Back in San Francisco

Sliver of Moonshine on the Bridge
Originally uploaded by annetics

After a wonderful visit with my family over Christmas, I am back in San Francisco, and was welcomed with this sight from Fort Baker yesterday evening. I am looking forward to ending 2008 with a bike ride through Marin, and am grateful to live in a place where this is easy to do on December 31.

Break in the Weather

After many days of cold and wet weather, we should have some sunshine tomorrow. I look forward to getting a ride in before visiting some snowier climes over the holidays.

As far as training goes, I am still working out my race plan for 2009. I had wanted to do the Race Across the West but decided to hold off for logistical and financial reasons this year. It seems like I would need to find a sponsor for the event and I just don't have the time to organize that. I would really like to do this in the future and am targeting 2010. Maybe by then I could find a group of 8 and shoot for the RAAM relay instead! Although from listening to the experience of TT1 guys & gals, it sounds pretty brutal! I am a big fan of sleep so it would definitely be a challenge!

So far on the calendar I have the Death Ride in July and of course Ironman Arizona in November. I also will be doing the Oceanside (California) 70.3 triathlon in April, some version of Wildflower in May, and the up-coming Disney World Marathon in January. In 2006 I made the mistake of signing up for too many races, which left me drained--I have found that I don't take the "Treat it like a training day" line too seriously. So I'm trying to not pack it in too much. (Hmm, maybe it's too late!) Plus, each of these races is expensive, especially the triathlons. (Triathlons are becoming way too expensive in my opinion. Come on!)

My general strategy is to focus mostly on cycling and swimming between Jan and June and to not get too worked up about any triathlons I have during this time. I've never really taken a break (more than a few weeks post-marathon or during injuries here and there) from running since I started running 20 years ago, so I'll probably still try to work in a run now and then. I've entered a couple other cycling events, including one double century, in early spring to keep me motivated, and the Death Ride in July will definitely be a big incentive for doing some serious training. I may also enter some local road races and plan to attend some clinics and introductory road races in January. (I had better get my old red road bike tuned up!) Cycling is generally my best method for weight loss and also has a significant, positive impact on my blood sugars. My heart rate on the bike is nearly as high as it is during running, although I can stay out longer with less impact, so I tend to burn more calories. And I do tend to enjoy it as well.

I'm not sure what the best approach to structure my training for all of this would be. Figuring that out is my next step.

My goals for Jan-May '09 are:

1) to get my weight down to my target "race" weight before the start of Ironman training in June, which will help me with my other goals
2) to improve speed/power on the bike;
3) to improve speed on the swim by 15 sec/100 m (as a start);
4) and to increase my endurance so I can be more "fresh" (in the Ironman sense) after the bike leg of the triathlon.

Any suggestions are welcome! I'm still having a hard time letting go of RAW but I think I have enough on my plate at this point...

Triabetes 2009

The day before the big race, September 6, 2008 (courtesy of Blair Ryan)

When Peter Nerothin asked me whether I'd like to continue with Triabetes in 2009, I knew the answer was inevitably "Yes." A few weeks ago I had the pleasure of reuniting with some friends from this year and meeting the new Triabetes team captains for 2009, as we volunteered for Ironman Arizona 2008 and signed up for the 2009 race. We have another group of amazing people, including some first-time triathletes coming from various athletic backgrounds as well as others who have already completed Ironman races. Okay, and I have to admit that I am pretty impressed by Seb, who decided to do an Ironman after CLIMBING MOUNT EVEREST! I remember when a woman spoke to our high school class and told us how she had lost a toe or two to frostbite climbing Mt. Everest, and that pretty much sealed the deal for me not doing it. I love the mountains and I love a good challenge but worrying about my insulin freezing on the top of a mountain that birds can hardly fly over (have you seen the Planet Earth episode on that?) seems pretty tough. As Seb said about the prospect of an Ironman, he is pretty good about dealing with blood sugar issues "under adverse conditions." Enough said!

Each teammate brings a unique background and I am honored to be training with all of them. Furthermore, it is a pleasure to continue with Triabetes to help support other diabetics in their desires to live active lives. I hope to stay connected to the 2008 crew as Triabetes continues to expand and reach more lives. If you or anyone you know with diabetes wants to get involved with Triabetes, it is now open to triathletes and wanna-be triathletes of all abilities and for all triathlon distances, and I would encourage anyone interested to sign up on the Triabetes website.

Triabetes 2009 Team Captains after signing up for Ironman Arizona 2009. We're committed now!

Run, Anne, Run!

I have some posts to catch up on but for now, her's an update of my on-again, off-again, now on-again marathon training. Earlier this year I was contacted by a friend with Children With Diabetes to run with them in January at the Disney World Marathon and Half Marathon weekend. Reluctant to commit to a marathon after a season of 2 Ironman races, I resisted. But as they say, "Resistance is futile!" I'm a sucker for signing up for races! And I loved the idea of running with CWD. I could have signed up for the half, but since I was traveling all the way to Florida, you know, I had to get my money's worth. (?)

Soo.... after Ironman Wisconsin was over and I gave myself some time to relax, I started to pick up the running again. I felt a little weary of training but figured I could get by with a weekly recipe of one tempo run, one track workout, one long run, maybe another easy run, a long ride and a couple swims. After all, I only ran 3 days per week for the entire season leading up to the Ironman events. Oh and I should say, I also planned on a couple days of light to moderate strength training. I get injuries if I don't include that. Well, despite not being Ironman training, it sort of felt like I was still training for an Ironman. I was losing my motivation.

But then, I saw the movie, Run Fatboy, Run, with my sister and her husband, and my game was back on! For some crazy reason, this movie about a guy who decides to run a marathon in order to get his girl back (after leaving her at the altar) inspired me to keep training! I can't exactly say why, because the main character isn't that inspiring as far as training is concerned. And he even had Mr. Ghoshdashtidar's spatula to keep him moving. But I guess, somehow, it reminded me why I love these events and I recommitted myself by running with my friend Rita a few weekends in a row, getting my mileage up to 18 for a long run. (Rita, by the way, just qualified for the Boston Marathon by killing her PR at the California International Marathon in Folsom/Sacramento. Congrats!)

I skipped my long run the weekend I was in Arizona, meeting my fabulous 2009 Triabetes teammates and racing through the desert in the Tour de Tucson 109-miler. (Much more on that soon!) I returned home eager to get some peak training done. I decided to add an extra run after my early-morning swim one day. I was running along, approaching an intersection when I had that horrible sensation of tripping, flying through the air and watching the pavement come up fast and hard! Argh! I was crumpled on the pavement and in a lot of pain. It sounds funny now, as tripping and falling usually does, but it was agonizing! I couldn't get up, really, and just lay there until a fellow runner came and helped me up. I had only been running about 60 seconds when I tripped, so I hobbled back to my car. I was bleeding and my elbow was very swollen.

When I got home, I was sure I had broken my arm but after a while the swelling went down. I think the pain was due to my landing hard on the nerve that runs along the outside of the elbow. My knee was another story. It was stiff so much so that I couldn't walk much for a couple days, and wasn't able to really do much for about 5 days. My blood sugar was going wild and the no-exercise moodiness was in full force. I was feeling pretty much done with the whole affair. I decided to give it one last shot last weekend with a long run. With the race a month away, I would need to get in a few more unless I wanted to be completely miserable on race day. My 19-miler went much better than I expected and I actually enjoyed my run through Portola Valley. And being out there for a few hours did not seem as long as it did in pre-IM days. My knee has remained a bit achy, but seems mostly healed.

So, I am back in. I received my sweet Nike race shirt from Laura at CWD and am going to give it a spin this weekend. I don't expect to pull in a Boston qualifying time in January, but I do look forward to meeting up with the CWD folks and having a chance to run with Goofy for a bit. And I definitely would not have been doing intervals on the track this morning without a marathon looming close!

Research News Flash: Gleevec and Sutent

Thanks to Peter Nerothin and Kerri Morrone Sparling for the tip-off. An article published in the December 2, 2008 PNAS journal (with early release today) showed that 2 leukemia drugs--imatinib (Gleevec) and sunitinib (Sutent)--had potent effects in preventing and reversing new-onset diabetes in NOD mice. Of course it hasn't been shown to work in people yet, but this does seem like a very exciting development, in particular because Gleevec and Sutent are already FDA-approved drugs. Another exciting finding was that one course of treatment (albeit a 10-week course) had long-lasting effects, suggesting that the drugs had a modulatory effect on the immune system--not just a more temporary, suppressive one.

I went to an informative talk today on the cell/molecular biology of diabetes and routes to a cure, given by Jeff Bluestone and Steve Gitelman of UCSF. I missed the first part of it so perhaps they discussed it then, but it seems like perhaps they didn't want to spill the beans. Dr. Bluestone was quoted in related news stories and is one of the main authors.

