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.

What Is Inspiration? My Triabuddy Elisa

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

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

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

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

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

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

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

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

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

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

Blood Sugar Wrangling

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.

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.

Hypoglycemia or Coyote?

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

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

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

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

Swim Low Psychology

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

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

A Word of Thanks

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

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

Wildflower v.6

Lake San Antonio, CA

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

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

***

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

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

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

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

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

***

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

Sean's out there swimming somewhere

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!

Dave Shack, Ironman Extraordinaire!

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

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

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...