Sights and Sounds of a Morning Ride

It was a bit tough to get up this morning at 5:15, but at least there was no rain. Today I would do my favorite local route, Sunrise Over San Quentin.

Here are some of the things I saw and heard on my way.
--Bright stars overlooking the city--refreshing after a week of rain;
--Four lanes of morning traffic coming swiftly into the City as I cross the Golden Gate Bridge;
--The San Francisco skyline from a break in the trees as I descended into Sausalito;
--Frost on the wooden bridges reflecting the light from my super strong bike lamp; water rushing underneath the bridges, filling up the tidal marshes;
--Birds calling in the dark and a few wet-looking ducks hidden in the grasses;
--My bike computer reading 8:21 for my split up El Camino Alto hill--not bad considering the added weight from my bike lamp + heavy battery. I measure my split every time I go up this hill to gauge my conditioning and motivation! I haven't broken 7 minutes yet.
--The sun rising as I rounded the first big corner on Paradise and pink morning light reflecting off of the white walls of San Quentin;
--An older man on a mountain bike who decided to pick up the pace as soon as I passed him, making me work a little to keep my lead;
--Flocks of ducks and isolated white egrets motionless, looking very cold in the water;
--Canada geese stopped on their way south, looking quite content as they searched for food;
--A screech and then loud "Thump!" which turned out to be a car smashing into the rear of a garbage truck that was double-parked;
--The City skyline again but now in full light;
--A guy getting frisked by two undercover cops in the Golden Gate Park, which was a discouraging sight;
--The last few hills to my home. I told myself I'd have to use a harder gear on the first and then could granny it for the rest (which still brought my heartrate above 170)!

My BG's behaved better today as well. Here's the data:

• 5:34 AM 235, ate banana, 1.5 U Humalog
• 5:45 AM start riding
• 6:23 AM 245, no correction, no additional food
• 7:40 AM 136 (yay!), 20 g carbs (raisins), no bolus
• 8:23 AM 195, feeling hungry, thought I was low
• 9:10 AM finish ride
• 9:28 AM 226, 10 g carbs (raisins), 2.3 U (correction bolus + insulin for raisins)
• 10:00 AM 258

My pace was moderate, average speed slightly less than 15 MPH on a somewhat hilly route (mostly rolling hills, some flats, a couple slightly longer hills, and a few very steep but short hills). It was cold--when I stopped to take the pictures, I tried to test but got the "Low T" error message. And I was pretty chilled out by the time I got home.

My guess when I tested at 136 was that I was dropping, which is why I ate. I think I was actually pretty stable or just dropping very slowly, so either should have taken a little insulin for the raisins, or just held off. Again, a continuous glucose meter is very handy for these sorts of situations. I would have been able to tell that my BG was more or less stable at 136 instead of having to guess. I wonder what the temperature range on the CGM's is.

Post-Swim Highs

Last year, I had some trouble with high BG's coming out of the swim at races and also at practices. At first I attributed it to being off the pump for an hour or more and under-dosing beforehand. But it still happened when I started wearing my pump while swimming. It doesn't happen all the time, though, so I'd really like to figure out what is going on and get a better sense for how consistent the pattern is (and how to deal with it).

Here's today's data:

• 5:10 AM 136
• 5:40 AM 155
  
• 5:45 AM start swimming--workout included 3 fast 300's and 1 fast 600, moderately intense pace with some easier, shorter sets
  
• 7:00 AM stop swimming
• 7:45 AM 211

I didn't eat anything this morning before or during the swim, and kept my basal at its regular rate of 0.575 U/hr. My pump was low on insulin (7 U when I got up); so perhaps the rise in BG was primarily due to that, especially since my BG was rising before I got in the pool. I've suspected that, when my pump is almost empty, the delivery is less accurate due to the accumulating air bubbles in the cartridge. The workout was fairly intense and sustained, which usually causes a rise in my BGs. Next time if my BG is rising, I will try giving a tiny bolus (0.1 U) and see what happens. I should also reincorporate eating beforehand, to improve the quality of my workout and to practice race conditions. (I'm trying to lose a few pounds and have been cutting out some of my training calories lately.)

