A Taste of Triabetes

Since Diabetes Training Camp in March, I have made a lot of progress but am still struggling with certain challenges. This promo video, produced by Nella and Ray and their production company, Andiamo, couldn't have come at a better time. This is what I will think about during those long miles of the marathon on the 22nd. And next time I will definitely wear a more colorful shirt ala Bill Carlson. (By the way I had a chance to see the high-def version and I realize now it must make film people cry a little inside to see what YouTube does to their work. The filming for this documentary is amazing!!)

Also, this is an open solicitation to anyone who has connections with an organization/company/foundation that may be interested in funding the documentary and research arms of this project, at any level. We have some incredible sponsors already--thank you!--but the scope of the project could be greatly expanded with more funding. It's tax-deductible!

Cheers, all! Check out the Triabetes page to see what some of my teammates are up to!

Preparing for the Swim

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

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

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

Rather, Don't Be an Underweight Type 1

I am glad to read a bit more on the study here. I was happy to read that this report states that there was no difference in mortality rates between normal weight and overweight subjects. Also, the study participants were all diagnosed between 1950 and 1980 so had been through many years of managing diabetes without many of the improved tools we have today. I also wonder what the quality of life and ease of control etc. was for people at different weights. Too bad I couldn't go to the conference and hear the talk myself. Did anyone else catch it?

An excerpt:

"'Although weight gain in adulthood is typically associated with increased mortality, this may not be the case for those with Type 1 diabetes,' said Trevor Orchard, professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, in a release.

'Gaining a reasonable amount of weight may be a sign patients are getting enough insulin and appropriately controlling their disease, which may partly explain why those who gained weight over time had lower mortality rates.'

The study also found that those participants with a normal BMI of between 20 and 25 and those with a BMI in the overweight range (25 to 30) had no differences in mortality.

However, participants who had an underweight BMI of less than 20 were much more likely to die prematurely.

The researchers caution that gaining weight with Type 1 diabetes is not advised as a protective measure, but they feel the findings cast a new light on weight recommendations for people with the disease.

The study was presented Friday at the 68th Scientific Sessions of the American Diabetes Association in San Francisco."

Weight Gain May Be Beneficial in Type 1 Diabetes

The authors of this study presented at the ADA Scientific Sessions found that some weight gain in type 1 diabetes reduced mortality. I would like to check out this study to see if those who gained some weight had a better A1c, since keeping blood sugars lower increases episodes of hypoglycemia, and those little Junior Juices sure do add up. Here's an excerpt from the ScienceDaily.com report: "Gaining body fat may be a good thing, at least for people with type 1 diabetes, say researchers at the University of Pittsburgh Graduate School of Public Health. Their study, being presented at the 68th Scientific Sessions of the American Diabetes Association in San Francisco, followed 655 patients with type 1 diabetes for 20 years and found that patients who gained weight over time were less likely to die." I still want to get my weight down for personal competitive reasons (i.e., I can run and cycle faster at a lower weight), but perhaps I should not be overly concerned about it for health reasons. I guess it probably depends on what is causing the weight gain. Does anyone have the skinny on this study? :)

Aquatic Park Swim

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

Big Swim

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

Weight Fluctuations with High Intensity Exercise

I have noticed a consistent pattern for my weight, which is this: after intense and/or long workouts or races, I usually see an increase. This was true for this past weekend--yesterday morning, my weight was up by 2 pounds. The longer the workout/event, the more likely it seems that my weight will increase. Sometimes the weight comes off but sometimes not and currently I am stuck in this weekly two- to 4-pound fluctuation. It is a source of frustration to me because it seems like exercising 20 hours per week should make weight loss relatively easy. And seriously, after spending 11 hours exercising in 2 days, don't you think I would weigh less the next day, not 2 pounds more? Since my exercise load has increased, it has also become more difficult to lose weight. I think part of the explanation is more hypoglycemia but that can't explain it all. I try to take solace in knowing that my body is incredibly efficient and doesn't waste a single calorie...

