World Diabetes Day

The United Nations adopted a resolution in December 2006 to designate November 14 as an annual day to recognize diabetes worldwide. The International Diabetes Federation has been recognizing 11/14--the birthday of Frederick Banting, who, with Charles Best, discovered insulin in 1921--as World Diabetes Day since 1991 to recognize the growing epidemic of this disease.

The motivation behind the resolution is to bring attention to the disease and encourage the creation of public and private health organizations to address prevention, care, and a cure. Especially in developing countries, which account for 80% of all cases of diabetes, the high financial and societal costs of diabetes care are increasing. Type 1 diabetes prevalence is increasing at a rate of 3% annually, and type 2 has now overtaken type 1 in children in Japan. For 2007 and 2008, the unite for diabetes campaign will focus on diabetes in children.

Action to help young people with diabetes is urgently needed. In poor and low-income countries, many people receive inadequate care or no care at all; the life expectancy for some diagnosed with type 1 diabetes is less than 2 years, when we see people in the U.S. living >75 years with the disease.

Please become familiar with the symptoms of both types of diabetes and do all you can to prevent type 2 diabetes. Realize that type 2 symptoms may be mild or completely unnoticeable, so it is best to get checked if you are at risk. In college, I worked for a year at the Joslin Diabetes Center. Although I had no complications at the time, and still have none after 19 years of diabetes, newly diagnosed people with type 2 diabetes were being treated there for severe retinopathy that could have been avoided with earlier detection.

Take care, World.

5.6

Sitting on the couch, I thought at first a loud wind was blowing by. But why so loud? As I quickly realized that this was no wind, I threw the computer down (gently), jumped off the couch, and ran to the hallway. It seemed safe there. Or was it? The rolling continued, reminding me of a pedestrian bridge that sways when I run on it. It wasn't too bad but it seemed to last a long time. Would it get bigger? What was happening? Then, after the earth stopped moving, I started to shake, my heart rate racing, my voice trembling. It seemed to be over, so I decided to stay indoors. Checking the usgs.gov website, only a micro-quake (<2 on the Richter scale) was showing up near Muir Beach. Then the big red square loaded up by San Jose. Yikes!

For the people who have lived here a long time, this was nothing new. Reading through the comments at sfgate, though, people seem to agree that it was longer than normal, and some were reminded of Loma Prieta in 1989 by the initial strong jolt followed by a rolling motion (albeit much less intense).

By the way, if you ever want to kill some time, read the comments at sfgate. Just don't take them too seriously. Some from tonight:
"my books fell on my head - who do I sue?"
"Well, I am quite sure that this is somehow Gavin Newsom's fault."
"I wonder if it shook the treehuggers out of the oaks in Berkely." [The courts just ruled that the protesters hanging out (literally) in some trees on the Berkeley campus had to come down.]

But there are also some comments on whether a small quake lessens the chance of a larger quake. I think, in general, that is not believed to be true. But what do I know?

Thanks for the Ride

Thank you to those who made it possible for me to participate in the September 2007 Ride to Cure Diabetes in Whitefish, Montana. While raising money for the JDRF was my primary reason for deciding to do the ride, the weekend far surpassed my expectations. Not only was I treated to explore and ride in one of the country's most scenic and peaceful locations, for a few days the burden of this disease was lifted and I was reminded that it is, in fact, possible for me to live better with diabetes. Unlike other athletic events, which also motivate and challenge me, the Ride brings people together with a common goal: to cure diabetes. It was also the first event where the medical tent at the end was never used. I met many friends with diabetes themselves or who have loved ones with diabetes. And some decided to ride just because the location was so spectacular. I can certainly appreciate that. Meeting other athletically-minded type 1's helped me to realize that we often share the same frustrations. I also realized that, despite my self-criticism, I have actually managed to learn quite a bit about how to manage my BG's while exercising.

