Next Up... Wildflower Long Course

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

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

Nothing Else to Blame...

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

Pump Break

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

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

A ride in Napa

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

Save the A1c

I have had a very frustrating week. Since my training weekend about a week ago, my blood sugars have reverted to their high-in-the-morning, crash-in-the-afternoon pattern. I thought I had taken care of this with a new bottle of insulin and diet modifications. Well this time it is not the insulin, the infusion sets and probably not the pump (although it is my current suspect). It is like I suddenly reverted back to my pre-Ironman-training state. Right now my BG is 300 and I only briefly was able to get it down this afternoon. It's either low or high--I'm not finding too much middle ground right now. The Dexcom has helped me cut back on testing, which makes my fingers (and my insurance) happy, but the high BG's do a number on my mood. I guess I should just increase all my basals, correction factors etc. It seems like the insulin is acting way too slowly--like 2 hours too slowly.

The Tierra Bella Century went great on Saturday except for the 419 that struck me after descending a 10-mile climb. I gave a 1-U injection of insulin and it came down to 124 or so within about 70 minutes. My gut feeling is that this would not have happened if I'd done it with the pump, but that is because my pump is currently the object of my blame. Anyway, the rest of the ride was good despite pretty decent headwinds for the last 20-25 miles.

On a cheerier note, I saw some random things at the ride Sat--a herd of all-white cows getting rounded up by a guy on a tractor. Those cows were running! I also saw about 200 soda cans that someone had spilled on the road. They were all blowing in the wind, reflecting different colors off the sun, and making little tinkling sounds as they rattled around. The whole group of riders I was with spontaneously slowed down to observe the scene and then dug back in to finish off the last few windy miles. The people who had lost their recycling were trying to reclaim as many cans as possible...

Save the Fingers!

I finally ordered the Dexcom7 and am now eagerly awaiting its arrival early next week. This should cut down on the testing I do while at work, when my blood sugars are typically very stable or dropping (as of late), and should also make things easier on the bike. During Ironman Coeur d'Alene last year, it was working well enough for me to stop using the BG meter for a couple hours. And that was the STS version--I think the 7 should be even better. Also, I am excited to be able to prevent some of the lows that I have been having lately. With the increase in exercise load, and the drop in weight, things are in constant flux. Adjusting my nighttime basal rates should be easier as well--I know from previous experience that it is possible to be decent at 2-3 AM (when I often wake up and test) and still have significant fluctuations at other times. The next hurdle will be to get some reimbursement from my insurance, which may be more difficult than my 100-mile ride on Saturday.

Sprinkler Fingers

Sorry for the gory title but seriously, why do I even re-poke my finger when it bleeds in 4 places when I squeeze it? This is getting ridiculous. I need to check on that Dexcom order. My fingers are not happy, even if my blood sugars are.

Change in Strategy

Yesterday, instead of taking my extended bolus on the ride, I decided to follow Matt's advice to set a basal rate that we thought would cover me for about 250 calories per hour. Matt suggested 0.55 U/hr, which is 0.1 U/hr higher than my normal basal rate at that time. Honestly I was a bit afraid that I would be high the whole time, but that was not the case. I was very happy with the outcome, and felt more comfortable that I could eat and keep my blood sugar high enough, as opposed to last week's ride. Above is a screenshot from the day using Kevin's logbook. (Thanks, Kevin!) I felt strong at the end and my only problem during the ride was some discomfort due to the heat. It was probably about 20 degrees hotter than it's been lately. I think the BG's would have been steadier if we hadn't taken such long breaks. I didn't experience a post-exercise rebound like I often do, and felt like I was absorbing more carb's following exercise without bolusing as much or at all. This may be in part due to the fact that doing workouts this long is still somewhat new for me this season; we'll see how it goes as the season continues. My insulin to carb ratio for the rest of the day was somewhere around 1U:20-40g.

