Anyone still here? Control IQ and exercise (part 1)

Hi. It's been awhile. Do people still read blogs? (I think I know the answer.) A lot has happened since I last wrote here, but I thought I would drop in to say that I am currently using a Tandem tslim:X2 pump with the Dexcom G6 CGM and the Tandem Control IQ ("CIQ") algorithm. I have been playing around a lot with the exercise mode and cycling and am finally getting something to work well. It took a lot of trial and error, and I got some really great help from some Facebook groups; but otherwise I felt like I was on my own figuring this out. Hopefully others can skip ahead past some of the stuff I tried. (Mostly, using my regular profiles in exercise mode did not work well for me for any exercise over an hour.)

I generally bike a minimum of 90 minutes nearly every day and have been on rides recently up to about 7 hours. The intensity varies quite a bit since I am sometimes working on intervals, often climbing and also often descending back down those climbs. My goal is to use the exercise mode with no lows or near lows, no serious or prolonged highs, and the ability to fuel my exercise rather than my blood sugar.

**Note! I am not a doctor! While I feel confident adjusting my pump settings, and my endocrinologist has basically said, "Why are you asking me? You know how to figure it out," please do not interpret this post as medical or insulin dosing advice. Check in with your doctor, please.**

The short story is that I created a cycling profile with sensitivity factors 2.5 to 3.5 times my normal settings, increasing every hour or two over a period of about 6 hours. So, for example, instead of 1:55, I am using 1:170 for the first hour. My basal rates stay about the same initially, since I tend to spike during the first hour, and then taper every hour or two. I can then allow the CIQ algorithm to automatically adjust basals and give correction boluses without messing around with it too much, but also eat when I need to. Initially I was taking a small 0.05 unit bolus to prevent CIQ from auto-bolusing, but this is hard to remember to do for longer rides, and I do want to be able to prevent highs as well. I turn on the profile and exercise mode right before I head out, because I also eat a small snack (about 11 g carbs) and tend to go high in the first hour.

I have modified my on-bike food to include foods with a bit of protein and fat, but still pack a ton of gels to bring me out of lows should I encounter them. FWIW if I ever get a hunger pang during a ride, it almost always is a precursor to falling BGs.

A recent ride beginning 6 AM and ending around 11. I ate about 100 cals/hour. Ride included 3 50-minute mountain climbs.

Update!

Over the past 7-8 months, riding my bike daily has taken on a new meaning--mostly because I have been riding for two!  My husband and I found out in mid-January that we were expecting our first child together this September 21st.  I have to add, that September 21 (1988) is also the date I was diagnosed with diabetes.  I guess I needed to have a happier occasion to celebrate on this day (aside from the fact that it also my wonderful aunt-in-law Ceil's birthday on this date!).  It has been quite an adventure--I have written more about it on my previously super secret blog here.  Eventually I will wrap that blog into this one; I started it as a private blog when I wasn't ready to spill the beans quite yet, but still wanted to share with my family and to keep a journal of sorts.

I recently was in a bike accident that has put my riding on hold until after the baby is born, when surely I will have all the time and energy to get back out there, right? right?  Anyway, that's the plan; I may start out with the jogging stroller first.  If I had to say one thing I have learned being pregnant with type 1 diabetes, it is that I can actually keep my BGs in a much tighter range than I ever thought was possible.  And the second lesson would be that pregnancy does crazy things to a woman's metabolism!

Exercising Post Breakfast

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.

Fond du Lac at Tour of America's Dairyland

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

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

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

Survey on Exercise and Motivation

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

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!

Twenty-two years

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.

Ironman Arizona Diabetes Details

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.

Race Report: Lotoja 2009

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

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

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.

Frostbite in San Francisco

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

Race Report: Disney World Marathon

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!

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...

Run, Anne, Run!

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

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

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

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

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

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

Symlin Observations

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

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

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