeks I've had a unique experience twice.  Both while traveling to Austria, and then again to Fond du Lac, I've experienced a dramatic reduction in what I can only describe as inflammation.

I've twice bounced between 220 and 207 lbs.  I'd love to think that it's related to calories, but I know that it's not.  13 x 3500 calories... no way - that's enough to power me through 3 ironman distance races.  I was working out less than 5 hours per week.

My wrist band fits looser, my wedding band almost slid off my greatly reduced knuckle.  I've always had gigantic knuckles (along with the entire big banana hands thing).  I've attributed the swelling of my knuckles to my career as a soccer goalkeeper.  I've recently dislocated both of my pinky fingers playing soccer from easy shots on goal.  I feel as if all of the joints in my body had been stiffening up on me.  But for a brief period of time following travel, my joints all shrunk.  And they felt good.

I wasn't dehydrated.  I felt great, experiencing a level of clarity in my thoughts that I have rarely been able to achieve.  It really felt great.  I want it back.

It's difficult to figure out what the difference is.  I'm thinking through all the food variations.  Peanuts?  I eat a lot of nuts. I don't think it's milk, but I've traded in my low fat dairy.  I still eat dairy, but only full test.

It could be fructose.  After watching all 90 minutes of  "The Bitter Truth" by Dr. Robert Lustig M.D. - actually I had to watch it a couple times to brush the rust off of my signaling pathways. If you'd like to dig into it but don't have the full 90 minutes, I'd recommend starting at 56:30 or 1:04:30.

It could also be the water.   City of Madison - News Release.  That would suck.  I drink tap water.  But I've noticed a significant difference in Fitchburg as compared to what I drank in Vancouver.  One thing I've noticed is the overall mineral content.  We use our steamer often to prepare rice and veggies.  While in Vancouver, I observed the mineral deposits on the heating element reduce and eventually become totally clear.  However, upon return to the Madison area, that same steamer is now clogged with deposits.  Same story with the coffee makers.

It could be coffee?  Oh like hell - it better not be.

Could it be the dogs?  Wouldn't be able to really change anything about that.  Nor would I even consider.

I started to find this list of possibilities getting almost impossibly difficult to figure out.  So close that it's just ticking me off.  Talk about dangling a carrot in front of me.  I want to feel that good again - but failed attempts have become frustrating.

A break was needed.  I loosened the belt and gave myself a break from tight control this weekend.  Yup, it feels rather awful physically, but mentally it's been a vacation.  A break from poking my fingers 10 times a day, a break from constantly thinking about diabetes.

But that break was yesterday.  Today is a new day - the swelling in my knuckles is motivation enough to get back at it.

Home.

Spent the weekend with my family in Fond du Lac this weekend.  It's so easy to get wrapped up in my 'busy' life and not make the time to go so my parents.  But my life is only as busy as I make it, so that part is really up to me.

This week I decided I need to make my parents a higher priority on the list.  Sure I'm still working on things for myself, however - barring losing my PDM for my pump, I've got this diabetes thing completely under my control (for normal daily living).  My daily management is simple enough where it no longer requires so much conscious focus.  I've passed the test of traveling and managing - the only part to work on is training and racing nutrition - but in a very bad analogy... that's just icing on the cake.  (coconut oil on the kale?)

While daily living is settled down, there is still an unlimited amount of info that I'm pursuing.  But not all of it has to do with me.  Now has come a time where I'm much more capable of helping those around me.  I know several of my family members could benefit from what I have been learning.  The challenge to them is to not overwhelm them with my intensity.  My new goal is to serve as a resource where anyone can come to me when they're ready.  I'll introduce a few topics, but I know that I can't make someone change - but I can support someone when they make an effort.

While on vacation and the 70 some hours of flight time, not counting the U-rail time, I was able to read through several of the books I packed.  One goofy one caught my attention, "Reverse Parkinsons Disease" written by John Pepper, a South African guy who has been living a very happy life with Parkinson's for the past 30 years.  He's not any sort of scientific expert, he's not selling anything.  He's just a guy.  Another canary in the coal mine.

