Windy Headlands Ride

I enjoyed a cruise through the Marin Headlands on this clear and windy morning. Coming down Conzelman, which is a narrow and winding road, I pondered my fate should a strong gust blow me over the edge into the surf below. Actually, it was less windy there than I expected. Climbing the hills has become much easier since I had my bike re-fit and my seat was raised a few inches(!). I think my seat had been creeping down. Anyway, it was a beautiful morning for a ride, which offset my frustration with my disappointing blood sugars. As my friend Peter put it, hey, maybe I have diabetes!

Century #4 (I guess)

Are we up to number 4 already? Sitting in the living room with the heat on, it is hard to believe that all I wanted on Saturday was ice water on my head! This weekend we rode 111 miles starting in Calistoga and looping around the Vineman course, finishing with a 30-mile out-and-back bit on Silverado Trail Road. The weather was hot and rumor has it that temp's were above 100 degrees in the afternoon.

I took my 5U of Levemir at 5:50 and also 5U Humalog for breakfast plus a correction for a high caused by treating an overnight low. We started the ride around 9 AM and after about an hour of riding, I had dropped a little over a pound despite drinking nearly a full bottle of Vitalyte and another of water. My BG's started to fall but then climbed up again before starting their slow, bumpy decline throughout the rest of the ride. From the Dexcom plot, one can estimate a negative slope of about 60 mg/dL/hour between 1 and 5 PM. I was eating and drinking during this time so it seems like my basal insulin was too high; perhaps I could take an initial bolus to offset the early highs and reduce the basal to prevent the steadily dropping BG's later on.

We weighed ourselves again about 50 miles in and at 92 miles. After 50 miles, my weight was down by about 2.4 pounds. We were at our midway break, and took some time to refuel and rehydrate. By the time I resumed riding, I was about 1 pound down. Soon after that point, the temperatures really started climbing, and I felt pretty bad between miles 65 and 80 (when I had a flat and, incidentally, had a few moments to rest in the shade). I was afraid of running out of water between stops but guess I had been drinking enough because my weight was up one pound by mile 92. I really struggled through the last 10, and especially 5 miles. More than anything, I wanted to stop. I was just so hot and uncomfortable! But eventually I pulled myself back into town. I was feeling a little dizzy and spaced out, although my BG's were fine. I think something may have been going with my electrolytes, but that is a topic for another day.

Here's the Dexcom data. I had disconnected my pump and ate without bolusing right away after the ride; hence you see the post-exercise spike. I tried to refuel as well as possible that evening since I had a 20-mile run planned for the next morning at 6 AM.

How's Your Humalog?

Has anyone noticed a recent change in the way your Humalog is being absorbed? Or has anyone had a change in the way your Humalog is absorbed over some period of time? Of course there are a million explanations for anything in diabetes but Humalog just doesn't seem to be working for me the way it used to--it takes a very long time to start acting (at least an hour usually) and seems to accumulate and then hit me later on in the day (by pump or by injection). I assume it's just me but I've had one other friend report the same thing in the past few weeks. I've used Lilly insulin since day 1 and it has been great but I am considering switching over to Novolog or Apidra. I've tried to rule out all of the usual suspects (pump problems, stress etc.) It could also be that I'm paying a lot closer attention so am more finicky about getting rid of those highs.

Century #3

I enjoyed a hilly ride through Marin and southern Sonoma Counties today for our 3rd century ride in about 5 weeks. We started off the morning with a quick 45 minute swim and then drove quickly up to Marin for the 107-mile ride. I guess we should have done a quick run at the end to make the day complete. Um, yeah, maybe not... The picture shows the diabetes data. Once I recovered from my initial free-fall, the BG's stabilized and I was happy with the Levemir. After being on the pump since 1993, it's been interesting trying some of the newer long-acting insulins.