I am optimistic about the state of research, but will make sure to keep stocked up on insulin and test strips for the foreseeable future.

World Diabetes Day Today!

Today is the annual commemoration of World Diabetes Day. One of the goals of this event is to raise awareness about diabetes in the developing world. The International Diabetes Federation has a program, "Life for a Child," to help children in developing countries gain access to insulin, blood glucose testing and diabetes medical care. Another goal of World Diabetes Day is to educate people on the warning signs of diabetes; catching diabetes early can help to delay and possibly significantly reduce complications. I have heard of many instances where type 1 diabetes was missed in infants, almost until it was too late. Read about the warning signs of diabetes and more about the IDF mission here. I should note that type 2 diabetes usually has different warning signs than type 1. Know them, especially if you are at higher risk.

As part of WDD, many monuments and buildings around the world are being lit up in blue. The Civic Center will be lit up in San Francisco today around 5:00 PM.

Symlin Observations

I've been taking Symlin again for several weeks and have noticed some significant changes in how my blood glucose responds to food, insulin and exercise. After the suggested ramp-up period, I am now taking 10 units, or 60 micrograms, or Symlin at breakfast, lunch and dinner, and have been very consistent about taking it (e.g., I am not skipping doses if I just exercised or plan to exercise after work). These are some of my observations, which may be confounded because I also cut down my weekly long ride from 90+ to about 45 miles, and similarly reduced my long runs from 16-20 miles to 8-12. I am still exercising nearly every day, although the daily volume is somewhat reduced as well. Another possible confound is that I am trying to eat a lot less, in general, but during exercise in particular.

• I have had to change my carb ratio from about 9g:1U to 15-20g:1U and must take an extended bolus anywhere from 90-120 minutes with only 15-25% of insulin upfront (typically). If I am on the low side, I will take less upfront and if my BG is high, I'll increase the upfront amount accordingly. (Thanks, Scott, for the tip on extending the bolus from an hour to 90 minutes.)
  
• I tend to go high in the evenings so take a longer extended bolus after dinner than after breakfast. Maybe this is a basal rate problem; I'm not sure.
• I must reduce my basal rates by 30-50% an hour before exercise; previously I could pretty much keep my basal right where it was. I have a sense that this is not just due to the fact that I am eating less, because I am not spiking as much during intense workouts, either. Previously, this was a pretty reliable response for me, regardless of whether I ate anything. I had feared that I would have have a lot of bad lows during exercise but have been okay as long as I reduce the basals in advance. For example, this morning, I reduced my basal rate from 0.7 to 0.575 one hour before going for a very early 45-mile bike ride. I didn't eat anything the entire 3 hours and was 142 at the start and 82 at the finish. It was an interesting test.
  
• My BG's are much more stable, and the Dexcom has been really important in my being able to fine-tune the symlin/insulin strategy. I initially would have a low after bolusing, then rebound with a bad high about an hour later. The extended bolus has pretty much resolved this.
• Sometimes my blood sugar seems to randomly take off more than a few hours after eating. The Dexcom shows a straight line with a steady positive slope. I'm not sure what is going on here but this seems to happen every now and then. Perhaps it is related to what I ate but I don't have a good explanation.
• I still have some nausea and occasionally wake up sickeningly hungry. You know that feeling when you are so hungry you could almost throw up? I try to ignore it and go back to sleep. Don't worry; I am definitely eating enough.
• Symlin really stings! And I don't like shots after all. I think the rubber is so thick on the vial top that it slightly dulls the needle going in. I remember this from before. I am injecting mostly in my arm and thigh since my abdomen is already crowded with my pump infusion site and the Dexcom sensor. I know there is a Symlin pen now, but I will have to wait until I use up my current supply.
• It takes longer to recover from lows. I try to avoid getting low in the first place by watching the Dexcom.

My experience has been much more positive this time around, but I still have some reservations about using Symlin for safety reasons. Although amylin is naturally produced in the body, Symlin is an analogue and I feel like I am basically a guinea pig here. (I know they do safety studies on it but how many other drugs have been pulled even after the safety studies were satisfied?) I don't like having to pull out a needle before eating, though, and am not sure if I have really committed myself for the long haul with Symlin. We'll see!

Triabetes Project by Andiamo Productions: Highlight Reel

I am excited to share this video, which shows some highlights from Ironman Wisconsin in September. Bascom Hill Band generously provided the music and the production costs were graciously donated by LifeScan, maker of the OneTouch glucose meter. From Steve Parker, diagnosed after signing up for the race, to Larry Smith, who decided to race to celebrate his 60th birthday and has had diabetes for 47 years, and from Dave Shack, with little athletic background, to Bill Carlson, a seasoned athlete with countless achievements, we had a diverse group. Special thanks naturally go to Andiamo Productions, who immediately understood the vision of this project, and have worked tirelessly and expertly throughout the past year. Keep posted for upcoming announcements regarding the 2009 Triabetes team!


Diabetes and Athletes: The Triabetes Project from Andiamo Productions on Vimeo.

Symlin-ing Again

I decided a few weeks ago to try Symlin yet again. Despite some lasting fears induced by a couple scary episodes of severe Symlin-induced lows, I felt like perhaps now might be a better time to really test it. My training schedule is a bit more mellow, and with no big races coming up, I am a more willing to do some experimentation which might result in me having to cut short some workouts. I have been taking Symlin for a few weeks and built up to my current dose of 5 units, which I take at each meal. Initially, I took a regular bolus with the Symlin but have found that, for me, it works better if I do a dual-wave bolus with 30-70% of the insulin upfront and the rest extended over an hour. Otherwise, I was getting low within the hour, having a hard time pulling out, and then shooting up over the following hour. So far, I am happy with the results although I definitely have to make bigger reductions in my basal rates before exercising. Of course, with diabetes, it can be pretty tough to pick out what is causing what, so I won't make any big conclusions yet (especially since my basal rates are in a state of flux since the Ironman, then my recovery and now getting back into training). I am still feeling some nausea but that seems to be lessening; also, I have felt more sated after meals although sometimes I wonder if I am just experiencing nausea. It's a feeling somewhere between feeling satisfied and feeling pukey. I do still worry whether this is safe to take since it's relatively new.

Note: I am not a doctor and this is not medical advice. Consult your doctor for help with Symlin.

Riding along Ridgecrest in Triabetes gear

Here's a picture from the race on Saturday, which the race photographers sold for a reasonable $4.50. (Hello triathlon photographers! How do you justify your ridiculous prices? Ironman Wisconsin high res images are currently $35 each whereas photos for this race were $15 for high-res and a reasonable $4.50 for a lower-res version. I know it's an Ironman but come on...)

As you can see, September is a pretty dry month in California. I was reflecting on how green San Francisco is year-round and had to admit that I guess I am okay with all the fog after all, and that I suppose it is better than getting rained on all the time. I just love wearing my Triabets jersey, which reminds me... Is there anyone out there that would be interested in purchasing a bike jersey if they were made available? Just wondering.

Mt. Tam Hill Climb

Here's a picture (from here) of Sister #3 out of the "Seven Sisters" that make up Ridgecrest Blvd. (See this post for more pictures from Ridgecrest.) At the Mt. Tam Hill Climb bike race this morning, I encountered these fine Sisters after a few quick miles on Highway 1 and a long climb up Fairfax-Bolinas Road. This was my first "real" bike race, I suppose, although I did several of the Low Key Hill Climbs last year. This definitely had less of a low key feel about it!

When I arrived at Stinson Beach, I saw many people warming up on trainers and one guy was on his rollers. This race was open to riders spanning the general public to USAC Cat. 1/pro racers. I noted that there were actually a couple tri bikes there but was still glad I spent the time this morning to clean up my road bike for this race. I didn't want to make it too obvious that I was a newbie, and my road bike has better gearing for this sort of climb. Because the "public" category had been filled, I had signed up as a USAC Cat 4 woman, which I guess is where I belong anyway as a beginner. I reflected how at ease I am with the triathlon race scene compared with this morning. The race number was supposed to be pinned on the left, which I gathered from the people asking "left side?" at the registration table. After a fellow first-timer helped me to pin on my number, another new friend came and said, "Hmm, I think your number is upside-down." Woops! We got that straightened out and I made my way to the start area.

My blood sugar had been low-ish since breakfast and was 65 about 20 minutes before the race; I think my breakfast bolus was too high and I was still feeling the effects, even though it had been 3 hours. I did skip the Symlin this morning. Also, I had reduced my basal by 40% for 1.5 hours beginning one hour before the race, and had eaten a banana (unbolused). At the race start, I had eaten some more goodies (half a cookie and a mini-brownie--bike races definitely have tastier food than triathlons!) and about 5 minutes before the race, checked in with a BG of 75. I assumed the food plus anxiety would kick in soon and keep my BG's afloat. At least, this was my hope. Without a swim and run, I would be going close to all-out on this 12.5 mile race.

