Swim Low Psychology

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.

Break in the Weather

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

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

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

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

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

My goals for Jan-May '09 are:

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

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

Water Warming Up in Lake Coeur d'Alene

A day of warm sunshine has helped Lake Coeur d'Alene to warm up a bit, and my swim this morning was pleasant. Either I am acclimating or else the water is definitely much warmer than Aquatic Park. I felt comfortable and had just a little regret that I was only supposed to go out for 8 minutes. The course is a 2-loop rectangle, with 9 buoys out and 9 buoys back. I'm trying to figure out a strategy that will help me pass the time, similar to a structured pool workout (vs. swimming a million laps for an hour). Maybe I will think of the way out as a 1-buoy warmup then 2 sets of 4 out, a crossover set, and then 2 sets of 4 on the way back + beach finish. Then repeat. Mentally I get in this mode where the swim seems to last forever! I think it's partly because it's hard to really mark distance out there unlike on the bike or running.

Okay, time to get my bike + transition bags ready! I call this T0 and it tends to be a lengthy "transition" for me!

Preparing for the Swim

The water temperature at Lake Coeur d'Alene, which was in the 60's last year, has barely budged above 51 lately, and it probably won't warm up all that much before June 22. NA Sports sent out an announcement regarding the temperature: as long as the water temp is below 60 degrees F race day, wet suits will be required. And they are allowing swimmers to wear aqua socks/booties. Now for the "real" swimmers out there, this will just prove once again that triathletes are wimps! I've seen the annoyed looks from swimmers sans wet suits at those triathletes clogging up the buoy line at Aquatic Park!

I've been trying to get in some solid time in the Bay and had a brief recurrence of mild SIPE on Monday, which has only served to increase my nerves for the event. If I have trouble with SIPE during the race, my race will be over. But last year I had no problems and I believe that, if I am well rested, I should be okay. At least I hope so! I've solicited swimmer extraordinaire Jen Alexander for some cold water swimming tips and I will be taking her advice (among other helpful suggestions) to wear an extra cap during the swim and also some sort of cap during the bike, and to stay very warm before the start.

By the way, I'm a big fan of the USGS for providing such great info!

Aquatic Park Swim

As a quick note, I swam at Aquatic Park yesterday morning. I hadn't been in the Bay for quite some time and the cold water was really a shock. The temperature was somewhere around 55, and the water temperature yesterday at Lake Coeur d'Alene was 53-54. There were more swimmers than usual there in preparation for Sunday's Escape From Alcatraz Triathlon. I also noticed, for the first time at Aquatic Park, small jellyfish washed up on the beach, as well as some blubbing their way through the water. No one seemed to be complaining about them so I just hopped in. After getting out, I noticed a seal swimming around a bit. He disappeared under the water when a group of swimmers approached...

Big Swim

Today's workout was about 2.4 miles (actually 4200 yards)--the same distance as for Ironman. I woke up this morning at 80, ate some Luna Moons (24g) before and one chocolate GU (20g) midway through the swim. BG 15 minutes after finishing was 124. I think I may have been low before I ate the GU but I didn't want to get out of the pool to check. I felt okay, a little tired, but got through it. I plan to eat a GU midway through the swim at Coeur d'Alene, since it is a 2-lap course. My basal rate this morning was 0.9 one hour before and throughout the swim. This will probably be a good rate for the race, especially since I will be both more rested and anxious.

Workout Report

By the way I do these for my own future reference or in the off chance that it might help someone else! Today we swam 1.2 miles in the Bel Marin Keys, which was fantastic and highly recommended. Following that, we rode about 93 miles through Marin, somehow having a mostly flat(ish) ride. Well, flatter ride might be more correct. Anyway, I remember being in my aerobars a lot which says something. I tried using the pump/Levemir combo that was suggested by Sarah F. on the Insulinfactor list. Also I took a lot more insulin for my breakfast (almost 1 U Humalog per 10 g instead of 15 g carbs). I still shot up a bit on the bike but held steady until we took a 20-minute break midway and then I got a flat a short time later. I need to keep moving when I am eating 250-300 calories per hour! Next time I might keep my low basal rate going on the pump a few more hours. I also have to be fairly aggressive with bolusing right after or even a little before I finish a workout like this. I think my body is still churning out the juice (aka glycogen) and doesn't realize I've stopped! Well, and that huge burrito didn't help matters. My BG has cruised on down to a nice 133 now by the way. I think it's still cruising on down...