Wildflower Note

There will be more to come on Wildflower but as a quick update, the race went well. I ended up going with Levemir and was happy with the outcome. From last year I took 3 minutes off my swim, about 10 minutes off my bike, and 9 minutes off my run. That adds up to 22 minutes but somehow I spent forever in transition and had a time of only 17 minutes faster. (I did forget to put my timing chip back on after the swim and forgot it yet again before the run and had to go back to get it right before I left the transition area. Argh!) It was great to meet up with Bill and Peter and some good friends from my San Francisco tri team. We scored a prime location for camping and enjoyed clear starry nights.

Race Report: Wildflower Long Course 2008

My friend Jill and I both noticed how unusually calm we felt before the swim start at this year's Wildflower. It was her first time doing the Long Course, and my second, but I felt relaxed (although my pre-race BG would indicate otherwise). Since our target races were still a couple months away, and we didn't really taper (by doing a 92-mile ride and a 16-mile run the weekend before), the pressure was not too high for this race. The weather looked good, with clear skies, decent winds and warm to hot temperatures. Given the possibilities, we were in for a good day.

Matt and I had figured out a strategy for using Levemir instead of my pump for basal insulin, and I had my pump hooked up with zero basal rate for any boluses I might need along the way. We had only had a few days to work out the Levemir dosing, and I had never tried it in any long workouts. Given my recent problems, though, I felt it was worth a try. But you should have seen the arsenal of GU's I had on both the bike and run! People were wondering why anyone would carry so much food.

I took my 6 units of Levemir at 6 AM and ate my breakfast--a chocolate brownie PureFit bar (yum!) plus a banana. I took a nice 3 unit injection + 0.5 unit bolus (just to make sure the pump cannula was filled prior to the race) in anticipation of eating a bit more, but decided to wait. As I saw my BG shoot up to 423, I was glad I hadn't eaten any more. I had practiced this breakfast the day before and my BG had stayed in a great range. These pre-race "anxiety spikes" really get to me. My BG slowly came down but I wanted to eat a bit before the swim (GU + some Vitalyte) and nudged it a little with 0.3 units. I came out of the water around 180, and started the bike. I waited until I was confident I wasn't going to shoot into the 300's, and began my nutrition plan of 250-300 calories per hour in Perpetuum, Luna Moons, and GU.

The first 15 or so miles are fairly hilly, and then it levels out to long, mild grades for another 20 or so miles. About 40 miles in there is a steep and long climb, fabulous descent, and then some mild rollers and a couple hills before the last mile downhill. The wildflowers were, indeed, still in bloom for the race, and it was a beautiful ride. I ate my food as planned and felt strong for most of the ride. Compared to last year, when my BG spiked above 400 in the first hour of the ride, I was happy to see readings in the 200-250 range. I thought about nudging it downward with a small bolus but wanted to see how it would play out during the run.

I started to feel pretty sick during part of the ride and was pretty miserable for the first 5 miles of the run due to my favorite kind of cramps (that only a woman can appreciate). I backed off the pace and concentrated on my hydration during those initial miles and started to feel better once I hit the trail portion of the race. The run course is one of my favorites--it starts on the road but a significant portion is on well-maintained trails along the lake, through trees or through open fields. I felt stronger as I went on and was able to keep my BGs afloat on 3 GU's and a swig of Gatorade at nearly every water stop. I would also take a couple waters--one to drink and one to dump on my head. Towards the end of the run, I was surprised to see my BG creeping up into the 200's. I'm not sure if that was an insulin issue or if I was taking in more carb's than necessary. I also had been increasing the intensity, which can cause an increase in BG, at least in a non-depleted state.

My unexpected mishap for the race was forgetting to put my timing chip back on after the swim. Yeah, I know it is not necessary to take it off after the swim but I was having a tough time with my wetsuit! I realized it was off about 5 miles into the ride and there was no way I was going back for it. I was almost to the run start timing mat when I realized that, yet again, I had forgotten my timing chip. This time I did go back--I had been so happy with my quick transition! I was a little worried whether I would get an official finishing time but that worked out. My bike time on my bike computer was 3:26, which did not include a 5-minute bathroom break. I was happy with my finishing time of 6:46 compared to last year's time of 7:03.

