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.

Triabetes and Ironman Arizona 2009, Part 2

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

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

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

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

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

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

the swim exit on a calmer day

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So happy. (Photo courtesy of Blair Ryan)

Triabetes & Ironman Arizona 2009, Part 1

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

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

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

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

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

Ironman Arizona...Here It Comes

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

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

Blood Sugar Wrangling

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

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

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

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

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

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

Help Put Triabetes in Lights

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

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

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

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

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