annetics

Lost Bones Reunited! (Hopefully)

2012-01-06T10:38:00.000-08:00

Ten weeks after my bike crash in February 2009, I wrote with optimism that my left clavicle fracture was beginning to heal. And for the most part, the pain subsided over time. Later in 2009, I was able to complete the 206-mile cycling race, Lotoja, and also Ironman Arizona; although, there were lingering issues with my back strength and upper arm strength, especially on my left side. Also, I still experienced a sort of searing pain, like the pain a tearing muscle might inflict, in my upper left arm with certain reaching movements. The pain became worse after I fractured my right clavicle in May 2010 and had to rely on my left arm while that healed. From the medical imaging, it became clear that the left clavicle fracture had never healed; and after months of PT and ruling out shoulder joint problems (cortisone injection, MR arthrogram, etc.), the orthopedic surgeon determined that the most likely cause of my continued searing upper arm pain was this "non-union" fracture. Surgery was scheduled for October 24, 2011, approaching 3 years after the original injury.

The surgical plan was to scrape off the substantial hypertrophic (i.e., overgrown) bone growth at the bone edges and to use that material as a sort of grout between the fractured bone ends. The bone would be properly realigned and then secured with a plate and several screws. Aside from some pretty unpleasant complications from the general anesthesia and pain meds, the surgery and immediate recovery went smoothly. The surgeon was unable to remove all of the hypertrophic growth from underneath the clavicle because of the proximity to major blood vessels; but otherwise, things went as planned. Currently, there is some skin tenderness on the surface of the plate, and it is still too soon to know whether the pain is resolved. But so far I feel hopeful that it will be better than before. If the plate bugs me, there is an option to have it removed once the bone has completely healed.

Six weeks post injury; hypertrophy of bone has not occurred yet. (Xray March 16, 2009)

About six weeks post surgery. There is one longer screw to insert into the hypertrophic bone that couldn't be removed. A healed fracture from 2009 is visible in the 3rd rib down, (Xray 12/6/2011)

What I didn't anticipate about this is that, although planned, the surgery was essentially the same as re-fracturing the clavicle and required a recovery period just as long. So, I am yet again facing another period of regaining fitness lost to injury. Of course, I am grateful that I was able to have the repair and the pain was substantially less (not even comparable, really) to the original injury.

Exercising Post Breakfast

2011-06-30T22:00:00.000-07:00

While there has been some press lately on how exercising before versus after a meal may affect calories burned and weight management, people with diabetes have additional considerations. For me, I have generally avoided exercising soon after a meal simply because I'd rather not deal with the conundrum of either taking my normal bolus and crashing from the insulin once it becomes super-active during exercise or underbolusing and then going high early on. This was especially noticeable with running, and I tried to never have more than 1 U of insulin floating around when I went out the door. For races or other times when I want to have a meal beforehand, I try to bolus & eat about 3 hours prior to starting to exercise. Then, I am able to take a full bolus that is pretty much gone by the time I start.

But today, for various, uninteresting reasons, I wanted to eat before my 1-hour easy ride. So I thought I would experiment a little. I took my full bolus and ate my normal breakfast. But when I took my bolus I also shut my pump off for an hour. Hmm, maybe it was 90 minutes. At any rate, by the time I started my ride, my pump had been off for 45 to 60 minutes; although I had a full bolus still peaking. My BG was somewhere in the low 100s and rose up a bit; I checked about 40 minutes in and it was starting to fall, so I ate a 20g gel. By the time I finished, I was 160; I took a correction bolus and settled in nicely in the low 100s.

I still prefer to exercise with just a snack versus a whole meal, but it was nice to figure out a way to sneak in a ride post meal in case I need to do that again. I think if it had been a much harder ride, I may have had a bit of trouble. Also, since I don't normally shut my pump off (or even modify basal rates) during exercise, I have some room to play with my basal rates. I guess, in the past, I have used this method if I had to take a correction bolus close to exercising; although usually I just take a smaller correction than I might have otherwise done.

ISCorp Downer Classic

2011-06-25T20:53:00.000-07:00

We are off to Madison early in the morning, but I thought I'd update quickly on my blood glucose victory in today's race. Yesterday, I came down a bit low after breakfast, and then turned my basal rate down to +15% (vs +30%), and ate a gel on the line, and finished around 300. Today I tried the same thing but was able to head off the low with a granola bar and a few Dex 4 tabs, and then left my basal rates at +30%. I hesitated but decided to go ahead with the gel again, about 10 minutes before the race start. This race was a fun course, with a sharp turn at corner 2 but two long straightaways which helped me to move around more. I spent some time at the front and also too much time in the wind again, but was felt more comfortable overall adjusting to stuff in the pack and was able to test out my sprint at the end. Following our 30-minute race, I checked the Dexcom and saw 110 with a steady arrow. I had gone up a bit from my pre-race 140 but settled down during the course of the race. Victory! So for the record, today I had my basals up 30% all morning (1 hour before breakfast onwards) and changed my carb ratio from 1:15 to 1:11 and my correction factors by 10 points. I rode around a lot more today and hence had a couple bad lows in the evening. I also did an easy ride yesterday late afternoon, so perhaps that also had an effect.

I stuck around to watch the rest of my team race in the P1/2/3 race in the afternoon, and enjoyed cycling a bit along Lake Michigan. The atmosphere at the race today was downright festive, with lots of local people filling the streets....er, sidewalks.

Fond du Lac at Tour of America's Dairyland

2011-06-24T15:10:00.000-07:00

On day 2 of my diabetes revamp, I seemed to have a bit too much insulin on board. I had a horrible high that kept me up for an hour overnight--I think it was related to the infusion site--but had settled down nicely by breakfast. Eating the same meal as yesterday, I rose up but came down a bit low, 58 right before I planned to warm up for the race in Fond du Lac. (My theory is that since we had such a relaxed conversation on our long drive before the race, I was less nervous than usual. Maybe??) I ate a granola bar plus a handful of Dex 4 glucose tabs, and turned my pump down so it was only +15% over normal. My BG was 166 the last time I checked, and was just barely starting to fall again; unfortunately, my CGM stopped working on the line of the race, and since I was feeling sort of lowish, I decided to eat a gel just in case. The race started and I went to the front and stayed with the pack. I have been working on staying in the pack, towards the front, without doing a crazy amount of work. (My average watts in these races have been high which is mostly reflective of me staying in the wind too much.) I felt like there were some improvements and that my comfort level was much greater. I could feel that racing feeling coming back at last. I enjoyed racing with Erin Ball, my teammate on Team Type 1, and was happy to see her right in the mix; plus she went for a prime and nearly got it. Very cool! It has also been great racing with my friend Katie Styer from the Early Bird Women's team, which I was part of for 2 years--she is a very positive person to have around and she helped rein me in from the wind a few times. After the race, my BG was up to 300 but came down to 224 after 15 minutes of easy riding. Overall, I felt better even though my BG ended up a bit high. We have two more races to go--tomorrow in Milwaukee and Sunday in Madison, where I am looking forward to meeting up with some great friends and supporters of Team Type 1. Yay!

Sheboygan BGs--Update on My Insulin Tweaks

2011-06-23T15:58:00.000-07:00

Dexcom readings around Sheboygan crit

(Update on BGs after major insulin adjustments described in my last post.)

After a bit of a low BG before going to bed last night, I shut off my pump for an hour, which allowed my BGs to creep up to around 200. The increased basal rates were a bit too much from about midnight until I woke up, as evidenced by a steady but slow drop between those times; but fortunately I landed in a nice spot this morning, right around 100. I lowered the early morning basal by 0.1 U/hr so hopefully tonight will be better.

For the rest of the day, things have worked out pretty well. The first bump on the Dexcom shown here is my breakfast spike, which came down after about a 20 minute warmup. I saw "86" with a slight downward trend about an hour before the race start, and still had my basals cranked up, so ate a granola bar. I warmed up a little longer and then headed for the car once it started raining about 40 minutes before the start. My last BG check before the race showed about 135 and the Dexcom showed a flat trend at 120. Finally things seemed to be where I wanted them! I was a little anxious, actually, about having a normal BG, and popped a couple Dex 4 glucose tabs just in case.

The rain began in a complete downpour and I was soaked just waiting on the line. The field quickly became strung out and I was somewhere in the middle (I think), tucking in behind people when I could. One of the biggest puddles on the course was right in the corner, but I actually enjoyed plowing through the water--at least it wasn't cold! After the race, I was elated to learn that my teammate, Becca Schepps, had won the race! I knew she was strong enough and had the tactical skills to do it, so was glad that it worked out! Very exciting.

Once I had changed out of my sopping clothes, I checked my BG and came in at 115, although I felt more like 60. If the race had been much longer, I think I would have gone low (perhaps)? I think that I might either bring my race basal down a little, or eat a little more before if I find myself in the same position tomorrow. I'd rather be up a little at the finish just to be on the safe side. I bolused a huge amount (compared to normal) for lunch and then corrected for the high (seen as the excursion above the line) and have been satisfied with how things are continuing to work out.

Although this game never ends, I am glad to have tamped down some of the constant highs and BG spikes. Tomorrow we race in Fond du Lac, and I am hoping for similarly good BGs but a race without rain!

Adjusting Type 1 Diabetes to Racing Tour of America's Dairyland

2011-06-22T17:05:00.000-07:00

Often when I travel, it seems like I need to increase my insulin basal rates; but racing this week in Wisconsin has required a surprisingly large adjustment. Leading up to the start of the series for me, I had my basal rates on increased, "taper" mode, which is what I try to remember to use when I have a rest week in my training, or am tapering my training before a race. (With a decreased training load, I will need more insulin.) After arriving in Wisconsin for my first race (Friday), I turned on my "race day" basal rate profile. This profile has an approximate 30% increase an hour before my planned breakfast and throughout my races, which are all 30-40 minutes in length, beginning sometime between 11:20 and 11:50 AM. At other times, the basal rate profile uses my normal rates. At my race Sunday in Waukesha, my BG started around 190 and ended up around 300 forty minutes later. I don't necessarily expect to have a flat line (BG-wise) during a race, so my goal is to start lower so that I don't finish the race quite so high.

Aside from the race-related BG spikes, I have had overall higher BGs, frustratingly resistant to multiple corrections. Leaving my race day basal rate profile on constantly was still not bringing my BGs down so yesterday afternoon I just decided to increase my basal rates by another 30% or so. Overnight, things were a bit better and this morning, I programmed a new basal rate profile that is 30% higher than my already high, "taper" profile. I looked back and saw that, instead of my typical total daily insulin dose of 20-32 units, I was needing more than 40 units for consecutive days, which is very much outside the norm for me. Since I had been staying high after meals and my corrections were not working well, I also reprogrammed my carb ratios from 15 g/U to 11 g/U and lowered all of my correction factors by 10 mg/dL/U.

It has seemed a bit paradoxical that during an 10-day race series (with 8 races), I would need so much more insulin. But, perhaps it makes sense. Although I am racing almost daily, the races are short & intense. My blood sugar always goes up during 30-40 min crits, which are high-adrenalin events. The common thought is that, with high intensity activities, adrenalin is released, causing the liver to release glucose from glycogen stores; for someone with diabetes, the lack of a normal insulin response can easily leave the blood sugar high. Furthermore, the short duration of these crits means that my overall exercise volume is much lower. And to compound that, we spend most of the rest of race days resting or doing light activity, which is in contrast to a more typical day of traveling (by foot or bike) to and from work, working a full day, etc.

So far, during our rest day today, I have only had a couple brief excursions over 200, which is a huge improvement over the past few days. It is always nerve-wracking to take so much more insulin, but it seems to be working well so far. But really--since when did I have to take 1.4 units for an apple? We will resume racing tomorrow and continue through Sunday if all goes well, and I fully expect that I will have to make more adjustments. Diabetes is always a work-in-progress!

Total daily rapid-acting insulin using Omnipod

June 12--end of 18-hr training week; June 13--begin taper;

June 17--daily racing begins; June 20--no race

Mid-tour in America's Dairyland with the Team Type 1 Women

2011-06-21T17:42:00.000-07:00

I am starting to lose track of time after multiple days of racing here in Wisconsin. Today is Tuesday I think? So far our team has raced in Shorewood, Thiensville, Grafton, Waukesha, and Milwaukee; we have upcoming races in Sheboygan (Thurs), Fond du Lac (Fri), Milwaukee (Sat) and finally Madison (Sun). We also had the pleasure of riding in the American Diabetes Association Tour de Cure in Grafton before our race there, and spent another day sharing our experiences with exercise and diabetes with local health care providers. We have been taking turns writing up reports, which are posted at the Team Type 1 website here. If you are in the area, we would love to have you come out for a race! Please come find us and say hello. We have women racing in both women's races, typically starting at 11:20 AM (Women's Category 3/4) and 3 PM (Women's Pro 1/2/3). The daily schedule is located at the Tour of America's Dairyland website here.

So far, I have learned an incredible amount both during the races but also in our frequent discussions together off the bike, and have had a lot of fun getting to know my teammates. What an incredible and fun group of women! We are very fortunate to have Kori Seehafer--with her enthusiasm and expertise--directing us each day; managing the logistics of 7 people racing day after day, as well as directing tactics and strategies, AND racing each day is a big undertaking!

It's surprising how much energy even a 30-40 minute race takes after several days, so I will write up more when I have had a chance to rest up a bit. But I will say that I am looking forward to the rest of the series and to racing with my teammates at future events.

Also, I wanted to say thank you to Sanofi-aventis for sponsoring our team, which makes this all possible. I am truly grateful to be able to help spread the message of the importance of exercise in the management of diabetes, and that we can reach for our goals regardless of having type 1 diabetes. Sanofi-aventis is not only helping to bring athletes with type 1 diabetes to the top levels of the sport but is also helping us share this message with the diabetes community and beyond!

My Latest Strategy for Managing Type 1 Diabetes During Road Cycling Races

2011-04-09T22:13:00.000-07:00

After a lot of trial and error, I have finally been having some good success managing my blood sugar during intense cycling efforts such as at criteriums, circuit races and time trials. This is very exciting to me because at some points last year, I was at my wit's end with race-related blood sugars severely high enough to not only hurt my performance but also to raise my A1c slightly.

In general terms, I pre-program my pump basal rate to increase by 30%, beginning an hour before I plan to eat breakfast, and I time my breakfast to be no closer than 3 hours before the race start. So, for example, I started my 30% increase at 5 AM this morning and ate breakfast at about 5:50, in anticipation of my 9:00 AM time trial (TT) start time. I ate a normal breakfast and took my full bolus plus a small correction for a 164 BG. (I actually bolused about 15 minutes before I ate, at 5:35 AM. In general I like to take a meal bolus as far away from my race as practical, while not eating so early that I'm hungry again before I race.) I pre-programmed my basal rate to be +30% throughout the duration of my race. I prefer using increased basal rates versus extra boluses because, in the case that I give too much insulin, correcting for the former is much easier.

Once onsite, I got all my stuff ready, rode about a mile to registration and back, and got ready to start my warmup on the trainer. By this time (8:15 AM) my BG was hovering around 100 so I ate 34 g carbs (clif kid twisted fruit ropes, which seem relatively easy on the BG); since I was about to warmup, I expected that effort to keep me from rising too much, as well. I only had time for about 30 minutes of warmup, and checked in with a BG of 89 ten minutes before my race start time. I ate one clif shot energy gel and could see my BG was starting to rise, so tucked another gel under my shorts and went to the line. (I also had 2-3 gels in my jersey pocket because, well, you never know.) My instinct, when I see a BG of 90 that close to a race is to overreact and eat too much; it has been hard for me to learn to trust that the adrenalin will really kick in (especially with a +30% increase in my basal rate).

Since I have been using the Dexcom 7+, I rarely bring my blood glucose testing kit with me on rides of less than a few hours; and it really is very impractical to test during a cycling race. My confidence in the Dexcom CGM technology has grown tremendously compared to the first STS sensor years ago. (I think anyone who used that remains a bit cautious; but I am quite impressed with the current version.) For races, I set all of the alarms on to sound plus vibrate; I also set the low alarm at 100, the high alarm at 200, and the rising/falling alarm at 2 mg/dL/min. Sometimes I can feel the CGM vibrate but usually I hear the 2 or 3 tones that tell me whether I am high or on the rise, or low or falling, respectively. (I really wish the low and high alarms were fully customizable; actually I wish the number of alarms was also customizable and that there were more sounds to choose from. I really want to know when my BG is below 120 or I may have some other arbitrary target. Actually, what would be even better is if it were displayed on my bike computer screen. Can the Dexcom transmit ANT+ please?) Anyway, for today's race I could hear that I was rising; although at the time I assumed I was high since the alarms are the same. The CGM graph showed that my BG rose throughout the race but peaked at around 180, which I'm pretty happy with. It was still on the rise until after I finished racing.

I've used this approach for the past couple races now, and I am slowly beginning to trust it; although I realize there may yet be a better strategy. In some ways, it is similar to the challenges I had during T1 (transition between the swim and bike) in half- and full-ironman distance triathlons. Believing that a 400 BG after a significant swim plus hour on the bike is due to my own hormonal response, and not some fault in the insulin delivery or some other wacky unknown, took some experience. And believing that I could really increase my basal rate during the swim (or end of the swim) took some trial and error as I gradually increased my confidence that I wouldn't go low. If insulin didn't cause low blood sugar, this would all be so much easier, no?

Oh, and for today's race, I came in 4th place for the women's 4 field. Race reports that may describe more of the race details can be found on the Team Type 1 website.

Total Daily Insulin Versus Cycling Time

2011-03-30T22:49:00.000-07:00

Thanks to my super-fantastic coach and team director Kori, I have been logging my workouts since she started working with me late last year. From my insulin pump, I can also pull off my total daily insulin amounts (or "TDD" for total daily dose) since the beginning of time, give or take. I thought it might be fun to just plot out my TDD as a function of my cycling time, even though the results are probably as shocking as showing that washing hands reduces the spread of colds. Anyway, I decided to just do a very simple linear regression of the data between January and March, 2011. This model ignores variables such as what other exercise I did that day (I often walk about 40 minutes per day), whether I ate more or less than normal, my weight, how old my infusion set was, etc. In short, the only variable I am considering is time on the bike. But there still is a clear trend that shows with increasing time on the bike, I took less insulin.

An Overly Simplistic Model But Still Sort of Interesting

For those who like details, the slope was -0.046 U/min, the y-intercept was 35.3 U and correlation coefficient was -0.65. If I included only March, rather than January through March, the correlation coefficient was -0.68. The mean TDD for January was 32 U and was 30 U for March. Total cycling time was only 90 minutes more in March although the intensity was higher. My weight was about 5 pounds less in March. Again, one of the most important and obvious variables affecting TDD is calorie intake, which is not included here. But still it was fun to plot this out since the data was readily available. Maybe I will be better about logging total activity time, including other forms of exercise, for a period of time. If I am super motivated, I might even track calories although I can only stand doing that once in a while.

Survey on Exercise and Motivation

2011-03-25T17:29:00.000-07:00

I am working on a post about what motivates people to exercise. If you'd like to contribute, please share your thoughts at this poll. Thanks!

Intensity and Blood Sugar

2011-02-09T12:18:00.000-08:00

When I was diagnosed with type 1 diabetes, one of the guidelines I was given was that exercise would make my blood sugar drop. Like most guidelines I received, this was an oversimplification. During my years of daily running, I would go out the door without eating or taking any insulin, and often return with a slightly higher BG level. I remember thinking, "'Guess I'm just weird." And during track workouts, the response was even more perplexing. After a few intervals at high intensity, my blood sugar would really start to climb. I grew accustomed to this response and began taking some correction boluses or temporary basal rates to help temper the steep rise. What I have learned since then, and which has hopefully become more common knowledge, is that high intensity physical efforts can increase the adrenalin and stimulate the liver to release more glucose into the bloodstream. (Here is an article that explains the phenomenon and suggestions for how to manage it. Also, fellow type 1 and exercise guru, Dr. Sheri Colberg-Ochs, has an excellent book devoted to the nuances of diabetes control and exercise.)

I think there is another reason that exercise does not always cause my blood sugar to drop, even when I am doing a more moderate-intensity workout: I have basically adjusted my basal rates to account for morning exercise, and I am consistent in exercising almost daily. So, instead of constantly reducing my basal rate, I try to remember to increase it on my off days. Of course, with anything diabetes-related, things don't always work out as planned--there are still days when I have to eat 3 gels to get through an hour of exercise!

When I first start a new exercise type, or increase volume and/or intensity of my current regimen, I will typically notice an increase in insulin sensitivity, as manifested by more frequent low blood sugar (unless I catch on early and adjust my basal rates). This can be significant, especially initially; over a few weeks, the effect seems to be reduced, although I will still be more insulin sensitive than prior to the change in exercise (up to a point). I remember, when I first started doing triathlon, I had a couple hours in the afternoon where I had to shut my pump off. My body adapted to the changes and the effect did not last for more than a week or so; but still, I had an overall, significant decrease in my daily insulin dose that persisted. I had been running 6 days/week for years so initially, at least, it was primarily the change in exercise type that was responsible for the effect.

When this effect diminishes and my insulin needs increase a little, I see it as a sign that my body is becoming more efficient at the exercise and that my fitness is improving. Or maybe it's just time to take it up a notch again.

bike class at the beginning

I regularly attend a bike class that has efforts mainly in my upper power zones, equivalent in intensity to a track workout for running. It takes a lot of focus to keep my intensity high because, basically, it hurts. I have been watching my CGM during class to see what types of intervals cause my glucose levels to rise or fall. Today's workout called for a five-minute warmup followed by isolated leg drills. We then moved into two five-minute high cadence intervals, following by two sets of six minutes at low cadence followed by a minute rest and then six minutes at high cadence. These were all hard efforts and I tried to push it as hard as I could. I came into the class right around 100 mg/dL and held off on eating anything. For the first half-hour, things remained steady. I expected to see a rise after the two high cadence intervals, but it remained steady. However, about 10 minutes later, there was a slight increase, which is the first bump you can see on the CGM display. This came back down somewhat and I remained in a good zone throughout the class. The high cadence intervals feel a lot harder to me; it takes much more determination to stay at 115 RPM for six minutes for me to do the equivalent Watts at 65 RPM. For me to have the same heart rate at 65 RPM, I can increase my Watts by about 30. This may explain my general observation that the high cadence intervals stimulate a greater blood sugar increase than the low cadence intervals. Perhaps, today, the alternating high then low cadence intervals kept things more steady. I need more data and translating this to the road may not be totally straightforward. But I will add that the only bike race where I have had low blood sugar was the hill climb at Kern County Women's Stage Race. (Of course, the hill climb being the second race of the day muddies the waters a little.)

Oh and now you can see, perhaps, why I want to have the power meter (and/or other fitness devices) and CGM all integrated. I won't go off on another rant right now since I already took care of that here!

And one more thing: I think this stuff also applies to athletes without diabetes. I am surprised that people haven't started using these tools to refine athletic performance. Seriously, people pay big bucks to save 10 grams on their wheel, which is absolutely meaningless if you don't fuel properly and get sub-optimal blood sugar during a race. It is really hard to nail down blood sugar levels unless you actually measure them. (For example, I have bonked with normal blood sugar.) And as luck would have it, there are plenty of tools to do so. I would love to see some top athletes show their data during races, for example. Bueller? Bueller? Anyone?

Addendum: I'd like to add a reminder that exercise can of course cause a drop in blood glucose, which can become life-threatening if treatment (i.e., a carbohydrate source or glucagon) is not available. I almost always have at least 50-75 g of fast-acting carbs with me, and more if I am exercising >1 hour or somewhere without quick access to a store etc. And I always bring along the CGM and/or BG meter. (I rely on the CGM alone for workouts <2-3 hours, but will bring the meter as well if I'm going longer.) Don't make fun of the bulging pockets on my jersey!

A Few Requests (Short of a Cure)

2011-01-12T23:53:00.000-08:00

"I'm melting!"

When I was in college, two days before my first marathon, I capsized while sailing in the Charles River. I blame my "date" who told me he sailed every summer growing up. That seemed likely until he pulled the sail in tight, and didn't then release it when we were jibing in a strong wind. End of story. The boat house folks sent out a canoe for the sailboat but nothing for us. After swimming to shore, I pulled out my pump, securely water-proofed in a few ziplocs, held it up and watched the water drain onto the ground. Oh no. For my first marathon, I was back on injections for the first time in more than a year. After then, I would have dreams where I was swimming or otherwise submersed in water and I would be holding the pump above the water, frantic that it might get wet. I felt like one of the witches in Oz. Once I finally was able to switch to a waterproof pump, those dreams went away. The development of water-proof insulin pumps is one of the advances that has made a significant, positive impact on my life--not just in getting rid of my pump-drowning dreams, but allowing me to stay connected during years of swimming and competing in triathlon. And I'm no longer afraid of the rain.