I learned a lot about Parkinson's, but what was also interesting is how it tied into the previous book that I read "This is your brain on Music" by Daniel J. Levitin.  I came across the music book thinking it would be a fun interconnection to my old interest in Neurobiology (who isn't interested) and Kim's Musicology pursues.  What I didn't expect was to make connections from Music to Parkinsons.  The brain is amazing.  Neuroplasticity, parallel processing, conscious control and mindfulness.  These few books have renewed a lot of hope in simple solutions.

The simplest solutions are the most elegant.  I now know better how to prompt my father into consciously focusing on the task at hand.  What I'm realizing is the problem with Parkinson's is that a PwP (Person with Parkinsons) still has many of the motor functions and muscle strength to do a task, what they lack is the ability for their 'subconscious' to do it.

For example:  This morning I knocked back a cup of coffee.  I then realized I had to pee.  I stood up, walked through a narrow hallway and maneuvered effortlessly to the toilet, had a nice pee (won't be too graphic), changed out of my pajamas and jumped into my jeans.  All told, probably less than 1 minute (not that I was racing).  During that minute - I didn't one think about what I was doing.  You wouldn't either.

The problem for a PwP is that the tasks that we normally relegate to doing without thinking, simply don't happen.  If my dad wants to walk across the room - HE CAN - but he has to concentrate on every little step.  Pick up your leg - push off the toe of the back leg - swing your arms - choose the clear path.  He cannot let himself get distracted by the dog or by the smell of the food or the conversation.  He CAN do it.  But he can only do it well when he forces himself to focus on it.  There are reasons for this and it has to do with using other parts of his brain rather than the 'subconscious'.

Note:  I use subconscious similar to how John Pepper does.  What he really means is the specific structure that is under attack and no longer producing dopamine - I forget whether it was the Nucleus Accumbens, the Substantian Nigra, Cerebellum etc... I'd look it up in my book, but my mom took it from me so that she can read it tonight.  :)

Over the past 2 months both of my parents are doing so well.  I wish I could have contributed more to their help, but it has a been a team effort with all of my siblings stepping up to the best of their abilities.  Together we make a pretty good team.

Even my mother is doing well.  She was very open to letting me do the cooking this weekend.  I was able to prepare her food the filled her up with tons of nutrients, but also satisfied her appetite.  No added sugar for this lady any more - she's learning how good she can feel when she's in control.

She's doing so well in fact, that it was fortuitous that last night she instinctively skipped her bedtime insulin and relied upon her oral medication alone to move her from 180 to 80mg over the course of the night.  And while those numbers don't sound amazing - they are a huge improvement.  Now that's she's addressing diet, she's going to have to make adjustments to her medications.

Currently she is taking 14U of lantus in the morning - and that covers her well.  She exercised in the afternoon and dropped a little low (mid 60's), but correctly that perfectly with 4oz of juice (I made a carrot orange juice).  Then after a good dinner she again rose up to about 180 before bedtime.  She is going to skip her evening Lantus again tonight since we predict that the oral meds will likely drop her again.

Obviously I do not want her dropping below 80 overnight and she will discuss the continuation of her oral medication with her doctors.  She had exercised harder the previous night than she did today so perhaps she won't drop as much.  She has a banana by her bedside and will plan to check her blood sugar when she gets up in the middle of the night.  We've already discussed that it may be better for her to exercise post dinner rather than post lunch, since that is when her morning dose of Lantus is wearing the thinnest.  This change alone would prevent her from having gone low in the afternoon and high in the evening.  But low & high are relative - 80 to 180mg/dL is a huge step as far as control for her.

It's been fun to hang out with my parents.  And success is also fun - so I enjoy seeing the success that both of my parents are experiencing.  I'm blessed that they are both open to my ideas and are willing to take control over their lives.  How can that not make me feel happy.