BG Blowup on Paradise

I enjoyed a late afternoon ride with a friend on one of my favorite short routes, known as the "Paradise Loop." Any cyclist who's spent time in San Francisco will probably know of this classic ride, which goes through Sausalito and then up a 1-2 mile hill to eventually reach Paradise Drive, which loops around the rolling hills of the Tiburon Peninsula. The views from Tiburon of the San Francisco skyline, Angel Island and the Bay are amazing, and there are fewer tourists than in Sausalito. It's a perfect spot for a mid-ride snack at the corner bakery.

Anyway, my BG's (BG = blood glucose or sugar) for the day went something like this:

• 11 AM (1 hour after breakfast): 77, ate 1 gel before a 25-minute walk.
• 1:10 PM: 337 (yikes!) -> 1.55 U insulin + 15 g carbs. I was hungry since I hadn't had food since breakfast and was about to ride for 45 miles. I thought the insulin would cover the carbs + bring my BG down since I'm more insulin-sensitive while riding.
• 1:45 PM: 315, okay it's coming down...
• sometime around 2:30 PM: stopped for 20 minutes to help someone change a flat
• 3:45 PM: 360, on the rise again. This was odd, I thought. I took 3.4 U to cover the food I was about to eat at the stop. I thought I was being overly generous and was surprised to see the BG had risen since it was previously falling and I hadn't eaten anything since then.
• 4:00 PM: 45 g carbs estimated; in retrospect I forgot to account for the steamed milk (1 C), about 15 g.
• 4:15 PM: riding again
• 5:00 PM: 508! Yikes. 3.1 U at 5 and 1 U at 5:20 PM. "Did they put regular vanilla syrup in my milk?" was my first thought. Um, I don't think I can blame them!
• 5:32 PM: 448. Okay at least it's coming down...
• 5:50 PM: 559!? Or maybe not...finished riding.

I had changed my infusion set this morning and wondered if there could have been a problem, so took 7 U by injection at about 6:15. At 6:45 I was 464 and just now at 7:21 PM I am 255. Let's see, that's about a 400 mg/dL drop per hour. No wonder I feel a little shaky. I think it's time for some oatmeal! I have no idea how much insulin is actually active in me, but let's figure it out. If I assume that my infusion site has been okay, then I have only 0.36 U IOB (insulin on-board, or the amount of insulin I've bolused in the past 2.5 hours) from my pump. So my total active insulin is 7.36, which would cover an extra big bowl of oatmeal.

I just tested again and my BG is 213 after 5 more minutes, which means my BG is falling at 504 mg/dL per hour. Okay, I will eat now.
**
I just finished the oatmeal, and it is 7:46 PM. My BG is 137, or falling 228 mg/dL per hour. It looks like I should be okay. I am just hoping I won't be bouncing up again.

There are probably some lessons to take away from this:
1) Exercising at a new time of day can be tricky. I almost never ride in the afternoon, and can usually manage my BG's pretty well on rides.
2) Don't eat when my BG is high and rising, especially if I suspect I may be having infusion site issues. This may seem like a no-brainer but when it's 4 PM and the last substantial meal you ate was at 9:30 AM and you've been riding for 2 1/2 hours, it can be tough! When I saw the 360 at the bakery I thought it was strange but assumed my extra big bolus (for being on a ride) would do the job. Sometimes when I am riding I could eat what I ate today with maybe 1 U or less. So 3.6 seemed reasonable to cover the food and to help jump-start the BG's to fall.
3) It would be really cool if I had a gadget that could track this info for me and connect the dots before I end up at 550. I can see it now but didn't have a big picture view out there on the ride.
4) It is necessary to test a lot to figure this stuff out. Test strips should be cheaper for all.
5) I don't follow the advice given to me in 1988 to not exercise with a BG over 250. I'm not saying that it's bad advice but it is too vague to account for every situation.
6) I probably should have pulled out my insulin + syringe right away when I saw my BG had started to rise.
7) The Dexcom would have come in handy, but I have one sensor left and am saving it since I don't want to buy a new box soon.
8) Why am I blogging on a Saturday night? Don't I have anything better to do, like go shop for Christmas presents? Riding around with high BG's makes me a little tired, or maybe it's just from a really busy week. Or maybe it's just because I want to stay home and continue reading What Is the What by Dave Eggers!

