Surviving the flu.

Despite getting my flu shot this year I still got the flu.  And while the flu is bad for everyone, I was really afraid of getting the flu this year.  I've probably had the flu a half-dozen times in the last 15 years - often enough to know that I am a huge baby!  Big tree fall hard.

This strain of flu seems to have hit many people.   I survived the first wave earlier this year, but this last version stuck.  I've been more unstable than I should be the last two weeks - falling behind on diet and sleep left this bug with the perfect opportunity.

Nothing special about the type of flu I had.  Headache, fever, chills, body aches, lots of sweating and a little gastro-intenstinal fun.  Pretty standard fair.  But I've been warned to have a sick-day plan due to the added dangers of the flu with diabetes.  The flu wrecks havoc with my insulin control - but without ever having the flu while diabetic before I wasn't sure what to expect.  So here's what I learned.

Flu makes me insulin resistant.  While my sensitivity to insulin is abnormally high when I'm healthy (12-15U per day) I had to double my basal doses of lantus from twice daily 6U to 12U.  And my meal-time (bolus) insulin needs were about double as well.

Initially I had been using my Novolog as a corrective every time my numbers crept up, but eventually I realized that instead of dealing with corrections after the fact, it turned out to be much easier to adjust my basal instead.  Its much easier to deal with the long-acting insulin while sick than to depend on the fast-acting.

The problem is that I need to take my insulin before meals. Meaning that once I dose myself I'm fully committed to eating what I planned and keeping that food down.  Realistically, I didn't really eat anything for 3 days.  I had a 1/4cup of greek yogurt and blackberries one day, a banana the other, but really had no urge to eat.  I even cooked a plate of bacon and eggs, but struggled to find a appetite.  (the dogs really love me now).

I stayed up on my hydration - I knew well enough.  I got my vitamins down with the small snacks - but largely existed on ginger tea.  I did resort to a Sierra Mist Natural soda to try to get some extra carbs in.  One 12oz bottle of soda is 70grams of sugar!  That more carbs than I eat in most meals now.  But the last thing I want is to put 'diet' soda in my body.

We all have our sick day rituals - for me the soda reminded me of the days I'd be sick from school as a kid.  I'd crank up the thermostat on my waterbed and my mom would bring me a ginger ale served over crushed ice in a specific thermos cup with a lid that only opened when I pressed on a button (saved from spills).  I even remember how that cup would then pinch closed on your lips if you released the button before you were done drinking... Funny how the flu takes you back.  Anyone else out there who got hit with this round of sickness knows how much we all wanted to have our mommies by our side taking care of us - and when I'm sick I'm a huge momma's boy.

Good news is that I survived.  It took 4 days but I think I'm finally coming around. Lessons learned and now I have a plan for future episodes of flu.  And I'm grateful.   Last Monday I was supposed to start using my insulin pump, but since I was feeling run down I opted to delay.  That decision was so very lucky.  If I had started on the pump Monday I would have been transitioning to just my fast-acting insulin and would have required a whole lot of extra attention fine tuning my rates.  Considering that my rates were all messed up - I consider myself very very lucky to have delayed.  That would have made a bad week much much worse.

Lows & Highs

Here is a random selection of crudite - totally unrelated to my post.

Stability has never been more important in my life.  Stable - however, can be dull. It's great to have perfect balance, but it's better to have perfect balance while doing something.  The analogy of sport is perfect.

I've been at conflict lately after coming to the realization that my goals lead me in two different directions.  Two of my major goals are at direct conflict with one another and it is not an easy for me to rank which has the higher priority.

My first goal is to continue to race and train for swim, bike, run events.  I've recently experienced some success on that front.  For this weekends WCRC relay challenge I was able to ride to within 95% of my potential.  Considering my low training volume and specifically my lack of intensity to my workouts, I consider it to be a surprising success to still be able to throw down.  

My second goal has been stability.  Three months ago at diagnosis, the test that measures my body's exposure to glucose (and also it's rate of destruction to vital organs) my HbA1C test originally was 11.0.  This translates into 3 month average blood glucose of 280 mg/dL prior to my diagnosis.  Last month I already got this down (after just 2 months!) to 6.0 - which correlates to a about 130 mg/dL average.  My goal for the test I'll take this week is to get that number to 5.3 or less.  5.3 is just about the mid point for healthy people.