I was a bit anxious and tucked in the back of the pack after the race began. There were about 15 other women in our group and we had a lead car clearing the road for us. I have to say, those first few flat miles were exhilarating and just a little terrifying, as I paid careful attention to stay with the pack while watching the road for hazards and making sure I didn't cause any accidents. This part felt easy physically because I had a nice draft and the road was more or less flat. I wondered if the lead riders were dogging it but concluded that I was just benefitting from the draft. Our group of ladies was pretty mellow and once the order of riders was settled, nobody tried to pass on Highway 1.

Once we started climbing up Fairfax-Bolinas Rd., people quickly separated. I stayed with a few riders for a bit and then fell back a little. My heart was pounding like crazy, partly from being so hyped about the race but also from the climbing, and I felt like perhaps I should back off a little. I guessed my time would be over an hour and wanted to keep something for those Seven Sisters. Fairfax-Bolinas Road is a little-traveled, windy road that intersects the main route for the Alpine Dam Loop when it connects with Ridgecrest. I had been up this road once for the Race Across Marin in 2006, but had forgotten how long it was! It seemed to go forever, constantly winding up, sometimes exposed with views of the hills and the ocean below and other times shaded in the redwoods. I could see the fog still clinging to Stinson Beach and the ocean with bright blue skies everywhere else.

As I was nearing the top of Fairfax-Bolinas, I heard the Dexcom CGM beeping in my back pocket. I ignored it. I didn't even want to take the time to pull it out and I assumed that my BG was rising--my typical reaction to climbing or intense cycling efforts. I remembered that my basal was lowered and decided that I felt good, that I had eaten enough, and that I would not be able to sustain a 185 heart rate with a low BG! There were a few people there cheering as I started out on Ridgecrest--"only 7 more rises!" I was actually relieved to hit this part of the course, since there is only one "sister" that is truly steep, and I would get some breaks after each climb. My heart rate was high but my spark was fading a bit. Determined to keep track of each hill number, I counted but lost track around the 4th or 5th sister as usual. But I made it to the finish, eventually, in around 71 minutes. I was last in our division but I guess this only gives me motivation to keep at it.

I pulled out the Dexcom and was surprised to see that it was beeping because I was at 86, below my alarm level of 90. "Hmm, this must be wrong," I thought. The BG meter read 82. I checked again. 82. I was really surprised. I guess in retrospect it does make sense because, although I often include intervals of high intensity in my cycling class and on some long rides, I don't generally keep this up continuously for an hour or more. I was glad I had cut back the basal and felt a little bit of diabetic smugness for hitting the nail on the head (this time).

I hope to do some more road racing in the future. This may be dangerous for my bank account though, since I'm not sure how much life is left in my dear red road bike. Anybody want to buy me a new one? :) (Here's a beauty, for starters...)

Study shows continuous glucose monitoring significantly improves pregnancy outcomes

An article published yesterday in the British Journal of Medicine found that using CGM technology significantly improved several pregnancy outcomes including decreased maternal HbA1c in the 3rd trimester from 6.4 to 5.8% and reduced occurrence of macrosomia in the baby. For more details, read ScienceDaily or the original article at BJM.

Ironman Wisconsin Diabetes Race Report

The day after the race, I quickly wrote up a race summary for Dr. Matt, who was in Snowmass, CO, busy, running his 3rd Diabetes Training Camp for 2008. The summary focuses mostly on the race itself and my diabetes management during the race. I thought I would include it here for anyone who might be interested. At the bottom, I've written a brief explanation of some of the diabetes lingo that I use here, for those who are less familiar with all this stuff! Photos are courtesy of Blair Ryan.

**

Here's a brief lowdown on the diabetes stuff (mostly) from the race yesterday. But first, it was an amazing experience. We had nearly perfect weather and the Triabetes support crew was amazing. And trying to look good for the camera kept my pace up a little. ha! Well, until the end anyway...

I ate breakfast (60 g breakfast, oatmeal/banana/PB/milk) around 4:15, 45 minutes later than planned but 2:45 before the race. This didn't give me as much time to deal with pre-race highs and I was high and rising. I bolused 0.5 when I was still on the rise at 380. It had come down to around 320 by 6:40 so I ate about 10 g GU before hopping in the water. My basal from 5-8:30 was 0.9 and then it went up to 1.6 until 10 AM (at which point it was 0.7). The swim started at 7:00 AM. On the 2nd lap, I became worried about going low and was feeling tired, so I flipped over and ate a GU sea-otter style and immediately started feeling better with the next stroke I took--it was probably psychological because I think I was holding back on the effort a little to avoid going low. I started cramping in my calves the last half mile of the swim and it was painful and slowed me down. I think getting out of the water after the 1st lap at IMCDA helps in this regard. But I was able to finish in 1:46, a few minutes slower than IMCDA.

Coming out of the water my BG was 83--a little on the low side so I ate prob. 60 g carbs in transition. In retrospect, my BG was probably in a great place if I didn't eat but I had that big basal going and I panicked. (I really hate low BGs during a race.) About a mile into the bike I lost my water bottle in a place that was difficult to turn around and made a decision to continue. I begged some water off a volunteer along the route but didn't get another water bottle until about 45 min into the ride. I was probably dehydrated from the high BG's earlier and should have stopped somewhere for water, although I didn't have many options there. I considered briefly grabbing one of the bottles on the side of the road after a particularly bumpy stretch, and was eyeing all the volunteers for spare water. My heart rate was high which is pretty typical for me on the beginning of the bike. I did note that when I got some water at the 1st aid station, my heart rate came down fairly quickly; I'm not sure if it was due to getting the water into my body or just finally relaxing. My BGs shot up to something around 350 after 1 to 1.5 hours on the bike. I was pretty surprised, but then again not so much; I guess I shouldn't have eaten so much in T1. I just went ahead and bolused 1 U and waited a bit before eating more. Eventually it came down and then I was struggling to keep my BG up towards the end of the ride even though I spent the last 2 hours at 0.25 U/hr basal. At about 65 miles into the bike, my calves started cramping again and it was painful. I had been drinking a lot of water/Perpetuum/Gatorade, had taken a lot of salt in, and couldn't figure out what to do. Fortunately, at one of these moments, the camera crew came by and I thought, "Well I can't just be a baby and stop pedaling here." So I just tried to pedal through it. That actually worked pretty well to work out the cramps, and I discovered that if I worked at a harder gear with a lower cadence, I would cramp less frequently. But I was a little disappointed that I couldn't really put the pedal to the metal since otherwise I felt good. I finished up the the ride in 7:05, which is about 7 minutes slower than my CDA time. I wanted to go faster, because I felt stronger than before CDA, but the cramping really slowed me down. I suspect that the high BG/no water situation had something to do with it as well as the cramping on the swim. I was worried that I would cramp on the run but that didn't seem to be a big problem (except for when I drank cola instead of Gatorade--I noticed that also happened in CDA).

My BGs were a little on the low side (low 100s/90s) at the end of the bike and I think I shut down my pump for a half hour at the beginning of the run. I felt well-hydrated. My BG's were in the 90-100 range and I lowered my basal to 0.125. I was eating a GU every 40 minutes, and pretzels and Gatorade at almost all aid stations. (Granted maybe it was only 2-3 pretzels.) I shut down my pump another couple of times because I couldn't get my BGs up. I was eating probably 200-250 calories per hour, maybe more. I ate what I could. I had a couple episodes of low BGs--measured at 60s, 70s and dropping fast--but noticed that I didn't feel great (GI ickiness) when I shut down my pump. At the last turnaround around mile 18 my BG was pretty low and I felt on the verge of emotional breakdown so allowed myself to walk for a few minutes. I ate about 50 g carbs and then saw my BG rising. I was happy to see it rising steadily upwards until it hit 200, at which point I started to wonder if my pump was disconnected. I had a couple miles to go so nudged it with 0.2 U just in case there was a problem. I was sort of bummed that I couldn't run faster but happy I made it through. I felt pretty low energy-wise for a lot of the run, although I had some better moments here and there. I tried to pick it up when I could, and was happy to keep running through the end. When I was walking due to the 2nd low BG episode, a woman said, "Don't worry--there is plenty of time to finish." I started running after a few minutes and she wished me good luck.

I did notice a couple times the sort of fatigue come on that I experienced on the run in CDA 07 and on the bike in CDA 08. I am more alert to the initial symptoms (basically low BG feelings when the BG is normal--especially slight dizziness) and backed off right away when I felt this way on the 2nd loop of the bike. After I finished the race, I felt the same way and it might have something to do with blood pressure perhaps. My blood pressure was 100-110 (can't remember) over 50; I drank 3 cups of broth and it came to 110/60. Who knows I guess.