I'll be damned if this hasn't been one of the more rewarding weekends of my life.

4/15/2013 - Barb Seder set the goal of getting herself off of insulin.

Well that was stupid!

Yesterday I made a mistake that I knew I would make.  In fact, I've impressed myself with how little time it has taken for me to make this mistake.

I live an active life, and especially now that I'm experiencing such great stability while on my insulin pump, I have begun building back up my training.  But training more often requires multiple duffle bags and numerous apparel changes.  Tracking down all of my stuff all of the time, is not something I'm always successful at.

I'm pretty good, but I have a lot of shit.  Bunch of stuff for the dogs, I blame them for most of it - especially their habit to trample over my stuff, often stealing my clothes.  I was joking at work that I always pack underwear at work just in case.  Now the case isn't that I am incontinent, it's that my dog steals my underwear off of my laundry piles.  Webelos.  I will be prepared.

But try as I might to track my stuff, it's inevitable leaving the house at 4am that I'm going to make mistakes.  It's humorous when it results in me riding the Rev3 Dells course in my soccer sandles - less funny when it's the control unit for my insulin pump.  Shit.

It took me 20 hours to find it.  I was at home and looked everywhere to assume I must have left it at work - but upon getting to work, realized that it must be at home.  Check every jean and jacket pocket, retraced my steps, bake tracked to the pool and even to the Bavarian Sausage house.  Seeing as I was without my controller I wasn't able to bolus (dose for carbohydrates in my meal).  No carbs in Old World German Salami.  I've had salami breath the entire day.

I made an additional mistake that made the loss of my controller extra dumb.  In anticipation of going for a morning run - a case in which I would want to turn my pump off for the hour preceding, during and even an hour after.  Without my controller unit (PDM - aka Personal Diabetes Monitor  to turn the basal insulin flow off - my solution was to simply remove my pump, which was still slowly dosing me with 0.2U of insulin per hour.  I was still confident that I would be able to go home, find my PDM, go for a run and upon return, install a new pump.

My PDM wasn't at home.  I cleaned everything.  It wasn't at work.  I was panicking.  This thing would be $800 bucks to replace.  Frustrating.  The clock was ticking.  If I went longer than 4 hours without insulin in my body, it would start to fuel itself  with fuels that would eventually (in conjunction high bloodsugar) acidify my blood to a point where I could go into a comma and die.

Scary.  So what to do?  Step 1:  keep some insulin in my body.  I still carried my Juvenile Novolog Pen - even had a needle tip stashed at work.  I wanted to match my basal rate of 0.2U/hr but now I only could dose in 0.5U increments.  To match this I dosed 0.5U every 2.5 hours.  As mentioned my major calories from the day were in the form of glutinous salami.  As a result, my blood sugar remained within my target range of 80-120mg/dl.  As the insulin slowly left my system I could observe my BG values slowly climb.  The balance our my 0.5U bolus as a basal, I would drink a 20g carbohydrate drink.

That's how you think on your feet.  The mental stress was exhausting.  I would have been fine had I not been trying to do this during a very productive and long day of work following several days of lower than preferred sleep.

But I'm back in control today.  Heading to see my parents today.  I'm going to introduce them to the 21st century bringing wireless internet technology.  Grandparents should know that their kids would visit more often if they got their own wireless.  Hoping to teach my dad how to use the Wii and Netflix.

Happy Birthday Challenge!

First, I'd like to bring your attention to today being my beautiful wife's birthday.  "Happy Birthday"  Two words synonymous in our household with another two words.  "Birthday Challenge".  To give credit, I have adopted this concept from my undergraduate triathlon club team's self-proclaimed "spiritual advisor".