I had a few other self-realizations while chatting with others:
1. I am so averse to having low BG's while exercising that I often keep my blood sugar higher than necessary. During the ride, I learned that I could keep my exercise BG lower, and have been experimenting with increasing the amount of insulin I take during exercise since then.
2. I put a lot of energy into managing my BG's during exercise and was, for example, able to avoid low blood sugar for almost 15 hours during the Ironman. Sometimes, it seems too hard to muster up the energy for the rest of the time. But by changing a few small things, I can improve my diabetes control, and the way I feel, even when I am not exercising.
3. I used to have excellent control. I was probably the most "compliant" teenager there ever was. I had a hard time adjusting my diabetes to my college schedule, and, while starting the pump my sophomore year gave me flexibility, I also slowly changed my behavior because of it. Being at the JDRF ride, and seeing other type 1's, reminded me of how I used to be--more strict--and I finally accepted that some of my difficulties do not arise from an inability to master the art of pumping, but in the types and timing of the food I eat.

And guess what? My A1c (measure of average blood glucose over ~2 months) went down a significant 0.6% since the end of August. A lower A1c means a smaller chance of most complications as the years go on, and better health in the short-term, too.

Some pictures from the weekend...

Here I am with Anne Marie, whose daughter has type 1 diabetes. This was her first JDRF Ride. She also convinced her friend Joe to raise money and ride. We had a nice paceline going for part of the first loop.

The ride consisted of 3 loops: Star Meadow, Whitefish Lake, and Northfork. Star Meadow Loop was the longest (~50 miles) and had the steepest climbs. It was also the coldest--in the 30's at the turnaround point. I was wearing plenty of warm gear and didn't chill out too much. A day or two before the ride, there was a report of some 10 grizzly bears being relocated from rural areas in the vicinity (not sure how close). They said the huckleberry season was particularly bad this year, and that the bears were trying to fatten up before hibernating. Being somewhat grizzly-bear-phobic ever since reading Mark of the Grizzly, I expected to see one lumbering along through Star Meadow, seen here, or maybe even poking a stick through my spokes! Easy dinner.

Here I am with Matt and Andy from Team Type 1 and another friend, Lynn. The 3 of them and many others stuck around at the finish, waiting for the last of the riders to pull through. Oh did I mention that the "century" was actually 118 miles? I was happy that I made it without having done many long rides lately. Early in the ride, the TT1 guys and a friend and I rode 5 abreast on one of the country roads. We decided that we were technically riding "single file" in a different sense. I enjoyed riding with them and am pretty sure my heart rate was at least 20-30 bpm faster than any of theirs! It was exhilarating. It was also interesting to hear about their strategy (which is similar to other relay teams' strategies) for winning RAAM. Apparently, they would take turns riding very short intervals at or near all-out intensity. It sounds pretty exhausting for everyone involved.

I believe Carlos, above, was the last rider who did the full 118 miles to finish. Several years ago, he nearly lost his infant son when doctors were slow to diagnose type 1 diabetes. I was shocked that the obvious symptoms did not quickly lead to what could have been a 5-second diagnosis (with a BG check). His son was near death when doctors finally realized what was going on. At that time, Carlos felt like he "had to do something," and signed up for his first ride. His son is now biking himself, and proud of his dad for doing this for him. I think his expression sums up the whole day--triumph that we had all been able to enjoy such spectacular surroundings & conditions, support, and friendships, and that we had moved $700,000 closer to a cure.

Thank you to all those who supported me. It turned out to be much more than just a ride.

One Last Plug for JDRF Ride

My bike is en route to Montana, and I will be leaving Thursday for the Whitefish Ride to Cure Diabetes. If you wanted to donate but forgot, it is not too late. Just go to:
http://ride.jdrf.org/rider.cfm?id=7134
or go to
http://ride.jdrf.org and search for my name.

Thank you to all who have already generously donated. If you know anyone who might be interested, please spread the word.

TCOYD

After a last-minute decision, I attended the Taking Control of Your Diabetes conference this Saturday in Santa Clara, CA. I showed up around 8, registered and filled out the "pre-test." I was wondering how much new information I would discover given the easy scope of the questions, but tried to have an open mind. The morning talks were interesting and fun and I met up with some old & new friends at the Expo. I finally met Amy T. from Diabetes Mine and her husband and talked bikes for a few minutes. I would have loved to visit longer, but there were some eager people wanting to know more about the online scene. (I still want to plan a Diabetes OC/DESA bike ride sometime this fall for the Bay Area.) And I picked up her book, Know Your Numbers, Outlive Your Diabetes, which I plan to read soon. I grilled the Dexcom people on their pricing (which I am really not happy about) for the new 7-day sensor and tried to ask a few people if it was worth upgrading. Steve Edelman, the conference director, said yes, that it does work better. My friend Bill King said that it is better but I saw that it still skips readings sometimes. I have a box of 5 sensors to get through so I will wait for now. Mine are usually waterproof, more or less, so there is no huge advantage to me, especially if the new one doesn't come with free, improved software, and if the sensors don't last longer than the 3-day ones. I guess another advantage would be not having to reset the sensor every 3 days and missing those skipped hours during calibration.