In the Dexcom plot below, you can see my breakfast + anxiety spike climbing after 5 AM. There is a gradual drop-off and then a steeper decline during the swim, which started at 9:15 AM. On the bike, the glucose levels climb a bit and then there is a gradual decline at the beginning and another increase at the end of the run. I was happy with the outcome, especially since this was a big experiment with the Levemir. Next time I'll try to get those levels down into the 150-200 range perhaps.

Next Up... Wildflower Long Course

Well, I pulled the tent out of the closet without too many boxes falling on my head and I found the Thermarest and the most important item for Wildflower: earplugs. I'm doing the Long Course Saturday for the 2nd time and looking forward to relatively moderate temperatures. Nothing will compare with the first year I watched Wildflower when it was well over 100--I was retreating under the shade and I wasn't even competing. I'm looking forward to meeting up with Bill C. and Peter N. and teammates on my tri team. I don't know how many athletes there are but it is in the thousands and it is one huge camping party--with the exception that most people will be in bed nice & early on Friday night.

I'm not sure if I'll go with the Levemir that I've been using or get back on my pump or do some combination; in the spirit of living on the edge, maybe I'll the ignore the (very good) advice, "Nothing new on race day!"

Nothing Else to Blame...

So I guess it is just me. Despite going off the pump and switching insulin, my morning highs are persisting with a fierce determination. I am taking a deep breath and will try to forget those few weeks of easy and beautiful control and just deal with the situation. Perhaps it is better not to wonder why I need more insulin despite exercising more and losing weight and just take it. It is hard to really believe I need as much as I seem to. For example, as of 10 AM today, I had taken as much insulin (~20 units) as I took for the entire day a few weeks ago. Thanks to some great help from Matt Corcoran and a few friends, I am not figuring this out alone.

Pump Break

I hate to blame the pump but can't find any other likely targets, so I will be taking a break for a couple days. The timing is not ideal with Wildflower on Saturday, but I am very frustrated. I did a basal rate check this morning--no food, exercise or bolusing from last night around 8:30 PM until noon today--and everything checked out perfectly. After midnight, it was more or less a flat line, trending ever so slightly downward. But after a lunch and snack later on, using pretty much the same bolus I would normally take, my blood sugar spiked to 410 and has been very slow in coming down even with my rage bolus on board. This has been the pattern I had been experiencing in the morning and it seems to have just shifted to my first bolus of the day. Any boluses I take seem to have a 3-hour delay, like I've got some nasty Regular-NPH combo going in. (I'm on my 3rd vial of Humalog and the vial I sent back to Lilly checked out okay.) I called the customer service at Animas and they were helpful; it doesn't seem like the pump is malfunctioning in any obvious way. But I just have this feeling that I get better insulin delivery through a needle. You know what I mean? Maybe being on a pump since 1993 has created too much scar tissue. But so suddenly?? I was doing just fine until 3 weeks ago.

So I'm done with the pump for a couple days. We'll see how it goes. I need one of those insulin pens.

A ride in Napa

Today we enjoyed a beautiful ride and run through the vineyards of Napa and Sonoma Counties. I was surprised to see wildflowers still in bloom and the hills still a nice shade of green (although that is fading now). It was a hot day--somewhere in the 80's--and it was a struggle to keep hydrated. Here's a snapshot of the diabetes-related stuff. I think that next time, I will cut back on the high basal rate an hour or less into the ride and then try to find a basal rate I can stick with for the remainder. I am trying to simplify things but am afraid I still may need to do the taper-as-I-go method for basal rates. I am trying to avoid bolusing during exercise to avoid the more sudden changes in BG that may result.