It was fantastic seeing everyone along the course and I was especially happy to see my partner in crime (or so I would like to think) Michelle after some hill somewhere and Ray and the camera crews and anyone in one of the blue IronFan T's. The IronKid crew on the run course was also fantastic and it was great to see Marissa and the rest cheering enthusiastically each time I passed by. Racing with 11 other type 1 athletes was such a pleasure for me; I had a big boost when I saw anyone on the course and it was such a comfort knowing that so many people "in the know" about diabetes were out there. And having that table for the swim was so incredibly helpful. It took a lot of stress out of the morning for me. I am pretty sore today and have a really weird bruise on my ankle but otherwise am doing okay. I had BGs >400 overnight and they are up again so I had better see what is going on.

**

"Basal what?"
For those who are less familiar with diabetes terms, here's a primer. BG refers to blood glucose, which increases with food intake (especially carbs) and stress, and decreases with insulin and, often, exercise. Sometimes exercise can cause the BG to increase, and many other variables affect the rise & fall of BG. Insulin takes the glucose from the blood and helps to shuttle it into fat & muscle cells. Insulin must always be present and can be delivered through injection or insulin pump. I use an insulin pump, which delivers a "basal rate" of insulin throughout the day. I program this depending on my activity level; basal rates also change throughout the day. For me they are highest in the morning and lowest in the afternoon. When I eat a meal, or need to correct a high BG, I take a "bolus" which is basically like an injection except it's done with a pump. The Dexcom is a continuous glucose meter (CGM) which measures the glucose concentration beneath the skin every 5 minutes. It is calibrated to a BG meter and can give useful information on BG trending and values (as long as it has calibrated successfully).

Triabetes Journey

How do I sum up my race in Wisconsin a little over a week ago? I could detail my BGs throughout the day and the diabetes-related decisions that I made. Or I could talk about how I picked up my pace a little every time I saw a red or blue Triabetes IronFan T-shirt out on the course. Or maybe I could talk about my amazing teammates, both the 11 others racing and the honorary diabetic (aka Michelle) keeping BG meters at the ready and cheering herself hoarse. Perhaps the real story is in the 12 months leading up to the race?

Being part of Triabetes this year was a gift. All those years of people asking "Are you still running?" as I played the never-ending game of what-will-this-do-to-my-BG finally, finally, paid off in my readiness to join this group of amazing people. Since being diagnosed I have tried to continue to live life as I would have otherwise, and have been blessed with extraordinary friends and family who supported me along the way. Still at times managing diabetes is difficult and frustrating. In some way, I have received acknowledgment from somewhere--maybe just myself--that, yes, it is hard but it is also worth it. As I crossed the finish line in Madison, Ray asked me that question, "Was it worth it?" My response was, "Ask me in an hour," as I experienced a huge emotional and physical relief to be done with the race, followed by "Yes, of course it was." This Ironman was a lot more painful for me, with cramping on the swim and bike, and a low-BG-head feeling for most of the run. It was hard. But the reward to me and, I hope, the many more who participated or will see the documentary, is great. Yes, it is hard. Yes, there are highs and lows. But, in the end, it is worth it all.

Triabetes Update

A full race report is in the works but I wanted to take a moment to thank everyone for making last weekend such a powerful experience. I did finish in 14:23 (30 minutes slower than IMCDA 08 but 20 minutes faster than IMCDA 07) and was happy to cross the finish line running. It wasn't a perfect race for me and I felt hampered in my pace on the bike and the run. So I guess I have not conquered this yet. But as one of the other Triabetics, John Moore, also mentioned, at some point during the day, the finishing time became irrelevant. Triabetes became much more than that. Thank you to Michelle Alswager for having this dream and setting it in motion. It has changed my life. Thank you for sacrificing your race to ensure that things went smoothly for all of us. Also my deep thanks go to the camera crew--Ray & Nella and Mike H. and everyone else--who were out there doing their own Ironman filiming session. Also thank you to InsulinDependence, Diabetes Training Camp, and LifeScan and the rest of our dedicated sponsors. You all made this possible. Finally a sincere thank-you to all of the many IronFans, following along in person or online, and the IronKids out there on the course. Your support was felt by all and appreciated greatly.

I am happy to report that, aside from some pretty painful stiffness for the couple days after the race, I am recovering well so far. I went out yesterday for a 90-minute ride along one of my favorite routes in Marin--Chileno Valley Road--and was proud to wear my Triabetes jersey. It was pretty fun, too, after 45 minutes on the bike, to be able to say, "That's enough," and turn back. I'm sure I'll be itching to do a long ride soon enough. My carb ratio has gone from 15:1 to 8:1 in just a week so it's time to get things hopping again!

Photo courtesy of Blair Ryan

How to follow Triabetes and here we go!

If you want to follow updates from the on-course fans tomorrow, you can do so at http://search.twitter.com/search?q=triabetes. By the way, you can also check to see if your text messages came through here.

I have my strategy for tomorrow mapped out as best as I can. I think in a couple years (or sooner) we will look at these methods the same way we look at pre-computer days! But using data from Coeur d'Alene, Vineman 70.3, workouts and just some intuition, I have a plan in place that at least I am comfortable with.

Visiting with everyone involved in this project today at the reception reminded me of why I signed up for this in the first place: I knew I would have the opportunity to meet and work with some of the finest people around. Thanks to all those who have helped to make this opportunity come to pass and my hope is that it will touch many more lives.

Okay, it's time for sleep.

Signing off,
Anne (#2079)

Final Preparations

With one day to go before the race, I am making my final plans, preparing transition bags and looking over my bike one more time. I have been more calm before this race, and plan to use my nutritional strategy from IM Coeur d'Alene. My blood sugars have settled a little but I am still anxious about the swim. NA Sports has allowed Michelle to set up a table where we can dump our diabetic gear before heading into the swim, and after getting our wetsuits peeled off. This will give me a little extra peace of mind, being able to check my blood sugar closer to the race start. And for some of the athletes, they will be disconnecting from their pumps at this point. Most people will be swimming/treading water for 15 minutes or so before the race, so I will need to take this into account.

The weather was rainy on Thursday, nice yesterday and should be nice today. Tomorrow there is a possibility of thunderstorms but I am hoping for the best. We have found one forecast that calls for decent weather, and that's the one I'm going with. At least, living in the Bay Area has prepared me for cool temperatures. I've been swimming in the lake a couple of times and the temperature is perfect; yesterday at the athlete meeting, they announced that it was 71 degrees. I can't complain about that! The course is beautiful as well and I was happy to see a lot more flat that I had been expecting. Driving it is a different experience than riding, but I was a little reassured after driving around the "lolly" part (vs. the "stick" part) of the "lollypop" course, as people describe it here.

It has been great to be reunited with the team members I had met and to meet those I hadn't, and to also visit with Ray, Nella, and Elisa. And this afternoon, the IronKids will be joining us for a reception after their canoe trip this week. I look forward to meeting up with Marissa and the other IronKids, and to having them on the course tomorrow.

Okay, enough procrastinating. I need to get my stuff ready. I added a twitter feed to this blog that may be updated tomorrow with additional information that you won't see on ironman.com. So if you use twitter, you can follow that feed if you'd like. You can also check triabetes.org or Michelle's blog at triabetesdocumentary.blogspot.com.

Ironman Wisconsin Count-Down

As I recover from a whirlwind work trip to Sapporo, Japan, I am already preparing to fly out to Madison for this weekend's big event. I am excited, and nervous, wondering how my last week of travel will affect my performance on Sunday. My blood sugars are slowly re-adjusting to the 16-hour time difference here and will be challenged by yet another 2-hour time change tomorrow. I am in taper mode and have bumped up the rates; still, I have noticed especially that my overnight basal rates are killing me with low BG and my afternoon BG's are too high. Get back with the program, body! We're not in Japan anymore! I am hopeful that this will not cause big problems, but I feel like making it through the swim on Sunday may be a bit of a guessing game, and that makes me nervous. Once I'm out of the water, I will be very relieved, especially if I can manage to keep my BG's <250 during the first couple hours of the ride. That would be a unique IM experience for me. I do have some careful records from before and during IMCDA and some more recent workout records to help guide me, and feel like my nutrition/hydration approach from IMCDA should also work well this time around.

For those interested, very cool Triabetes "IronFan" T-shirts are available from Michelle Alswager. Check out her blog for more details. We are also trying to put together some live tracking in addition to that available on ironman.live. Check out triabetes.org or the "Triabetes 2008" group on facebook for more information! (You can also join the facebook group if you'd like updates.)