Workout Report: swim/run brick

Last night at the gym I ran out of test strips and, thinking I was low, ate an extra gel. Well, I wasn't low and this set off a late night rollercoaster. But, things should be better today. Here are the workout details:

• 2:56 AM--39, ate 20 g gel, 1/2 banana and ~20 g Skittles (still felt low); had a hard time falling asleep after
• 3:00 AM--basal rate 0.525 U/hr
• 5:06 AM--214, didn't correct
• 5:40 AM--started swimming, no food since I had plenty at 3 AM; took the swim easy because right shoulder is bugging me a little
  
• 6:30 AM--stopped swimming
• 7:11 AM--141, ate one 20 g gel (chocolate GU, my favorite!)
• 7:16 AM--started running, average HR 157; couldn't test during the run because it was raining (with a little hail mixed in? Brr!), flat route
• 8:12 AM--stopped running
• 8:17 AM--249, glad I didn't eat an extra gel on the run even though I was feeling low
  

During the run, I felt low in my head (a little light-headed) but my arms were a little achy and tight, which usually (but not always) indicates high blood sugar. Since I hadn't had any recent boluses, and had eaten a gel right before running, I figured I was probably not low. Also, I was able to keep my pace up. I'm glad I was right!

The traffic was horrendous coming back from the pool! It's like people forgot how to drive in the rain. But it's been raining for the past 3 weeks. What's up, people?

Swim Stats

Due to an apparent overcorrection of a high BG last night, I woke up this morning at 1:40 with a BG of 42; I had some milk and cereal and was 62 by 1:50 AM. Somewhere I read that milk works really fast to raise BGs and it seems to be working well for me. My only concern is the extra calories from fat and protein. Anyway, I guess I had a few too many Puffins (the cereal of the moment) since I woke up at 5 AM at 227, feeling much higher actually. Here's how the morning proceeded:

• 5:07 AM 227
  
• 5:15 AM 0.2 U insulin (Humalog)
• 5:40 AM 170, 20g carbs (chocolate GU, also has 2g fat), left basal rate normal at 0.575 U/hr
• 5:40 - 7:00 AM Masters swim workout, mixed sets with main set consisting of moderate to fast 200s, felt strong and was swimming 200's in 3:53-3:55.
• 7:25 AM 176, 1 U insulin
• 8:20 AM 141
• 8:42 AM 136
  

My question is this: would I have had a low if I didn't eat the gel beforehand? I think so, in this case. But in addition to keeping my blood sugars decent (i.e., not low) for the swim, the gel gave me an energy boost, allowing me to work harder and to have a more productive workout. If I hadn't taken the 0.2 beforehand, I probably wouldn't have eaten anything and might not have felt as good in the water. I suspect my blood sugar would not have fallen much, either, and may have even gone up.

Post-Swim Highs

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

Here's today's data:

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

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

4200 Yards

Friday morning I finally completed the approximate distance for the Ironman swim--2.4 miles, or about 4200 yards. It took me about 1 hour and 39 minutes, which the swimmers out there will recognize as a pretty slow time. But, I was happy that I could finish it comfortably and with decent BG's. My swim strategy is to turn my basal rate down 30-40%, which at the time of my swim, meant a basal of approximately 0.33 units/hour. I ate one gel and started swimming. About an hour into the swim, I felt hungry and ate another gel, after which I felt more invigorated. When I got into the water, my BG was 149, and when I got out, it was 139. The interesting thing was that my BG started climbing after I stopped swimming, and was above 200 in less than 30 minutes. I decided to wait it out and see what would happen; it rose a little and stabilized to about 240 an hour post-swim. I'm not sure exactly why this happens, but I've noted it on many occasions. Originally, I thought it was because I disconnected my pump during swimming, but it still seems to happen since I've started swimming with my pump. My new strategy is to set the basal rate reduction until about 30-60 minutes before the end of the swim, depending on the length of the swim, and my initial state (falling BG's, high BG's, etc.). Then my normal basal rate will be in effect by the time I get out of the water.