But wait. I have more requests. Short of a cure, here are a few things on my diabetes wish list:

1) Blood insulin meter. Let's say it's been 2 hours since my injection and I'm about to go exercise. Wouldn't it be handy to just be able to know how much insulin is really still active? Or how about when my blood sugar is 400 and I take a huge bolus to correct and two hours later I'm still at 400. What happened to all that insulin? Is it just hanging out, waiting to crush me later? How could I know? Bolus up, maybe do a super bolus, and hope for the best! Or be conservative and watch the BG hover up there for hours. I imagine the metabolism of insulin varies a lot depending on many factors but no one really seems to discuss this much, probably because we (as patients) have no way to measure it. And what about being able to pinpoint that the infusion site is bad vs I am coming down with a cold or maybe that day off from exercise is affecting me more than I expected. So many variables! This could help significantly to cut down on the guesswork.

2) Stable glucagon in a pen delivery device. One of those glucagon kits is $100 and can't really be used more than once according to enclosed instructions. Sure it's easy to eat food and doesn't require an injection. But seriously, I don't care about injections. Those pen injectors are pretty slick. What I want is good glucose control and to not have to eat 500 calories in a day to treat a low. I don't want to go drink some soda after I overestimated the carbs in a filling meal. I just don't want to HAVE to eat. Especially after I just brushed my teeth for the 3rd time. Maybe it sounds petty to some people but I just wish I didn't have to make food and carbs such a focus of my life. Let me introduce a little distance between food as nourishment and food as the thing that makes all my crappy feelings (i.e., hypoglycemia) go away.

3) Data integration with non-diabetes devices. FREE THE DATA! Free it! Do it! Do it now!! Hey diabetes technology people! Hey FDA! Design your devices so they are safe but let us capture the data in a way that we can use how we want! I am not a moron! This is perhaps the thing that drives me the most nuts. There is absolutely no reason technology-wise that the continuous glucose meter data, for example, should be restricted from streaming to my iPhone or workout device. Arghhh! I have to stop writing about it because it is so incredibly frustrating. I know there is a lot of work on this but there shouldn't have to be any. Free the data and people will design apps. FDA are you listening?!

Okay, those three things are probably enough for now. If the list is too daunting, let's just get that cure all sorted out. Thanks!

What I Wish People Knew About Diabetes

2010-11-09T01:03:00.000-08:00

Part of the joy of attending events such as a JDRF ride or a triathlon with Triabetes is being surrounded by people who really "get it" with respect to having type 1 diabetes and trying to live a full and active life. I have also been fortunate to have many close friends and family members without diabetes who have taken time to learn and have been patient as I rambled on about my experiences managing my diabetes. In my mind, I carry a little corner of worry--or perhaps "attention" is a better word, depending on the circumstances--about my blood sugar and insulin levels and how they are changing, and how they might be affected by anything else happening. For example, I may be running, watching my blood sugar falling and thinking, "Hmm, can I beat this or am I going to have to eat something before I finish up in 15 minutes?" Or maybe on a long bike ride I may see my blood sugar rising and wonder whether that half-of-a-unit will be enough or should I risk having to eat more later or getting a low blood sugar because I treated it more aggressively. Being able to share these moments with a friend who understands, or is willing to learn how to understand, eases my worry. Knowing that there is at least one other person nearby who understands what it might mean for me to see "42" on my meter helps me to feel so much less vulnerable. When I was in a crash at a criterium in February, 2009, the medical staff person (thank you Katherine H!) for the race came over and said that she was a nurse and experienced with diabetes; a wave of relief passed through me. "My blood sugar was 250 before the race and now my pump is broken! I'm on Humalog!" She knew exactly why I was worried and was able to find my meter for me and communicate my concerns to the EMTs. This was a tremendous comfort to me during a truly frightening and painful experience.

What do I wish people knew about diabetes? Honestly, there is so much to learn and so many other diseases and medical conditions that people may need to focus on in their own lives, that I wouldn't expect anyone to become an expert on diabetes unless it were required of them or else they had a particular interest. I would hope that people are aware of the signs & symptoms of both type 1 and type 2 diabetes, since delaying a proper diagnosis can lead to a great deal of unnecessary suffering. Also, there is a type of diabetes called "1.5" or LADA, which presents more like type 2 but which is actually a slow-onset version of type 1 (and is often misdiagnosed). I wish more people appreciated the dramatic effect of exercise and diet on their metabolism and worked to prevent the onset of type 2 as much as possible. Diabetes is no joke. Still, I think it is unhelpful to make assumptions about either type 1 or type 2 diabetes unless one has already gained some actual fact-based knowledge on the topics, and met quite a number of people who actually have type 1 or type 2 diabetes.

But if you happen to be a friend of a person with diabetes (and I will focus on type 1, since that is my area of expertise, so to speak), and want to be someone who "gets it," here are a few starting points:

1) Type 1 diabetes does not have a cure, although there are a lot of exciting lines of research. I am 100% uninterested in anyone claiming to have an "unknown" or "magic" cure. Really, once it is found, I am sure it will not be a secret for long. I will take insulin until a cure is found. Although changing my diet and exercising will affect the way I manage diabetes, it does not cure me of it. Type 1 diabetes is caused by an auto-immune process that seems to be triggered by something environmental. The exact cause is unknown. Although it is more common in kids and young adults, it can occur at any age.

2) Insulin is a hormone made in the pancreas by the beta cells. In type 1 diabetes, the beta cells get destroyed and the insulin must be replaced through injections (via an insulin pump, syringes, or pens). Insulin is required 24 hours per day, even when fasting. I take a background rate of insulin ("basal rate") to cover basic metabolic needs, and take a "bolus" (like an injection) when I eat anything with carbohydrates. High fat and/or protein foods also require insulin over longer time period. Food gets converted into glucose (in varying proportions) which eventually enters the bloodstream, causing a rise in the blood glucose level. Insulin lowers the glucose concentration in the blood by facilitating transport into fat and muscle cells.

4) Although the normal blood glucose for someone without diabetes is typically 70-90 mg/dL and temporarily a bit higher after a meal, my blood sugar can be anywhere. If you ask me what my "normal" blood sugar is, I might give you a blank stare. I try to keep it above 70 and otherwise as low as possible given the situation; I guess my target is around 110. When I am exercising I will usually keep it a bit higher, since it can fall very quickly. I have had readings below 20 and above 600, otherwise known as "LO" and "HI" on the blood glucose meter. It can fall and rise really fast; but sometimes it can take forever to budge. Low blood sugar makes me feel really weak and also scared, if it is quite low. I am still able to communicate (this is not universal) but I may speak slower and act a little dazed. I really hate having low blood sugar. High blood sugar can make me sleepy and/or moody and it sometimes feels like a mild stomach flu. I get thirsty and can become dehydrated more easily. Sometimes my arms will cramp. Things that lower my blood glucose include: insulin, exercise, not enough food. Things that can raise my blood glucose include: food, stress & anxiety, exercise, too little insulin. These are not the complete lists. On my pump, I have different basal rates for the different times of day. I also take a certain amount of insulin in response to the amount of carbohydrates in a meal and another amount to correct for a high blood sugar.

5) Exercise can lower or raise my blood sugar in the moment. In the long run, the increased insulin sensitivity due to exercise makes it easier for me to alter my blood sugar and allows me to take less insulin overall. During exercise, I am exquisitely sensitive to insulin. For example, I may take 3 units for 45 grams of carbohydrate normally; but when exercising, I might just take 0.5 unit. Frequently, I may not even take any insulin at all, other than my ongoing basal rate. Stopping for too long to eat in the middle of an exercise session can make it difficult, because then I will either need to bolus for the food or will watch my blood sugar start to climb. If I take a normal bolus, and then start exercising again, all the insulin in my body becomes supercharged and my blood sugar may come crashing down. Then I have to eat more, which is really annoying to me, or I will have to stop, which is even more frustrating. I could compromise and take a partial bolus and this is often what I do. But there is a bit of uncertainty about how much to take and then all I get to think about for the next couple hours is whether my blood sugar is going to crash. This is why I may get eager to get going again; really, I can relax!

6) I plan my insulin and meals around my exercise. If there is a big change in schedule, this can make it more difficult. I may have changed my insulin dosages in anticipation of a race or workout start time. If there is a big change, then I will need to compensate for that. This could require me to eat 2-3 extra GUs to get through a run (boo!) or could result in a super high blood sugar for the first hour of a bike race. I realize changes happen and try to be flexible.

7) Please don't ditch me if I have to stop to test my blood sugar. I usually try to test when people are stopped for some other reason. I don't get bothered by most things, but getting left behind on a ride because I needed 45 seconds to check my blood sugar makes me want to cry. Fortunately this rarely happens anyway, and having a continuous glucose meter means I just have to pull it out and take a look.

8) If you find yourself surrounded by some PWD (people with diabetes), just throw out the question, "What's the fastest way to raise a low blood sugar?" and you will keep the conversation going for at least 10 minutes. In general, simple carbs without fat or protein absorb quickest and are best for treating low blood sugar. How much I need to eat depends on how much insulin I have in my system, how fast I may still be dropping (i.e., how fast my blood glucose is dropping), if I am exercising or planning to exercise, if I ate something else already, etc. I try to carry enough sugar to feed 100 hypoglycemic PWD but if a friend happens to carry a spare GU, that certainly could come in handy. Foods that help me bring up a low blood sugar include: glucose tablets, Skittles, Smarties, juice, milk, energy gels (like GU), soda, honey (but eat carefully--I seriously choked once eating honey too fast during a low), corn syrup, etc. Foods I wouldn't target but could bring up my blood sugar more slowly include: bread, fruit such as apples/bananas, candy with a lot of fat, granola bars, crackers, cake. Foods that won't help include: pure protein (steak, chicken, cheese, eggs, etc.), nuts, non-starchy vegetables, lard (hey just seeing if anyone is actually reading this).

Well, I could go on but anyone reading this probably either knows this stuff already or is now completely overloaded. Perhaps most importantly, what I would like people to know is that I and most people with diabetes are always willing to answer questions, as much as you are interested. Personally, I don't expect people to know too much about the particulars, just as I don't know the ins and outs of most other chronic diseases. So if a friend says, "Hey does insulin cause your blood sugar to go up or down?" I am not thinking, "What a dufus!" I am sincerely glad to explain it because your just asking about it makes me feel more supported. And I believe that PWD have insights gained through their unique window on their own metabolism that can be enlightening to anyone, with or without diabetes. Finally, I believe that as the incidence of diabetes continues to increase, PWD who have observed the dramatic changes in metabolism related to insulin, exercise and diet are in a unique position to support efforts to prevent type 2 and to help people improve their management of both type 1 and type 2 diabetes.

(See other blog posts addressing this diabetes blog day topic.

I was supposed to just name 6 things but I got a little carried away. Oops.)

Triabetes documentary tonight in San Francisco

2010-10-06T10:16:00.000-07:00

Please join us tonight at 7 PM at University of California San Francisco for the Northern California premiere of the Triabetes documentary: "The Science of Inspiration."

Here's the info:
In 2008, 12 people with type 1 diabetes, including myself, set out to complete Ironman Wisconsin as part of a team called Triabetes. Triabetes has now grown to be the world’s largest triathlon club for people with diabetes, shattering presumed limitations and revolutionizing the way people approach diabetes management.

Come meet current Triabetes members, and join us for an evening of inspiration, education and exploration as we follow these athletes and the kids who partnered with them for their journey to the finish line and beyond.

Tickets are free; $5-10 donation welcome at the door. There will be raffle prizes awarded at the end!

See the preview here: http://vimeo.com/1871013

Location:
513 Parnassus Avenue, San Francisco
Cole Hall (first floor of 513)
7 - 9 PM

Parking is available across from the main hospital in public lots or you can take N Judah to Arguello/Irving and take the parking elevators all the way up to Parnassus. Buses 43 and 6 will drop you off right at 513 Parnassus. Free parking is usually discoverable in the neighborhood if you are persistent.

photo courtesy of Blair Ryan

Twenty-two years

2010-09-21T10:25:00.000-07:00

Twenty-two years ago today, I was pulled from 9th grade gym class at Highland High School and made my way to Primary Children's Hospital in Salt Lake City, where I was diagnosed with type 1 diabetes. I started using Regular and NPH insulin and learned how to test my blood sugar on an early model One Touch meter. It took me fifteen minutes to poke my finger the first time. I continued on the cross country team and since then I have run twelve marathons, qualified for and run the Boston Marathon, completed four Ironman triathlons, and competed in about 30 road bike races. I would give anything to be able to go just one mile without diabetes. Today I am raising money for a cure for type 1 diabetes with the JDRF for all of us with type 1 diabetes and in honor of those who have been taken from us too soon. Please donate generously if you are able; any amount is welcome. Donations can be made at my page at http://ride.jdrf.org/rider.cfm?id=9740.

Riding Again

2010-09-07T22:38:00.000-07:00

Earlier this year, when in Wisconsin for the funeral of Jesse Alswager, I decided that I would like to join Jesse's mom, Michelle, as she and a number of friends chose to honor him by riding at the Juvenile Diabetes Research Foundation's Ride to Cure Diabetes in Death Valley, California, on October 16, 2010. Since then I have become aware of similar stories of great loss, including the deaths of several young people close in age to Jesse. I have tried to live with a philosophy that diabetes is more of an inconvenience than a death sentence; still, these heart-wrenching events have touched me and reminded me that insulin and all of our wonderful technological advances still allow too many to slip away. It is still hard for me to reconcile these events, knowing that I share the same condition.

After my accident at the velodrome in May, I wasn't sure what the next few months would hold, and whether I would be able to continue with my plans for Death Valley. The collarbone surgery was successful, but I would need to take blood thinners (warfarin) for up to 6 months to help treat three clots that had formed in my lungs. The scare tactics from my physicians were pretty effective and I felt discouraged that I would not be riding for the rest of 2010. Slowly, though, I was connected with other athletes on warfarin and realized that some riding would be okay. A month after the crash, I was elated to be out riding again. I chose the safest routes I knew, and backed off a little on the descents and when approaching intersections. I spent more time indoors on the rollers, and also picked up swimming and running again. Road racing and other large group rides were out of the question. But, fortunately, my time on the warfarin was shortened to just three months, and I am happy to now be riding warfarin-free as of this past weekend. (This experience has given me an appreciation for those who must remain on warfarin for life--a topic for another post.)

I decided to continue with my plans to ride in memory of Jesse, Trent, and all the other people whose lives have been shortened by this disease. I will also ride in support of their families. Additionally, I will ride to honor those who currently face a daily struggle due to serious complications of diabetes. I am fortunate and grateful to be in good health and to be able to pursue my dreams. Finding a cure is the best way to ensure that all people with type 1 diabetes can continue on that same path.

I would be touched by your donation. If you are able to donate, please go to my JDRF page here. Any amount is helpful and welcome, and you can donate anonymously if you would like.

Velodrome Crash: the Long Story

2010-06-23T21:55:00.000-07:00

I had been interested in racing the track for a while, but didn't have the confidence to try it out. After a clinic last December, another 2-day clinic about a month ago, and then a great workout session the night before, I felt comfortable racing at the Hellyer Velodrome's “Get Ready for Summer” races on Saturday, May 29, 2010. We would have our own women's category 4 field, rather than race with the guys. The first race was a tempo race, with points given each lap for the 12 laps. I think I came in first or maybe second for a couple laps, and I ended up placing third overall. Our next race was a 12-lap scratch race, which is like a criterium in that the winner is determined by who finishes the whole thing first.

I'm #519 in red. photo by Steve Woo

Throughout the race, I felt like people were squeezing the group somewhat down track (i.e., towards the inside); for me to move around I would go up and around and advance. I realized partway through that I did not feel comfortable advancing my position, and settled somewhere towards the back, looking for a good opportunity. With three laps to go, I was in the sprinter's lane (the innermost lane on the track) behind a line of riders. We were approaching turn three. I have a few seconds of memory lapse here but the next thing I recall is riding on the apron pavement towards the warmup circle (in the infield area) and seeing someone down immediately in front of me. I had nowhere to go. It was a déjà vu moment from last year as I flew over my handlebars and hit the ground. Stars flashed and I came to a stop, sitting up. I assessed the situation and immediately felt relief--no great pain. Maybe I wasn't that hurt. But moving a little, I was certain my right collarbone was broken. I felt angry, mostly, and was pretty quiet. I noticed some blood trickling down my face and people were coming over. It was very sunny, bright and hot sitting there on the black asphalt.

People began helping me while we waited for the ambulance. The initial numbing shock started to wear off and I could feel the pain increasing, mostly in my shoulder. Since I couldn't lie down, and I had hit my head, a friend stabilized my neck while I sat. It was quite a while, so thank you, Evan. I felt bleeding in my pelvic area and thought for sure there must be blood gushing. Once the paramedics arrived, I heard the words "dislocated" and "deformed" with regard to my shoulder, and was not amused. The thought of someone pulling my arm to put it back in place was horrifying. They were good about not forcing a certain position and got me on the spine board (yeah, here we go again) and into the ambulance. I asked for morphine since last year I didn't get pain medication quickly enough. The paramedic continued asking me questions and I felt sleepy but he didn't want me sleeping, I guess. I felt like I was still bleeding in my pelvic area and mentioned it again. But the bleeding was internal; the paramedic put an ice pack there and also one on my shoulder, which brought some relief. I was most impressed that he was able to start an IV while the ambulance was moving without jabbing me all over.

I arrived at the Regional Medical Center San Jose, the closest trauma center, and things got busy. I was very happy to see two good friends, Rita and Amy, waiting there for me. The ER staff did some Xrays and other exams and cut off my favorite bib shorts and team jersey. It wasn't until we were there for some time that they noticed a puncture wound on my shoulder, and soon discovered that the clavicle fracture was open, meaning that it had broken through the skin. This has been my nightmare and the ultimate in bad injuries! Ahhh! The surgeon came in and numbed it, thinking he could perhaps set it in the ER. I felt and heard him tapping on the bone (ugh!) but at least it didn't hurt. It became clear that surgery would be required. Later I learned that the clavicle had fractured, completely shredding the ligaments attached to the scapula below, and piercing through the trapezius muscle and out through the skin. Somehow it had also retracted back in a bit; so there wasn’t a huge piece of bone sticking out, at least.

Waiting for the results to come in, I was still

unaware of the compound fracture.

I was scheduled for surgery as soon as possible, the next morning. They admitted me from the ER and put me on morphine to help with the pain. I was nervous about the surgery but was comforted by the company of good friends. They wheeled me to the OR where the surgeon explained his plan to repair the torn ligaments and to stabilize the fracture using a surgical device called a "tight rope." Also, the anesthesiologist and I discussed diabetes management; he was interested in my Dexcom CGM, which he kept with him during the surgery. The next thing I remember was waking up with severe pain in my shoulder. I was in a daze the rest of the day and would briefly see my friend Rita every now and then when I woke up. Thanks for staying with me all day. After some physical therapy to get me moving a little the next day, Monday, I was ready to go home. I wanted to get back to San Francisco; if I needed further medical care, I preferred to go to my regular doctor. Also, it was so hot in that hospital that I was constantly sweating and uncomfortable. My friend June from my bike team stopped by after the Memorial Day Crit and graciously offered to wait for me to be discharged and to drive me home. I was still a bit dizzy and unstable walking around but the medical staff seemed to feel it was okay to leave. I noticed some pain in my right calf that I hadn't felt before.

Before surgery

After surgery: the two metal "buttons" connect the clavicle and
corocoid process via "rope" and constitute the "tight rope."

I was glad to be home and was comforted by my having my roommate Radhika there. Sleeping was still difficult and I woke up that night around 1:30 AM, a bit uncomfortable, but fell asleep again. I had some weird dreams including one where I was outside in a storm at my parents' home in Utah, watching lightning strike uncomfortably close. I thought that I might get struck and then a thick bolt, covered with burning embers, struck my parents' house, causing it to burst into flames. Then the lightning came my way, striking me and throwing me down into a dark pit, where I was burned up. Lovely! I'm so lucky! I woke up at that point to severe pain in my right side. It was around 4:30 AM and I was disappointed I hadn't slept more. I thought I must have jammed my arm into my side or something--that the pain was just from sleeping in a bad position. After standing up and walking around a bit, the pain started to subside. Still, when I would try to lie down again, the pain would return. Last year, the rib and L2 fracture diagnoses took about a week to come in, so I assumed I had just broken a rib that was somehow missed on Xray. Or maybe somehow my side was slightly injured and my sleeping position further injured it. I did sleep again for a bit and after that, I couldn't find any comfortable position. I noticed that the pain in my side was completely eclipsing my collarbone pain.

A good cycling friend (and nurse!), Cheryl, came that morning to help me and stayed for quite some time; I was so grateful for her company and help. I was feeling anxious about being home alone with this pain and was still somewhat lightheaded and unstable at times. I was so happy to finally be able to shower and was put at ease to have her there. Throughout the day, the pain would get worse and then subside again. My doctor felt like the trauma center most likely did not miss a rib fracture and helped me to get a new prescription for pain medication. In the afternoon, a case worker from my health plan called; she was in the process of transferring my medical records from the trauma center, including my radiology images. She asked how I was doing and I told her about the pain, that it was a "10 out of 10" when I tried to breathe deeply. Basically, I could not breathe normally at all. It felt just like a broken rib. She recommended that if it did not improve with the vicodin, that I head to the ER. I took another vicodin and the pain did improve somewhat. But by about 4 PM when my friend Colleen arrived to visit, I felt like it was time to go in. I was mostly worried that my shallow breathing would cause my blood oxygen levels to drop and that that might put any brain injury (if I had one) at greater risk. I was still pretty sure I had a rib fracture--the pain felt very sharp and was consistent with where I fell.

Colleen braved the insanely steep ER driveway in her stick shift car and dropped me off. I was becoming somewhat hysterical because I felt like something was really wrong but I hadn't been able to find an answer. I had tried to get in touch with someone--anyone--to review my Xrays from the trauma center. I knew I would not be able to sleep with this pain. And I was becoming short of breath and very uncomfortable breathing. I was seen very quickly (for an ER) and they started doing tests. Let me tell you--if you have to be in an ER, Colleen is someone you want with you. She had an uncanny way of making me laugh and relax and I was grateful for her company. They did the chest Xrays and didn't find any broken ribs, and also started some blood work. At the last moment, the attending doctor said he would run the D-dimer test to check for blood clots in my lungs. He said that, due to my recent trauma and surgery, the test would likely come back as elevated, and that they would need to do a CT angiogram of my chest in that case. He seemed to feel that it was unlikely that I would have clots, but that they would check it out anyway.

Well, the D-dimer test came back elevated. I asked, "How elevated is it?" and he responded that it is either elevated or not. Oh. I was hoping it would be like having a blood sugar of 150--a little high but not an emergency. I was prepped for yet another CT exam and had the nasty, hot contrast injected as I held my breath. The tech asked if I worked in radiology--I guess because I held still so well? This is something I instruct people to do all the time so I guess I take it seriously when someone asks me to do it! Back in the room, I waited with Colleen for the results. I said, "I doubt it will show anything," and was not overly worried. I didn't really know how serious blood clots were but they sounded bad. After some time, a different doctor came to tell me the results. She seemed serious when she said I had three small clots in my lungs. I don't remember what else she told me but came to understand over the next hour that they would put me on heparin right away and that I would be admitted for treatment. The nurse was having a difficult time getting the IV tubing set up and I was getting increasingly agitated as the doctor tried to explain again what was going on. I asked if I would be okay and the only answer I got was, "It's good you came in." Ugh. They finally got the IV sorted out and injected a huge bolus of heparin. My confidence was sort of shot with that particular nurse and I just hoped she was giving me the right amount. Colleen was there and after the chaos calmed down, I started to relax a little. Over the next hour or two, I could feel the pain lessening in my side with the heparin starting to work. The IV heparin drip would continue for another day or so.

I think the blood clot is that dark spot in the left wedge-like vessel. Get that?