Doug Burns spoke during lunch and told us his inspirational story. What struck me is how tough the whole movie theater fiasco must have been given his childhood. He had a rough time with diabetes as a kid, and was picked on because he was so skinny and weak. He turned his life around by working tirelessly at his goal to get stronger, and to ultimately win the Mr. Universe competition. I wonder if getting beat up by the police reminded him of those tough times. I am so sad that he has had to go through this, and whatever he decides to do (litigate or come to some mediated solution) he has my support, for what it's worth. As he told us, he was returning to the theater to get some food when the police put his hand on Doug's shoulder from behind. You just don't grab someone from behind--if someone did that to me, you bet I would whip around in a defensive posture. Sheesh. Anyway, it was great to hear him talk, even though he wasn't able to give his slides as planned.

The highlight of the afternoon was probably the talk with Dr. William Polonsky on psychological issues related to diabetes. The patients were seated on the left and the healthcare providers on the right side of the room, and Dr. Polonsky asked each side what drove them crazy about the other. I think most of the healthcare providers were genuinely caring and understanding, but there were a couple that made my blood boil (specifically, the "they have no will power" lady). Then Dr. Polonsky worked with the group to reconcile these differences and try to understand where the feelings were coming from. I am fortunate now to have a team that seems to get it, but I have had previous experiences that were negative and had a few things to say.

I was glad I went and although some of the talks were not new to me, it got me thinking to the time when I was diagnosed and I was so strict about everything. If nothing else, it reminded me that it was possible to have better control, and that many people share the same frustrations that I do. If you have the chance to go to a conference in your area, I would recommend it. And if you are like me and register late, it will only cost you $40. I think the pre-registration price is $30.

Big Kahuna Race Report

On September 9, I completed my last triathlon of the season, the Big Kahuna Triathlon in Santa Cruz, CA. I had been feeling somewhat tired and unmotivated training for the race, and felt less prepared than usual. Going into the race, I wasn't sure if I would try to run, since my running has been particularly difficult to recover since Ironman. I figured I could muddle my way through the swim, and felt more confident about the bike leg. But the run. Hmm. I told myself that I would do the swim and bike, and stop after that if I wanted to. I tried to believe that I would be okay with that.

Race morning came. I ate my oatmeal early (no milk) and headed to the race start. I was calm, more so than for most other races. In fact, this was the first race in recent memory where my pre-race BG's were less than 100 mg/dL. I was actually alarmed to see a reading of about 95 on my meter before heading down to the swim. Still, since my training volume was considerably less than during Ironman training, I wasn't as afraid of having a low BG during the race, or at least during the swim. I ate one gel and went into the water around 160.

Swimming out around the Santa Cruz Pier, I heard the sea lions barking. The water was mostly calm, with a slight current to the west (this part of the beach runs east-west). I had the usual experience of being smothered by each wave of swimmers, which unfortunately seemed to happen right as I was rounding each buoy. I was surprised at how good I felt, though. I tried to pick up the pace now and then but was mostly enjoying the opportunity to swim out in the ocean with a safety crew on hand.

There was just a little surf to push me in the final distance, and I was happy to exit the water. I found my strategically placed shoes for the quarter-mile run back to T1, and made my way. I saw others barefoot and in flip-flops and was happy to cruise along in my old Saucony's. The weather was pleasant with overcast skies and the wind light as I started out on the bike.

Most of the 56-miles bike course ran along Route 1, with majestic views of the Pacific Ocean. The first time I rode this route, the headwinds riding north were incredible. Riding north for 50 miles took me at least 90 minutes longer than the swift 50-mile ride back south. Today, however, the winds were fairly calm and I saw my average speed was almost 19 MPH. There were a lot of us bunched together and it took some effort to avoid drafting. I noticed many who didn't bother to not draft and others who were outright drafting. The race officials seemed pretty casual about this; actually I should say that the race officials seemed mostly absent. I guess they were probably up front with the race contenders. After the turn-around, I rode 10-20 miles with another guy, swapping places every few minutes. I would generally pass him on the downhills and he would gradually catch up on the uphills of this rolling course. I found him after and thanked him for the fun ride.