Well, it's now 8:15 PM and my BG is 182. Do you think it's going up or down?

(Thanks to Blair Ryan, a triathlete who races for UCSD, for inspiring me to do a little analysis on my BG's!)

Building the Team

I had an amazing visit to San Diego this weekend for my first visit with the Triabetes team. Several of the Triabetes athletes met up at the TCOYD conference, as well as Michelle Alswager, the project founder (and an athlete herself) from Madison JDRF, and Nate Heintzman and Peter Nerothin from Insulindependence. Peter is also an athlete on the Triabetes team. Kudos go to Amy Tran, one of the officers of Insulindependence, who also volunteered all day. It was a great pleasure to meet Bill Carlson, who inspired the world by defying conventional medical advice and completing in the 1983 Hawaii Ironman and many more to follow.

In the morning, a group of us enjoyed running together along Mission Beach, starting at the south end and running up for several miles before turning around. After a bit of kelp-dodging on the sand, we moved to the boardwalk. My sock had done that annoying thing where it creeps down your foot. The pace was fast and I didn't want to stop since it would be tough to catch up. Oh, well, I didn't want my sock all scrunched up either. I stopped quickly, unlaced and fixed the sock. There was Bill C. waiting patiently. Oh great! Now I would have to run fast! I joined him and we made good time catching up to the rest of the group. We all stuck together for the first third or so and then split off, but I have to say it was one of those runs that leaves me beaming. And Nate was following us along catching some footage and taking some snapshots. Thanks, Nate! I am sorry to say that I did not win the best blood sugar contest at the end. The early intense pace had popped my BG up a little, and my 0.2 U correction bolus midway didn't knock it down. I started the run around 150, was 280 by midway when I took the correction bolus, and was about 265 at the finish. I didn't eat anything during the run, nor did I reduce my basal rate. I was a bit dehydrated, which didn't help.

It was also great meeting up with some folks from DESA and some Insulindependence members, and reminded me of the feelings of camaraderie we had up at Whitefish this September for the JDRF Ride. I look forward to meeting the rest of the Triabetes team, and working with them as we train for Ironman Wisconsin. It is going to make working out for 10-20 hours per week much more enjoyable!

Also, you can see the awesome Triabetes T-shirts in the photo above. Here's a picture of the back. Let me know if you would like one!

Triabetes at TCOYD San Diego Tomorrow

A few athletes and other members of the Triabetes group will be at the Insulindependence booth at the TCOYD conference tomorrow in San Diego. If you're in town, please stop by and say hello. We will also be selling some Triabetes T-shirts there, or you can buy one from me later if you'd like!

Sickle Cell Mice on the Rebound

Well, it appears that mice are doing well these days. Some seem to have been "cured" of type 1-like diabetes recently and now some others are overcoming sickle cell anemia. An article in Science today describes how Tim Townes at the University of Alabama, Birmingham, and Rudolf Jaenisch of MIT (Cambridge, MA) and colleagues were able to coax stem cells derived from mouse skin cells into blood-producing stem cells, and to administer them in such a way that the mice produced only normally-shaped red blood cells. Check out ScienceNOW for a good description of the study. Thanks, mice.