Blood Sugar and Moods

I've been noticing more over the past couple years a stronger correlation between my blood sugars--especially high blood sugars--and my moods. When I'm low, everything seems hard--it's not a good time to ponder, for example, doing an Ironman. But when I'm high, I can feel really depressed and easily frustrated, as well as sleepy (a symptom more commonly expected). I have noticed a fairly rapid improvement as my BG's return to normal, even before I know my BG's have come down. Maybe these mood changes were always there and I am just finally noticing how my BG's relate to them; or perhaps they are becoming more pronounced through the years. I'm not sure. Anyway, this post was prompted by a BG over 400, which I attribute to letting my pump run too low (air bubbles?) and also going on a BG testing strike of 4 hours. My basals also seem a bit off these days. I loaded up on a few units which, with my current insulin on board, should bring it down. These are the times that diabetes can really be a challenge for me, emotionally, even though I know it's just the BG picking on me. Fortunately, though, I will be able to shake it off with a long swim + run in the morning. Hooray for that.

(Note: BG=blood glucose, aka blood sugar.)

Triabetes Triabetes!

I can't wait for IM Wisconsin! And I can't wait to see the Triabetes documentary! I could sit in a dark room and watch all the footage in one sitting. Wow, these people (meaning Ray, Nella, Mike and whoever else is working on this at Andiamo) are amazing. I have a lot more to say, but let me say this now: being part of this project makes all of those 75,000+ fingersticks over the past 20 years, and the thousands more to come (but let's hope not another 70,000), just a little more tolerable.

Check out Michelle's blog and if you want to help get T-shirts for all the fans on race day, you can contribute right there. You can also donate through the Triabetes website. We still need more support for the documentary. And if you want to come cheer in person in Madison, let me know. It is going to be a fun day.

Vineman 70.3 or maybe 70.8

A couple weeks ago I did the Vineman 70.3 race up in Sonoma County. This course is nearly identical to Barb's Race, which was my first half-IM distance event in 2005. I did Vineman 70.3 in 2006 on a hot, difficult day, and came in much slower than my Barb's Race time of 6:01. So, this year, I was wondering, would I beat that time? Could I come in under 6 hours? The race was exactly 4 weeks after IMCDA and I thought it would also be a good test to see if I'd recovered.

I've had to keep my basal rates lower after IMCDA even though I am about 5 pounds heavier right now. I don't get it but that's how it is sometimes. So planning out insulin for the race was a bit of a guessing game. I decided to really amp up my swim/early bike basal rate, from 0.9 to 1.3 U/hr. I was going to take care of that bike spike once and for all! A couple hours before the run, I would lower it to a level I though would keep me steady. After reviewing my IMCDA basal levels, I settled on a rate of 0.2 U/hr.

We were staying close to the start, so, on race morning, I meandered to the transition area about an hour before my wave went off. Soon enough I was swimming, not sighting too well, but happy to come out of the water with a few minutes' improvement over most of my 2007 swims. I hopped on the bike and, after about 15 minutes, checked my blood: 155. Great! I felt good and was happy to have some overcast skies. I noticed that neither my cadence or speed were getting picked up. That meant I would not have mileage either. I decided to just go by heart rate, targeting heart rate zone 3 for the bike and run.

I tested a bit later and was surprised to see my BG climbing fast, again. Hmmm. I thought my 1.3 basal would have taken care of this. I checked again a bit later and it was still rising merrily into the 300's so I took a small bolus to knock it down a bit. I backed off on the calories but still did drink a little Perpetuum because I was getting hungry. Around mile 25 or so, I pulled out my meter to test and somehow dropped my velcro-laden lancet. I kept riding. There was no way I was going to stop to get it. Bah! I kept riding some more and then my reasonable mind reminded me that I still had a long way to go, and that my BG's were not stabilized yet. I grudgingly peeled off to the left to turn and look for it. I had a nice comment from one of the riders, who called out, "Once isn't good enough for you?" I had words for him but muttered something and rode past the spot where I had dropped it. I slowly rode back up the road, eying the ground for a gray lancet with red velcro. I couldn't find it. Well that was time well spent! Oh well. I figured I could test by just squeezing my fingers hard enough to make them bleed. I usually bleed from a couple spots when I test, anyway! (The problem is, I don't seem to bleed from multiple spots unless I prick a new one!) I was able to test one more time and then just went by feel and past experience. I figured I would start to come down, and assumed this was the case when I started to feel better.

I had no idea of my mileage or average speed, but was familiar enough with the course to think that I might be able to break 3 hours. For most of the ride, I felt good and was enjoying riding on familiar ground. My heart rate was on target and the weather was pleasant. After the one big climb at Chalk Hill, I knew the end was in sight. I kept pushing through the end and was happy to see 2:59 on my watch. Fun! I was glad my little lost lancet incident hadn't pushed me over the edge.

Once on the run, I discovered my BGs were not only high but rising from my end-of-ride food fest. I had finished off the Perpetuum and eaten another 25 g of carbs in anticipation of my usual drop at the beginning of the run. I had also lowered my basal rate a bit earlier and a bit lower than I did in Coeur d'Alene. All of these factors, as well as not being able to test, contributed to another spike over 300. I waited a bit to see if it would fall; it didn't and I took another small bolus. After several additional miles, it seemed to be settling around 250 and I decided to leave it there. I felt so much better not being on the brink of a bad low all the time and it gave me energy and confidence to push the pace a bit. My heart rate was theoretically in zone 2 so I guess I could have pushed even harder; still, it felt like the right effort-level for the distance and conditions. I guess it would have been good to nudge the BG to somewhere below 200 but I was stable, felt good and, with an hour to go, just left it alone.

Although it got a bit warmer when the sun broke through, I tried to hold my pace; I didn't have to do 2 loops, after all! (That was the theme of the day: only one loop for each leg! yay!) I was pretty excited to see that I would likely be able to finish in under 6 hours, and pushed the pace through the finish, for a finishing half-marathon time of 1:57 and a total time of 5:56. And the cool part was that my average heart rate was 165 compared to 178 three years ago with a time that was 5 minutes slower. Yay for progress! And it was a great relief to realize that, unlike last year, my recovery was going well, and that I would be able to continue to train well for IM Wisconsin. And speaking of IM Wisconsin, I can't wait for that race, where I will not only have spare lancets but spare meters out on the course. Fantastic! In the meantime, I think I'll try some string as a back-up to velcro.

A Few Ramblings...

Good luck to everyone racing in Lake Placid this weekend! Ed Liebowitz will be doing his first Ironman. Go Ed!! I also have a slew of friends from San Francisco racing; many of them helped me to get started with triathlon in the first place, and a couple even came to cheer on Jill and myself this past June in Coeur d'Alene. Good luck! Some race numbers to keep an eye on: 2550, 1377, 683, 286, 598, 2108, 859, 254, 416, and 341! I hope I didn't miss anyone. And if you have a chance to come across #683, check out his calves--they're legendary! You can follow the action live on Sunday at ironman.com.

I'll be catching the race in the afternoon after I do the Vineman 70.3 race up in Sonoma County. I was on the waiting list and got off so I am in! I've raced the course twice before and done many training rides up there, so it will be a familiar route for me. Sunday will be four weeks post IMCDA so the race will be a good test on how my recovery is going. I feel pretty good other than the fact that my weight bounced up several pounds within days of Ironman and has been fluctuating a lot since then. My first 80-mile ride was pretty painful but I felt pretty decent riding 90 last weekend with a short run after. I am starting to think that I have recovered after all; because of my experience last year, I had been sort of expecting a sudden disintegration in energy and motivation at any moment! Having the motivation to race with my Triabetes teammates in September has been very helpful this time around.

And if you are riding in Sausalito in the next few weeks, be careful at the intersections and crosswalks. The police there have nothing better to do than to conduct stings to ticket cyclists who don't stop for pedestrians at crosswalks. I had heard about this before and stopped quickly at a crosswalk when I saw a pedestrian on the other side of the road put one foot onto the road. The guy riding behind me a little bit (and to the side) continued through and was given a ticket. I hope they do stings for cars, too.

Jen Alexander Swimming Northumberland Strait Today

Cheer on Jen Alexander as she swims the Northumberland Strait today. Her plan, according to a quick email this morning, is to swim from Prince Edward Island to New Brunswick and then to Nova Scotia. Wish her warm thoughts, calm water, and clear skies! You can follow along at her blog or track her real-time at her Britech site. Also give her cell phone a call if you have the number, and they will post your name on a board that she will see every now and then. Go Jen!

Dancing with the World

I saw the first one that this dancing guy Matt Harding made a couple years ago. This one is, perhaps, even better. Enjoy! It's better if you go to YouTube and watch the high-res version; also make sure to listen to the sound at some point.