I was moved to the telemonitoring floor where they would be watching my EKG constantly at the nursing station (in case I suddenly keeled over, I guess). I was hooked up to the IV, the EKG leads/box, my insulin pump and had my Dexcom CGM handy. Oh, and of course I had to keep my iPhone by my side. It was impossible to move anywhere without dropping something. I still can't find the clip for my pump so I have been carrying it everywhere. I tried to see how low I could get my heart rate and was sort of disappointed it wouldn't go below 45. I think I can get it to 42 when I am really rested. I was hoping a 45 would set off some bradycardia alarm but alas, they were not concerned. They frequently checked my blood pressure and temperature and regularly drew blood for lab tests. Unfortunately, my veins were not happy and they had about a 30% success rate of finding one. Most of the bruises have just disappeared. They gave me pain medication when I asked, and I should have asked more frequently. I was quickly breaking out in a rash all over due to some allergy and they decided it was probably from the morphine and/or vicodin. I was not happy with the way vicodin was making my head feel, anyway, so we stopped the narcotics around noon on Wednesday. Later, my doctor determined that the allergy was due to the IV cephalexin (antibiotic) I had post-op.

All throughout the day Wednesday, I had a stream of visitors who really kept my spirits up (and kept me distracted from worrying). Those visits, flowers, calls and other help really meant so much to me. Thank you, thank you.

I had an ultrasound exam to check for blood clots in my legs (negative) and a brain CT to check for possible brain injury, since a blood thinner could cause significant complications in that case. I continued to feel sluggish in thinking and speaking, and since I work with people with brain disease and trauma, I know the signs all too well. I was so worried. At one point, the nurse said something that made me really scared and I called my mom and asked her to bump up her flight to that evening, instead of the next morning. I think the comment, "I've had a patient die here from this," was not helpful. I guess I wanted to know how serious it was; I think I would do better with statistics than a horror story, though. After that, the doctor's suggestion that my prognosis was good didn't really stick well.

Thursday morning, I received the news that my brain CT was clear. I was feeling a little more clear-headed and was greatly relieved by these results. The nurses had started me on a twice daily regimen of Lovenox shots on Wednesday, as well as coumadin. The coumadin (i.e., warfarin) is a drug that interferes with blood clotting, and is the drug I will be taking for six months while the clots dissolve. It takes a while to build up, so in the meantime, they wanted me on Lovenox as a backup. Lovenox is a form of heparin that also works to block clotting. The needles are huge and leave bruises that don't want to go away. Since I was comfortable giving myself injections, I was sent home Thursday. Thank you to Alissa for helping my mom with the flowers and for taking me home.

Flowers from the hospital stays.

My INR, a measure of clotting time, was 1.5 when I left the hospital; they want me to be at 2-3 for the duration of my treatment. I continued taking the Lovenox shots until the next Monday. Since then, my INR levels have been 2.7, 2.3, 1.7, 1.4 and then 2.6. I will continue going in for blood work a couple times a week until things stabilize better. I have learned that the INR is affected by foods, exercise, sickness, stress, etc., which sure sounds like another fun drug that I get to take all the time (i.e., insulin). But fortunately, there is a clinic with pharmacists who read my results and call me, telling me how much to take for the next few days. I am looking forward to going in for blood work less often, since I'm getting weary of being poked in my arms.

As of now, the pain is gone except for my back and shoulder and occasional headaches. The clavicle is healing well and I can already drive. The road rash has mostly healed. If it weren't for the blood clots, I could imagine being out on the road again in another week. I am still easily fatigued, though, and don't want to ride until I am 100% confident of my upper body stability. Although racing is completely out of the question, I have been told it is okay to ride my bike while taking coumadin, as long as I am extra careful. But since I am always careful, I'm not sure what this will mean for me. I was glad to connect with a few other athletes who have had blood clots and continued training to some degree while on coumadin. Compared to last year, I am physically less injured. But the clots present a different challenge that from here on out, seems more mental. It has been hard.

I am so grateful to the many friends and family who stepped in to help me out, and for your continued support. It would have been impossibly difficult without you. Thank you.

Relaxing outside at Crissy Field.

Here are some additional pictures. My mom tells me I should warn you that they could make some people queasy. But I don't think they are so horrible.

Race Report: 2010 Kern County Stage Race

2010-06-13T22:02:00.000-07:00

I had meant to post this earlier. Here it is, although it seems long ago now. I originally wrote this up for my team back in May and have left it pretty much the same.

Race: Kern County Stage Race (Bakersfield area, CA)
Date: May 14-16, 2010
Category raced: 4
Weather: sunny, some wind, warm to hot
Number of starters: 22
Early Birds present: racing: Deanna, Michal, Anne; supporting: team director Laurel Green
Other teams present: Dolce Vita, Tibco II, Los Ranchos, Metromint, Velo Allegro, Los Gatos, MetalMtn, Lenovo, DudeGirl
Your goal for the race: Do my best to place high in the GC (general classification or overall finishing placement).

Short story:
We raced 4 races in 3 days and took 2 ice baths. The races went: good, good, bad, great!

Long story:
Stage 1: Bena Individual Time Trial (ITT), May 14, 2010, 9 AM, warm to hot

We lived up to our Early Bird name by arriving before Velo Promo had even set up the tent, and were perhaps the second group there. The parking area was next to the train tracks and also the road to the local dump, so there was a pretty steady flow of trains and trucks. I had pre-ridden the 10-mile (10.2 mi according to my computer) course the day before a few times, and noted some pretty strong headwinds on the return leg. The course starts out flat, then has a pretty steep and short descent, followed by a barely perceptible rise for a few miles. Towards the turnaround, there is a mild climb for a couple minutes, which levels out as the road turns right. I had borrowed a Zipp tubular front wheel and worked out my paranoia about getting a flat the day before. I used my time trial bike and aero helmet. I warmed up for about 40 minutes on the trainer and then rode some on the road to get a feel for the wind, which seemed similar to, although not as strong as the day before. We started every 30 seconds in alphabetical order (the same order as our bib numbers). I went off at 9:21:00 behind another category 4 woman; there were 2 gaps ahead of her from no-shows. I would use the riders ahead of me as targets. My goal was to pass but not be passed by anyone. I worked pretty hard on the way out and tried to go harder on the way back. I was able to pass the rider ahead of me after about 2.5 miles and got close but did not pass a group of two further ahead. I could hear someone behind me on the hill but was able to pull away on the flat before the finish. I finished in a time of 29:01 and came in 6th. I felt that I could have been more consistent in my effort and that I wasted some time by veering around the road a bit, trying to find a smoother path.

Time trial staging area. A train full of cars passed by right before this one.

After the TT, we found the local Trader Joe's (HOORAY for that) and then relaxed for the rest of the day, aside from our stage race ritual: the ice bath. I apologize to the other hotel visitors who tried to get ice after we were done...

Stage 2: Walker Basin Road Race (~30 mi), May 15, 2010, 9 AM, warm, some winds

Again we scored prime parking spots (next to the graveyard of course) by our early arrival after winding through some narrow canyon roads. It was fairly cool when we arrived and I contemplated putting on knee and arm warmers and maybe a jacket; but after warming up and by the race start, it was a jersey-only kind of race. The finish was on a climb similar to Snelling Road Race (as I recall) and we pre-rode that a few times. We would do 3 laps with time points possible for each lap for the first three across the line, and one final, 4th lap with more points awarded for the top 3 finishers. The course started on a mild downhill over some rough roads (but not "Madera rough"), and then turned right onto some rollers, straight into a pretty decent headwind. It then turned right and looped back through some mild turns to the start/finish at the top of a hill. Centerline rule was in effect (which means all racers must stay to the right of the yellow line). Before the right turn up the finishing hill, there is a straight-away, then a left turn and brief descent. Laurel had pointed out a road sign on the left that might be a good place to start the sprint. The hill was longer than one might guess.

Walker Basin area. No, the race was not on the dirt road. Photo courtesy of Jill Eyres.

We started off and made our way through the first loop. The pack was staying together although there were surges now and then. On the outbound long stretch, the pack really slowed and often, no one would pull through to the front. There was a strong headwind here. I went out as did Deanna and also riders from Tibco II, Metromint and Dolce Vita (and probably others that I missed). But once someone started pulling, there were not many willing to take the reigns it seemed. After taking a turn pulling, my approach was to just keep slowing until it was semi-ridiculous and someone would eventually pull through. I felt comfortable in the pack, moving around. I wanted to be near the front for the first lap while we got used to the course, and also wanted to stay close to the front in order to try for some points and test a finish strategy. We made our way around and were starting on the short descent and I decided to just go for it to get ahead at that point. Well, I was ahead at the beginning of the climb but you know how this story ends... I was passed by two then more people right before the finish line. Dang! There was a gal from Metalmtn who stayed back and then just powered up that hill like she did hill sprints in her sleep. Anyway, I decided that the effort was probably not worth the few seconds I would gain, and decided to try and conserve a bit more, working for a better finish for this race and saving energy for the afternoon.

The pack stayed together and I tried to work up toward the front on the last straightaway stretch. People were jockeying for good spots and I was probably in the front third but not as far up as I would have liked. We got to the hill and I was jamming it, feeling pretty good, but needed to shift to my small chain ring. I tried and tried but it was stuck and the hill was getting steeper then BAM! it dropped and it felt like my chain had come off. But it hadn't. Some people passed me and I was mad but I got it going and worked to keep ahead of the gal beside me. She had contested the first hill points and I had passed her then. Everyone finishing with the pack was given the same time, which was A-OK with me.

Michal, Deanna and I warmed down and then jetted out of there pretty quickly to get to the Havilah Climb race site. We had about 4 hours to recover before the next race. We found some prime parking in the shade and started refueling and resting for stage 3. I was sort of guessing on how to manage my blood sugar since I had never done two longer (longer than 1 hour) races back to back like this. Before I got on the course, my blood sugar was a little on the low side; I was hoping I didn't have too much insulin buzzing around. I ate a chocolate GU and headed to the start.

Pinning my number while resting up for stage 3. Photo courtesy of Jill Eyres.

Stage 3: Havilah Hill Climb (~11 mi), May 15, 2010, 3 PM, hot in the sun, cooler at the top

We staged the race on the dirt road at the entryway to the ranch where we had been resting. No one seemed able to tell us exactly how many miles we had to go. 17? 13? 15? No one seemed to know, although we were pretty sure we would have 4 miles before we got to the base of the main climb. We started on a gradual climb--someone had said it was a neutral roll out--with Deanna setting a manageable pace. Because of this, the pack stayed together for about 3.5 miles on what was actually a pretty steady climb (as I noticed more on the return trip). Some people eventually got impatient and the pace took off. We turned the corner and started the real climb. I stayed with the main pack for a couple turns but then decided to focus on holding my own pace. I lacked some zing in my legs and so ate a bit. I stayed with a couple riders for a couple miles and then felt myself fading. I ate some more but just felt crappy. I wondered if my blood sugar was low but thought it might also be high. I should have checked it but I didn't want to stop. I think I ate some more but with about 3 miles to go I felt really horrible. Michal passed me, motoring up and looking strong. I was happy to see her having a good race. Our good friend Julie Nevitt (category 3, racing masters) passed me around 1 or 2 miles to go and asked how I was. I knew from my response that my blood sugar was low, since I could just barely mumble out, "Okay." I was so happy to see Laurel around the last corner and finally made it to the top. I finally pulled out my Dexcom and saw "45" and that it had been like that for the past 30-40 minutes. Ugh, no wonder. I think one reason I didn't check coming up is that when I see that, it totally deflates any remaining motivation since I start to get scared. On the other hand, my doctor would probably pull me out if he saw that. I should have stopped to check. Michal took care of me at the top and helped me fuel up on watermelon and I recovered okay. I was glad to see Deanna finish and we took some time to relax at the top a bit. The total distance was 11 miles or so, I believe, with about 7 miles of serious climbing. I was disappointed that I hadn't been able to give it my all, and felt like perhaps the race was over for me, in terms of reaching my goal to place well in the GC. At least there was some great practice descending for 7 miles on twisty, gravelly roads! I pounded out my frustration on the final 4-mile, fast descent back to our cars.

Trying to put on a smiley face after a frustrating race.

We all more or less willingly took an ice bath that night, knowing we had one big race to go. While I was reflecting that evening, I decided that I should just try and forget about whatever time I had lost. Who knew what would happen?

Stage 4: Iron Hill Road Race (~46 mi), May 16, 2010, 8:45 AM

I had taken a look at a course map from mapmyride.com and from what I could tell, we started on a longer descent. Because of this, I really wanted to be in the front. We started about 15 min late and people were huddling under the shade. It was hot. Soon enough we were off and I was on the front down the first hill. Surprisingly, to me, though, it was more rolling the first several miles; I stayed in the front trying to set a good pace, expecting a longer descent at the top of each roller. I felt like I was working pretty hard to keep the pace up as we climbed each roller. Finally I moved back although I tried to stay close to the front. We rode over the cattle guard (that could "kill you" if you rode over the middle according to the race official) and could see that the real descent was imminent. Jill from Tibco II went to the front and set the pace down the hill. I had not been quite at the front and was about 10 riders back, with a little separation and taking the inside line. I came around a corner and saw a cloud of dirt off the side of the road, and then another rider down in the middle of the lane. Oh no. "Don't stop don't stop" was what went through my mind as my urge to stop and help kicked in. (What I realized later is that in the moment, I was not thinking at all of anyone behind me, but only the rider who was down in front. Thus it was crucial that I remembered and followed the "don't stop" rule that had been drilled into us by the mentors. It made me feel totally inhuman at the moment but that was because there was not time to process the danger to those behind me as well. Once I passed I remembered that there was a follow car behind us and that they would be given assistance.) I slowed to avoid the rider and water bottles but was able to navigate around since I had taken the inside line. I moved quickly to catch the group ahead and we finished the descent in silence. Once it leveled off, everyone started talking about the crash. One gal admitted to taking a line too wide and brushing the rider who came around her to the outside and who went down after the encounter. The conversation continued, focused on the crash. It was getting a bit negative and icky for me so after a few minutes of this I felt like it was time to move on and get things going. Talking about the crash was not helping us to have a safer race at this point. Jill from Tibco II, Christine from Dolce Vita and I set up a paceline; I wanted to take advantage of our break, which I felt had not been caused by the crash since I was behind it when it happened. Still I sort of wondered if doing so at that time was a negative thing to do. We had been riding comfortably for about 5 minutes, though, and still had a break and so it was time to get going.

It took about 10 minutes to get things moving more smoothly in our rotating paceline. One gal would pull off but not drift back and then the whole line would stall. After this happened a few times, I rode up to her and just asked if she wanted to participate in a paceline. "Oh! Okay!" We increased the pace on this flatter section and our group of 8 continued until the next longer descent, where we dropped one rider. I tried to hold up the group a little, but it didn't really work. The momentum was moving fast and I didn't want to get dropped, too, so I picked it up again. I had seen a really huge-looking hill on the profile and I kept expecting it at any moment. It was when we started on the last big descent of the first loop that I realized we had already gone over the hills and that this course had a lot more flat and descending sections that I had thought. Being in our paceline really helped make the climbs easier, since they weren't so steep that it became a truly individual effort.

Photo from the course by Jill Eyres.

Everyone chatted about the descent on the second loop and that we would all take it single file. I wanted to be in the front, since I felt like I would naturally descend faster and wanted to keep it a comfortable but fast speed. We all made it down safely and moved through the second lap. I was a lot more conscientious about drinking water and eating every 40 min or so, since I knew it was hot out. I was able to check my continuous glucose meter, and could see that I was in an okay zone. What a huge relief. We made it to the feed zone and I was so excited to see Laurel. "Laurel, Laurel, I'm in the break! I'm in the break!" was what I was thinking but instead I yelled out "My bike computer is in the dirt!" since it had fallen off on the short dirt section right before. Thank goodness Laurel picked it up! It would have been a super long and annoying trek out there otherwise, on top of a super long drive back to San Francisco. The second time up the longer hill was tiring and felt never-ending; we could hear some music playing in the follow car behind us and someone asked them to turn it up. So momentarily we were treated to some 90s rock music? I can't recall the name but it I enjoyed the mini-party. I had no computer and had no idea if we had 5 or 10 miles to go, so was so happy when he called out, "4 miles to go!" Hallelujah! Finally, we hit the descent, which had a lot of cornering but was not too technical, and rolled in close to Woody. I knew the finish was a long climb and thought I would get dropped. But then, in some effort at positive self-talk, I thought, "Hey Anne, you stayed with this group the whole time. You belong!" But I got dropped anyway (ugh!) and didn't have the energy to really push it harder. I think there was one gal I could have beaten but knew from riding almost two laps with everyone that we had some super strong climbers in the group. I also knew I wouldn't beat any of them for the GC, since the next time closest to me coming into this race was about 3 minutes faster. (Thank goodness I had looked at the results beforehand.) But I didn't want to slack too much because I had no idea how close people were coming from behind. I just pushed through the interminable last 1 km and finally, finally reached the finish. Lina from Metromint saved me by giving me a full bottle of chilled water after the finish. My legs were ready to start a cramp fest.

Coming into this stage, I was about 11 minutes back; I noted that no one else seemed to pull in for about that time, or a little more. Everyone in the break was ahead of me in the GC so my big hope was that we put enough time on the rest of the field for me to move up to 7th place. And when it was all said and done, I finished with about a 1-min gap faster than 8th place and so was very happy to finish 7th in the GC.

I think stage races are my favorite road events, since the multi-day strategy adds a fun twist. Also, with the various types of races, Kern balanced out peoples' strengths and weaknesses. This particular event had a very friendly atmosphere and I got to know the other women pretty well by the end. Of course it also provides a great opportunity to get to know each other on the team. Also, Bob Leibold really makes the award ceremony special. I would highly recommend this for everyone next year! It takes 100 women for them to break even financially. He currently puts this event on at a financial loss--it would be awesome to be able to support someone who is doing so much for women's racing in Nor Cal.

Early Birds Deanna, Michal, myself and team director Laurel (back) relaxing after a tough 3 days.

More photos from Jill can be seen here and the rest of my iPhone photos can be seen here.

The Short Story

2010-06-06T09:13:00.000-07:00

Memorial Day weekend, I was caught up in a crash that occurred directly in front of me while racing at the Hellyer Velodrome. The most significant injury was an open fracture of my clavicle, which was surgically repaired the next day. The following day, Monday, I was discharged and returned to San Francisco. Early Tuesday morning, I felt severe pain in my right side, lower rib cage area. I thought it was an undiagnosed rib fracture perhaps, but wasn't sure. The pain would subside and then return. It made breathing difficult although I was not short of breath. I was worried I had experienced some head trauma and that I might not be getting enough O2 to my brain. Late afternoon, I checked into the ER, where they determined I had 3 small blood clots in my lungs. I was admitted to the hospital immediately and started on IV heparin to help dissolve the clots. They would never really tell me I would make it through the whole thing so it was pretty traumatic. I stayed in the hospital for 2 more days while they started adjusting my INR, which is the measure of how much the blood is clotting. They want mine between 2 and 3. I am taking a heparin injection (Lovenox) twice a day and warfarin (Coumadin aka rat poison) once a day to bring my levels up. On Thursday when I was discharged, I was at 1.5. While on warfarin, I am at risk for severe bleeding if I experience any trauma, so bike racing is obviously out. I think cycling is out in general, since even a slow-moving fall could result in serious injury. Also, "strenuous" exercise is out according to my doctor--such as exercise that might put a lot of strain on the muscles. (!!) I am finding it really hard to get any medical advice on what that means, exactly, since I don't exactly fit the typical profile for people on blood thinners. My doctor said most of his patients are elderly and that he doesn't have anyone in their 30s or 40s. I don't think he can really understand my life. I feel like I have been given a 6 month sentence and that I am now this fragile person--"Handle with care." I think my body and mind were primed from the trauma last year, and it has been hard. It is devastating to me because I had worked really hard to recover physically and mentally from last year, and was just at the point where everything was coming together. Now, I find myself at the beginning again. But this time, I don't know where I am heading.

I should add, on a more positive note, that I have gotten through this completely from the support of friends and family. Thank you for your visits, calls, emails, flowers and other gifts. I am very grateful. Also, the clots seem to be dissolving so the long term prognosis is good.

Race Report: Wente Vineyard Road Race

2010-05-09T21:05:00.000-07:00

Race: Wente Vineyards Road Race
Location: Livermore, CA
Date: April 24, 2010, 12:15 PM
Weather: Sunny, moderate winds, hot--sunburn weather!
Field Size: 50
Category Raced: 4
Personal goal: Start at the front and stay there, be ahead at the start of the hill, test my climbing, work it on the descents/flats, test my pack comfort level! Race!

I was looking forward to this race as a test of both my fitness and my pack riding comfort level. The group rides I've been going on have been ridiculously hard at times and I figured I could at least put a
similar effort into this race. They have also really helped my comfort level riding fast in a group. I tried to view this race as more or less like another group ride. I felt relaxed and at ease before the race. We arrived with plenty of time to get ready and I had a good warm-up on my trainer.

With the big field and the early climb, I knew I wanted to be on the front at the start, so I made an effort to position myself well. The promenade to the first turn was mellow and I enjoyed riding next to one of my teammates, Stephanie. We were just one or two rows back and riding together and I ended up being surrounded a little. She asked if I was okay and I realized I was totally comfortable. Cool. Pretty soon we hit the hill and I just tried to work it as much as I could. I fell back some as the group started to splinter but was holding some ground. We hit the feed zone while still climbing, and I looked for Laurel, our team director. Yeah! There she was. There was a short downhill section after the feed zone and finish line, which was very welcome. I saw my teammate Yuko ahead and also Alissa, who cheered me on to go go go. We hit the second part of the hill and I just kept it going at a steady pace. I held back a little because I just didn't want to burn it all up on the first lap. Well, I guess I should say, I was going very hard but not trying to sprint up the hill. People were sort of scattered at the top and I finally caught another gal. We worked together and then saw Yuko. We were starting to descend quickly so I yelled loudly for her to get going and hop on! We picked up a few others here and there and had a group of around 5 or 6 through the descent. I was really happy with the descent on this course--it was fast and not too technical, other than the couple of sharp turns that were marshaled. (Hello hay bales!) I pulled down the descent until the left turn at the bottom, and then we started rotating a bit. Another gal in our group pulled through the next descent and I was happy to follow in the draft!

We hit the flats and a gal in our group organized us into a rotating paceline. We were closing in on the chase group and worked in the wind, finally catching them. People started to relax a bit before we caught them, though, and I had this memory from group rides of being that close but still getting dropped. I said, "We're not there yet!" and we had to work a little after the next turn to get fully attached. Well, I did, anyway. We went up a short climb there and the draft was pretty awesome. Descending on the other side, I felt comfortable riding in the mix and moved around our group--I think there were maybe 12-15 of us at this point? Anyway, I pulled a bit but also rode in the pack and felt totally comfortable doing this. A lot of times in the past when riding in a pack, I have this little voice that is expecting disaster to strike. But it was gone. I just felt like I would on a normal ride. I think being more confident with my own riding has helped considerably because then I am able to focus better on the situation around me. Also I have gotten more accustomed to having to having to brake ever so slightly when descending in a pack to control my speed. This is something that has unnerved me in the past.

We hit the climb the second time and I more or less stayed with people but was also thinking, "Hey I pulled for y'all, do you have to hammer it up the hill?" But oh well it is a race and all's fair in love and war and bike racing? Hmmm... Anyway I dropped back a bit and was definitely off the back at the beginning of the descent. I had the group pretty close in my sights and advanced closer down the descent. At that left turn at the bottom, I was pretty close but again knew I was not safe yet. I thought, "It's now or never, Anne, get moving!" and just worked as hard as I could to get back in. We went through the next descent and flats again. Briefly I thought about organizing Yuko and a couple other women who were also at the front a lot into a break if they were up for it. We had a group of about 8-10 riders and I was feeling pretty dehydrated and a little crampy and knew I didn't have a lot to give on the final climb to the finish. So if we took everyone to the climb then I knew I would lose a lot of places; I was a little afraid I would completely blow up if I put in a hard effort at that point. I was able to control the pace by staying at the front a bit there. No one wanted to pull so I just kept it easy for myself. I tried to stay ahead of Yuko, hoping she could rest a bit before the finish. We finally hit it and I felt like my goals had been met at that point. I just didn't want anyone from behind our chase group to pass me so I worked it up that last hill with a little caution since my calves were cramping.