As I got back to Santa Cruz, I realized that I could finish my bike split in under 3 hours if I really booked it. Throwing caution (i.e., heart rate zones) to the wind, I pushed to finish those last few flat miles and crossed the mat in 2:58. Unfortunately the official results combined my bike with my T2 for a time of 3:04. But I know I did it so ha!

I threw on my run gear, hit the portapotty and was off. After the first small hill I saw my cheering friends and one of them said, "I guess you are doing the run!" I guess I was. I decided to just take it as easy as I wanted and to not worry about my time. I felt better than I expected on the swim and bike, and thought I could probably make it through the run.

The run course also goes along the coast, and has a couple of miles on a dirt trail at the turnaround. The sun came out and warmed us up a bit, but it was still pleasant. My BG's were decent and I ate a few gels along the way. Coming back to the finish line, I kept a pretty steady pace and was not horrified by my time of 2:14. My finishing time for the race was 6:19, a bit slow on a day when people were getting PR's all over the place, but a good enough time for me given my expectations.

The best part of the race for me was the realization that the Ironman training did have some lasting benefits that I hadn't been able to see in the weeks leading up to the Big Kahuna race. I was pleased that I could "take it easy" and finish in the time I did. I didn't take it easy on the bike, though, and was happy to see that I could still push myself if I wanted to. As my coach had reminded me before the race, triathlon is a lifestyle and not just about racing. I tried to take that advice to heart and had a much better experience because of it.

I'm back!

I checked my blog this morning to find that it was no longer available! What?! I discovered that I had been flagged as a "spam blog" by Google's blog checker. I suspect I got flagged because of my JDRF solicitations, and perhaps since I haven't posted in a while? I don't know. After about 8 hours, my blog was restored.

In other news, I am planning to do the Big Kahuna Triathlon on Sept 9 and of course the JDRF ride on Sept 22 in Montana. Other than that, I am trying to sleep and rest more. Last night, we practiced swimming into the surf at Baker Beach in San Francisco. The waves there are big (well, not Hawaii big but big for me!) My goggles got knocked off once but at least, now, I know I will survive BK if there happens to be a bit of surf in the morning. Right before we dove in, we saw a seal swimming around. Or maybe it was a sea lion. I was perturbed but forgot immediately about the little (or big?) guy once I started focusing on surviving the waves. You should have seen me running out of the water, looking back at the monster waves that were hoping to knock me down.

I am also trying to coordinate some studies with some investigators from Israel to learn more about SIPE. We are trying to spread awareness, especially within the triathlon and open water swimming community, about this potentially life-threatening condition.

Riding to Somewhere

I emailed this letter tonight:

Diabetics are accomplishing amazing things these days. Just today, an article in the New York Times highlighted Team Type 1, a group of eight type 1 diabetics organized to compete in the Race Across America. Not only did they win their division this year, they beat their own best time by 21 minutes. (And they have a longer term goal of competing in the Tour de France!) Another diabetic, Gerald Cleveland, has had diabetes for 75 years and holds the record for the oldest type 1 diabetic at the age of 91. He's planning to make it to 100, at least.

I have been fortunate in my life to be able to participate in activities that I enjoy, and reached my 10-year goal of qualifying for and competing in the Boston Marathon in 2006. And about a month ago now (time to get off the couch!), I was able to successfully complete my first Ironman triathlon--a 2.4-mile swim, 112-mile bike ride, 26.2-mile run--in 14 hours, 42 minutes. I have tried to approach life with the attitude that diabetes will not prevent me from reaching my goals, whether in athletics or education/career.

Still, the reality is that managing this disease takes constant vigilance, and even then, outcomes are not certain. I try not to dwell on it too much, but diabetes remains a leading cause of heart disease, blindness, kidney failure and a host of other tough problems. Without insulin, I would die, which is why you won't see me sending hate-mail to Lilly and Novo Nordisk pharmaceuticals. Type 1 diabetes usually strikes children and adolescents, but is also diagnosed in younger adults. The exact cause of the disease is still uncertain, and there are no known ways to prevent its onset.