Don't Waste a Low BG

I'm just wondering who else out there, when you have low blood sugar, will spend an extra 5 minutes to find that yummy treat you've been stashing somewhere but can't find because you are low in the first place? It makes me just want to cry if I have to eat a vanilla GU when I'm low, especially when I just know I have one last bag of Luna Moons somewhere. (And it's even worse if I just finished a 5-hour bike ride fueled by GU! Ack!)

Ironman Dreams

Last night I was asked to give a speech at the Greater Bay Area JDRF Chapter's annual family day at the Giants. (The Giants won, by the way.) I pondered what I might say to an audience of kids, teens, and adults recently and longer ago diagnosed with diabetes, as well as their family and friends, and this is what I wrote. It is meant to remind myself as much as anyone else not to sell oneself short because of perceived limitations from diabetes or other challenges. Also it is a reflection on the strength I have gained from a community of friends and, in particular, the diabetic community. This includes everybody, actually, since if you know me, that makes you a "type 3" diabetic. (No doubt you have spent some time as a captive audience hearing about diabetes from me, which is qualification enough.) I was reluctant to post the speech here; however, since a friend requested that I do so, I have posted the text with some pictures below.

I also had the great pleasure of meeting my IronKid, Marissa, and her family and friends. (Hi!) Steve Ahn might be jealous because I was also able to meet his I'Kid Sam last night as well. Please consider supporting Marissa and the other IronKidz at http://triabetes.org/support.html if you are able.

Here's the talk:


June 24 of 2007 I lined up with over 2000 other triathletes, all clad in black rubbery wetsuits, ready and anxious to start Ironman Coeur d’Alene. Beginning at 7 AM and ending before midnight of the same day, an Ironman race consists of a 2.4 mile swim, 112 mile bike ride and 26.2 mile run—otherwise known as a marathon. The cannon went off and, with a little trepidation and a lot of excitement, I plunged into the water to begin my first Ironman race adventure.

Swim start Ironman Coeur d'Alene 2008 (photo by Julia Bavely)

Training for an Ironman triathlon takes a lot of time and a love of the sport. During the heaviest training periods, I spent more than 20 hours per week swimming, cycling, running and weight training. The race itself is equivalent to starting here for a swim past Treasure Island, a bike ride to Monterey, and a run past Walnut Creek.

Why would I choose such a goal? The bottom line is that I love to swim, bike and run and I love the way it makes me feel. It’s hard to wipe the smile off my face after a ride through the hills of Marin, or a good run through the Golden Gate Park. And it gives me some satisfaction to know that if I had tried to escape from Alcatraz, I could have (most likely) made it safely. An Ironman seemed daunting, but I had friends who had started out like me and done the work to get there. I just thought I might be able to do it myself.

Reach for your goals and do what you love to do

Setting goals and reaching for my dreams have been important themes throughout my life. At first, when I was diagnosed at the age of 14 as a high school freshman, I wondered how diabetes might impact those goals. I had experienced the typical symptoms of type 1 diabetes and knew something was wrong when I joked with my best friend, “I must have diabetes or something!” Ha ha. Well, I did have diabetes and I soon found myself in the hospital, learning how to inject insulin into an orange, and then myself. I remember testing my blood sugar at home for the first time. Sitting at the kitchen table, it took me 15 minutes to press the button on the lancet. It seemed so wrong to have to do that!

I wondered how my life would change. Would I still be able to do the things I loved? Some things did change. I was on a fairly rigid insulin schedule and no longer slept in on weekends in order to get my morning shot on time. I learned to count food exchanges and how to treat low blood sugar. But the rest of my life went on. I continued to play flute in the high school band, and to take piano lessons. I continued with my goal to earn my way to college and was able to achieve this with a full scholarship to Boston University. I studied Biomedical Engineering in college and earned a fellowship for graduate school in the same field. After taking up running in high school, I had learned to love that as well, and carried that with me throughout college, graduate school and working here in San Francisco. After 10 years of trying to qualify for the Boston Marathon, I finally did so and returned to Boston in 2006 for a celebration of reaching that goal. Managing diabetes has remained a challenge with ups and downs, but it has not taken center stage in my life nor has it prevented me from pursuing the dreams of my heart.

In Boston, getting acquainted with the finish line.

After moving to San Francisco nearly 6 years ago, I still thought there was no sport to rival running; I soon discovered, though, that I could actually learn to swim and enjoy it after all these years and that cycling came naturally to me and even rivaled skiing in my book. That’s quite a complement given that I grew up skiing on the powdery slopes of Utah.

My first triathlon was an Olympic distance race called Wildflower—a race was so tough for me during the run that it brought me to tears. But I made it through and somehow, despite the challenge of the course, was hopelessly hooked to the sport. I continued with Olympic distance, then ventured into half-Ironmans and then knew it was time to sign up for my first full Ironman Triathlon.

After finishing the swim of my first Ironman race, I exited the water. One of the biggest perks at an Ironman is the army of wetsuit “peelers” who sit you down and yank off the very tight wetsuit. A couple peelers pulled mine off, tossed it at me, and off I ran to prepare for the bike. I dried off a bit, tucked my pump into my back pocket, threw on my shoes and helmet and grabbed my bike. I was off! I tried to stay mellow for the bike portion, and felt comfortable for most of the ride. After struggling with some high blood sugars early on, I was happy to settle down around 130 to 140 for the rest of the ride. I had a few periods of fatigue but overall felt good.

It’s hard to imagine looking forward to a marathon after exercising straight for 9 hours, but finishing up 112 miles on the bike is a happy moment. I threw on my running shoes and was off. I loved to run and felt happy with my pace. About 9 miles into the run, though, my race started to unravel. I stopped at an aid station; my brain felt tired. I felt like it would be unwise to continue, that my race was over. What had gone wrong? My muscles still felt strong. But I felt like my blood sugar had hit rock bottom when it was actually above 100. An astute medical guy suggested that I might be low on insulin. I saw that I had suspended my pump and that my blood sugar was on the rise. I took more insulin and within another 20 minutes, felt strong enough to begin racing again. I completed the last 17 miles of the race, a bit uncomfortable but running. I had done it. I had finished an Ironman race.

Build a community

Throughout the years I have been fortunate to be surrounded by supportive family and friends. My parents encouraged me to reach for my academic and athletic goals, and I always felt their confidence in my abilities. I have to say, though, that my mom was a bit concerned about my sanity when I told her I would be doing 2 Ironmans this year. I’ve had good friends over the years who patiently slow down when I need to test, and stop if I need to wait a bit for my sugar to come up. My teammates and co-workers humor me with my “guess my blood sugar” game—which, incidentally, they tend to win more than I do. And I have sought out other friends who also are positive role models to me in my life.

More recently, in the past few years, I have re-discovered the diabetes community. After hearing about the JDRF for years, but never participating in their activities, I decided that I might as well put some of my endless miles on my bike to good use and signed up for the Ride to Cure Diabetes in Whitefish Montana. What I received in return was far more than a beautiful ride in Montana—although I enjoyed that plenty. Being with a group of people, both with and without diabetes, all united in a common goal to find a cure, was overwhelming. I was able to connect with other type 1’s who were athletically inclined, and to begin to realize that some of the problems I had were not so unusual. I had just assumed over the years that I was a “bad diabetic” for not always being able to keep my blood sugars within the windows prescribed to me when newly diagnosed. And for a few magical days, I felt like the mental burden of the disease was lifted. We were all in this together and it was a comfort to just be around people who really understood what it was like. It was really life-changing for me.

With one of the many amazing parents riding for their kids

My experiences at the JDRF ride further confirmed to me that I had made the right decision to join a group of type 1 athletes to compete in Ironman Wisconsin 2008 as part of a documentary and exercise research project called Triabetes. Meeting up with several of the Triabetes athletes last December in San Diego reminded me of that same feeling I had in Whitefish. It was just a relief to run with some other diabetics who were also carrying a lot of extra gear and didn’t ask me if I really needed to carry all that sugar for an 8-mile run. And it was inspiring to be able to run with Bill Carlson, the first type 1 to ever do an Ironman 25 years ago, and to see, that even after all of these years, he is incredibly fit, healthy and able to do the things that he loves to do.

Meeting some of the team in San Diego at the TCOYD
Triabetes/Insulindependence booth.

I was able to meet up with Triabetes athletes again at Diabetes Training Camp down in Santa Barbara this past March. At the camp, run by an endocrinologist, Matt Corcoran, I learned about exercise physiology and made some discoveries about why I might have had such a tough time at Ironman in 2007. I learned new strategies about how to improve my training for the coming race season and practical methods for implementing those strateiges. I met with the filmmakers of the Triabetes documentary and met their daughter Elisa, who also has type 1 diabetes. I connected with my Triabetes teammates and enjoyed riding up through the Santa Barbara hills as a team, and made new friends from around here and all over. And I learned that, despite my own self-criticism, I hadn’t done so badly on my own over the years. But, better yet, I felt like I was finally developing both a medical and support network to help improve my diabetes control and to allow me to maximize my potential as an athlete. Plus, I discovered, type 1 athletes—even those just starting out on the path—are pretty cool people.