Side note:  I have learned through reading the data that when test results compare to ranges in average americans, they are not specifically claiming the ranges for the 'above-average' american who is actually healthy.  It's sort of like comparing my 3:4x marathon time to the average american and calling myself an above average marathoner - while in reality I'm traveling half the speed of the winners and no where in contention of the race.  I choose to set my goals higher than the "average" american - I would rather shoot to match benchmarks in people who know what they are doing with their bodies.

So that test result is rather a big deal in my mind.  I thought at the rate I was going I had a 5.3 in the bag.  However, I've had two challenging weeks in a row.  I haven't even had time to enter my numbers and chart the results.  I know I've had higher numbers.  My average daily control is probably 100-130, which isn't bad, but it's come with a few moments of high peaks to match the increased baseline.  Realistically I wouldn't be surprised if my A1C stayed at 6.0

Part of the problem is that along with having a few bad days:  I had one vial of insulin expire and lose potency,  I've had a few sleepless nights either due to sick dogs or sick people.  I've struggled more than usual these past two weeks.  I know I can do better, but it's not that I sat still during those two weeks and did nothing.  I struggled because I was challenging myself.  I added in exercise, I added in managing unexpected responsibilities.  There were things I had to do, and there where things I wanted to do.  

I feel held hostage at times.  When I'm stressed there's nothing I'd rather do than grab my running shoes and dog leash and just run away.  My favorite way to survive Wisconsin Winter is to train my running.   But now I feel like I have a leash on me.  I can run with company sure - but the time I need to run and vent I really need to be alone.  I'll have a dog - that's all the company I can handle some days.  

When I exercise, especially at high intensity, it is amazing the amount of sugar that my body blows through.  Based on the calories from my hour on the Computrainer at work I managed to plow through over 1200 calories in 55 minutes!  There is some solid science behind that number as well.  I put out a lot of watts and my body generates a ton of heat.  How I manage this high demand for calories was the trick.

This is still a process under development but my current race fuel of choice is honey.  Honey is a disaccharide - meaning it's breaks down into fructose and glucose.  Two difference sugar molecules which enter the muscles using different transport channels.  I've already learn that at high intensity my body is able to import sugar independently of insulin - and in reality, I want my insulin levels to be safe on the low side when I race.  

I've also learned that in order to compete and train for high intensity session I need to boost the amount of sugar in my blood to meet such a high demands.  To me sugar is gasoline, except your car still runs fine on half a tank.  Mine doesn't.  If I let my levels drop - which I can easily drop 50 points in 10 minutes at intense work levels - then I will experience a low. 

Prior to this weekends time-trial I had the pleasure of some pre-race banter with the master of all things data, Mike Wolfgram.  He was asking me about my plan and checking in on how I felt.  When he asked what it feels like to have my numbers go low all I could explain was this...  A low feels like weakness.  It feels like failure.  It feels like quitting.

A low puts my life on the line.  A low while racing truly defines the phrase "Eat like your life depends on it".  I have to gain comfort with knowing that every time I race or train hard, my life is at risk.  I can certainly minimize that risk with proper preparation, but still prefer to currently only workout indoors or with a partner.  I carry emergency fuel and glucagon pens.  

Side note #2:  If you are reading my blog this far, you must be of the opinion that you'd prefer that I live rather than die.  So if there is ever question or need...  In my pocket somewhere on me at nearly all times you will find a red hard shelled container holding a needle with water in the syringe, and a vial with powder.  Using the needle, squirt the water into the vial with the powder to dissolve, then suck that solution up, jab that needle into my butt muscle and push that plunger down.  Glucagon will stimulate my liver to produce enough glucose to revive me.  And don't worry about hurting me - I'm unconscious and won't feel a thing.

Back to the topic and the source of my conflict.  I want to race and train hard, but doing so requires that I manage my numbers much higher than aligns with my goal for my A1C.  The A1C test reveals the health of my organs and pretty much that age at which I age is accelerating.  It's a pretty big deal.