I was really happy with this race because it was the first race I have done since before my crash where I was really racing with my mind fully engaged. Prior, I have felt like I was either in observation mode or just riding with something nagging at me to stay out. It was super hard and there was a point about 3/4 of the way through where I thought, "Really? Does this have to continue?" But I felt comfortable in the group and was really happy that we were able to catch the chase group and that I stayed with them more or less until the final climb. I was so happy to find Yuko and to work with her. I knew she would do awesome on that final climb! I probably should be more patient when the pace slows in the pack and not take the front so readily; on the other hand, I didn't want our group to be caught from behind. When another gal said, "You really love to pull!" I did not take this as a compliment! It's true though! Also I definitely need to pay more attention to hydration. I didn't even drink one full bottle...maybe 1/2 a bottle? That really caught up with me in the end. I think with more hot weather races, I will also try using salt tabs or something similar.

Here's a link to a photo taken on the climb! I think I am grimacing but maybe it looks a little better than my super-serious marathon face? You'd have to ask my mom and aunt, who have been the most frequent recipients.

A Role for Leptin in Type 1 Diabetes?

2010-03-24T22:42:00.000-07:00

While glancing over today's science headlines, I noticed a write-up in Science Daily of a study from UT Southwestern Medical Center involving the administration of recombinant leptin (Amlylin Pharmaceuticals) to non-obese mice (which serve as a model for human type 1 diabetes). Treating the mice with leptin alone, the researchers saw a return from a ketogenic state and a normalization of blood sugar levels, as evidenced by a normalized HbA1c. They postulate that leptin mediates this effect by suppressing glucagon and therefore glucose production via glycogen breakdown in the liver. The most exciting aspect of the study to me was that the improvement in blood glucose levels was not accompanied by the wild variability that people with type 1 diabetes deal with daily. There were also improvements seen in lipid profiles and other biomarkers related to complications of type 1 diabetes--heart disease, in particular. While insulin is a hormone that enhances fat storage (lipogenesis), leptin works in an opposing manner, suppressing lipogenesis. Another effect of treatment with leptin was that the mice returned to a normal weight (vs those on "insulin monotherapy"). The authors found that a combination of leptin and a low dose of insulin led to significant improvements in blood glucose levels as well as in other metabolic markers.

While I still maintain my wait-and-see approach--after all, how many times has the NOD mouse been cured?--this seems like one of the more interesting research headlines I've seen in a while. There are some questions I have, such as whether leptin regulation is actually impaired in type 1 diabetes, and if additional administration could have unanticipated consequences. After all, it clearly is potently bioactive. Another huge caveat is that the mice started with very low blood leptin levels because they had a depletion of fat due to an initial state of uncontrolled diabetes. So it is unknown whether leptin would have as strong of an effect in humans with type 1. Still, I hope that clinical trials are already well into the planning stages. It seems like a worthwhile avenue of pursuit. Read the original study at PNAS for the many details that I have missed!

A few thoughts about Jesse

2010-02-15T21:23:00.000-08:00

I was not surprised to see a steady stream of friends and family of Jesse Alswager pour into the church for the 4-hour visitation prior to his funeral last Monday. Several people I've grown to know and love through Triabetes were there, as well as other friends of Michelle's that I've gotten to know in the past few years. We took time together to reflect on Jesse and what a wonderful and amazing kid he was, and how he will be missed--of course tremendously by his family, but also by the rest of us. The last time I saw Jesse was when he gave up his room for me to stay with his family for the JDRF Gala last spring. He had this confident and happy manner about him that I will not forget.

During the two short days I was in Madison, I learned even more about Jesse. My strongest impression was how well loved he was by everyone who knew him, and how he will be missed immeasurably. He was a light in the lives of many. I thought I would share just a few of the many other things that I learned.

When his sister's friends came to visit her, they also wanted to visit with Jesse. He had a knack for making them laugh and keeping life fun. They felt like Jesse was their little brother, too. He was a loved big brother as well, and didn't complain to have his little brother come along.

Jesse was an excellent student of the guitar; his teacher put his lesson last because he enjoyed teaching him so much and liked to end his day that way. Jesse didn't need to be reminded to practice.

His school friends loved him dearly and wrote their thoughts down on some large banners that were displayed at the visitation. It was clear that he touched many people at his school.

Jesse never complained about having diabetes, but took it all in stride. I don't know many who can make this same claim. I think the only time he had a hard time was the first time he started using insulin pump infusion sets. Those needles are long. . .

Jesse represented all of us numerous times in local, state, and national events. He was honored by Governor Doyle of Wisconsin and had opportunities to testify before Congress regarding stem cell research and other issues. He was an advocate helping to improve the lives of all of us with type 1 diabetes.

Jesse loved snowboarding and loved his good buddy Sean Busby, who loved him equally back. With Jesse's inspiration, Sean took his snowboarding camps to a new level, helping many kids with type 1 diabetes the world over. Sean asked us to ponder, when we might be too afraid to move ahead in life, what Jesse might do. Don't wait; go for it.

Diabetes was obviously a part of Jesse's life but he was still a kid like any other who loved to be with friends, to spend time with his family, and to pursue other interests.

These are just a few thoughts that don't even begin to do justice in capturing Jesse's spirit. For that, I would recommend that you read the poem by Joe Brady that is posted here on Michelle's blog.

It is still hard for me to wrap my mind around the reality of what has happened. My heart aches for his family. Yet, the message that I carry with me is to take charge of life, and to live it with joy and wonder, despite diabetes or whatever other obstacles might appear before me. I hope that by doing so, in some small way, I can honor Jesse's life and keep him and his family in my heart.

BRAVA Magazine Hosting Fundraiser for Jesse

2010-02-06T11:58:00.000-08:00

The following was posted by BRAVA magazine, where Jesse's mom, Michelle, works. If you are in the Madison area, please consider attending this event. This is separate from the events on Monday at the Good Shepherd Church.

Here at BRAVA, we are mourning the loss of an extended member of our company's family.

On February 3rd, 2010—at age 13—Jesse Alswager was taken from his family and friends all too soon. Jesse, the son of BRAVA's Marketing and Events Director Michelle Page Alwager, lived with type 1 diabetes since age 3 and was known as "everyone's little brother." Jesse and his family have been recognized as strong advocates nationwide for type 1 and finding a cure, and he was passionate about guitar, drums and snowboarding.

Spread the word and come out to the Lazy Oaf Lounge anytime after 5pm on February 10th to celebrate his life and raise money for the family. There will be a free buffet of food, a place to donate to the fund directly and in addition, 50% of the proceeds from anything purchased that evening will go to the Jesse Alswager Memorial Fund.

If you aren't able to make it, The Jesse Alswager Memorial Fund has been set up at UW Credit Union, and all UW Credit Union branches will be able to accept donations, or donations can be mailed to:

Jesse Alswager Memorial Fund
c/o UW Credit Union
PO Box 44963
Madison, WI 53744-4963

If you'd like to donate online via Paypal, visit: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=GMW43ZYQXJR9C

Please spread the word and keep the entire Alswager family in your thoughts...we hope to see you there!

Funeral Services for Jesse Alswager

2010-02-05T13:39:00.000-08:00

Funeral services for Jesse Alswager will be held at Good Shepherd Lutheran Church, 5701 Raymond Road, Madison, at 7 p.m. on Monday, Feb. 8, 2010, with Chaplain Linda O'Leary presiding. Visitation will be at the church from 3 p.m. until the time of the service. In lieu of flowers, memorials may be made to U. W. Credit Union, Jesse Alswager Memorial Fund.

Share your condolences here: http://www.caringbridge.org/visit/jessealswager
Memorial tributes can be donated from the above link in the "My Story" section.

Memorial for Jesse Alswager

2010-02-04T18:43:00.000-08:00

Email from Joe Brady earlier:

Here's the updated information on Michelle Alswager and her son, Jesse.

You can visit a memorial website at http://www.caringbridge.org/visit/jessealswager. There you will be able to read "Jesse's Story," leave a guestbook message for Michelle and her family, and donate to the Jesse Alswager Memorial Fund at the UW Credit Union through PayPal. You can also donate through snailmail at:

Jesse Alswager Memorial Fund
c/o UW Credit Union
PO Box 44963
Madison, WI 53744-4963

The visitation and funeral will be held Monday from 3 to 7 pm on the west side of Madison on Raymond Road. Jesse's obituary is scheduled for Saturday's Wisconsin State Journal.

Watch the local news Channel 27 Thursday evening news at 10:00 for a feature on Jesse. Channel 15 may also have a segment on Thursday (or on Friday).

At present, Michelle and family have plenty of food. She's answering her phone when she can. Since you are a supporter of the cause to cure diabetes, take comfort in Michelle's words and spirit as found on Jesse's memorial website. Michelle writes, "I've spent the past 10 years fighting for Jesse and a cure, and rest assured his passing is just the beginning."

**

If you would like to mail a card to Michelle and her family, please email me for her mailing address.

Beyond Belief

2010-02-04T10:45:00.000-08:00

I am so incredibly saddened to share that Jesse Alswager, who inspired not only his mother Michelle, but countless others in the diabetes community, passed away last night. Michelle was tireless in her efforts to support finding a cure for type 1 diabetes, and in showing people with diabetes that they could live full and happy lives. Jesse was 13 years old, and was diagnosed with type 1 diabetes 10 years ago in March. He was loved by all who knew him.

More information will be forthcoming but I believe that in lieu of flowers, a memorial fund will be set up. If you would like to email condolences for Michelle and her family, you can send them to an email that I set up: forjessealswager@gmail.com. I will make sure they are delivered to Michelle.

I have just heard that funeral services may be happening Monday in Madison, Wisconsin, although this has not been confirmed. I will post more details as they become available.

From Sean Busby: "If it was not for my hero Jesse, Riding on Insulin Snowboarding Camps would have been a fling. Jesse and Michelle were my diabetes support system and the reason of making Riding on Insulin go global. Jesse inspired so many and has helped so many children and adults that suffer from diabetes. His mother is an amazing fighter and she fought along side of Jesse for everyone that has type 1 diabetes - in his name. Our sky will now shine brighter now as we have a new star in the sky. He is loved and missed tremendously."

Note: I should re-emphasize that funeral plans are tentative and have NOT been confirmed yet.

Early Bird Crit, Revisited

2010-01-31T23:10:00.000-08:00

Last year after my horrible crash, when I was still unable to get out of bed without crying tears of pain, I was faced with the decision of whether I would get a kit (jersey + bike shorts) for the bike race team I had joined. "Why in the world would I even consider this?" The final diagnosis had been fractures in my left clavicle, 9 posterior ribs (if I add up all the fractures reported on the Xrays) and L2 transverse process, pleural effusion, severe bruising and road rash. I have never gone through anything else even remotely as painful, physically, as that experience. But, I decided that it was not a good time to make the decision to quit. I would order the kit.

As the months passed, I thought a lot about what I would do with bike racing. I debated, "Do I actually want to get over this crash?" Was the right thing to recover and get back in the game, or take my exit? One might say that it is brave to go back, to face the fears. On the other hand, what about the notion of learning from one's experience in order to avoid harm in the future? Perhaps it would be foolish? What risks could I live with for something that was not required to get along in life?

So early this year, when I decided to attend the Early Bird clinics, I wasn't planning on participating in the practice races. Last year, I had decided that I would never do a crit again. Crits equalled crashing in my mind, even though I had seen many friends get through them successfully, uninjured. I had done 3 of the practice crits and 8 hours of clinics leading up to that race; but those were trumped by one very bad race. All of this year's Early Bird clinics and practice races, as well as the official crit, were on the same course where I crashed last year, and I hadn't been back since that day.

When I got there the first week, all the memories came pouring back in. I remembered where I had tossed my arm warmers right before the start (and had seriously regretted later). Were they still there? I remembered where I had parked my car, and how a friend's friend had retrieved it for me, since I was in the hospital (and wouldn't be driving for 2 months). I remembered that trip to the hospital on the spine board, wondering what this would mean for me. This year, in the first clinic, we were practicing pacelines and one of the mentors was repeatedly encouraging me to move up right on the wheel in front of me; I kept resisting, frustrating him. All my brain could handle was just riding my bike around that course; feeling pushed to do more put me over the edge emotionally and I pulled out in protest, muttering "I can't do this." After some moments riding solo and regaining some composure, I joined back up and continued the drill. Each time I passed that spot, an image of crashing flashed across my mind; but, I noticed that the emotional aspect of it lessened and I was able to focus more on the drill.

My plan was to sit out the practice race; but I thought that, perhaps, I could at least go to the start line. And maybe I could just do one lap, and see how I felt. Taking the pressure off myself to try to do well, or to even complete the race, allowed me the freedom to relax and just take it at my own pace. I went one lap with the pack and realized, "I am okay." I went another and decided I could keep going a few more. When I say "with the pack," I should really say "behind the pack." I just hung on, not really even in the draft much, prompting frequent "Close the gap!" comments from the mentors. Really, I was listening; but I just couldn't get in there.

As the weeks progressed, I had some moments where I broke off ahead of the pack. Most of the time I was consumed again; although, I came in 5th at one race. But in my mind, breaking off was basically an escape, as if the pack behind me was a tsunami wave that might consume me if I were caught. When the pack did catch me again, I would drop to the back and give up the fight. I just was not comfortable. And a couple crashes in those weeks seemed to prove my point. See? I was right to stay out of there. On the other hand, I also remembered something I had forgotten: I really enjoyed this. Although I had enjoyed the practice crits the year before, these feelings had been completely silenced by the louder memories of my crash.

Today, I arrived in Fremont after attending all of the clinics and practice races; still I felt uncertain about this, the official race. I would continue with my "one lap at a time" motto and allow myself to quit if I felt really uncomfortable. I knew, though, that I would want to complete the race. We got to the start and I was relieved to see they would continue splitting our field into racers who had completed 10 or more and those who had completed fewer than 10 races. The weather was similar to last year--sunny and warm--and I could have tossed my arm warmers. I kept them on.

As we began the race, I noticed that I was much more comfortable, at least staying with the pack (well, most of the time). I again took the position in the back, but at least stayed in the draft more than before. I didn't go for any breaks; my main goal for the race was to become more comfortable pedaling through the corners with the pack, remembering how I used to feel doing that. As the race wore on and as one mentor, aware of my corner anxiety by now, gave me helpful pointers, my confidence increased. Why, if I was going the same speed and following the lines of other riders, would I be the one to go down? I started to feel the road better, and to feel my anxiety a little less. I stayed in the pack a little more at times, but just focused on being safe. I found the advice to keep a broader view of the race, rather than to focus on the wheels just ahead of me, to be very helpful in anticipating the pack slowing and surging. I can't say that I was totally comfortable, but I wasn't miserable either.

We approached the last lap, which was when I crashed last year. The last lap can be dicey, when people are tired and positioning themselves for the final sprint. I wasn't sure if I would try anything or just coast in. I could see that some people were not going for it and I thought I might as well move up a little. I gave it a good effort and crossed the line feeling happy and relaxed (well, and completely winded). It was over and there was no repeat trip to the hospital.

Earlier in January, I had wanted Tara to take me to the point on the course where she had witnessed my crash; I was obsessed with going over every detail. I thought that I still wanted to hear her perspective on that today. As we were riding over, I thought, "I don't even really care about this anymore." She gave me her feedback, but somehow, I just felt like the story was old and over, like a movie that had become boring after too much viewing. I was done.

I still suspect it may take me time to get totally comfortable; but I think, now, that this is more a matter of me just becoming more skilled, rather than carrying a lot of fear from the crash. I will definitely be very mindful and careful and will respect my intuition; I will continue to give myself the freedom to pull out of a race if it feels unsafe. But I am really excited to feel free of this mental block that has been holding me back. I didn't know whether doing this race would really make a difference; my sense today is that it has. I feel excited and happy to be opening the next chapter, to see what stories will unfold.

New Year

2010-01-25T18:39:00.000-08:00

Last year was one of those extra special years that leaves one changed forever. Learning lessons in having patience with oneself and life's circumstances does not come without some struggle. Becoming a more empathetic person can be painful. As I approach the one year mark after my bike crash, my bones are healed and I am riding my bike again with joy. Still, I have frequent reminders--pain here or there, or thoughts of reflection--that tell me it's not over yet. And I wonder what subconscious lessons I have drawn from these experiences. Am I less trusting of myself and others? Will my sense of fear of re-injury and pain hold me back from taking risks--risks that could, ultimately, lead me to something greater than I could imagine now? How do I let go and become fully engaged, both physically and mentally, again?

Originally for 2010 I had signed up for Ironman St. George, excited to race on a course familiar to me after running the marathon there several times. I signed up when I wasn't even back to work after my crash, before I had taken a single pedal stroke on my bike again. After Ironman Arizona in November, I told myself to wait until January 1st to make any decisions. As the new year approached, it became clearer and clearer that I did not want to do this race. My knee injury that bothered me during the marathon at Ironman Arizona was not healing quickly and I did not want to spend another several months playing the "Does it hurt too much to run?" game. I needed a break.

I feel fortunate that I was able to do so many events during the second half of 2009: Death Ride, Barb's Race, Folsom Olympic, 3 road races, Lotoja, and Ironman Arizona. As I wrote before, the Triabetes events in Tempe were amazing and made the struggle getting there 100% worth it. But I feel like I need and want to take a step back from the super endurance events (Ironman and double centuries!) and focus on healing my body and giving my mind a break.

As soon as I made the decision, I was so relieved and happy. After 4 Ironman races in 3 years, I was really caught up in the energy and thrill of the sport; and doing the last two with Triabetes has been a gift. But I have to say, not having that big pressure is exactly what I need right now.

"Taking a break" to me means taking the pressure off any one huge event. I am still training, focusing mostly on cycling this year. I will also continue to swim, because I have really been enjoying it and also because it really helps my upper back and left arm stay loose. And there will be events that I will target; still, I am allowing myself to take things at a slower pace and to appreciate incremental steps of progress.

Ironman Arizona Diabetes Details

2009-12-08T09:16:00.002-08:00

I thought I would give a description of diabetes-related details for Ironman Arizona for those who may be interested. This is not necessarily the best approach for anyone else or even myself, but is what I have been trying as of late. My strategy in training for past long triathlon events has been to do a lot of record-keeping, especially around key workouts that simulate aspects of the race. This time, for whatever reason, I didn't have the time or energy to be as diligent about that. Also, I was trying to cut back on calories during workouts, so it was a little harder to compare with race day. And furthermore, I really wasn't able to do any long runs so it was hard to simulate the conditions for the marathon.

On Saturday, I pre-programmed my pump for the race the next day, based on my predicted times for each leg of the triathlon. Typically for a race, I will program an increased basal rate before my planned breakfast time in order to help counter my tendency to run high on race morning. For an Ironman, this is typically about 4 hours before the race start. About an hour before the swim start I might drop it a little from normal; I don't need to drop it much because my basal rate is pretty much set to keep me stable during morning exercise. I'll keep it slightly lowered during the first hour of the swim, and then raise it quite a bit about 30-45 minutes before I get out. The reason I do this is because I consistently have a spike in my BG at the start of the bike. I have had races where, within one hour of starting the bike, my BG has gone from upper 100s to over 400, even with eating very little to no calories. I believe this is due to the high level of excitement (and therefore increased adrenalin) that naturally occurs in the transition between the swim and the bike. I'll keep my basal rate raised (say from my normal 0.6 to 0.7 units/hour to 1.0 or more) for the first hour or two of the bike, and then drop it down to a level that has worked for me in training on the bike, given my planned calorie intake. An hour or so before the run, I'll drop it down lower, to a level that has worked during training runs, especially those that had followed a long bike ride. I may also eat a little extra in the last hour of the bike. During the run, I often have to do some trouble-shooting it seems, but try to settle into a good level as soon as possible. After the race and overnight, I set my basal rates back to normal or to slightly reduced levels.

For me, this strategy has worked well, especially if I have done a lot of testing during training to get really comfortable for what rates work well for me. I try to get familiar with the actual numbers, rather than just a percent increase or decrease. Still, it is hard to predict how my body might react to the increased stress and duration of exercise on race day, especially after a week of tapering. I tend to err on the side of letting my BG ride a little higher rather than increase my chances of having a low BG, which is really painful during an Ironman. Although, having high BGs during a race is no picnic either.

Regarding bolusing, I will take my normal breakfast bolus 3.5 hours before the race start to give myself time to correct for post-meal highs, and to give the bolus time to taper off before starting the swim. I am still learning how much I can bolus during an event without crashing later. Correcting for highs on the bike seems easier, and I have more recently learned that I can manage with a couple units of insulin on board without my blood sugar crashing. I get really nervous taking big boluses, even to correct for severely high BG, during exercise. I just hate so much having low BG during a race. It really destroys me, physically and mentally. Although I have also learned that I seem to recover okay if I am patient when I have a low.

Record of my diabetes management during IMAZ 2009
(Thanks to Kevin for his Excel logbook, which can be found here.)

At 3:30 AM, 3.5 hours before the race start, I bolused 4.5 units for my 65-g carb breakfast. About 1.5 hours later, my BG was good at 165, but then started to climb before the start. I was surprised to see it rising up through the 200s and then spike at 303. I skipped my pre-race gel/Gatorade and decided to correct with 0.3 U before getting in the water for the swim start at 7 AM. During the first half of the swim, I felt good, but started to get hungry about an hour in; after some internal debate I ate a gel, which gave me confidence, and finished the swim at 182. I started the bike around 9 AM and was really hungry right away. I ate a few bites a few miles in and before checking my BG again, trusting that my basal rate of 1 U/hr since 8:30 had been enough. Unfortunately, I popped up to 349, so went ahead and bolused 1.4 units. This gradually brought me down to the 180s and then 130s about an hour before the run. I started the marathon at 139 and promptly dropped to 53 in the first 2-3 miles. It took me some time to recover from this and I was shocked at how high I had set my basal rate! What was I thinking? Anyway, I temporarily shut off the pump for 30 minutes and set my basal rate at 0.2 U/hr. This seemed to work for a while but then I had an unexpected, enormous spike in my BG; I think this was the beginning of the third loop. I wondered if the pain was stressing me, causing the high BG? Or probably the slow pace was requiring fewer calories? Did that chicken broth have a lot of calories in it? I took about 2 units but this high was stubborn, and I had to take another unit of insulin. I was over 400 for about an hour. Yuck. I drank lots of water, took some salt tabs to replace depleted electrolytes from the high. I eventually came down and then relied on the cola to keep me from bottoming out. I didn't check right after finishing, but had come up to 242 about 45 minutes after. I bolused for the pizza I ate and went to bed a little hungry, and woke up with a BG of 63 early the next morning. But otherwise, I didn't have any issues with low BG following the race.

Next time, I would keep my increased early morning basal rate until 6:30 AM, rather than 6; or perhaps I would raise it from 0.8 to 0.9 (above my normal of about 0.55 that time of day). For me, it's easier to treat a too-high basal rate than a bolus over-correction. About 30-45 minutes before the swim finish, I would increase my basal rate even higher--maybe to 1.5-2 U/hr--and would keep it there for about an hour on the bike. Or else, I could take a couple units as an extended bolus in T1, which would have the same effect but would be timed a little more precisely with my race. I used to use this method but felt like it was less to think about to pre-program my basal rates. Also, I think it works better for me to have increased insulin on board before I get out of the water. For the run, I could have lowered my basal rate earlier before getting off the bike, and should have lowered it more. It was essentially the same as it would normally be at that time of day, if not higher! I had based this on a level I've used for long training runs in the past but at a different time of day and not after a long ride. I need to keep my wits about me and realize that, if my pace is really slow, I am probably not burning as many calories per hour, so probably will need more insulin. I think my strategy next time might be to drop my basal to something like 0.2 units/hour before the run start and then increase it a little to 0.25 or after an hour or so of running.

I'd like to believe that I can figure it out once and for all and then have perfect insulin and BG levels at every race! But I think, for me, it is more realistic to expect a certain amount of fiddling. There are so many variables, new and old, to consider on race day. I definitely feel that, after several years of experience, I can anticipate a lot of the tricky spots during a race; and, even when things don't go perfectly (which is always the case for me, it seems), I have less fear and anxiety over it all.

**
(Stolen from an earlier post of mine...)
"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.

Triabetes and Ironman Arizona 2009, Part 2

2009-12-06T21:29:00.000-08:00

Date: November 22, 2009, 7 AM
Race: Ironman Arizona, Tempe, Arizona (2.4 mi swim, 112 bike, 26.2 run)
Weather: cool, ~50 at the start to mid-70s during the day to cool again by the end.
Teammates present: 15 teammates from Triabetes, a bunch of guys & gals from Team Pacific Bicycle and a whole host of Triabetes friends & family
Goals: to keep focused on finishing and enjoying celebrating the day; to stay comfortable during the swim and bike and to allow myself time as needed in transition; to manage IT band injury so I could finish without causing long-term consequences.