The Juvenile Diabetes Research Foundation, or JDRF, is the leading charity whose aim is to support diabetes research leading to a cure and/or prevention of type 1 diabetes. They are one of the top-ranked charities in terms of efficiency and efficacy. One of their current projects is to develop an "artificial pancreas," using insulin pumps and continuous glucose monitoring to ease the mental burden of the disease and to provide greater control. Researchers are closing in on the cause, and there are many other promising avenues of research that may lead to a cure or a prevention.

I decided when I signed up for the Ironman race last year, that I would try to raise money for the JDRF in conjunction with that. In the end, I decided to do the JDRF Ride to Cure Diabetes in order to take advantage of their fund-raising resources. I will be riding 100 miles in Big Sky country, Montana, on September 22, as part of my effort to raise money for a cure. The fund-raising requirements are higher than most charity events--$4000 is the minimum required by each rider, but my goal is to raise at least $5000.

I realize that there are many demands on our resources, and that you are all already generous with yours. If you would be willing to donate any amount, it would help me to make my goal. (If there's one thing I've learned in marathons and triathlons, it's that every small step takes me that much closer to the goal, and that all I need to do is make sure I am continuing to make forward progress!) If you are able to do so, you can go to my site at the JDRF website, or simply go to jdrf.org and look up my name under the Ride to Cure Diabetes donation page. My site contains more information about my story, and shows a picture from my recent Ironman race. Donating online is available there, or you can donate by check if you prefer (just contact me). All donations are 100% tax-deductible.

Again, here is the link: http://ride.jdrf.org/rider.cfm?id=7134

Also, if you have any coworkers, friends or family who may be interested in reading more about my experiences, or in donating to the JDRF, please feel free to forward this letter or point them to my JDRF site ( http://ride.jdrf.org/rider.cfm?id=7134) or to my blog (http://annetics.blogspot.com). If you have a blog and feel like pointing people my way, that'd be welcome as well. ***If you already donated, thank you very much for your generosity--it means a lot to me. I am sending this again in case there is anyone you know who might be interested in donating.*** Also, if you are not able to or prefer not to donate at this time, for any reason, please do not feel any pressure. But, again, if you feel like you may have friends who would be genuinely interested in donating, please spread the word.

Finally, if you are not completely bored by my long email and tons of embedded links, you can read even more:
1) My top ten (or eleven) reasons for doing the Ride (please note reason #11);
2) My original post explaining why I signed up;
3) And, my plea for a cure.

Oh and if you are still killing time on the computer, you can check out some of my bike pix/stories:
Marin Headlands
Point Reyes Lighthouse

Whether or not you are able to donate, thank you for the support and friendship you have all given to me.

IMCDA, Here I Come (Again)

Yes, it's true. I signed up to do Ironman Coeur d'Alene again. A friend who called after I finished the race in June asked me if I would do it again, and, at the time, I really didn't know. My response was, "Not a good time to ask." But I knew that I could do better managing my diabetes and avoiding some of the problems I had on the run. Before this year's race, so much was unknown. I feared low blood glucose on the run but in fact, faced a different problem--low insulin and rising blood glucose levels. With the confidence of completing one race, I can direct more energy into ironing out nutritional/hydrational issues and fine-tuning my BG management, especially after the swim and towards the end of the run.

My race prep calendar will be much the same as it was this year--Kaiser Half Marathon in Feb, California 70.3 Triathlon in March, and Wildflower Long Course in May. This fall my focus is on the JDRF ride in September. In preparation I will do a couple local century rides and a half-ironman triathlon in September. I am considering participating in the Janus Charity Challenge next year to raise money for the JDRF; although, I will have to come up with some creative fundraising ideas to avoid annoying my friends too much.

Wake up!

It is 5 AM and I am awake now. The reason? No, I did not get up to swim today... The Bay Area was greeted this morning with a moderate 4.2 earthquake, centered 2 miles ENE of Oakland. I woke up to sounds of creaking and rattling and felt my bed shaking--it didn't feel strong enough to cause any damage. Still somewhat new to California, I still get a little anxious about earthquakes. I guess what makes me nervous is that these small ones could lead to something much bigger. It is another reminder that I should make sure I have enough supplies (food, insulin, etc.) in case services are disrupted by a more major event.

Now I have one choice facing me: try to get back to sleep or go swimming...Let's give sleep another shot, eh?