However, I find great pleasure in racing.  Tibetan monks may live to 90 years, but if they have to spend 30 years staring into space (unless it's more pleasurable than it appears), then really in my mind they are no better off than those living to 60, maybe 61 years.

Finding balance is just that.  I'll spend some time on one leg, then the other.  Holding onto a high level of fitness shouldn't come at the expense of my health.  Right now I'm worried that it does.  I can race quite well with my bloodsugar in the 180-200 mg/dL range, consuming 6 oz of honey per hour.... but is it wise?

I can't quit racing, but I'll save that level of intensity for special days.  In the meanwhile I'll probably slug through my workouts with my numbers on the conservative side, knowing that I'd be stronger/faster if I ever choose.  Sandbagging perfection.

My catabolic life.

At times its hard to not feel like the sky is falling.  I take relief in knowing that not all weeks will be like this past one.  Wow, did that not work out.  I'm putting this week behind me and hoping not to dwell on it.

I started the week chasing my tail and never got up to where I needed to be.  The week began with a sleepless Sunday night as my dog who has concurrently been sick with an inflamed digestive tract (weeks worth of diarrhea).  Well it now appears that the (suspected) wheat/grains or other ingredients in her chow have been chronically irritating her bowels so as to leak out the proteins of her blood (albumin) and calcium to a severe enough extent that she suffered with a seizure/ stoke.  I don't know what it was, but she was not herself and her eyes were not pointed in the same direction.  Scary shit.

From there the sleep deprivation was too much for me to recover from.  After 2 hours of sleep, it has taken 3 x 10 hours/night of sleep for me to finally feel caught up.  By screwing up my sleep I was too tired to manage my numbers as well as I had previously.  I didn't have everything set up ahead of time nor did I maintain inventory of where my meter's were, or more importantly, the fact that my home source of Novolog (my fast acting meal-time insulin) has been open for almost 45 days now.

I was warned that 30 days was the limit.  But between the price of this stuff and the hassle of the volume of trips to the pharmacy this fact fell through the cracks.  Until the 2nd morning of waking up with severe intestinal cramps and very high blood sugar (likely caused by my portion of mealtime insulin not covering the carbs that I sleepily consumed for dinner the night before).  I was too exhausted to stay awake to test 1hr or 2hr post meal blood glucose measurement.  I just needed to sleep.  I wasn't capable of anything but sleep.

But 300 mg/dL glucose and intestinal cramps are plenty reminder that I cannot afford to make this mistake again.  It requires an entire day to steadily reduce my blood glucose levels to a level at which I am not causing physical harm to my body and every vital organ.  The long term side effects are serious.  It upsets me to know that my carelessness as to miss an expiration date on a medicine has resulted in irreversible damage to my body that if anything can be translated into days of my future life lost, along with a rather unpleasant present day.

The process of waking up after having my numbers creep up is like slowly boiling your body.  In the comfort of sleep I slowly reach a level of 160 which is my safe limit.  And while it is a great limit at which to target as a pre-exercise level, anything above that will set up a reverse osmotic gradiet which will prevent my kidneys from properly filtering my waste products.  I experience severe headaches and an elimination of water that at essence, being pulled directly out of my muscles and blood supply and into a very dilute urine.  My mouth is severely dry.  I void my body of carefully built up nutrients.  Waking up high is only made worse by the transition of medicating my way back down.  This round of control loss resulted in a peak as high as 300 and a steady 8 hour decline to 100 mg/dL which felt like my brain was being juiced like a lemon.  Not the best way to spend a Saturday.

I'm trying to simplify my life.  I will be sending off my Weimaraner Bella to be staying with a friend.  I haven't been able to provide her with the attention or exercise she needs.  I'm going to focus on improving my health and steadying the ship.  In the meanwhile, Moab will be benefiting for the pulpy byproducts of my vegetable juice based snacks.  She loves the pulp and over the past 4 days of a rice-pulp-broth and egg-white diet, she has rapidly turned the corner toward good health.  (Still some bladder control issues, but greatly improved on all other fronts).  More test results are due for her later this week.  But I am optimistic that a dietary change is all the treatment she will require.