Some races are about shooting for a new personal record (PR) or placing well; others are about making it to the starting line and doing one's best to finish. This race would be the latter.

Before the Start
Since I arrived with fellow teammate Sean at 5 AM, two hours before the start, I had plenty of time to make final preparations. I pumped up my tires, dropped off the special needs bags (which they give back to you midway through the bike and run), and cycled through the portapotty line a couple of times. I felt relaxed and ready to go--it really helps that they have you drop off all your gear the day before. Also, I planned to take a simpler approach to the bike and run this year, and would rely more on the aid stations for my fluids and nutrition. In past races, I have used Perpetuum on the bike, but this time I would just try Gatorade, water, and mix of solid food supplemented with gels etc. as needed. I would shoot for about 200 to 250 calories per hour while on the bike. For the run, I would carry plenty of fast-acting carbs with me, but also knew I could use the PowerGels and other food they were offering if I ran low. I had an extra infusion set inserted and primed the day before, but also had a spare on my bike and in my run special needs bag. I had a meter for the swim start, and another that I would stick in my jersey pocket on the bike and run. I had also thrown in a spare meter in my run transition bag.

Swim
After pulling on my wetsuit, I randomly found a few other Triabetes people; we made our way to the start with the slowly moving crowds. Sarah Jane and Sarah W. had set up a table near the start where we could leave our diabetes gear, and I was able to check my blood glucose (BG) one more time before hopping in the water. Although a bit on the cold side at 62 degrees, the water felt okay compared to swimming in the San Francisco Bay, and I was hoping that the fresh water would be kinder on my neck, since I yet again forgotten to put Body Glide on beforehand. I've seen some pretty bad wetsuit neckline welts before and wondered how long those took to heal. Oh well, it was too late; I just hoped for the best.

I lost everyone by then and just swam toward the start line, which was probably about 200 yards away. I had barely gotten somewhat close when the gun went off; we were underway! I started somewhere in the middle, trying to avoid the right side, where I imagined the more aggressive swimmers would be. Anyway, it was your typical Ironman swim start mayhem for a while but I could tell that we were going at a decent speed, and tried to stay in the pack. With about 2500 people starting, it was a big crowd! Partway down, I just didn't feel like dealing with it and inched out a little. Then the sun came up directly ahead and I couldn't see anything and just sighted off the other swimmers. I hate it when I look over and realize there is NO ONE to my side. I would move left, back to the pack to get some draft and then find myself to the right again. We passed beneath some bridges that I thought were near the turnaround, but I couldn't see the landmarks I had picked out earlier. But suddenly I was at the big red buoy; for the first time ever in a race, I thought, "Wow, it's already time to turn around!" I think having so many swimmers packed together in a somewhat narrow lake made for a stronger current than you might have at Ironman Coeur d'Alene or Wisconsin. Also, the turnaround buoy is not quite halfway through the course. I wondered if I might PR on the swim.

Swimming back, I felt really hungry and debated whether I should stop for a gel. I wasn't sure if I was low or just hungry since I had skipped my pre-race GU (gel), but decided to go ahead just to be safe. Also, if I even suspect that I have low BG, I tend to slow down; and usually when I am swimming, if I think I'm low, I am. But not always. For me, though, feeling hunger pangs is a pretty good indication of falling BG while exercising. I did feel better after the GU, although kicking on my back while eating seemed to disturb my calves and I started to cramp up. I tried to flex my feet and relax my calves, but they totally seized up. Owww! As I floated on my back, trying to relax the cramps, a woman in a kayak asked if I needed help. Hmm, I had sort of prided myself on not needing to stop during an IM swim, but this sounded like a good idea. Another woman who was closer slid up next to me on a surfboard and I grabbed it while trying to stretch out my calves. It took a few minutes but finally they relaxed, and I was able to swim the last half-mile without a problem. The Triabetes table had miraculously moved to the swim exit; I was very grateful for help with a post-swim BG check, which would give me a few extra minutes to make necessary adjustments. Also, it appeared that my neck was not chafed. Yeah!

the swim exit on a calmer day

I ran to get my transition bag, and slipped into the tent to get on my bike gear. I had opted to wear the Triabetes tri shorts and top for the whole race, rather than changing into separate bike and run clothes, so didn't really have that much to do. The volunteers rubbed me down with sunblock, which sort of globbed up on my wet skin. Clearly I wasn't in too much of a hurry, because I stopped in the portapotty to rub it in, probably wiping most of it off! (Yeah I had some weird sunburns the next day.) Eventually, I made it out of T1 and was on the bike. The Kestrel felt light under my feet as I made my way up the ramp, forgetting the rule about not passing anyone there. I saw some Triabetes fans wearing their blue shirts and I was happy!

Bike
My plan for the bike was to pace conservatively so that I could finish this leg without a flare-up of my IT band knee pain. I kept telling myself, "Don't be greedy!" meaning that it was NOT okay to just say, "Forget about the run! I'm going to hammer on the bike!" I have done this before! With such a flat course, I suspected that I might PR while keeping a steady but comfortable pace. Because I only had one water bottle cage on my bike, I planned to drink one bottle of water between each aid station, and would grab some Gatorade at the beginning of each, drink what I could and toss it at the last trash drop. With aid stations every 10 miles, I figured I would be passing one every 30-40 minutes, which would be fine. Actually, I suspected I might drink more, knowing that I had one bottle that should be mostly empty by the next stop. Also, I felt that by forcing myself to slow down a little for the aid stations, I would keep the pace under control better. My goal was to finish, remember? I tried to keep this in mind.

The course was 3 loops and nearly flat. Well, there was a mostly big-chain-rideable uphill on the way out and then the reverse slight downhill on the way back. There was a small short hill near the turnaround just long enough to stretch my legs out a bit. On the first loop out we had a pretty strong headwind, which took me by surprise since there had been NO wind whatsoever the days leading up! But the way down was super fast and fun and wow, that Kestrel is a bullet. I was so happy to see my mom and aunt along the sidelines on the way back, and got a big lift from the Triabetes crowds (as well as other friendly cheerers) at the turnaround for the start of lap two. I was enjoying this and felt strong and comfortable.

Just starting the bike. (Photo courtesy of Blair Ryan)

The next loop up, there was also some headwind, but on the turnaround there was also headwind. What?? Where did that beautiful tailwind go? Still, it was downhill and I had my goofy aero helmet on, which I actually love after all these years of mocking them, so it wasn't too bad. I stopped for my special needs bag and munched on some food and took a stop at the bathroom and was on my way again. I reminded myself that it was okay to not go crazy and rush through everything. I felt pretty good for the rest of the ride despite one serious flare-up of IT band pain. My physical therapist (PT) told me to swing my knee a little wider if this happened and lo! and behold! it worked. The pain was completely gone after a few minutes. I was happily surprised. Riding in the aero position was not entirely comfortable for me but I hadn't prepared much that way so I wasn't too surprised. I was probably in my aero position for about 50-55% of the time, when it should have been closer to 90-95% given the course.

Even though it was a good ride for me (and a PR of 40 minutes), I was happy to finish up and get off the bike! Immediately after handing a volunteer my bike, my knee started hurting. I walked slowly towards the transition bags as the volunteers pointed me up the hill towards my number. Well, I guess I just had one leg left. A marathon. Maybe if I took my time in transition, my knee would chill out and I could at least get through half the run still running. I finished the bike sometime around 3:30 PM, so would have over 8 1/2 hours to get through 26.2 miles. I felt like I could do this but I really didn't want to be out there that long!

Run
Eventually, after procrastinating as much as I could, I crossed the timing mat to start the run. My plan was to start off at a really conservative pace and just hope I could maintain that for the whole marathon. My knee was hurting a little for the first few miles, but I was relatively comfortably maintaining an 11-12 min/mile pace, which was my target. Around mile 3, I started feeling really spacy and checked my BG, which was in the 50s. I reprogrammed my basal rate, shut off the pump for 30 min, and loaded up on carbs. I decided to wait to start running again until I got above 80. I think Seb passed me here and it was good to see a fellow Triabetes teammate. My BG finally came up and I resumed my slow run. I was happy to see my mom and aunt, who were exactly where they said they would be, at the top of one of the short hills. "This is going to be a long run," I said. I was glad to note that they had some chairs to sit in!

Around mile 5, I decided to walk a little to give my knee a break, which seemed to help. On the second loop, by mile 8, the pain had increased and I was limping quite a bit. Some volunteers tried to help at an aid station by massaging my calf and knee area, but it got even worse after that, and my pace dropped off closer to 14-15 min/mile. I don't know if it was the massage; it probably would have gotten worse anyway. I kept recalculating how long this would take. Four MPH and 18 miles to go? I didn't want to think about it. I had asked my PT before the race whether the pain was something that should alert me to stop. I really wanted to finish; but more important to me was the ability to continue exercising after the race. He said that it could be a few weeks for the recovery, but that it shouldn't cause long-term problems. This was a relief to me as I continued, and although it was painful, I kept the pace below a level that would have caused burning pain. This would have been a show-stopper, whether or not I wanted to continue.

After an eternity I finished the second lap. The Triabetes tent area was amazing and it was so special to run through there. Thanks to my teammate Reid's sons for giving me the extra cheers as I passed through. Thinking about that last lap was a bit discouraging, because my pace was now somewhere between 3-4 MPH and I kept thinking, "I can't believe I am going to be out here for more than 2 hours!" But dang! I still wanted to finish this thing. I felt that physically I could get through it. Mentally, though, it was a struggle. At least, on this last lap, I knew I would be passing through each spot for the last time.

I was really happy to see a few faces from last year out there, including Aaron Perry, who was giving big cheers out in the boonies of the run course (yeah!) and Dave Shack, who was close to the Triabetes tent area. I commented to Dave how I had thought many times of his "power-walking in biking shorts" comment that made it to the documentary. Dave had made it through with a lot of walking and massive blisters on the bottoms of his feet! I guess I could muddle through another 5 miles. (But, still, ugh!!!) Thanks, too, to Ray Ibsen of Andiamo who walked with me a bit, his camera in hand. (Ray, you must have a really strong right arm.) A week of traveling had caught up with Elisa, so she had gone to bed; but she was still in my mind as I made my way around.

Crossing one of the bridges, Reid and Sean caught up with me, and we walked together for a while. It was so nice to be together, and I was happy to see that they were doing well. Soon enough, Denise came motoring on through like the Energizer bunny, and Reid and Sean decided to pick it up for the end. I tried to run a little here and there; it didn't seem to really help my pace all that much. But the end was in sight. After hearing Mike Reiley announcing other finishers for hours, it would soon be my turn. I discovered I had a little juice left and picked it up (relatively speaking!) for mile 25, and then dropped my pace by about 3 min/mile for mile 26. The crowds had all moved to the finish line, except for Nate Heintzman and teammate Jerry Nairn, a happy sight in the solitude of that last mile.

Entering the finish area was maybe one of the best experiences I have had, ever. I saw so many people who are so dear to me, and others whom I hadn't met but who were sincerely cheering me on. I think this is a huge part of what makes these events so special. Not to be too sappy, but there is a genuine sense of caring, love and happiness and as my dad once said, it is a "celebration of humanity." Doing an Ironman is a self-inflicted challenge and some may wonder, "Why do it?" But what you do when you participate in an event like this is to teach yourself on a physical, emotional, and mental level that you are capable of pushing through something that may seem too difficult to bear. I tried to take it slow and just enjoy celebrating this finish, and immediately knew that it had been worth it all, not just that day but over the whole year and many years prior.

Thank you to everyone who participated in the weekend, both in Arizona and remotely in other locations. And thank you to my Triabuddy Elisa; I am totally serious when I say I wouldn't have made it to the start without her implicit support. Also I am very grateful to Kristin McGrath from Colorado Premiere Training; she enthusiastically and patiently coached me through my recovery and a complicated race schedule.

I hope to see Triabetes continue to grow so that more and more athletes with diabetes feel supported in their fitness goals, whether racing an Ironman or training for their first 5k run. For me, it has been a gift that makes it worth struggling with diabetes all these years. I am grateful to those who have supported Triabetes through volunteering, donations and sponsorships, making all of this possible. Thank you!

So happy. (Photo courtesy of Blair Ryan)

Threatened by Driver of a Black Truck in Portola Valley

2009-12-05T16:28:00.000-08:00

Today, I was out for my first ride since Ironman Arizona, and was enjoying a leisurely ride on the Peninsula. Heading back towards Woodside on Portola Road through Portola Valley, I rounded the corner and was heading down that smooth, gradual descent that just makes me happy to ride. There is a wide bike lane and although people often drive fast, traffic is usually light, and was today. I was approaching the intersection with Westridge when an older, dull green BMW, followed closely by a large, black pickup truck both passed me. The BMW's right-turn blinker was flashing. I also noticed some items in the bed of the black truck as it passed. There wasn't really time for the BMW driver to turn right but he proceeded anyway, and both the truck driver and I slowed a little as he turned. No big deal. The truck wasn't making any indication that he would be turning right, and I continued along downhill. It was impossible to believe he hadn't seen me, and we were already too close to the intersection for him to turn. When we were already both passing through the intersection, he screeched forward as he accelerated hard and then turned right, wheels squealing, onto the left side of Westridge, cutting in front of me. He continued to speed away quickly as I yelled some choice words; I noticed that the driver side window was up and figured he probably didn't hear me anyway. It was really close.

Momentarily I was just mad but then quickly became completely emotional and could hardly even ride--my legs were shaking on the pedals and I lost the spirit to go on. I saw a similar-looking black truck pass me again on Portola and wondered if it was the same one; it seemed entirely possible that the truck driver had not turned for any reason other than to threaten me. I pretty much coasted all the way to the turn-off to Woodside. I think it was just enough stress to open up some buried fears and emotions. I didn't have any flashbacks, but on a deep, maybe even subconscious, level I felt like I had come very close to serious injury, at least; furthermore, there was no doubt in my mind that this was a deliberate act on his part. Why would someone do that? Practical concerns kicked in because with the 15 minutes of easy riding I started to get really cold, and needed to pedal again. The emotional response eventually subsided and then I was just mad. I decided I would call the cops and report the guy. There was probably nothing that would come of it; but I figured this was probably not the first or last time this guy would do something like this. Anyway, it was all I could do. I stopped and made the quick phone call, and the police said they would send someone to check it out. They took it seriously, and noted all the details. I'm pretty sure that by that time, though, the truck was long gone. Mostly I just wanted to make a report so that it was on their record.

I don't know if this guy was mad at cyclists for some reason, but I was just riding along, alone, to the side of the road. I try to be courteous to drivers, especially near places like Woodside that see a lot of bike traffic on a regular basis. It doesn't really matter, though; this driver was using his truck as a way to physically threaten, and potentially harm me. I hope he takes a look at the news coming from So Cal and thinks a little more before trying this stunt again. I sort of doubt it would make a difference to him though.

Be careful out there.

Triabetes & Ironman Arizona 2009, Part 1

2009-11-29T19:21:00.000-08:00

I guess it was really when I bought some Ironman Arizona socks and a commemorative T-shirt that I knew I would do what I could to finish. But what erased that lingering doubt was meeting up with my Triabuddy Elisa, and then watching the documentary premiere in a theater overflowing with the many friends and supporters of Triabetes.

I was happy to meet up with Elisa and to hear about her adventures sailing out to the Channel Islands, kayaking, exploring sea caves and hiking with her new friends. (Kayaking was her favorite, and I heard she was very brave!) Perhaps my favorite aspect of our conversation was that diabetes didn't even come up until I asked her about it; the weekend was about being a kid having fun, and realizing that diabetes didn't have to stop that from happening. I was so proud that she overcame some fears that any 10 year old might have, as well as diabetes-related uncertainties. Yeah Elisa!

I savored every second of the documentary that followed, and remembered why it was that I couldn't wait to sign up for another Ironman with Triabetes a year ago; I knew then that I would do what I could to finish the race. I was reminded of the challenges that every athlete faces out there, with or without diabetes. I was reminded too of that special bond we have as people with diabetes (and those with type 3 count too), and how a little bit of magic happens when there are others around who know what it means to be 53 and suffering during a marathon, or going strong at 140 on the bike. When someone wants to know my blood sugar out of empathy and concern rather than rubbernecking a potential diabetes mishap, I feel their care; I was reminded of this feeling during the documentary. My family who came to support me in the race loved it too, from the focus on the Triabuddies to the struggles and achievements of the adults and those who support them. I was so caught up in reliving the moments on film and enjoying seeing these people who I've come to care about so much, that I want to watch it again and again to capture everything I missed.

I left the theater and awards ceremony that followed feeling relaxed, more determined and also a little fearful of the day to follow. I would be counting on the energy of friends and other athletes on the course to pull me through this race, especially the marathon. We dropped off our bikes and gear bags and ran some last-minute errands before settling in for an anxious night of sleep. The big dance was about to begin!

(A quick note of explanation: In my book, a "type 3" diabetic is anyone who tries to learn and understand what my diabetes is all about, and doesn't look surprised when I lick my finger after testing...)

Ironman Arizona...Here It Comes

2009-11-17T16:17:00.000-08:00

This year has been one with many unexpected challenges, and I have never gone into a race with this much uncertainty. Because of a nagging IT band injury, I haven't been able to train as much as I would normally have done, especially with regards to running. As a result, I spent more time swimming; not only has this helped me to improve my stroke, but also I have come to enjoy swimming much more. Although my swim time probably won't be faster than last year, I am happy to be back to my pre-crash state (more or less). Because I have basically spent this whole year rehabbing, I do not want to set myself back in a major way. While some pain is to be expected in an Ironman, I am hoping I can know the line between enduring to the finish and risking permanent harm. At Lotoja in September, the left side of my back and shoulder became quite weak and my IT band really started to hurt after 150 miles or so. It might have been wise to stop at that point. Lately, I've been able to ride without pain most of the time and run without pain for about an hour. I feel that I should be okay on the bike, and we'll just have to see about the run. I know that seeing many friendly faces will buoy me along the way, and that I am not the only one who has faced extra challenges training this year.

But, more importantly, I am looking forward to once again being in the community of amazing people involved with Triabetes, from last year and this year. And maybe some new people will discover us and join us for future adventures. I can't wait to see the documentary and to meet up with my Triabuddy Elisa, and to visit with Ray & Nella (her parents). Their dedication in filming and producing this documentary is unrivaled and I know I share the gratitude of many for their efforts. Saturday is a celebration and Sunday will be a time to enjoy having so many friends and family members on the course while I enjoy my little "catered workout" in Arizona.

What Is Inspiration? My Triabuddy Elisa

2009-11-11T16:46:00.000-08:00

The Triabuddies program of Triabetes has given me cause to reflect often over the past couple of years on what it means to be a positive influence. Each team captain is mentoring a young person with type 1 diabetes; this group of Triabuddies will go on a sailing trip together next week, and will meet us all race weekend in Tempe to share the Ironman experience. My joy in swimming, cycling and running is my primary motivation for doing the sport of triathlon. Secondly, I see the positive effect the training has not only on my health but also on my strength to carry on with my daily life. I expect myself to exercise regularly as much as I expect myself to eat, sleep and go to work. So, sometimes, I struggle with the notion that what we as athletes with diabetes do serves as an inspiration for others. It seems presumptuous. But with continued reflection, I remember key people from my younger years who stepped in with confidence in my possibilities and the subtle direction they have had on my life. Visiting a research lab with my mom’s friend, Shirley, added to my belief that it was a normal thing for a woman to be a scientist. My high school running coaches gave me the gift of a lifetime love of running by pushing me just enough, and never doubting my ability to run with diabetes. Many similar experiences have added up over the years, helping me to operate with the assumption that most personal roadblocks can be overcome with the right approach and enough work. (Okay, I am more cynical at times and of course I get discouraged but I do try to get back to this.)

So I guess what I hope to show my Triabuddy, Elisa, is something she already seems to grasp—that diabetes doesn’t have to stop her from living her dreams. In fact, I have sometimes wondered, “How can I help Elisa? She seems to already fully understand this.” I was impressed with my Triabuddy, Marissa, from last year, in the same way. These kids have innate determination and encouraging parents who give them confidence that they can succeed. But perhaps I can be one positive influence she can remember if she ever wonders if diabetes might be a reason to let a goal slip away. And maybe what I can offer Elisa is an understanding of diabetes—that, yes, you should go for your dreams, but when you have frustrating moments, I understand that, too. Just because you can “give it a shot” doesn’t mean that it is always easy. But you just keep going.

People who have been positive influences in my life have also made efforts to build relationships with me. This year, I have had the opportunity to visit occasionally with Elisa and enjoyed very much a recent phone interview with her. Her descriptions of her life unrelated to diabetes were refreshing, and reminded me of how I have tried to live with diabetes; sure, it’s there, and it requires my attention, but it is not the focus of my life. For other kids and parents out there, here is a summary of my interview with Elisa, a smart and athletic, nearly-11-year-old girl in fifth grade, who happens to have type 1 diabetes.

In school, Elisa recently enjoyed learning how to create circuits with batteries, wires and miniature light bulbs, and discovered how to make a bulb burn brighter by reconfiguring the circuit. (Can you do that?) Also, she enjoyed designing an island with her team of classmates. They named it “Birthday Island,” complete with Party Hat Forest and Ribbon River. In math class she is learning about lattices, which sounds pretty advanced to me. (I had to do a wikipedia search on that one.) A couple of her favorite musicians are Selena Gomez and Taylor Swift. Although she won’t be pinned down quite yet, her answer to the adult’s favorite question, “What do you want to do when you grow up?” was photography, which she enjoys, especially if it includes animals. Her favorite animals are lions and tigers.

Elisa recognizes kindness in others, and kind people—friends, family, and people she “doesn’t even know”—are the ones she admires most. If given the chance to meet a historical figure, she might choose Sacagawea. Some of the games she enjoys are Club Penguin, Pop Tropica, and videos on YouTube. She enjoys playing mid-field on the soccer team and prefers freestyle and breaststroke during swim season. Another favorite game is 4-square. (Yes! I’m glad some things are still around.) Not surprisingly, Elisa “would rather play than to watch.”

Having been on injections for years, Elisa took the brave step of starting on the Omnipod insulin pump in the summer of 2009. Regarding the change she said, “It is different…because you don’t have to take a shot whenever you are high [hyperglycemic] or have a snack. And you don’t have to change it for three days. It’s comfortable to me because I can barely feel it.” She feels like it is easy to bolus and knows how to use many of the pump’s programming features. She reports that her blood sugars have been very steady on the pump and that she likes it “way better than having to get shots.” Although she was scared at first that it might hurt, and says that sometimes it does hurt, she would advise others her age who were thinking about it that “it’s not a problem. You’ll get so used to it that it will feel like you don’t have to do anything anymore.” Her parents help her by telling her how many carbs are in her lunch, but overall she is able to be much more independent on the pump. I asked whether her friends knew about it and she replied, “They keep forgetting, and ask every week, ‘What is that thing?’” She has one friend who seems to remember, so she directs the others to her.

Next week, Elisa will embark on her own Ironman adventure of sorts as she joins the other Triabuddies for a sailing trip in California. She is excited for sailing but it will be a new challenge to be away from her home, dealing with highs and lows without her parents nearby. Her new friends in the Triabuddies program, as well as the staff, will be there to help her. I am proud of her for taking on this challenge and hope she can gain new confidence in her ability to manage diabetes while enjoying the sailing experience.

And of course, I was curious what Elisa thought about triathlons. Her reply was, “They’re difficult,” especially the long run (i.e., marathon) at the end. Someone, please take Elisa to a sprint triathlon! Her favorite part would be crossing the finish line.

In the end, I’m not sure who is inspiring whom with regards to the Tribuddies program. Without a doubt, knowing Elisa will be cheering me on during Ironman Arizona has kept me going this year throughout many physical and personal challenges. I can say with certainty that I would not be pulling on my wetsuit a week from Sunday without Elisa’s implicit support. Making it to the start line will be my biggest victory this time around. I will do my best during the race and however I finish, I look forward to celebrating our mutual growth and success this year and to sharing many more experiences in the years to come.

As a final note, if you are able to support Elisa on her Triabuddy trip, donations of any amount are still needed and welcomed here.