The idea is every year you celebrate your birthday with a success, usually along the lines of impressive physical feats of strength or endurance to a volume or distance related numerically to your age.  In the past we each have completed challenges such as our # of years old - repeats of the Wreck Beach Stairs.  23 For me (since I was doing them after work I ran out of daylight.  My bday is on the 23rd) on my 32nd birthday in Vancouver.  Kim then one upped me on her 27th, by doing 28 because it's really hard to count after 28 repeats of a 451 step staircase that linked a beautiful beach with view of sunsets, sea and distant mountains on Vancouver Island.  A nude beach.  Stange exotic people, vendors, recycle-bums, and college students.  Wreck Beach is on the University of British Columbia's campus.

I miss that place.  While Kim was studying for her PhD in Musicology (at task which continues into year 3 while she currently travels to Salzburg sponsored by a Fulbright grant).  She's a pretty amazing woman.  And we have a lot in common.  None of which we knew when we first fell in love.

We certainly didn't have much in common as far as hobbies when we met.  I was playing soccer, drinking beer, running and biking.  She was playing the organ and going to church with her family.  I was a sport playing kid.  She was obviously into music, school and church.  (hey, I like school!)

But now during year three of our marriage we have so much in common that its almost scary.  I'll spare everyone the details, just know that we are borderline the same person in many many ways - but not all.

Last week I took Vacation time to go see her.  It's been lonely to be apart for already 4 months.  81 days remain, if you count from her time zone.

This weekend she will be running the Vienna marathon.  She's trained for it, making due with what time she's had in Salzburg.  It's a beautiful city.  She took me for a run along her usual route.  Along the river, past the downtown, and of course, up a hill because that's where the best views are.  (more on that hill later).  View was great, even on a cloudy day.

The pace of life abroad is so much more relaxed.  Man did I need that.  Relax I did and relaxed I remain.  I need to remind myself that I am the same person here as I was there.  We have no reason to rush and stress out our bodies and minds.  There is very little to gain, and everything to lose.

We all relax in different ways.  I relaxed by going for a swim and beginning my Birthday Challenge early this week.  My birthday is not until June, but due to inclement weather I'm deeming this season Birthday Season.  Technically from April 11 - June 23, spanning the length of our birthdays.  During this period of time I have set my Birthday Challenge to be swimming a cumulative distance of 10,000 yard-meters of butterfly - with the challenge coming to a peak on my birthday with a 200m Butterfly Race.  Block Start and all.  I know I spam this event a few times during my youth - even then I found it a challenge, but I don't remember being half bad.

Now for a swimmer who has been training all four strokes and kept their swimming skills from their collegiate team experience, my challenge is a week's work, however for me it is a huge challenge.

For several reasons over the past 3 years I have not been taking any time to train my swimming.  There I admit it publicly - it feels good to get that off my chest.  Often it's the logistics of the availability of flexible pool time at an acceptable price - but primarily I have learned to avoid all swimming due to the chemically induced sinus stress or open water allergy exposure.  I had the worst year of allergies of my life last year.  Not much of a stretch to connect that issue with the autoimmune attack on my body which lead the way for rising blood sugar values in almost every cell in my body.

The current goal for my life with regards to managing my life on an insulin pump is to use as little insulin as possible.  All my instincts lead me to this conclusion.  I am currently using 7 or less total units of insulin per day - and I haven't even started heavy training volumes!  To explain further, while exercising my muscles can uptake glucose independent of the presence of insulin.  I can still eat carbs during works and not have to pull over and dose myself with a hormone that is a growth hormone.

I don't want my blog to become a place where I cite articles directly, but I know that multiple studies have found increased longevity with lower caloric intake diets. - the theory is based on the analogy the more rapidly dividing and faster grow the cells continue to remain, the more opportunity for replication mistakes and greater metabolic stress through oxidation and exposure to free-radicals.  Antioxidants quench these free-radicals in our bodies, thereby protecting us from the pesty particle.

Look around and you will see that we are all still growing.  It shouldn't be this way.  It really isn't that hard, there is just so much more bad information an bad products than good.  But there are plenty of good.  And plenty more that taste good.  Good?  Good.

That's all for now.  Plenty to write about, but life is too busy to rush.