As a fun note, I set my new max speed on the bike: 47.4 MPH. I think I was going downhill with a slight tailwind (the only tailwind we had for the entire ride).

My race plan (in case you were wondering)

After much deliberation and many discussions, I have decided to go ahead with my plan to do both Ironman races this year. I am 100% committed now! (I was already mostly committed but felt uneasy about my approach. Would I race IMCDA hard? Or Wisconsin? Would I live through September? Would I be able to recover from IMCDA in time?) My plan is to continue losing weight over the next couple of months and to use Ironman Coeur d'Alene as a tool to refine my diabetes management and nutrition for Ironman Wisconsin in September. Instead of peaking my conditioning for Coeur d'Alene, I will back off most of the high intensity intervals except for my weekly cycling class, and lengthen the weekday workouts a bit. I'm sort of sad, actually, because I was really enjoying my tempo runs at heart rate zone 5a (seriously). We still need to do some planning for the recovery for IMCDA and the last 2 months' training before IM Wisconsin. (There are 11 weeks between the 2 races, to be exact.)

Thank you Duane Franks, Rick Crawford and Matt Corcoran for all your help & confidence. I'm pretty fired up!

WFTW 2008

Wildflower Triathlon 2006

Another weekend traveling on 101 brought me to Lake San Antonio for the annual pre-Wildflower training weekend, aka WFTW. Saturday, we had the pleasure of doing not one, but two loops of the Wildflower Long Course bike route. For those in the know, that means going up "Nasty Grade" twice. (However due to a romantic event between two of our favorite coaches at the top of aforementioned Nasty Grade, we had to rename it "Engagement Grade" or perhaps "Proposal Point"?)

I felt great on the first loop of the course, and my BG's and nutrition were on target, despite an initial high due to an unbolused banana right before starting. I had breakfast (PureFit bar + banana with 2.15 U insulin) 3 hours before riding and started a 2.1-U, 3-hour extended bolus at 8:22 at the beginning of the ride. I had one bottle of Perpetuum (5 scoops P. + 4 scoops electrolytes) and planned to eat another 100 cal's per hour in Fig Newtons and GU. That all seemed to work out pretty well. Around 45 miles, I swapped out my Perpetuum bottle for the second bottle (4 scoops P. + 4 scoops electrolye) and continued with the same plan. I decided to try eating without any further boluses. From mile 50-85, my BG's were reading 103, 99, 108, 110, 107, 122, 95, 119, which sounds great, but didn't feel great. Like another diabetic runner, Marcus Grimm, I also feel better with a slightly higher BG, somewhere in the 125-140 range. I'm not sure if it's because my body is unused to exercising at the lower level, if it's a mental thing (i.e., I might get a little nervous and start imaging low BG symptoms?), or if the muscles actually work better at a higher level (maybe related to my average BG or maybe there is an absolute difference for diabetics?) As it is, when my BG is around 100, I feel like I am eating to prevent a low, and it is distracting to be on constant alert for hypoglycemia.

And speaking of hypoglycemia, I'm pretty sure I had a bit of that on my second climb up Engagement Grade (i.e., N.G.) but I didn't stop to test. I ate a GU while redlining it (not so appetizing) and managed to drink some water, all without getting sick to my stomach. (Thank you, stomach, for being so tough!) But at the top, or around mile 90, I had a reading of 78, so something was definitely going on. I didn't really recover for the rest of the ride, but made it back with okay BG's and even did the insane climb back up to the cabins. (Shannon's cookies were waiting.)

Overall, I am really happy with the way the ride went. It was a gorgeous day, windy as usual for the area, with sunshine but a bit of coolness in the air. It was a great confidence builder to do the course twice, and I will certainly be happy with doing "only" one loop on race day! I feel like the first half of the ride went well as far as nutrition and diabetes are concerned, but the second half needs work. Perhaps I need to reduce my basal rate further as the day goes on (my basal rate was 0.25 U/hr at its minimum) or reduce my bolus for the food the first few hours (maybe 1.5 U over 2.5 hours) as Ed L. suggested to me in a recent comment. I guess there will be plenty more opportunities to test this out!