Blood Sugar Wrangling

2009-10-28T19:44:00.001-07:00

For those who don't live with diabetes, here are some reminders:
basal rate = background insulin, usually fast-acting, delivered 24/7 by an insulin pump
bolus = equivalent of an injection of insulin, usually rapid-acting
CGM = continuous glucose monitor, which gives glucose readings every 1 to 5 minutes
BG = blood glucose, measured by a BG meter; aka "blood sugar." Normal is 70 to ~120 depending on various conditions. BG is affected by insulin concentration, stress, exercise, food, illness,...
insulin = hormone that facilitates movement of BG from blood to cells; fast-acting insulin starts working fairly quickly, peaks in about an hour or so, and sticks around for 3-4+ hours (for me). Exercise makes insulin much, much more potent.

The other night, I woke up around 1 AM feeling weak and hungry, as if I had low blood sugar. I checked and it was okay at 100. Not sure if my BG was rising or falling, since I am not, sadly, using a CGM right now, I ate half of a gel--about 10-15 g carbs--and went back to sleep. When I checked again before starting a morning swim, I was startled to see 279 on the meter. If anything, I have been waking up low in the morning recently since I significantly increased my basal rates. I was about to hop in the pool and figured leaving my basal rate at 100%, instead of reducing by 20-30%, plus skipping a pre-exercise snack, would help knock it down. Although I might typically give a little insulin to get things started, I decided to forgo it because of my elevated basal rate. I started my swim with a big set of 50's and felt thirsty and lethargic. I kept going, realizing that some days are better than others for a variety of reasons; still, I was having to work really hard to make intervals that were manageable the week before. After 45 minutes, I checked my BG, which had risen to a sticky 316. Ugh! No wonder I felt horrible. I gave a 1.2-unit bolus, drank some more water, and got back in the pool. A little disconcerted, I checked again about 20 minutes later and saw that I had already fallen to 262, and following my swim I had settled down to 122. There were many moments during the first half of this swim where I wanted to call it a day. While I am obviously a big fan of exercise, I do it for health benefits and for my enjoyment; it is not required to be an act of heroics! But sometimes, it sort of feels that way. Once I could see that my blood sugar was falling, I felt comfortable from past experience that things would improve. Throughout the day, I still felt off, and wonder if my probable prolonged overnight high BG had taken a toll.

My blood sugars were pretty oscillatory for the day and I had a late lunch/snack around 4 PM, requiring about 6 units of insulin, which is a lot considering my daily insulin is anywhere from 20 to 35 units. I was supposed to run after work, but had not been looking forward to it during the day. With my IT band troubles as of late, I haven't been able to really enjoy running, with each run ending in pain and frustration. Maybe I subconsciously ate late so I could use a massive bolus-on-board as an excuse? It's possible. For some reason, though, taking a lot of insulin made me feel a little better and I started to think that maybe I would run after all. So, about 45 minutes before I started running, I knocked my basal rate down by 90%, meaning I was basically taking little to no insulin. I didn't really think this would work, but had plenty of back-up GU handy. At 6:30, I started my run; I decided to run on the track in case I had to bail early. My BG was at about 120 and I decided I would just run and see how it fared. I just didn't want to eat more calories if I could help it. About 30 minutes into it, I had that sudden realization, "I'm low." I was at 74 and ate one gel and kept going. My blood sugar came back up nicely and I was able to finish my 50-minute run without any BG or IT band catastrophes.

In retrospect, it would have worked better to take a little insulin before my swim, and check partway through. If I needed to eat at that point, I could have. Also, during my run, I felt like it was likely that I would drop, so it might have been better to eat before I got started, rather than waiting until I was low. (Well, in the first place, it would have been better to not take 6 units of insulin that close to exercise.) In both cases, I was motivated by trying to avoid eating extra calories. I had to eat the calories anyway for the run, and getting my BG down sooner during my swim would have led to a more productive, healthier workout. And I was definitely hungry in the pool, so being able to eat a gel might have helped me swim stronger.

In the end, I was happy that I was able to get through both workouts, although the mental struggle in getting through them (and even starting them) was tough. I do love exercise, but that doesn't mean I love every workout. Anyway, Ironman Arizona is coming up quickly and at this point, each workout is key and will make a difference in how I feel race day. I am hoping that a little pain now will make race day a little less painful; I'd like to keep my focus on the wonderful experience of racing with my Triabetes team and watching out for my Triabuddy Elisa and other friends and family along the course!

Note: We're still short of our fundraising goal for the Triabetes documentary. Please click on the widget to the right or go here to donate a few bucks if you can. You can donate anonymously if you want by putting in an anonymous name on the first page. Note that Crazy Sea Lion has done just that.

Help Put Triabetes in Lights

2009-09-20T21:25:00.000-07:00

Just over a year ago, twelve teammates with type 1 diabetes woke up on a beautiful September morning to compete in Ironman Wisconsin. Our group had diverse backgrounds with respect to athletic experience and diabetes management, but were united in the goal to make it together to the race healthy and ready to give it our best.

Not only did we race for each other and our own personal goals, but also we raced to show our Triabuddies (formerly called "IronKidz") and anyone else that diabetes does not need to keep them from dreaming big. The year of training and racing was captured on film by Ray and Nella of Andiamo Productions, their Emmy Award-winning company based in Madison, Wisconsin. Their lives have been greatly impacted by type 1 diabetes since their daughter was diagnosed in 2004; when contacted by Michelle Alswager about the idea of creating a documentary of "10 athletes with type 1 racing Ironman Wisconsin," they were on board immediately and have, since then, given generously of their time, talents and personal resources.

The premiere date of the documentary is November 21, 2009, the day before the second group of Triabetes athletes competes together in Ironman Arizona. (Anyone interested in attending the premiere in Tempe, AZ, should purchase tickets here--there are limited spots available so please act quickly if you plan to come!) Still, there are post-production costs that must be met to make this a reality, and to help ensure that all who wish to see this are able to do so. To see a sliver of what is to come, see the video trailers here.

Please consider donating to help get this documentary to the finish line. To donate directly, you can just click on the widget on the side of the page, or go to the donation page here. To read more about the fundraising efforts, please go to the "Triabetes in Lights" fundraising page here. All donations are greatly appreciated, especially in this time of tight budgets; if you are able to do so, please consider a generous donation. Also, if you or your business/organization is interested in being listed as a sponsor of the documentary, please contact Peter Nerothin of Insulindependence. All donations are tax-deductible.

I am a little cynical by nature but can say with 100% sincerity that I believe this documentary will change lives. I know, because it has already changed mine.

Race Report: Lotoja 2009

2009-09-16T13:14:00.001-07:00

Event: Lotoja (206-mi race from Logan, Utah, to Jackson, Wyoming)
Date: 9/12/2009
Weather: cool, pleasant in the morning; a little warm/hot midday and cooling considerably by the finish; moderate winds during first 2/3 of the ride during open stretches
Teammates present: raced with 4 other friends on our team, the "Part-time Models": Jane Bergeson, Rita Ogden, Erika Feinauer, and Kristan Warnick. Jerseys were donated by Jane's sister from Contender Bicycles. SAG by Contender plus some team friends/family.
Other teams present: various, mostly local teams
Category raced: women cat 4 in a mixed race with women cat 1/2/3
Goal: stay with the pack until at least Preston and finish the race before the 8:15 PM cutoff.

(Note: making it through this whole post is an endurance event, perhaps to reflect the nature of Lotoja...I'm not sure my mom will even get through it this time.)

For 2009, I had the goal of doing mostly cycling--focusing on bike races and longer endurance events--until late summer, when I would transition to full Ironman training. With this in mind, I signed up for Lotoja with several other friends, as soon as I was relatively confident I would be able to get back on the bike. Lotoja is a 206-mile bike race (or ride) from Logan, Utah (~4500'), to Jackson, Wyoming (~6500'), with about 10,000' elevation gain. The event has USAC race as well as fun ride categories; although our intention was to ride together in the fun ride group, we ended up in the women's cat 4 race. I think I was the only one initially happy about that. My training included doing the Death Ride in July, the Santa Cruz Mountain Challenge Century (highly recommended!), and a string of triathlons and bike road races. My longest training ride for Lotoja was the Death Ride--129 miles, but done back in July. I felt strong on the bike leading up to Lotoja, but wondered if my body, especially my back, would hold up for such a long ride.

Compressing 206 miles into a 3-inch picture leaves out a few details.

We were treated with pleasantly cool, clear weather the morning of the race. Making one of the largest teams, the five of us lined up on the front with about 35 other women. Perhaps our matching Contender jerseys got us a little more respect? At precisely 6:58 AM, we were off, winding our way out of Logan and onto some country roads. The pace was manageable and I was comfortable staying toward the front during this mostly flat stretch. After 5-10 miles the pack narrowed and someone managed to organize a rotating paceline with the front 20 or so riders. I found myself moving up to the front in the left line and watched the women in front rotate clockwise in a continuous motion. It was a beautiful sight, moving smoothly and efficiently! I found it tricky to accurately gauge the speed of the line moving back but one of the women gave me a tip of just slowing by about 1/2 to 1 MPH once I moved over. The paceline was moving pretty quickly but I didn't have to work too much. But of course, I found myself in front when we hit one of the few short uphill sections. I didn't want to be the one to slow down the group, so worked hard to keep the pace going. Well, I looked back and there were just a few of us off the front. Duh! Anyway, I felt comfortable in the pack and reflected several times how relaxed I felt. Because we were riding the first 34 miles of a 206-mile race, there was no need to be too assertive, and there were no attacks. Soon enough, we were at the first feedzone in Preston, Idaho, where we met up with our SAG team.

I tested my blood sugar and was pretty horrified to see "435" staring back at me. Twenty minutes before the race, I had been 120 and had eaten 1 gel for a little boost. By the race start I was 177 and felt that, once things got going, I would drop a little. I did not consume any carbs those first 34 miles, but the effort was greatly reduced by being in the pack. This is the part of bike racing that seems so hard to manage--the effort is not necessarily predictable. Or perhaps it is, but I am not good at predicting it. Still, 430 from one gel? I bolused a couple units, drank lots of water, and rejoined the race. It took what seemed like forever to get my BG below 300, and I had to bolus another couple units. I don't like taking boluses >1 unit when I am exercising but needed to be more aggressive here.

There was a little climb out of Preston, with a fabulous descent, and then some flat/rolling sections. The pack either got out of the feedzone before us (likely) or splintered, but we found a few others to ride with. I think any notions of rejoining the pack were abandoned after our bathroom break, though. I was happy to continue with friends and just enjoy the day. Still, we would have to maintain an average pace of 16 MPH to finish in time. From the course description, this seemed doable. A few miles later, I dropped my chain off the small chain ring. I made a big mistake by telling everyone to keep going, because the chain was really jammed and it took me a few minutes to get rolling again. I was then riding alone and fighting the wind a bit; I didn't want to work too hard to get back, but I didn't want to ride alone either. I had another chain drop incident, this time off of my big chain ring. A guy nearby said, "You dropped your chain." "Yeah, I know," and I wondered if I could get it back on without moving it by hand. Inspired by a teammate's recent dropped chain victory at the Giro di San Francisco, I tried to move the chain by shifting to the small chain ring while pedaling very gingerly. It worked! The chain dropped to the small ring and I was able to shift it back up. I got a cheer from the guy nearby and was on my way again. (Thanks, Sarah!)

After a few more miles, I was happy to see Rita drifting back to pick me up. Soon enough, we started our first significant climb of the day: Mink Creek. The grade was not too steep and there were plenty of easier sections throughout this long climb. I still felt pretty fresh and enjoyed the scenery on the way up. I reached the neutral feedzone near the summit and waited for Rita to rejoin. There was a nice descent on the backside and then many flat miles on the approach to Montpelier. It was quite windy on this section and I was really hoping to find our front 3 riders, so pushed it here. At one point, I saw a group ahead and thought I saw our jerseys in there but alas, it was another group. I had been expecting a little more downhill from the elevation map but, really, it just felt flat. I was torn between trying to catch our group and slowing down to ride in with Rita.

Finally, I pulled into Montpelier and saw our crew. My parents had decided to drive up to cheer us on and I was very happy to see them there. After restocking and resting for a few minutes, we were off again; Jane was ahead but we had a group of 4 together again. There was another shorter climb and another great descent. We regrouped for the flattish stretch before the 3rd big climb of the day at Salt River Pass. We were at mile 110 or so and my high blood sugar woes were a thing of the past--I was hovering around 85-100, about 40-50 points lower than I like to be during a race. A BG below 100 can very quickly drop to a seriously low level for me, and I generally feel hypoglycemic at anything less than 110 during intense exercise. I felt pretty bad on this climb and had no motivation to push it for the Queen of the Mountain timed race. This was also the warmest section and very exposed to the sun. Mercifully, the climb was not too long. I have no memory of the ride into Afton, the next feedzone where we met up with our SAG crew.

Star Valley, Wyoming was a section well-suited to pacelining and I hoped we could keep our speed up here. (Here is a youtube clip.) Unfortunately, my ITB near my knee, which has bothered me since Barb's Race, acted up again and I also started feeling the effects of a long day on the saddle! I was feeling okay in the paceline but at one point, I just dropped off. I knew I should have said something but didn't even have the energy. I ate some more food and was grateful that Rita came back to see what was up. Pulling over, I checked my BG, which was around 80. After a short break, I felt a little rejuvenated but just didn't have a lot of energy, and didn't enjoy the pain. Around mile 150, I noticed that my left arm and shoulder were starting to feel tired and I was having a harder time keeping a normal posture. I felt good pulling on the downhill sections, where I could help with the pace, but was not feeling great otherwise.

Pulling into Alpine, I was relieved and dismayed to see that we had 47 miles to go. I knew we had to finish this in about 3 hours, which would have been no problem under other circumstances. This stretch goes up the canyon with spectacular views of the Snake River; with a mild grade and some rolling sections, maintaining 16 MPH average should have been easy. But facing another 3 hours on the bike was daunting. We picked up another rider here and there, and made our way. Thanks to Rita who took the flat/uphill sections, we eventually got through. I continued to do my best to pull on the downhills, which were never as long or steep as one would hope. I saw people rafting down the river, and told myself I needed to come back to visit again someday. It would be a fantastic ride if one started from Alpine!

We stopped at the last aid station around mile 175 and eventually made it to the turnoff from the highway. I was in pretty serious pain from my knee and saddle discomfort and never felt sure of how many miles we had left. After the longest 15 miles ever, we witnessed the gorgeous spectacle of the sunset over the Tetons, and saw a happy sign: "5 km." All races should be measured in kilometers! Those last 5 km fell away and we finished, a few minutes after 8 PM and before the finish line came down at 8:15. It was a relief to be off the bike and I was happy that all five of us had finished. I would not have been able to get through this without Rita especially, my other teammates and our wonderful SAG crew. Our official time was 13:04 for 206 miles.

Crossing the finish line at last!

Positives: I was happy that I felt good the first 110 miles, and that, for the most part, I felt good on the climbs. Feeling comfortable in the pack was a big step for me, and very enjoyable. It sort of turned the 200-miler into a 170-miler (sort of). I was glad I got my BG down, even though it seemed to take several hours. Having great support on the course made this a great experience, and I am proud of our whole team for finishing in time.

Needs improvement: I feel better when my BG's are in the right zone, which they weren't for most of this ride. Instead of overreacting to seeing 120 on my meter, and eating a gel, I should have trusted that my basal rates were in the right place. This was tricky because it seems that high altitude has an effect; but it's one I don't feel confident relying on yet. Also, when I was trying to increase my BG later in the race, I should have made a more drastic reduction of my basal rate, or forced myself to eat more. I am very happy that I finished, but I like to finish strong, which was not the case. I felt like I had the strength to ride better but was held back by recent and longer-term injuries. (Don't worry--I am very grateful that I had the opportunity to discover that 150 miles was the limit for my shoulder and back. But on the other hand, I look forward to the time when my left side catches back up to my right.)

Would I do it again? I think my statement at the end was, "This is a once-in-a-lifetime thing for me." But I think it is likely that my sign-up-for-race-itis will get the better of me on this one again.

This sort of sums up my feelings at the end.

Back to Triathlon

2009-08-13T09:02:00.000-07:00

In the past couple weeks, I've done my first triathlon races since Ironman Wisconsin last September. The first was Barb's Race, which is up in Sonoma on the Vineman course; the second was last weekend at the Folsom Olympic Distance Triathlon up at Natoma Lake in Folsom, CA. For both I took a relaxed approach and just wanted to test my body. I would say that they both went well, although I didn't break any records. The highlight of both was probably the bike leg, which I always seem to enjoy the most. My time for Barb's (a half-iron distance) was 6:18 or so, and my time for Folsom was 3:05. For both, and especially Folsom, I had slower swim times than I expected; I think that I really need to warm up more and dare to push myself harder on the swim. Also, I tend to lose focus in the open water and need to work on that. My bike legs for both races felt strong although I had some issues with my tri bike towards the end of Barb's, which prompted me to just go with the road bike for Folsom. So, I probably lost some time there. But I'm fine with that for now. When I got to the run at Barb's, I thought, "Now is when the suffering really begins!" But then I considered why I was out there. Was it to be miserable? Or did I actually enjoy this sport? I knew I wouldn't PR that day and decided to give myself a break and just run at a more comfortable pace. I tried to keep it steady but relaxed and did enjoy the run. For Folsom, though, I decided I would try to keep the pace up for the relatively short 10k distance. It was hot but not unbearable and the hilly course was a good challenge.

For both races, I had high BG issues. In particular, for Folsom, I could not get my BG below 300 for most of the race, despite taking a lot of insulin and not eating anything before and until the last few miles of the bike. I think I ate breakfast (only 25 g carbs, though) too close to the race start (about 90 min) and, although I bolused and had increased my basal rate about 0.2 U/hr higher than normal, I popped up to 350 before the swim. By the end of the swim, with my basal at about 0.3 U/hr higher than normal, I was down to 300 and stayed there despite another bolus. My guess is that the intensity of the shorter race caused a greater adrenalin response? I hadn't done an Olympic distance event since 2006 before Folsom.

For Barb's, I really cranked up my basal rate for the second half of the swim and into the bike. This seemed to work pretty well, since I only went up to the low 200's, vs. higher which has happened frequently in the past. I really need to lay on the insulin in the beginning part of tri's! And, I need to force myself to get up earlier to eat breakfast.

I had a great time visiting with friends at both events and was very pleased to meet 2 of the Northern Cal Triabetes members and another who had come up from Southern Cal to race on Saturday! I am the local team captain and am hoping to get more members in Nor Cal/Tahoe area to do periodic training events and races together. So if you know someone who might be interested in being a part of Triabetes, spread the word. There are local teams forming all across the US/Canada and I'm sure we'd be happy to expand out of that region as well.

Death Ride Report 2009

2009-07-22T19:10:00.000-07:00

Event: Death Ride (129 mi, 15,000' climbing and 5 mountain passes near Markleeville, CA)
Date: July 11, 2009
Weather: Clear skies, warm in the morning to hot later, then cold rain showers during the last pass; some winds, moderate at times but mostly head/tail rather than strong side gusts (which I experienced there a few weeks prior)
Other people present: I rode with my friends Shannon and Rita along with a few others.
Personal goal: finish all 5 passes safely

A few weeks prior, I went up to an altitude training weekend with the Velo Girls. [Note--thanks to Kyle T. for sagging that weekend, and for giving me some of the photos posted here!] The first day, we rode an easy 30 miles just to spin the legs out a little. The next day, we tackled Ebbetts Pass, which has a max elevation of 8730', and Pacific Grade, which has a section with a 24% grade. (I'm glad I have a compact.) The next day we climbed Monitor, front and back. For the actual Death Ride, cyclists climb to Monitor Pass, descend to Hwy 395 and then return along the same route. For the 3rd and 4th passes, cyclists climb to Ebbetts Pass, descend to Hermit Valley, and then return. There is a long section with flat to some big rollers and often headwinds to get to the last pass—Carson. This pass is quite long (9-19 miles perhaps, depending on where you consider the start to be) but has a long, mild section partway through.

We stayed in South Lake Tahoe, about 40 minutes from the start, and left early enough to get riding by 5:40 AM. The actual start is at Turtle Rock Park, but people just start from their cars parked along a long stretch of road. We hit a big hill right away and I could feel my lungs burning. I was still recovering from a really bad cold/cough that struck me down earlier that week. I wasn't sure if I would be able to ride, let alone climb at altitude. Initially worried, I decided to wait and see how I felt. We cruised down some fast, open descents and I was happy to note that the winds were not too bad. Descending in my drops felt comfortable, unlike a year ago; this is probably one of the biggest improvements I have made to my riding this year. (It helps that the front end of my new bike fits me a lot better.)

Pass 1: Monitor Pass, front side. This climb is about 8 miles long, with a steady grade. Halfway up, there is a brief and welcome respite. I felt strong although I was having some blood sugar issues. Since then, I have learned that many people have high blood sugar problems at high altitude. Perhaps high altitude causes insulin resistance or some delivery problem? We got to the top and someone slapped the first sticker on my number as proof that I was there. Descending down the backside of Monitor was fun. Although some of the turns are tight, most of it is manageable at a good clip; and with the wide, open views, I had the sense that I might take flight at any moment! In fact, when I was there before, a motorcyclist somehow lost control on one of the corners and flew off over the steep edge. So this contributed to an extra dose of caution on my part. Going down, we realized that we must have started later that most people, because the mass of riders was heading up. We got down the 10-mile descent safely, and took off our arm warmers. It was getting hot. They slapped on our sticker at the bottom. Nowhere to go but up...

Pass 2: Monitor Pass, back side. This climb feels steeper and is very exposed. After an easy first mile or so, the climb has a very steady grade until about 2-3 miles from the top. I tucked in behind a Webcor guy who was fine with me latching on. This helped me maintain a steadier pace. I caught up with my friend Shannon halfway up at one of the water stops and we rode the rest of the way up together. The winds were not bad near the top, and I latched on to a group of guys cruising by. They were going pretty fast and I held on for a while and one guy seemed surprised. Fun... We finally made it to the top of Monitor for the second time and stopped briefly. My blood sugar, which had been hovering around 300 (very high), was coming down a bit to 250. I had to eat something anyway, though—I was very hungry by this point! The descent down Monitor was fun; I felt comfortable especially since the winds were not too bad. There was a pretty strong headwind at one point but that wasn’t an issue for this grade of descent.

Pass 3: Ebbetts Pass, front side. Two down, three to go. From my training weekend, I felt that this was the hardest climb. It has a lot of variation in grade, and I think the average is only something like 6%; but, some of it is very steep, close to 20%, and there is a section of sustained climbing at 12% (or so I've read) at the end. The actual real climb (you know it when you see the road go straight up) is about 6 miles. Before getting there, some Davis guys came by and Shannon and I tucked in behind until the road got a lot steeper and one of them had some mechanical issue with his wheel. During the climb, I just plugged away but had some moments where I just felt really, really tired. At one point, I just pulled over to the side for a break. I checked my blood and it had dropped from 250 to 100 in about 40 minutes. Yikes! No wonder. (Ha, it's easy to blame it all on the blood sugar.) I ate a couple gels to keep me from totally bottoming out and just plugged along. I think it took me 55 minutes to go 5 miles during this climb. It was a really hard section for me, but I told myself all I had to do was just keep going and not worry about how fast or slow I was. Did I mention this was a tough stretch? It was more exposed and hot during this stretch. The views are spectacular, though, and there is a sparkling mountain lake partway up. Stopping for a brief dip in the water did cross my mind. But onward... Finally, finally, I made it to the top and got my 3rd sticker. A volunteer grabbed my bike and I went for the food. I hadn't eaten as much in the morning because of the high blood sugar, so took the opportunity to chow down. As a special bonus, some kids were handing out Red Vines as I left the aid station. I nearly bit the dust grabbing a couple vines (totally worth it). Descending the backside was a little technical, mostly because of all the people. Because there were more people climbing than descending, and because the road is narrow with no centerline, people had a tendency to squeeze out the descending lane. Also, since people have various comfort levels descending, there would be times when I needed to pass but had to wait a while to do so. I erred on the side of caution here and just tried to be patient. Eventually I got around the main logjam and cruised on down to Hermit Valley. I met up with my friend Derek, who had joined Shannon, but told him I was just going to turn around right away.

Watch out for these!