Inviting some younger adventurous types to the Triabetes project was the next step with the IronKidz program. Ten kids were selected from across the country to team up with one athlete each in a summer mentorship partnership and some fundraising, culminating in a canoe trip for the kids a week before Ironman Wisconsin this September. I was just able to meet my IronKid today and look forward to visiting with her more over the summer as she and I both prepare for our trips to Wisconsin, and to having her there on the course. (Hi Marissa!) I can’t tell you how helpful it is to have support during a race like this, and it will definitely keep me going when it gets tough (as all Ironman races do) to know that she will be there, pulling for me. Thanks Marissa for your enthusiasm in being part of the IronKidz project.

With my IronKid Marissa, chilling out at the Giants game.

I also hope that the kids doing this can continue to be a part of the diabetes community—even after they are too old for Bearskin Meadow Camp—and don’t spend years trying to figure it all out on their own, as I did after high school.

After signing up for Ironman Coeur d’Alene 2008, I didn’t tell anyone for a month. I was afraid people would tell me I was nuts for doing it again! But I knew after the 2007 race that I could do better. And after learning from my first experience, and from the insights I’ve gained by connecting with other athletes and experts in the diabetes community, I am happy to report that I came across the finish line a week ago Sunday, smiling, feeling victorious to have taken almost a full hour off my time. I still didn’t have a perfect race, but had some big improvements; I was pretty excited to see a blood sugar of 149 midway through the swim, and a finishing blood sugar of around 110. And throughout the race, I knew that my friends, family, Triabetes teammates and others in the diabetic community were behind me 100%.

Knowing that I will be racing with 11 other type 1’s and will have a team of 10 IronKidz cheering for us along the way will make Ironman Wisconsin 2008 an experience of a lifetime. It might even be enough to wipe away the tears of my 34th birthday 2 days before the race! I can’t wait to see the smiles and tears on the faces of my teammates as they cross the finish line (assuming I beat all of them of course)! Keep posted for the documentary which will tell the whole story.

This is how I have tried to live my life.

When I look back over my life so far, and try to think about how diabetes has played a role for the past 20 years, I have a hard time. I don’t think of my life in terms of diabetes, but rather I remember those experiences that have shaped who I have become.

I have tried to continue to do those things that I love to do, and to reach for goals that may seem just beyond reach. Along the way, I have been supported by friends and family who have given me help when I needed it and quiet confidence that they were there even when I felt strong on my own. I’m not saying that diabetes has always been easy, but for the first time in the past year, I feel just a little less anxious for a cure because of how much I treasure becoming part of this community.

Best wishes to you all as you pursue your own Ironman dreams, whatever they may be.

Ironman Coeur d'Alene 2008 Race Report

(Note: this race report includes some details on diabetes management but I will write up another summary with more details and data, as well as pictures!) Glossary below is for those not familiar with diabetes lingo:

• BG, blood glucose, blood sugar: the amount of glucose in the blood; in someone without diabetes, this is usually around 90-100 mg/dL;
• BG meter (UltraMini): device to measure blood glucose, requires a drop of blood
• Insulin pump: insulin delivery pump, used instead of injections; does not replace BG testing; I use an Animas pump which is waterproof, enabling me to wear it during the swim;
  
• Dexcom: continuous glucose sensor, measures glucose subcutaneously, must be calibrated to a BG meter, does not always match up perfectly with BG but can be particularly useful to spot rising or falling glucose
• Basal rate: the amount of insulin being infused at a constant rate from the insulin pump, usually varies with activity and time of day
• Bolus: like an injection of insulin only through the pump, programmed manually
• Insulin: hormone made by the pancreas, missing in people with type 1 diabetes; insulin allows glucose to move from blood into muscle and fat cells and causes a decrease in blood glucose concentration; carbohydrates cause an increase in blood glucose concentration and exercise has variable effects depending on the concentration of insulin and glucose in the blood.

When I signed up for Ironman Wisconsin for Triabetes, I wondered how I would handle Ironman Coeur d'Alene. For many reasons, I still wanted to do it but worried about the toll it might take. Would I be able to do both? That remains to be determined but after my positive experience on Sunday, I feel confident that my body will recover and I will be able to resume training for September. Last year, my recovery was very difficult and it took all I could muster to compete in the Big Kahuna Triathlon, a half-ironman triathlon which falls on the same day as Ironman Wisconsin. But the theme of this year's race was how much better things went than last year. The race still had its ups and downs, but I felt like I was able to achieve my goals in nutrition and hydration and to learn a lot about diabetes management that will help me have an even better race in September. Don't get me wrong--the race was hard and there were moments on the course where I pondered (fleetingly) how the Triabetes team would feel with one less member! Of course, pondering the next Ironman is not a wise thing to do after being on the course of the current one for 10 hours.

Late Saturday afternoon, I had a light dinner and headed back to the motel. I had finished packing my special needs bags and was ready for bed. Unfortunately, sleep would not come easily. I really wanted to have a working Dexcom sensor for the race, and the current one, which I had inserted a few days prior, was not calibrating well. I didn't want to reset it because I would have to wake up around 11 PM to calibrate, and I knew once I was awake it would be tough to fall asleep again. But it wasn't working and so I decided to reset it. I woke up later to calibrate and then again at 1 AM to check and see if it was working. No. I decided to get out of bed and put in a new sensor. So a couple hours after that, I got up to calibrate and then tried to sleep for a few minutes. I think I got about 3-4 hours sleep max. But, I did have a working Dexcom at least. I tried to comfort myself knowing I had slept less before marathons.

Race Day
Around 3:45 AM, I got out of bed and ate my breakfast of oatmeal, banana, peanut butter and a cup of soy milk. My basal rates were pretty high from my taper and I was happy to see that I never had a big pre-race spike from breakfast. Soon enough, we were all down at the race start, getting body-marked and doing last-minute things with our bikes and transition and special needs bags. The sky was mostly clear and the temperatures were pleasant. The only hitch in the forecast was for possible thunderstorms during the swim. I wondered how the swim director would handle that one. About 15 minutes before the start, my friend Jill and I made our way to the swim timing mats--it was crowded! I was a little anxious about getting to the beach before the gun went off, but we barely made it with about 4 minutes to spare. We headed over to the left, where I started last year, and stood for just a few moments until the canon blasted right in front of us. I guess it was time to start!

Where's the fire (or should I say "shark"), people?
The first lap of the swim was pretty rough. I tried to take the line near the buoys to avoid getting stuck far on the outside, but there was not a smooth line to be found. People seemed to be swimming frantically; perhaps because I held back a little at the start I was in a clump of more nervous swimmers? I'm not sure but it was pretty much impossible to get a rhythm going. And the corners were especially bad. My suggestion to race officials would be to emphasize swim etiquette at the Friday night athlete meeting. We hear a lot about cycling rules but the anonymity of the swim seems to lead to some pretty rude behavior--outright shoving and dunking are not uncommon! Who are you people who do that?

Hopping out of the water I looked for my friend who would help me to test my blood sugar between laps. There he was! I tested at 149, ate a GU and hopped back in for my second lap. My time after the first lap was about 48 minutes, faster than my Wildflower time by one minute and 2 minutes ahead of last year. I was happy with that but, more so, I was happy to see my BG was pretty much perfect. I was confident that I would not get low on the 2nd lap, and relaxed a bit. A few buoys in, though, my right bicep/shoulder injury flared up and it was painful throughout the rest of the swim. I was a little disappointed that I couldn't use my right arm fully but it seemed to slow me down by only a few minutes. I was very happy to see a time of 1:42 coming out of the water--a 13-minute improvement over last year.

And regarding the water temperature of the lake, it was nearly 60 degrees the morning of the race, and was not an issue for me. I did not wear the aqua socks or booties and actually felt a little warm when the sun came out during the swim. I did wear my nice Tyr black insulated cap under the pink cap, and that kept me comfortable. I'm glad I spent some time acclimating in the Bay and Lake Cd'A beforehand, though.

A ride through Kootenai County
The wet suit strippers did their job and I found myself preparing for the bike. My BG was a bit above 200, a little on the high side--I guess I should have left my basal a little higher. This year, I decided to wear the same thing for the swim and bike since I finally had some great tri shorts that were suitable for a long course triathlon. Thanks Team Pacific Bicycle! I grabbed my bike and made my way, pretty happy to be on the ride before 9 AM this year.