I tried this new technique today and it worked great! It was one of those shocking times when I test twice, separated by at least 15 minutes, and read the exact same number on the meter. Hooray for small victories!

Today I swam 3200 yards, then rode 80 miles, and finally ran for 42 minutes. More on that later... Right now it's time for sleep. (Here's a teaser, though! The Dexcom was the star of the day and I think I'm sorta maybe getting some better strategies for managing BG's through these insane workouts. Coeur d'Alene is only 2 weeks away now!)

Update on CGMS, Symlin

So now that it's been over a month since I started using the Dex and nearly a month since starting Symlin, I thought I would give an update.

Dexcom
I have enjoyed having the Dexcom, but have also experienced frustration with it. When it works well, I don't have to check my BG as much, and I use the data to reign in my BG swings and uncover trends. But when it is not working well, I want to hurl it across the room. I get pouty and refuse to look at it. But then I put in a new sensor and, lo and behold, it is working well again. I love it! Right now Dex and I aren't talking. Or, rather, Dex isn't talking to me because all I see on the screen is "---" meaning that for some reason, the sensor isn't picking up any readings fit to report. Ask me again in a few days and I'll probably tell you it's the best diabetes gadget since the pump. (Note: Dexcom has been very good about replacing sensors that don't work well, whatever the cause.)

I have been able to use it successfully on many bike rides at this point, and it has tipped me off to rising BG's long before I would have caught it with my BG meter. Also, it has helped to uncover some high BG trends that I have following swimming. I discovered that, although my BG could be decent immediately following a 70-minute swim workout, it then tends to rise rapidly. This is due to the fact that I disconnect my pump while I swim and shower, so I go about 1h40min without any insulin (other than the small bolus I take immediately prior to disconnecting). I have modified my regimen to take a larger bolus after swimming, and am experimenting with taking a larger bolus before I get in the water.

Also, I have been able to get a lot more overnight data, which has helped me to bring my overnight highs in a bit better.

This all, in principle, should make my A1c better, right? Unfortunately, after a recent check, it seems to have risen in the same period of time since I got my Dexcom. That was a sad day for me. But I suspect that part of the reason is that I have been fiddling around a lot with basal rates and Symlin, which leads me to my next update.

Symlin
I have tolerated the Symlin well. I increased the dosages as recommended and am now taking the full 10 unit (60 ug) dose, 1-2 times per day. I never experienced any nausea or other symptoms at the lower dosages, but do sometimes experience it at the current dose. When I do, it is very mild and is more of a feeling of fullness than nausea. I went out to eat one night and, after an amount of food that I would typically eat at this restaurant, felt like I would seriously throw up if I ate even one more bite. This is not a typical feeling for me. So, in general, I would say that it has mildly suppressed my appetite after a meal. I wonder if this will be a lasting effect, or if it will fade with time.

With regard to keeping my post-meal BGs under better control, I'm not so convinced. I need to do a few more controlled tests to see how it is working. It may be helping after breakfast, but there are other variables, such as insulin delivery timing, that might also be playing a role.

I did realize though that I have gotten used to not taking shots! I hate it! And it seems to hurt more than I remember. What happened? I used to not think twice about it. I'm convinced the needles are less sharp than they used to be! And why am I dutifully following the instructions to use a new syringe for every injection? I never used to do that.

So far I haven't been able to decrease my insulin bolus for breakfast; when I review my total daily dose history on my pump, though, it does show a reduction since I started on Symlin. I suspect this is due more to a reduced appetite than to a reduction of insulin for a given amount of carbohydrate.

I'm hoping the claim that Symlin reduces the amount of glycogen released by the liver is true and will somehow save me more energy for exercise! I suspect any effect would be minimal.

I have noticed on 4-5 occasions a sort of strange feeling in my chest approximately 5-10 minutes after taking a Symlin shot and have had some paranoid diabetic hypochondriac thoughts that it is going to give me a heart attack or somehow result in cardiac complications. But maybe this is more likely to be the result of me keeping my heart rate at 185 for 20 minutes while climbing King's Mountain on my bike! It is a new drug, though, and sometimes I do worry about unknown side effects.