Pass 4: Ebbetts Pass, back side. I couldn't remember how many miles this climb was, but did know it had felt sort of endless when I went up during training. But I also remembered it being a little easier. Partway up, I ran into my friend Courtney, who was sporting her Team Type 1 jersey. She just finished helping crew for their RAAM team this year, and so it was good to chat with her briefly. I was hot climbing and not feeling great, and I wished I knew how many miles we had to go. Also, for the first time that day, I thought I should check and see how I was doing with respect to the cut-off times. It was about 11:50 when I checked, and I had climbed about a mile I think. The cutoff at the top was for 2 PM. Huh. I was a little concerned that I was cutting it tight; for some reason I just couldn't figure out how far I had to go. I had to stop at some point to rest in the shade. I wasn't sure what was going on but I just didn't feel so great. I think I was just feeling the effects of the climbing, the altitude, having a cold, and crappy blood sugars. I thought maybe I needed more insulin but didn't dare take any. Low blood sugar is usually much worse for me than being a little high. I rode up the last bit with Shannon (who had easily caught up with me); we were guessing we had 2 miles to go when we turned the corner and saw the top! We were there--hallelujah!! And we made the cutoff by about 30 minutes I think, so it wasn't too horrible. I was happy to have only one more climb to go. Somehow, I thought the last one would be easier. The descent down this side of Ebbetts is probably the most technical on the ride. Very few people were climbing, so it was much easier to pass slower riders. I tried to be cognizant of my technique and enjoyed this stretch.

LUNCH: of course, lunch gets its own section. We ate lunch at the bottom. As we were getting ready to go, someone lost control of his bike somehow, rode into the bushes and flipped over. He popped up after saying, "I'm fine!" but the medical people were on him. I guess he was okay after all--just some scrapes and bruises. I think he had some technical issue because the road was clear. Anyway...

Interlude: There is a long stretch before Carson, with some headwinds. The beginning part was more or less flat and I had revived a little after our lunch break. I was able to jam it into high gear and Shannon and some other guy fell in behind. I love this type of terrain and felt great despite the headwind. After a longish pull, the other guy offered to take over. And just in time! The winds really picked up and he had a much harder job. I should have mentioned that the winds weren't so bad during my pull, but I decided to let the guy be a gentleman, after all. Some other people stuck on to our group and we cruised past Markleeville. At this point, it was very hot and exposed, and I just fell apart on the climbs. After the last long climb here, we passed by the cars. I was going to toss my arm warmers but passed the car going downhill and decided I'd rather lug them with me than turn around. I still had about 40 miles to go at this point, after already going somewhere around 90. Forty sounded like a long way to go, but I knew about half of that would be downhill. We hit the aid station before the start of Carson Pass and I let them cool me off with the hose. I just felt bad at this point but just wanted to get this thing done. I tried some Coke and ate some other food and we eventually got going.

Pass 5: Carson Pass. I think this climb is something like 19 miles, but it's not all uphill. I wish I could say that my legs came alive or that I got my second wind. I was just struggling through it, though. I had a few good moments here and there but mostly I was just hot and tired. There was also a moderate headwind in this section, if I remember correctly. A few of my friends who had completed 4 passes were waiting for Shannon and me and cheered me on as I passed. Thanks, guys! We hit the last aid station before the top of Carson and I tried to refuel one last time. I had noticed a few raindrops with surprise. "I wonder what's going on up there," a rider said, pointing to the top of Carson Pass. Dark clouds were covering the tops of the mountains there. Ugh. Please, no rain.

We rode a couple miles before the rain really started in earnest. It still wasn't too cold, but it was soaking. I hoped it would be a passing storm. It kept raining, though, and we decided to pull over to put on our arm warmers. This is when I learned 2 valuable lessons: 1, don't dump your arm warmers when riding in the mountains and 2, don't ride your bike into a soft, sandy shoulder. I pulled over and immediately sank in the sand/gravel. My right foot was unclipped but of course I fell to the left. As I went down I saw some bikes and felt my head hit against something. Ugh!!! We had been pacelining with a couple guys, one French guy and another Google jersey guy. They were trying to lift my bike off of me but I was still clipped in. I had hit my head on Google guy’s foot/pedal and it hurt. Fortunately he managed to get around me okay. Oh man, was I going to make it this far and then have to stop? I got up and saw that my seat post had twisted; but surprisingly I felt no pain at all, which seemed sort of strange to me. Jim (the Google guy) was so kind as to fix my seat post but then I turned and saw my handlebars. The left shifter had bent in. At first I thought the whole handlebar was bent ala my Cannondale from my Feb 1 bike crash. This is when I totally lost it. I mean, I was standing there, bawling uncontrollably on the side of the road. Being as tired as I was, it was too much to handle. But French guy saved the day. "See you can just pull it back." He fixed it and things seemed to work okay. I was surprised a little by my reaction but I guess I have been holding a lot of emotions in lately and being tired, I had no will to resist. Once I got going I felt a lot better, and stronger (for a while) and thought, "I guess I just needed a little cry."

The rain stopped and we ticked off our last 9 miles. I just told myself to keep going, not to worry about my pace too much. The road curves and I somehow told myself that the finish must be right there, even though I could see the road kept going higher (“Maybe this pass doesn’t end at the top!”). But I didn't see any cyclists up on that stretch. "Oh wait, there's one," I realized with great disappointment! Ahhh! Finally, with cars whizzing by on this stretch, the long march came to an end, and I was at the top. I got my 5th sticker, but didn't have the energy to sign the poster at the top. As someone offered me an ice cream bar, I said "No thanks," but was thinking, "Hell no!" A cloud had come over the pass again and it was cold and starting to rain. I started shivering and felt uncomfortably cold. Shannon scored some plastic bags, which would be our impromptu jackets for the descent. I needed to warm up a little, though. Poor Shannon, who had already waited for me to finish, kindly waited some more in the cold as I covered myself in a jacket and blanket from the emergency radio operators. The radio woman thought I was there for SAG, but I really, really wanted to just finish the rest of the ride. I knew that it would be warmer once I got off the top. But I was shaking and didn't want to do anything stupid. SAG wouldn't be leaving for a while, though, and I just felt like I needed to get off the top of that mountain. Once the rain let up again, Shannon and I headed down.

Taken after the ride and after I started to take off my bag-jacket,
this photo sort of sums up my feelings at the top of Carson.

The first few miles were absolutely miserable. I was freezing, and I usually don't mind the cold too much. The plastic bag helped, and I don't think I would have made it without my arm warmers. I tried to keep my lips warm; for some reason, this seemed important! I was still shivering and kept the pace conservative and looked forward to any sections where I actually needed to pedal. After getting down several miles, I could feel the air warm up and I stopped shaking. There were also a few flatter sections, which helped me to warm up. Thank goodness. The descent is really fantastic, and I think this is where I hit 46 MPH, my max for the day (maybe ever). No 50's for me... I just didn't feel like it was safe. Before too long, we got to the last turn before our cars. "Oh please let my car not be too far or over any climbs," I hoped. Soon enough, we were there, finished. I was totally exhausted, but so happy to have done it.

Overall, I was happy that I finished, but wish I could say that I felt better doing it. But I hadn't been able to train as much as planned, and the bad cold really knocked me down the week leading up to it. So, I got my pin and I'll get the jersey. And I think I am stronger because of the experience.

A few lessons learned: I learned even more about the value of pacelining, and felt much more confident of my bike handling on the descents than during the training weekend. (This had something to do with the winds, though.) I also learned that having a mental strategy for something like this is important. The climbs plus headwinds at times can become really discouraging, especially when tired and/or not eating/drinking enough.

A morning at Lake Tahoe (and a huge hamburger)
washed away all the pain.

Hypoglycemia or Coyote?

2009-07-15T22:00:00.000-07:00

Stress, getting sick and not being able to train as much in the past couple weeks have taken a toll on my blood sugars and my mood. Today, I increased my basals by 30% and have still been running high. (This is also despite spending the whole day Saturday on the bike during the 125-mile Death Ride near Lake Tahoe.) So I squeezed in a longer ride after work today in one of the cycling hot spots of the Bay Area: Portola Valley. The climbs here are gradual and most consider this a basically "flat" ride (although almost no sections of it are truly flat). I didn't worry about dropping low since I actually had to increase my basal rate to get my blood sugars down while climbing 7-9% grades last weekend.

About an hour into the ride, I stopped at one of the large parks in the area to hit the bathroom. I set my bike by a woman reading a book and her border collie (mix?), who started whining when I approached them. I asked the woman if the dog was friendly, and was assured she was. When I reached out to pat the dog's head, she turned and walked away. As I came out of the bathroom, the dog started whining again. The woman was perplexed by her dog's behavior and I asked whether she was acting strangely. She agreed that this was very unusual behavior for her dog. I just wondered, could this dog be sensing that I have low blood sugar? Am I even low? I didn't think I was, but after checking in at 65, I had to wonder. I mentioned this to the woman, that some dogs can sense low blood sugar. We both agreed that the dog didn't seem too concerned about me in particular, but was more interested in getting the woman's attention. Anyway, it was probably wishful thinking on my part that this creature would take notice of my blood sugar; but it was an interesting coincidence, regardless.

Or, perhaps there was just a coyote nearby...

Picture from http://advocacy.britannica.com/blog/advocacy/2007/05/coyotes-the-wild-becomes-urban/

Pescadero Classic Road Race Report

2009-06-14T18:29:00.000-07:00

My original plan for 2009 was to focus on bike racing from January through August and increase triathlon training gradually in June, and then more so as I got closer to racing with Triabetes at Ironman Arizona in November. In January, I joined a group of women cyclists called the Early Bird Women's Developmental Cycling Team--a team for women in their first year of USCF racing--in hopes of fully pursuing this goal. Well, plans changed on Feb 1 with my accident. While I have improved vastly, the rehab and conditioning is far from over. Sometimes I wonder if I will ever fully recover. So, it was with some anxiety that I signed up for the Pescadero Classic Road Race on June 13. I continued with the Early Bird Women, although I was pretty tepid about ever racing a bike again in those first several weeks in February. Here is my report for my first official USA Cycling race event of 2009 that I completed--about 4 months later than originally expected.

Name of race: Pescadero Classic Road Race
Date: June 13, 2009
Category raced: Cat 4 in a Cat 3-4 field combined with 35+ 3-4 field
Weather: rainy before start, cloudy/damp but not cold, westerly light/mod winds
Field size: 45?
Early Birds present: Stephanie D., Beate H., myself
Other teams: Poggio, Metromint, Velogirls, Roaring Mouse, Dolce Vita, ...
Individual goals: feel in control of my safety, experience a road race, work hard, try working with others if there is an opportunity
Team goals: support each other

Short Story: I finished the race in one piece and am happy for the experience. I wasn't expecting to be fast but a problem with my front derailleur didn't help the situation.

Very Long Story (mostly appreciated by family members & best for reading when you are stuck in line somewhere. You've been warned):

I pre-rode this course last weekend to give me some confidence on the reputed technical aspects, and felt comfortable that the descents etc. were nothing I did not routinely encounter. Part of the appeal of this course for me was that, with the hills, it was likely that the riders would get strung out, and I would not feel stressed riding in a pack. Because of my current fitness level, I expected to be dropped from the main pack at the first climb.

After a belt in my car (with only 52k miles) inexplicably broke Friday evening (what's up, Mazda?), I thought I was doomed! I had been feeling pretty anxious all day and it just pushed me over the edge. Fine, I would just go for a ride and race another day. But thanks to my teammate for stepping in at the last moment, I was able to get a ride to the start early Saturday morning. Driving down the coast, it was rainy, foggy and generally not looking so great for a race. Once we arrived and warmed up, I discovered it was actually not that cold and was happy to see that at least the rain had let up.

There was a neutral promenade from the high school to the race start. I thought, "Promenade, easy pace," but realized I would have to pick it up a little to avoid getting dropped before the race even started. We turned the corner on Stage Rd and I guess there was some signal that the race was under way. The first few miles were flat and I was able to stay with the pack. I enjoyed it and felt comfortable. I noticed most people around me were not in their drops. There were a few other riders in the back with me and there was one gal behind. I was working pretty hard at times to stay with the pack, especially with the early sprint prime; it would have been easier if I tucked in a little closer. Once the road started to climb, I was dropped along with a friend of mine, who was doing her first road race. I gave her a quick how-to on getting back to the pack but it sort of fell apart and we were both on our own.

I knew there was one gal behind me and thought, "Well maybe I won't come in dead last." Or maybe we could work together to try and get back to the pack, just for the fun of it at least. I was coming down the first descent and shifting to my small chain ring in prep for the steeper climb ahead, when my cranks locked up. I looked down and the chain was jammed somehow in the front derailleur cage. Somehow, I loosened the chain and got in my small chain ring. "Hmm. I hope that's solved." I was a little concerned I would be stuck in my small chain ring, but was able to shift back up on the next descent. Turning onto Highway 84, though, I realized I had a problem. I could not shift to my small chain ring. This would be okay on 84, which is a gradual uphill climb, but not on Haskins Hill. I was hoping there would be a mechanic at the feed zone. I had no idea why my derailleur wouldn't shift down.

Being stuck in my big chain ring on 84 was probably not a bad thing, because it forced me to keep up a faster pace. There was a lovely tail wind for most of it and I felt strong and happy. Turning the corner onto Pescadero Rd., I ground my way up the initial hill and caught the attention of a friend of mine who was supporting his team, Dolce Vita. "Chris! My bike won't go into the small chain ring!" He tried to adjust the derailleur but it was stubborn about working properly. Finally, he got it to work okay, and I took off. I rounded the corner for the climb up Haskins but to my dismay, I was still stuck. I pulled over to see if I could just put the chain in place; at this moment, one of the men's large peletons came charging up the hill and I stepped off the road. They were taking every inch of the road (right-side, anyway) so I was sort of glad I hadn't been riding at the time. The cables were still moving the derailleur so I was able to drop the chain in place, and continued up Haskins. The climb is through redwoods, and was shady, moist and cool. I was a little flustered from the chain thing and lost my focus. I think I forgot I was racing for a little while there.

Once on the descent, the roads were mostly dry, but I still took a somewhat cautious approach. Some of the turns are tight but most are not too bad; but I knew that another group of guys would probably be passing me and wanted to be sure to hold my line tight on the right side of the road. Sure enough, I heard someone call out "Left side!" followed by 4 guys in a paceline just screaming by me, insanely fast through the turns. It was a little nerve-wracking as a larger group came by. I just hoped they were being careful. I felt like I was a little too cautious on the descent due to passing racers; once I was through the first few miles, though, I picked it up, effort-wise. The rest of Pescadero Rd was a sort of rolling descent with a bit of a headwind. It seemed like it should have been easy all the way to Pescadero but it took some effort to keep the pace up.

view from a climb on Stage Road

Taking the corner onto Stage Road for the second lap, I got some sympathy cheers but joked with a couple people that I was off the front, of course! I was trying to figure out if the pro/1/2's were still on the course, and calculate where they might pass me. When I got to the first climb I stopped to move my chain to the small ring. This was annoying more than time-consuming. Who wants to stop during a race? At the next climb, I devised a new method to move my chain--I just unclipped and pushed it over slightly. It seemed to work but then I noticed some rattling. Was my whole derailleur going to fall apart? I got off and inspected and discovered that the cage was broken on the right side--snapped through completely. So it could move my chain to the right, but not to the left. I was impossibly behind at this point and trying to remember that I just came out here to gain the experience. I continued up 84 and made the 2nd and final turn onto Pescadero Rd.

I thought I would try my kick-the-chain technique but this time the chain fell off instead. Argh! I got off and tried to put the chain on 4-5 times until fixing it. My hands were covered in smudgy grease and I just started to lose it emotionally. Getting myself in a position to do this race was a mental challenge and it just seemed like a disaster to me at that moment. But wait! I recognized those exaggerated emotions as a sign of low blood sugar! I may have been frustrated but, really, was it so bad? I popped a chocolate GU and after 10 minutes asked myself, "Are you still losing it?" When the answer was, "No," then I figured I may have just had a bout of frustration + low blood sugar, which can really wreck havoc on the emotions!

I didn't want to bother with another small-big-small chain ring transition so just rode the flat part of Pescadero Rd in the small chain ring, cruising along at a sad 14-15 mph. Alas, I was finally at Haskins again. Another 1.6 miles and I would be done! Well except for the 10 miles back to the cars. As I was climbing, the pro/1/2 men came by, which was fun to watch. Shortly after, the main pro/1/2 women pack came on by, followed by a couple small groups and solo riders, who were encouraging me on. The 1k mile and 500m signs were both missing from the first lap, which I didn't realize until I was about 300m from the finish. Hallelujah. I crossed the line at the top, and was directed to keep on going back to Pescadero, where Beate & Stephanie were probably wondering if I had come to another terrible fate.

Diabetes management (Diabetes primer: BG = blood glucose, or blood sugar. Bolus = insulin dose taken by pump. Basal = background insulin level delivered by insulin pump 24/7. Basically insulin causes BG to drop & glucose to go into the cells (muscle/fat); carbs cause BG to rise, and exercise can cause BG to rise or fall depending on intensity, duration & insulin levels. Usually exercise causes a drop in BG without adjustments in insulin & food, which is why I carry so much extra sugar. BG in non-diabetic is from about approx. 70 (fasting) to approx. 120 (after a meal)):

5:30 AM: BG 80, breakfast, PureFit + small banana, calculated bolus to bring BG to 160, 1.1 U insulin given 1U:17g insulin:carb ratio, 70mg/dL:1U correction factor.
7:23 AM: BG 302, 0.6 U, trying not to overreact; I didn't want too much insulin on board right before a really hard race effort.
8:11 AM: BG 289; hungry, ate 25 g carbs
8:36 AM: BG 345; somehow was hoping to get away with 25 g carbs & no insulin?? 40 min before race start, took another 0.5 U
8:55 AM: BG 359
9:09 AM: BG 372, 0.5 U. Yuck, not a good place to be.
9:15 AM: race start

For the first ~70 minutes, I drank water only. Once I started to feel hungry and could feel the BG coming down, I started eating a GU every 45 minutes and alternating Vitalyte and water. I finished with a BG of 169. Basal rate started at 0.55 and went to 0.45 a couple hours in. I was really sloppy with my hydration and only drank 1 1/2 bottles. I forgot how race anticipation can really drive the blood sugar up before a race. Usually I have to increase my morning basal rates race day but hadn't really established a routine for road races yet.

What went right: I made it to the race, thanks to a lot of help. I was able to ride, even if briefly, with the pack; I could feel what it is like to be in that situation again. I figured out how to deal with my crappy mechanical situation so that I could at least finish. I dealt with bad pre-race BGs and felt okay BG-wise for most of the race. I took a few moments here and there to remind myself, "I do this because I enjoy it." Pre-riding the course was very helpful, especially considering my mechanical issues.

What would be good for next time : Think through BG management better. Continue to work on my fitness/rehab goals so that at some point in the future, I can stay with more Cat 4's. Go to more group training events where I can practice some racing skills and get more comfortable with that.

Swim Low Psychology

2009-06-03T19:34:00.000-07:00

Due to a rare thunderstorm, I had to skip my morning outside swim today, and decided I would drop in on the evening Master's team. My blood sugar was 133 and rising after eating a GU; by the time I got in the pool, I was up to 165. "Great!" I thought, "I should be good to go for an hour." I decided to leave my meter in the locker because of my rising BG and because, well, I just didn't want to bring it. Also, if my blood sugar is low enough during a swim to get out and check, chances are I will be done for the day anyway. I usually can't tell if I'm low while swimming until I'm really low (somewhere around 40), and I don't like swimming until I am back up to a normal level (whereas I might be able to walk for awhile if I get low during a run). I can usually tell I'm low only by watching my times start to slow on the pace clock, or else I will just have a sudden thought, "I'm low. Um, I'm really low."

Well, I guess it's clear where this story is headed. I did the warm-up and some gal joined my lane who should have been 3 lanes over (in the faster, and only, direction). But anyway, I proceeded with the workout for about 35 minutes, and was feeling some pain where I broke my collarbone as well as pain in a my right shoulder that has resurfaced from last year to join in the injury party. I started thinking, "I hate this pain!" and feeling really sad, like it might even come to tears. It did occur to me that my response was a little over-the-top. I mean, there is some pain there but it usually doesn't make me want to cry in the middle of a swim. I tried to swim a couple more laps when I suddenly had the feeling, "Oh no, can I make it to the wall?" I got out and ate a chocolate GU, but still wasn't convinced that I was low. Maybe I didn't eat enough during the day? Or maybe I have been overdoing it this week? I tried to do a few more laps, and paused for about 5 minutes in the water. I thought, "Come on GU, do your thing," and then, "What would I recommend someone else to do?" I was wishing I had my meter handy so I could just hop out and settle the issue right away. If the BG were normal, I would feel better, mentally, and dare to finish the workout. I had another GU on deck but this was already a 2-GU workout and I was hoping to not make it to 3. I do not like to abandon a workout over low blood sugar, but decided I would give diabetes the win on this one. "Fine! I'll get out." After showering, I got to my locker and tested, twenty minutes after eating the GU: 74. Although I'm not usually relieved to see a low BG, I was happy that the reason I felt so horrible was easy to explain, rather than some sign of an impending downward spiral into over-training and weariness.

Frostbite in San Francisco

2009-05-19T20:05:00.001-07:00

After getting home from a surprisingly successful run this morning, I decided I would be pro-active and ice my hip. I am supposed to be doing this regularly to treat some hip pain that has arisen secondary to my bike accident. But, it is tough for me to ice it at work, since our fridge/freezer can't keep things cold enough, and I keep forgetting to do it at home. But today I would do it! I was wearing some tri shorts and thought, "Hey how convenient! I can just stick this ice pack right inside the shorts and it will stay nice & close!" I thought about putting something in between the pack and my skin, but only spotted thick towels. The other gel pack I use generally doesn't get very cold so a thick towel would be too much. I didn't really look too hard. "Hey! Ouch! It's stinging!" I thought, but remembered back many years to prior PT sessions with ice, where it stung until it was numb. I put some oatmeal in the microwave and was getting stuff ready for work and didn't notice that the stinging had stopped.

Getting up to get my oatmeal, I looked down and noticed frost on the outside of my shorts. Uh-oh. I pulled out the gel pack and to my horror, my skin was white, completely numb and completely frozen! I mean, it was stiff. It grosses me out just to think about it. "Oh no! This is bad!!" I grabbed a wash cloth and put some warm water on it and applied it to the skin. The cloth totally cooled and I repeated the process until the skin started to soften. It was still whitish but started to pinken up, pretty painfully I might add.

Frostbite in my mind is forever associated with people who climb Mt. Everest and lose toes, fingers, limbs... (In 9th grade a mountain climber came to talk with us and told us how she had lost some toes to frostbite. I think it was supposed to be an inspirational talk but I pretty much just remember the losing toes part of it.) Will I have to have my whole hip amputated?! Granted I could use a little reduction here and there but not this way. Seriously, I wasn't that worried but I wasn't sure how to treat it. Once it started warming up, the skin became really hot to the touch, and swollen. Fortunately there were no blisters and after some time, the swelling diminished, leaving red welts about the size of the gel pack. After a call to the advice nurse, who admitted to not getting many frostbite cases in San Francisco, I stopped by the injury clinic at my HMO and the awesome nurse practitioner there eased my worries. I should treat it as a bad sunburn, she said. Aloe vera, pain killers if necessary, and expect it to itch and then peel in a few days. Swimming is okay (phew) and I should even apply cool compresses. Oh and, please use a towel around the gel pack in the future. I felt like I was 16 again when I was in a bad car accident the one time in years that I hadn't been wearing a seat belt!

Sometimes I feel like I insist on learning things the hard way.

Vicious (and viscous) flesh-freezing gel pack,
more dangerous than a winter in Minneapolis

A Word of Thanks

2009-05-13T20:00:00.000-07:00

Triabetes is lucky to have some fantastic sponsors for 2009; the full list can also be seen at the Triabetes website. Their steadfast support of Triabetes has allowed us to continue to grow upon last year's success with a new group of Ironman athletes(-in-training), and to expand the team to include all triathletes with diabetes. In fact, this year, Triabetes was recognized by USAT, the governing body of triathlon, as an official triathlon team. Membership has been opened to athletes of all levels--from beginners to the very experienced--and distances (i.e., you don't have to do an Ironman to join Triabetes!) Join here! I'm the team captain for Northern California and Tahoe regions and would particularly love to have some local teammates.

Some of the sponsors that I have the most experience with, and can whole-heartedly support, are Diabetes Training Camp, PureFit Nutrition Bars, Polar, RoadID, Vitalyte, Thorlo Socks, TriSports, SweetSpot and Spibelt, and I very much look forward to becoming more familiar with the others--Kestrel bikes, Giro, Fluid, and diaTribe. Another sponsor is the TriFest in Tucson, which I had to miss due to my bike accident. Individuals at these companies have really reached out to Triabetes, often on a personal level. Of course a huge thank-you is extended to LifeScan OneTouch for their title sponsorship in 2008, which made it possible to continue with the documentary.