My goal for the ride was to keep it easy and to keep my heart rate around 150 bpm or less. It was tough those first few miles to stay below 160 bpm but I was pretty disciplined about slowing down; although what I really wanted to do was blast by a lot of people and catch up to the faster swimmers. I hate being left behind! One fun thing about being a slower swimmer is that I don't get passed by too many people on the bike, except for the random guy who, by his aero helmet and bike, seems to be in the wrong spot. The bike course is beautiful and I enjoyed the scenery more this year than last, perhaps because I was less anxious throughout the day. The only warm area was near the first section of rollers by Hayden Lake, and then we did have some moderate headwinds on the ride back to town. It was hard to complain too much since those headwinds were pretty nice tailwinds on the way out.

I can't remember why I waited so long to check my blood sugar on the first lap, but when I did, I was surprised to see a reading of 306. "Shoot! I thought I was going to have perfect blood sugar!" After such a great swim, I was hoping for perfect BG day! I did not get anxious but took a 0.5 U bolus and started drinking a bit more water. Since I recognized this as a pattern, I did not get concerned that I was having insulin or pump problems and knew it would come down if I just took some extra insulin. The BG continued to rise over the next 45-60 minutes--meanwhile, I continued to hydrate with water, took one salt tablet and bolused another 0.8 U insulin. The Dexcom showed that the rise was tapering off, and once I saw a plateau in BG (2 readings of 390), I resumed drinking my Perpetuum (4 scoops + 4 scoops electrolyte powder) and started eating the bananas offered at the aid stations. I had to stop a few times to use the portapotties because of all the water plus the high BG, but was not too worried about it. I was happy to see my BG settle down to 157 after a couple hours and the Dexcom showed that it was pretty stable.

I felt great going into the second lap and ate all of my pretzels (but nothing else) from my special needs bag around mile 65. Riding back through town, I was trying to pass a slower rider who wouldn't move over to the right. He kept blocking me as we went around the corner and up the hill to Government Blvd. I took the hill a little fast and my heart rate was probably up because right after that, I started to feel pretty bad. It was as if my body was saying, "No you don't!" Unfortunately, that happened to be where my parents and another friend were waiting. I tried to muster a cheery "Hi" but thought they might be worried. I was barely moving and started to think about how unlikely it was that I could continue like this. How could I possibly finish the ride and then run a marathon? I was feeling some cognitive disconnect and a bit dizzy and thought my BG might be low, but it was a healthy 127. Hmm. I looked down at my odometer and saw "75" and then it struck me. "So this is that 80-mile thing that can happen on the bike." Last year, a sports psychologist, Jim Taylor, had spoken with our group about mental strategies for an ironman. In particular, he had noted that many people hit a point of mental fatigue around 80 miles on the bike. At that point, the day is starting to wear on you a bit, yet there is still a long way to go. Since the symptoms felt so similar to low blood sugar, I decided to eat a bit more and to just keep the pace low. For the next hour or so, whenever I pushed my heart rate above 152, the dizziness and spacey feeling would return, so I just kept things mellow for awhile. This meant going up the hills really slowly but I had promised myself not to worry about pace, especially on the bike. Eventually, I started feeling stronger again and for the last 20 miles of the ride, felt great.

Riding back into the transition area was a joy, even though I had 26.2 miles of running ahead of me. I like to run and felt ready to go. Plus, I was glad to ditch the bike for awhile. Expecting a slower time on the bike than last year, I was surprised to see a time of 6:58 on my watch. Great!

A lakeside run
Coming out of transition, I saw a group of friends who were there to cheer on Jill and me. They were cheering enthusiastically and I was happy to see them and so I returned with a vigorous cheer. A few slow steps into the run, though, I thought, "Hmm, maybe I could have toned it down just a bit there?" But, well, we owe a lot to those spectators who run around all day to keep us going, no? It wasn't too hard to smile when I saw my friends and family along the course; I had usually been looking forward to seeing them for miles.

My pace for the first few miles was okay, but it started to taper off a bit and I was having to eat a lot to keep my BGs above 80. During the first half-marathon, I had one (measured) dip below 80 and would periodically get it above 100. I kept adjusting my basal rate downward, but avoided shutting off the pump entirely, which had led to some problems last year. Still, last year I shut the pump down for three hours and it probably would have been helpful to just shut it off for 30 minutes when I was continuously below 100.

After the halfway mark, I ditched my Vitalyte bottle and decided to do cola and 1 GU per hour. Either I wasn't taking enough cola in, or else it wasn't being absorbed as well as the Vitalyte, because I had a sudden drop in my BG to 66 around mile 17 or 18. I had noticed my heart rate falling and pace dropping off but hadn't caught the falling BG. I ate a GU and started drinking Gatorade and shut down my pump for 30 minutes. I noticed at the 20 mile mark that it might be possible for me to break 14 hours if I could increase my pace a bit. But looking at my splits, I was getting slower and I decided to not worry about it. I hit the big hill of the course for the second and last time, and decided to walk it, noting that my walking pace was about the same as my running! Bummer! Anyway once I hit the turnaround, I resumed running. I was on the home stretch now. Only about 5 miles to go!

The weather was still pleasant with some overcast skies, if I remember, and I was happy to be running in the light. One spectator said, "You are going to see a beautiful sunset!" and I remember thinking, "Not if I can help it." I secretly wanted to finish before they handed out the glowsticks this time. But would it be possible at my 12 min/mi pace? I hit the 21-mile mark right at 8 PM, which would make finishing before 9 pretty tight. I didn't take a split again until mile 23 but was surprised to see 20:42 on my watch. That was about 10:20 per mile or nearly 2 minutes faster per mile than I had been going. Hmm, maybe I could make it after all! I noticed on the Dexcom that my BG had risen and was starting to plateau. I would have to race my BG to the finish, I thought. "We'll see if I can finish before it drops!" I kept drinking some gatorade and cola but didn't eat any more food for the remainder of the run. The next splits were 10:09 and 9:57 and I saw that I was going to make it. I was feeling strong and felt some pain but was not suffering too much. People were happy to see a happy runner and cheered me enthusiastically those last few miles. I rounded the last corner and had my own few moments of being a super star since I was pretty much alone for the home stretch. The finish at Coeur d'Alene is amazing and I waved my pump, UltraMini and Dexcom in the air in victory! Yay! The last 1.2 miles I finished at about a 10 min/mi pace although according to my Polar I was running at a 7:36 pace at my fastest. (Thanks Duane for making us do a time trial at mile 21 of our 22-mile run!) I had finished the marathon in 4:55, slower than I had hoped for but 27 minutes faster than last year.

My finishing time was 13:52:19, 50 minutes faster than last year. Splits were as follows:

• swim: 1:42:42
• T1: 8:48
• bike: 6:58:10
• T2: 7:04
• run: 4:55:37

After crossing the finish line and receiving my medal and T shirt, I was asked if I needed any additional help. Last year I had about 4-5 people surrounding me and had a "catcher" escort me to the medical tent. When the volunteer at the finish let me go on my own this time, I was surprised. I guess last year I needed special attention! I felt surprisingly good and never experienced the post-race misery like last year. I felt properly hydrated but not overly bloated or puffy. Sure I was sore and a tad dizzy but overall I was doing great. I signed up for my massage, grabbed some pizza and visited with my teammates and coach who had already finished. Soon, my family and friends made their way to the athlete area and I greeted them, very thankful for their dedication in staying out there all day. It is a long day for them, and they deserve a lot of credit in getting us all across the finish. Thanks!

A celebration of humanity
Visiting with my parents the next morning, I asked if they enjoyed the Ironman experience. My mom had come last year but this was my dad's first time at any triathlon, let alone an Ironman. My dad suggested that the whole experience was a "celebration of humanity." After reflecting on that, I agree that the Ironman is indeed a celebration of what is possible for the human body and spirit; the coming together of family, friends and volunteers to make the day possible is an act of love. It is so uplifting to see spectators cheering on not only their own loved ones but other athletes who need some encouragement. And there are moments between athletes, little words of encouragement and assurance, that touch the spirit and remind us that we are all in this together.

Thank you
Thank you to all my friends and family supporting me on the course, online, through phone calls and emails and words of encouragement throughout my training. I was lucky to again be coached by Duane Franks and Dorette Sommer of Trifiniti and to have the added and much-needed expertise this year from Matt Corcoran and his staff at the Diabetes Training Camp. It was a big victory to me this year when I passed the aid station on the run where I had to stop for some time last year. Also thank you to my teammates from Triabetes and Team Pacific Bicycle, as well as my co-workers, whose support buoyed me along my way.

Now it's time to start thinking about September. After my experience this year in Cd'A I cannot wait to race IM Wisconsin with our Triabetes team. (Um, well don't take that too literally.) It will be amazing.