Training Update

I am savoring the last 4 weeks of 2007 without a rigid training schedule. My goals for this month are to work on my nutrition, swim like crazy, and to continue building a strong base in cycling, running, and strength training. My race schedule is pretty much planned for 2008 with 2 early-season half-ironman races, IMCDA in June and then IM Wisconsin in September. My main concern for next year is being able to recover from IMCDA and then race IM Wisconsin 11 weeks later.

This fall (it's still fall right?), I have enjoyed a number of early-morning rides around Tiburon, starting in the fog or under moonlit, starry skies, and ending with a gorgeous view (or fog!) as I cross back over the Golden Gate Bridge. Fortunately for my riding (but not for the snowpack), there has been little rain so far. I enjoyed completing 3 rides as part of the Low-Key Hill Climb series--up 84 West from the Pacific Ocean to Skyline, up the "are-you-kidding-me?!" steep Welch Creek climb, and 19 miles up Mount Hamilton to the Lick Observatory. It's been fun to watch my power output gradually increase since I started doing Duane Frank's cycling classes a couple months ago. Instead of focusing only on heart rate, we set our interval intensity on % of max power output. From the beginning of the class a couple months ago, my sustainable max has increased ~50 Watts.

I checked my bike computer the other day and it looks like my little red bike is nearing 10,000 miles. I guess it's okay, then, that I've recently had to replace the rear cassette (again), chain, and middle chain ring (for the first time). This past year, I also had to change all of the cables, the brakes, and pedals. It might be time to get a new seat, as well. I'd love to be able to upgrade my wheels for this season, or to actually be able to buy a tri bike for racing. In the meantime, though, I still love my bike!

My running is going okay, although I haven't been as consistent due to my recent preference to swim or bike. But I have been running at least twice a week and went to my first track practice in ages this past week. When I am in good shape, running is generally my strongest sport; or at least, I generally rank higher in my race run times vs. bike times. Right now, I am running at a somewhat mediocre pace, but am generally comfortable.

Finally, I've designated December as my month to focus on swimming. I'd like to get in 3 practices a week, and more if possible. It took me a very long time to get fast enough running to qualify for Boston, yet I still expect to be a speedy swimmer overnight. I have to constantly remind myself to focus on how much more comfortable I am swimming; also, my great coach and swim teacher Laura Goodwin reminds me that my stroke is much improved. I've had a bit of fun working on my breaststroke, which may be my best stroke. In an effort to improve my swim endurance, I've been forcing myself to do flip turns as much as possible. For you pro's out there it's no big deal, but today I did 2 sets of 4x75 + 300 yards doing flip turns at every turn. Sometimes I come up gasping or just barely brush a toe to push off, but it's getting easier. My main struggle is to keep the flip turn together when I feel tired or out of breath.

I am truly grateful to have the health and opportunity to participate in these activities and look forward to another year of training. I am excited to see what emerges from the Triabetes project as well, and look forward to the friendships and learning that will come from that experience.

Kill off some B's to treat Type 1?

According to a news story at sciencedaily.com, Dr. Li Wen and colleagues at Yale University have been able to successfully prevent and treat early type 1 diabetes in mice engineered to express a human antibody (CD20) on immune B cells. I am trying to find the article in the Journal of Clinical Investigation but the story must have been a pre-release, since the December issue isn't available yet online or at pubmed. Anyway, B cells expressing this antibody have been targeted in rheumatoid arthritis, another autoimmune disease, with some success. It took some time to develop the appropriate tools to do this in a model of type 1 diabetes, but it seems like the results are promising. Once the article becomes available, I will try to find some answers to my many questions regarding this research.

Reference from sciencedaily.com: Journal of Clinical Investigation (2007, December 3). Treating Type 1 Diabetes By Eliminating B Cells. ScienceDaily. Retrieved December 3, 2007, from http://www.sciencedaily.com­ /releases/2007/12/071203190636.htm

Update Dec-06-2007: A link to the article can be found here.