Wildflower v.6

2009-05-11T21:11:00.000-07:00

Lake San Antonio, CA

Earlier this month marked the 6th year I have made the trek down to Lake San Antonio for the infamous Wildflower Triathlon. The first year, I was a spectator, and swore to myself, as I inched along my chair to stay out of the 100+ degree heat, that I would never do the Long Course (half-ironman distance). That was the first triathlon I had ever seen and I really had no intention of signing up for one myself at that point. I thought that there was no sport I could ever love besides running. And even though I did enjoy getting out on my mountain bike from time to time, the swimming was a deal-breaker. At the age of 7 or 8, when I was taking swimming lessons at the local high school pool, I was doing backstroke when my instructor called out, "That's terrible!" Assuming he was addressing me, I was so afraid that I hid out in the locker room for the next several lessons and never really got back into it.

So it was a huge step for me in many ways to arrive again at Wildflower in 2005 to race in the Olympic-distance event. I had taken swimming lessons, bought a bike, and gotten used to clip-in pedals. The swim was mayhem as usual, the bike felt insanely hilly, and the run up the last hill brought me to tears; but a day or so later, I couldn't wait to sign up for my next event. Four years since then, here is my race report of my 6th Wildflower race event.

***

Last-minute, I found a team that needed a cyclist for the annual Wildflower Long Course Triathlon. The course is a very hilly one, starting out with big rollers for the first 15-18 miles, then long mild grades for another 10-15 miles, then some easy stuff before the really big climbs begin. It is a beautiful place to ride, with little traffic, and lots of wildflowers out this year. Everyone camps, and as we pulled into camp, I saw a 4-foot snake slithering towards someone's tent. I made sure to keep mine zipped up!

The weather was very rainy on Friday, but cleared up by Saturday morning, which was a huge relief. My start was at 10:20 AM, after our relay team swimmer finished. There were a couple of relay cyclists out there on trainers--an unusual scene at a triathlon--getting ready for the big legs of their relays. These guys were out to win. For our team and others that I noticed, there was a jovial mood--we were pretty happy to just worry about one event for a change. Anyway, the course starts out with a couple of easy miles before the first big climb, which is significant. Since the relays start last, there were few people on the course by the time I started. My goal was to see people ahead of me and pick them off one by one. (Although I kept telling myself, "I am not racing!") At one point a gal tried to pass and it got my competitive juices flowing and I took off. (Triathlon does not allow drafting, for good reason, since it is a serious safety hazard unless you are trained. If you are passed completely, you have to drop back 4 bike lengths.) I was careful about drinking and keeping my nutrition going, and making sure my blood sugar was in a good zone. I descended in the drops and am feeling a lot more comfortable doing this. Actually, now I feel much more glued to the road in the drops vs. holding the hoods.

There was a nice tailwind on the flatter section of the ride, and I tried to take advantage of this bonus. (Usually there is a headwind in this section!) I felt strong and was so so so so happy to be out there. The worst hill of the day up Naciamento Lake Rd. ("Nasty Grade") was okay and I just plugged along, happy to have my compact gearing. The descent is a long sweeping curve and I felt solid but was shocked when a truck+trailer blew by me from the left about 2 feet away. But no harm done. It was another moment I was glad I was in my drops.

I was able to feel good through the finish & my stamina has improved somewhat. My collarbone felt good and my lower back held up. The next couple days I was achy in my lower back and arms, but felt more or less recovered after a few days. My time was about 30 minutes slower than last year, which I am trying to not worry about too much, all considered.

On the diabetes front, things went well. I took my full bolus, as well as full symlin dose, about 3 1/2 hours before I started. My BGs were in the upper 100's before the start, when I got hungry and munched on half of a granola bar. I ate it a bit too early and so had to correct with 0.5 U and I upped my basal a little for a half-hour. My BG's were a bit on the high side to begin with, but came down nicely. I had one reading in the 80's but nothing too serious. Basals were as follows
9:00 AM 0.5
10:00 AM 0.65
(10:15 AM race start)
10:30 AM 0.5
12:45 PM 0.35
1:00 PM 0.22
2:15 PM 0.32 (race over).
I didn't bolus during the ride and ate about 150 calories per hour, or one GU + some gatorade about every hour. I didn't have a swim before or a run afterward, so didn't feel the need to eat a ton.

***

It was great to be there with Triabetes team captain Sean McKendry, who successfully completed his first triathlon in the Long Course event. Just to add some perspective, many people consider this race to be one of the hardest triathlons out there and say that, in effort, it could be considered a 2/3-ironman distance event. It is tough. Way to go, Sean! And he ended it with a rock-star BG of 130.

Sean's out there swimming somewhere

At last!

2009-04-16T19:17:00.000-07:00

first ride

"Hallelujah!" was the thought running through my mind as I rode my bike last Tuesday for the first time in 10 weeks. And, actually, this was my first ride on my new bike, which was an incredibly generous & timely gift from an "anonymous benefactor." The new yet-to-be named bike had rested quietly in my bedroom, reminding me that being patient through my recovery would be worth it. I had my bike fitting early in the morning in Mill Valley, and then took off, a little hesitantly at first, to try out one of the classic area rides--the Paradise Loop. This route loops around the Tiburon Peninsula, and is mostly rolling hills and flat, with one longer climb at the beginning, depending on how you start. I was wondering, "Would I make it up El Camino okay?" "Could I last the whole distance?" "Would my clavicle become too sore?" I am using a new type of Speedplay pedals (Zero) for this bike, which are a bit more stiff to get into. But I was determined to give it a shot. I ate half of a PureFit bar and was on my way. The hill was not too bad, and the descent was okay, although I felt a little rusty on my cornering skills and I was on the brakes more than usual. But with a short stop for photos in Tiburon, I finished the ride feeling pretty good, all things considered. More than anything, I was happy--so happy--to be outside riding again, and riding my new bike in particular. My cousin, a cellist who had a devastating injury to her elbow at a crucial point in her college career, advised me that the best therapy she had was to just play her cello. And for me, after one week of being back "out there," I couldn't agree more.

another weekend ride

10 Weeks Post (Almost)

2009-04-09T20:11:00.000-07:00

Today I had some good news from my visit with the orthopedic physician assistant (PA) who has been following my progress over the past two months. The X-ray tech showed me the images of my clavicle and ribs immediately after the exam and my first reaction was, "Oh no! I haven't healed at all!" I walked back over to visit with the PA and wondered what he would say. He pulled up the X-rays and pointed out the areas where bone callus has formed, which is a critical stage in healing. I don't know why, but thinking about all of those bone cells finding each other just makes me laugh. I have this image of cells on one bone calling out, "We're here! We're here!" and cells on the other fragment saying "Catch this rope!" Anyway, I am happy to think of my bone doing its thing to repair the damage I so cruelly inflicted! My PA said that I had passed a critical stage in healing, and that the bones were strong enough now to bear almost normal weight. I asked whether I might accidentally re-fracture the bone but he said this was unlikely unless I did anything really stupid like throw a 50 gallon jug over my head, or take a bad fall. "Can I ride outside?" "Can I run?" "Can I swim?" The answer to these questions was "Yes" with the disclaimer that it would probably be quite painful for some time, so I may not want to. Yeah, I get that. I admit that I've tried running here and there to see how it feels, and I don't think I'm quite ready to go for it yet. Apparently, the bone takes about 3 months to be mostly healed but a full 9 months to become fully remodeled and calcified etc.

After my PA listened carefully to all of my questions, and answered the ones he could, I hustled over to my physical therapy appointment. My PT gave me some new exercises to increase the flexibility in my arm and shoulder. Throughout the healing process, the shoulder joint itself has not stiffened up too much, which is a relief, considering my prior episode of (probable) frozen shoulder on this side. My PT explained that the muscles form a sort of internal brace to protect the fracture and that this may be why stretching my arm much causes nearly searing pain in my upper arm. Also, I need to work on loosening the muscles in my upper back, which is the other area of continued pain. I have a hard time not slumping forward because sitting with an upright posture quickly leads to an achy back.

While not being able to swim, run or bike, I have been able to enjoy hiking during the beautiful spring weather we've been enjoying. The hillsides are green and the wildflowers are in full bloom. Here's a shot from the top of a hill in the Marin Headlands.

6 Weeks Post

2009-03-16T12:47:00.001-07:00

6 weeks post accident
Originally uploaded by annetics

Here's a snapshot of the Xray I had done today on my clavicle. It has actually been hurting more in the past week, but the orthopedic PA says that it is still in a good position, and that it is beginning to heal. I'm very grateful that I did not require surgery and will try to be patient. I have a lot of pain in my arm and shoulder area and I guess that may subside once the fracture heals? The physical therapist was pleased with the range of motion of my shoulder joint and got me started on some simple exercises to build my core strength up again. The pain in my back doesn't seem to be improving much these days but I guess that is not too surprising. In my mind, 6 weeks was the magic point when I thought I would feel better, and 8 weeks the absolute latest that I would still be healing. In the meantime, I am glad that I'm able to ride my bike trainer, as mind-numbing as it is, and was very excited to get up to a full hour on Saturday. I'll continue with the mini-updates on the right-hand side of my blog using Twitter. These are mostly so I can keep track of my progress and for my family members who enjoy these details. But, follow along if you're interested.

In Memory of a Bike

2009-03-12T20:24:00.000-07:00

This weekend, I'll be getting back my bike that I was riding in the crash. I haven't seen it yet but have been told that it is pretty much toast. At least, the handlebars, wheels, and fork are demolished. I don't know about the frame--I'm hoping I can salvage the saddle and am really hoping that the bike computer survived. If saying good-bye to my trusty Geo Prizm (after I was hit in a hit-and-run in San Francisco in 2006) is any example, it will be sad to say good-bye to my faithful red Cannondale. The bike has seen me through thousands of miles of training and racing, including 2 of the Ironman races and numerous other triathlons. I've taken the bike into the shop far more often than my car, and have been careful to keep it running well. Most of the parts have been replaced, and often upgraded. I was hoping to use it for awhile to race with while I get more experience, and then pass it off to someone who would appreciate the gift.

In 2006, on my red bike, next to my red car.
Don't worry, I always wear my helmet while riding. See, it's on the car.

Morning Thoughts

2009-03-04T08:29:00.001-08:00

Morning Rainbow
Originally uploaded by annetics

We've had some pretty intense rain and hail in the past day or two, so I was happy to be greeted by this sight this morning and am reminded how fortunate I am to live in such a beautiful place.

This week is Diabetes Training Camp for the Triabetes captains down in Tucson, and I am not able to be there because of my bike accident on Feb 1. It has been heartbreaking for me to miss it but it just wasn't an option. The healing is going well, and I have been able to get on my trainer for 15 minutes at a time for several days now; but I won't be able to swim, bike (outside) or run at all until the end of the month, at the earliest. I'm really glad I can use the trainer, though, and conveniently, I already had an old tire on my rear wheel, so won't care if it is completely worn down by the trainer flywheel.

I had a visit with the physical therapist on Monday, and she felt that my shoulder joint is in good shape and gave me a few exercises for loosening up the muscles in my arm and shoulder. We couldn't do much with the core muscles because the ribs are not healed yet, so that will have to wait. I have been concerned about some loss of muscle mass in the left calf, which I noticed 5 days after the crash. None of the doctors I have seen felt like it was a neurological issue; the PT felt like it was most likely related to some deep bruising in the area. I still have an area of bruising on the outside of my calf which is quite painful to the touch. Perhaps the bruises in the lower leg just take longer to heal. I am breathing easier since the rib pain is much reduced and I do not get out of breath as easily. I never did get the Xray of my hand because, even if it were broken, nothing would be done about it, and I think I'm getting enough radiation as it is. I still wonder if I broke some ribs on the right side. The last time I saw the orthopedic PA, he said that I had likely broken at least half of the ribs going down the back on the left. He was pointing out the fractures in each rib in the Xray going down the left side. "Here it is, here it is, here it is...."

Despite all of this, the PT and others feel optimistic that I will have a full recovery and I am feeling much, much better than a month ago! It is going to take a lot of work and I think my biggest challenge will be in having the patience to build up slowly instead of thinking I can just jump in where I left off before the accident. In a way, I feel like I have been building a house over the past few years (of training) which was just burned to the ground in a fire. But if I think about it, I probably still have a good foundation and framework, and just need to put the walls back up (and probably not even all the walls).

2009 DiabetesMine Design Challenge!

2009-03-02T08:43:00.000-08:00

It's time to get your creative juices flowing for the 2009 DiabetesMine Design Challenge, which was announced by Amy Tenderich of DiabetesMine this morning. A while back, Amy asked me if I would be willing to participate in the video announcement for this contest; of course I readily agreed! I strongly believe that huge strides in diabetes management could be made by improving the design of current medical devices, without necessarily requiring huge improvements in the medical technology itself. (Although, I would love to see some diabetes products that don't require expensive and high maintenance disposable parts. And of course a super-accurate, noninvasive blood glucose meter is the holy grail!)

View the video below, and check out the rules at the official contest page. There are top-notch judges and cash prizes of up to $10,000!

Early Bird Crit...I Should Have Slept Late

2009-02-12T15:22:00.000-08:00

My goal for the first 6 or 7 months of 2009 was to spend a lot of time on the bike. Things were going along as planned until February 1, the day of the Early Bird Criterium Bike Race in Fremont, CA. There was a lot of aggressive riding and the field was large at 62, so I was relieved to finally hear the bell signaling the final lap. I took the 3rd of 4 corners wide and had a clear path ahead of me--I had decided to stay away from the pack for the final corner and sprint to the finish. Out of nowhere someone was down in front of me and with horror, I ran into the woman and flipped over the handlebars, landing flat on my back according to a witness. From what I have been told, the other rider had some mishap in the pack and darted out to the left and crashed right in front of me. Laying curled up on my right side in agony, I was screaming bloody murder. The first words out of my mouth were, "Why do I do these things?!" and "I think the tip of my finger is missing! Ahhhhh!" I am not impressed by my bravery at this moment. At least I didn't curse. After receiving very caring help from friends, race organizers and a nurse named Katherine, I was quickly taken with the other rider to a hospital by ambulance.

thumbs-up from the spine board

readmitted the day after for more testing and happy drugs!

Since then I have been diagnosed with 4 broken ribs and other fractured ribs on the left posterior side, a broken left clavicle and fractured L2 vertebra (transverse process). Additionally I have a small region of collapsed lung on the left side which I am hoping is not too serious. There is something wrong with my left hand and left calf although I am told that the hand is somehow related to my clavicle injury (??) and I haven't really had the calf checked out yet. I had some pretty nasty contusions and the expected road rash and weird pains that make me wonder if the bike hit me as I went around. (Why wouldn't it?) There is a big patch of numb skin and something is still funky with my gluteal muscles. My helmet was cracked and I had a very sore spot on the back of my head for days due to being strapped down to the spine board for 4 hours. Fortunately, I escaped with no traumatic brain injury. I won't lie--this has been by far the most painful experience of my life, easily beating out my tonsillectomy in my late twenties.

trying to cushion the broken bones

On a more positive note, I have been overwhelmed by the kindness of teammates, family and friends. I appreciate every call and email that I have received. Once again in my life, I have been reminded that one of my greatest blessings is an abundance of wonderful friends and family members. Also, I have made steady albeit slow progress and the most severe pain seems to be making its way to the past. I finally have some medical appointments lined up that are giving me more confidence that I will be thoroughly examined, which is a huge relief.

When my left arm regains a bit more functionality, I will write up the story of how my Animas pump survived its own test, coming away a bit scathed but still doing its job to keep the ketones at bay.

Ride through Marin

2009-01-19T22:02:00.001-08:00

Stinson Beach from Panoramic Highway
Originally uploaded by annetics

After puttering around this morning, I finally made it out the door for my ride through Marin County today. My plan was to start in Mill Valley, and do a loop through Nicasio, Point Reyes Station, and then head south on Highway 1 to Stinson Beach. From there, I would climb up Panoramic Highway and head back down to Mill Valley.

After my recent tune-up to my bike, I was surprised that the shifting was still acting up and by the time I reached Ross, I couldn't get the bike to shift to the big chain ring. The guys at Paradigm Cycles in San Anselmo quickly diagnosed the problem as a frayed cable, ready to snap completely. Yikes! They were able to make the repair in less than 30 minutes while I had a nice chicken salad at a cafe across the street. I was very happy that they were able to do this repair on the spot, and I was back on the road in about 40 minutes, with much snappier shifting. Thanks!

I continued my ride as planned and enjoyed the warm day. I stopped here and there to take pictures. My goal was to go for an easy ride but if I'd really been serious about it, I wouldn't have chosen to ride through Stinson. I just couldn't resist with the clear weather! More pictures can be seen at my flickr site here.

The blood sugars behaved. I ate about 1 gel per hour and left my basal rate at 100%. My blood sugars were all between 89 and 115; I checked about once an hour. I had taken 0.5 units for a bar I ate right before riding, and another unit for the chicken salad (which had some carbs in it); I was worried that the 1 U might do me in but it seemed to work out pretty well. I don't usually exercise in the afternoon, so it was a bit of a guess.

Grateful for Family

2009-01-14T19:31:00.001-08:00

Since receiving the news that my Grandma Findlay passed away on Saturday, I have been reflecting on her life and our relationship. I am grateful that I was able to visit with her and my grandfather over the holidays, when she seemed as strong as ever. With my grandfather currently recuperating from surgery in a care center, she was dissatisfied that there wasn't a better place to go for a walk. "I wish I could do some digging in my garden!" was her sentiment. At 89 years of age, she was still going strong. I have many, many good memories of times together over the years, and will deeply miss her chuckle as I share with her my latest adventures. Recently, we enjoyed trading stories about swimming, since she had done that regularly for many years. Always, I knew she cared for me and wished for my continued happiness and well-being. She had an unbending sense of integrity that I hope I can emulate, and a tough and hard-working spirit that was also a great example to me. She had her share of struggles in life yet continued onward with hope and determination. I will miss her greatly.

Race Report: Disney World Marathon

2009-01-14T09:14:00.000-08:00

Although the temp's were actually warmer in San Francisco over the weekend, I had the pleasure of traveling to Florida to meet up with friends from Children With Diabetes for the Disney World running weekend. Races included a 5k, half marathon and full marathon. Brian Foster gets the award for running both the half marathon and the full marathon, one day apart. Way to go!

Diabetes-wise, things went well. I managed the taper by boosting my basal by 20% in the couple days leading up to the race. I was having some big oscillations 2 days before, likely related to traveling across 3 time zones, not eating normal meals and getting too little sleep. Things settled down and the day before, my BG's were good. I continued with my regular Symlin dose of 6 U before meals up until race morning. Because the marathon started at 5:50 AM and we needed to be on the shuttle at 3:45 AM (!), I had to get up around 3:15 (that's 12:15 AM Pacific time, mind you). In order to help with breakfast and pre-race adrenalin, I had pre-programmed my basal rate at 0.75 U/hr beginning at 3 AM until one hour before race start. My normal rate at that time is 0.5 U/hr but with the 3-hour time change, who knows what "normal" really was.

There weren't a whole lot of options for breakfast at the Coronado so mine consisted of a container of soy milk for some protein and a banana. Typically I don't eat a whole lot before a marathon anyway. I took 2.5 U (which was unintentionally a little more than I would have normally bolused for my 32-g breakfast) at 3:25 AM for the food and watched as my BG remained close to 90. Sometime around 4, it started to climb. I watched it on the Dexcom, looking to see it plateau, but it was climbing steadily. When I tested at 200 at 4:30, I decided to take 0.5 U to nudge it down a bit. By the race start I was at 132 and felt comfortable starting there, since my basal had been reduced back to 0.65 for an hour. (Normal for that time is 0.7 so it was not a big reduction.)

The blood sugar was holding steady around 160 and I was eating 1 gel every 45 to 50 minutes, as well as sipping some of the sports drink here and there. About 90 minutes into the run, I saw the BG come down to 128 so decided to lower my basal to 0.50. This worked great and I relied mostly on the sports drink, along with 1 or 2 more gels, for the duration of the race. I finished with a BG of 143 (narrowly losing out to Peter's 139!) but promptly started to rise into the 300s. I'm not sure if this post-race spike is because I'm not paying attention to what I'm eating (and bolusing for), or if there are some calories hanging out in my stomach that suddenly get digested, or some other reason. Anyway, I need to remember to increase my basal right after the race.

I increased my basal rates by 30% until I got the BGs down. Interestingly to me, the stiffness in my legs started to feel a lot better once I got the BGs under control.

Thanks to Peter, who ran with me the whole way, even when I was not feeling so speedy. At times, I was probably even not very friendly! (Sorry!) The pacing on the race was a little less than ideal for me. Three weeks ago, I ran 22 miles with no problem, and was able to kick it in the last few miles. But during the race, I was feeling sore by mile 18 and feeling like I would be happy to finish after the 20 mile mark. Against my better judgement, I allowed myself to run at a faster pace the first half of the race. My heart rate was creeping up to the mid-170s by the 3rd mile or so, and it never really dropped below 170 for the rest of the race. My original plan was to keep it closer to 155 or 160 but my average HR ended up being 174 and I actually hit my max at some point. Silly Anne! I think, had I stuck to my plan, my finish time would have been about the same, if not faster, and I would have experienced a lot less pain. The race surface was asphalt but also a lot of concrete, which is also pretty tough on the body. Also, I don't think I tapered too well, unless doing 3 rides of about 50 miles each less than 2 weeks out counts as a taper.

I am satisfied with my time of 4:11. It's 21 minutes slower than my most recent non-IM marathon (Boston in 2006) and 32 minutes slower than my PR, but I knew that I would not be running at that pace for this marathon. It was great meeting up with some old friends and making some new connections with people in the diabetes community. Thanks to those who organized this event!

With the marathon done, I am anxiously recovering, if that is possible, and looking forward to doing a lot of cycling in the next 6 months! I can't wait!

Dave Shack, Ironman Extraordinaire!

2009-01-07T22:06:00.000-08:00

Triabetes team member Dave Shack was featured in an article in the New York Times today. Check it out here and be sure to listen to the audio on the left side. It has been great getting to know Dave and his family over the past year. It took me many years of running and a couple years of triathlon to get the courage to sign up for my first Ironman; Dave tackled it all in one year of training. Congrat's, Dave!

Note: I thought I would add a note for those who may be interested in supporting Triabetes. You can currently do so through the Triabetes website here. If you are associated with a business that may be interested in sponsoring Triabetes, you can send a .

Thanks, IronKidz!

2009-01-05T08:43:00.000-08:00

A new video has been released from Andiamo Productions, featuring the "IronKidz"--our young training partners leading up to Ironman Wisconsin. Thanks to Marissa, my IronKid, for her support before, during and after the race. Not only did it spur me on to the finish on race day, but her support also kept me going in the weeks and months leading up to the race. Thank you Marissa and all the other IronKidz!

The Triabetes IronKiDz Project from Andiamo Productions on Vimeo.

Back in San Francisco

2008-12-31T08:21:00.001-08:00

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

2008-12-20T00:20:00.000-08:00

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

2008-12-13T13:51:00.000-08:00

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!

2008-12-11T21:10:00.000-08:00

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

2008-11-17T20:57:00.000-08:00

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!

2008-11-14T09:09:00.000-08:00

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

2008-10-14T20:30:00.000-07:00

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

2008-10-07T08:00:00.000-07:00

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

2008-09-30T20:41:00.000-07:00

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

2008-09-29T20:48:00.000-07:00

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

2008-09-27T13:31:00.000-07:00

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

2008-09-26T16:34:00.001-07:00

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

2008-09-19T08:45:00.000-07:00

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

2008-09-15T20:53:00.000-07:00

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

2008-09-14T12:20:00.000-07:00

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 Ca mp, 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!

2008-09-06T19:25:00.000-07:00

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

2008-09-06T06:32:00.000-07:00

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

2008-09-02T18:51:00.000-07:00

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

2008-08-07T22:05:00.000-07:00

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!

2008-08-04T20:55:00.000-07:00

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

2008-07-29T19:09:00.000-07:00

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...

2008-07-18T17:27:00.000-07:00

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

2008-07-11T09:50:00.000-07:00

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

2008-07-10T21:02:00.000-07:00

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.