As another note, the 13-mile run the next day went great. I tried reducing my basal rate 20% 30 minutes before starting but I guess I fueled up pretty well after the ride, because I ended up battling highs (250-300) the whole time. I felt strong and didn't seem dehydrated but who knows what was going on. I tried doing mini-boluses of 0.2 to bring it down but it wasn't budging. I had eaten a banana before starting, which set it all off I guess. I expected my BG to fall once I started running. The intensity of the run was moderate, with an average heart rate technically still in heart rate zone 1. I did have some more intense bursts since it was quite hilly and I was going pretty hard towards the end, so that could explain my finishing BG of 309...

We did a swim in the morning in the lake, which happens to be completely full of algae or some other creature/plant that looks like tiny blades of grass. On the one hand, I thought it was sort of freaky--I kept thinking of the sea lion at Aquatic Park who, according to officials, had gone mad due to "toxic algae!" In the end, though, I wanted to swim, and like most triathletes, plunged into the water with iffy water quality. I tried some of my swim drills on the way out, and then did some serious swimming on the way back when I realized that the current was pretty strong against me.

Aside from the training, I enjoyed having some time to visit with my teammates on Team Pacific Bicycle. What an inspiring group of women! And, KC, it was nice of you to hang back with us for a while on the ride. :)

Take a Break at Sojourner Cafe

We were definitely happy with our decision to take 101 instead of the shorter I-5 route home from Oceanside last weekend. The hills were green from recent rain and many hillsides and valleys were carpeted with violet or golden wildflowers. I don't think I have ever seen it so beautiful. One of the highlights of the trip home was stopping for a nostalgic visit back in Santa Barbara. I miss DTC! We took Bill Carlson's recommendation and stopped by Sojourner Cafe for a late lunch. For me, it is a good sign when I don't immediately eliminate 75% of a menu because the items are not well balanced or otherwise unhealthy. I'm pretty sure I would have been happy with anything I chose, but was particularly excited to see a long list of salads that were not your run-of-the-mill green salads. I opted for the Sojourner Cobb Salad, which was excellent. This is basically an athlete's (or other health conscious person's) dream restaurant--fresh ingredients with a gourmet/California/international flair prepared in a health-conscious way you would be happy to eat for lunch and dinner every day of the week! You can take a look at the menu online for now; if you ever find yourself in Santa Barbara, don't miss this place! The desserts looked pretty fabulous as well, but since I was basically going to be sitting in a car for another 5 hours, I opted for the fruit salad with cottage cheese. It was the perfect way to end the meal. Yum.

TT1 in Walnut Creek Tonight 7 PM

Posted on Insulinfactor list by Kyle Rose:

April 1, 2008 - "Diabetes and Exercise" Presented by Team Type 1
(7:00pm to 8:30pm)

Come hear inspirational stories from two members of Team Type 1, a
winning eight person cycling team, who's members have Type 1
Diabetes. Matt Vogel (RAAM Cyclist, 2007) and Kyle Rose (RAAM Crew
Member 2007, Dev. Cyclist 2008) will share their experiences,
including winning the 3,052 mile Race Across America Cycling event in
2007, the world's longest running ultra-distance bicycle endurance
competition.

This free event will take place at: John Muir Medical Center, Rooms
Sequoia 1 & 2, 1601 Ygnacio Valley Rd, Walnut Creek, CA 94598.
Please call (925) 941-5076 for more information.

RSVP is not required. Hope to see you there!

Race Report: California 70.3 (Oceanside, CA)

Racing in Oceanside on Saturday, my primary goal was to improve my diabetes management, especially after the swim. I also hoped to improve my time from last year. Friday, Matt Corcoran and I worked out a race plan considering my expected finish times for each leg. I stuck to the plan pretty closely and was really happy with the results (thank you Matt and DTC). Here is what I did:

• 4:30 AM: PureFit bar + banana, full bolus, basals 100%
• 7:00-7:10 AM: 25-g GU + 10-15 g Vitalyte, got nervous and had another squirt of chocolate GU, basals still 100%
• 7:33 AM: swim start, BG on the rise, left basals at 100%
• 8:33 AM: with a BG of 149 (yay!), programmed 2.3-U extended bolus, 5%/95% spread over 2.5 hours. Ate 300 calories/hour using Perpetuum (135 g total) and 25 g GU/Luna moons per hour. Corrected with 0.3 U when I saw my BG was rising rapidly and took a small bolus for the first 25-g snack. I also ended up eating a chocolate GU (20 g) in the last few miles of the bike since I was on the bike longer than my estimated 3 hours. Perpetuum had 4 scoops of Hammer electrolyte powder mixed in and I had drunk about half a water bottle by each aid station.
• 10:30 AM: basal rate reduced to 0.35 U/hr (78%)
  
• 11:30 AM: basal rate reduced to 0.25 U/hr (55%)
• 11:46 AM: start the run, meter had "hi temp" reading so had to wait to test
• 11:55 AM: BG 118, ate some Sports Beans and continued to drink Gatorade (1-2 gulps) at every mile and 5 GU's total along the way. I was really nervous having my BG hovering around 100 the whole time, afraid that I would drop if I weren't vigilant. When my BG dropped to 86 I turned the pump off for 30 minutes. I felt like I was eating a lot to keep my BG high enough. Although the GU's were not appetizing, I ate them anyway and washed them down with some water. I did not have any GI discomfort except temporarily after eating/drinking carb's, which was resolved by drinking more water.
• 12:30 PM: pump off 30 minutes
  
• 1:00 PM: pump, on, basal rate 0.25 U/hr but at this point, this is 83% of my normal rate of 0.3 U/hr.
• 1:46 PM: pump off 30 minutes
• 1:55 PM: finished race in 6:22, feeling strong through the finish.
  

Some things I might do differently next time:

• Perhaps increase basal rate towards the end of the swim to offset the spike I get in the first 1-2 hours on the bike. Or, include a correction bolus in anticipation of the spike immediately after the swim.
• Reduce basal rate more on the run, and try to keep BG around 120-130 instead of 100. I wasn't comfortable at that level and had to eat too much (400+ calories/hr) to keep my BG up; although I did not feel any GI discomfort eating that much food, and did feel better after eating each GU. Perhaps I should keep the basal rate reduction to about 50-60% so that it goes down even more at 1:00 PM (when my basal normally goes down). Maybe reduce the basal rate to 0.2 once I'm on the run?

My final splits were as follows: 49:33 swim, 3:12 bike, 2:09 run. I ranked highest in my age group in the bike (49 out of 118) followed by the run and then the swim. Both my swim and bike times, as well as my transition times, were slightly faster than last year; whereas, my run time was about 7 minutes slower. I think testing my BG 12 times had something to do with this, as well as my weight being higher this year. I also think I was taking it a little easy on the run, since I didn't feel like I really suffered enough! I felt great on the ride as well--this is the first half ironman in recent memory where I haven't spiked >350 during the ride.

Above is a chart of the day. Additional details can be seen on my sugarstats page. I am also very happy about the post-race management. I usually have horrible highs after the race and even the next day, but avoided that this year. I think it helped that my BG's were better managed during the race, and that I took quite a bit of insulin right after to correct for my pump being off for a bit and for those 3 pieces of pizza I ate. I also turned my basals up 40% for about an hour when I saw my BG climbing rapidly. It worked out really well, and my recovery has been great. I went out running this morning for 40 minutes, and felt comfortable.

The better BG management is also thanks to the eating strategy given to me by Rick Crawford at Diabetes Training Camp. It is very exciting for me to see "140" on the meter and think, "I had better correct for that--a little high." I am looking forward to my next A1c check.