...And 18 More

As the finale workout for our last peak week of training for Ironman Coeur d'Alene, I ran 18 miles early Sunday morning, about 14 hours after winding up our 124-mile ride. One of my favorite running spots in the Bay Area is Sawyer Camp Trail, which runs alongside Crystal Springs Reservoir. It is not uncommon to see deer along the trail, blue jays flying from tree to tree, and rabbits hopping out of the way. I felt surprisingly good and refreshed for the run--it must have been that sushi and miso soup the night before! I was pretty happy with the BG's as well. I fiddled around a lot with my basal rates, and would watch the resulting pattern with the Dexcom. Clearly there is a delay between a basal rate change and a change in blood glucose, but I was running for a long time! On the Dexcom, my BG's varied from about 125 to 148 while I was eating pretty steadily, 250-300 calories per hour. One of my revelations this weekend is that, even if I come in with a basal rate that is too high, it won't affect me for more than an hour or so. This is not the same for boluses, however, which seem to last with me for many hours.

123.6 Miles

Today we rode from San Francisco, around Tiburon, to Nicasio and towards the lighthouse at Point Reyes and back. The weather was cool and cloudy at first but sunshine broke through for the second half of the ride. I initially felt weak from low BG's last night and especially this morning before the ride, but I felt stronger after about an hour. I used the basal rates shown in the chart and decreased them throughout the ride. I was consistently eating about 300 calories per hour with a slight increase towards the end of the ride. Most interesting to me was how steady my BG was right around 80-100 despite the changing basal rates. And for the second half of the ride, the Dexcom was completely flat. It didn't seem to matter whether I ate something small (chocolate GU at 20 g) or big (40 g of honey fruit snacks). It was almost as if my body wanted to stay right there! But there is a more likely explanation, of course. Initially, when my basal rates were a bit higher (0.7-0.9) I was rising a bit after each snack and then falling again. But when my basal rate was lower at 0.5 for the second half, I stayed pretty steady after eating. So it appears that the glucose entering my blood from the gut was leaving at about the exact same rate there.

The basal rates were a touch too high initially and need some adjusting; however, I want to make sure I don't start off high, since it seems to make things much more difficult to manage overall.

The ride was a great confidence-booster for Ironman Coeur d'Alene, which is approaching quickly!

Post-Exercise Highs and Lows

Today's workouts were great but the rest of the day was a little rocky--how easily my body reverts back to its high-in-the-morning/crash-in-the-afternoon pattern. I woke up a touch on the low side, ate some Luna Moons and started my 4000-yard swim. I decided beforehand that I would test halfway through, since I was trying out a new basal rate of 1 U/hr. After 2000 yards of warmup, some drills and long sets, my BG was 137; I ate a GU (which I also intend to do at IMCDA) and finished off with 4 sets of 500 yards. I came out of the water at 184 and was stable over the next 15 minutes. Previously my BG would start climbing immediately after I stopped. I started running about 20 minutes later, and ate 20g about 20 minutes into the run when my BG had fallen to 129. I was happy to see that this was stable through the rest of my run and for 15 minutes following the run. When I finished the run, I bolused and waited a few minutes before eating a Stinger (honey) energy bar (about 25 g), and then I bolused immediately for breakfast using my 1U:9g carb ratio (same as yesterday). As is apparent from the chart, though, the results were very different.

My workouts ended about an hour later today than yesterday, once my basal rate had already moved from 1 to 0.4 U/hr, which leads me to wonder if the high was mostly caused by the reduced basal rate following exercise. Yesterday my basal rate was still at 1 U/hr for the whole hour following exercise. But I did bolus almost 10 units immediately following the exercise. Wouldn't that be enough to substitute for a 1 U/hr basal if I didn't eat more than my recovery bar (25g) for a full hour?

I believe I was low throughout the afternoon today compared to yesterday due to the increased duration of the workouts. My basal rate was pretty low at 0.25 U/hr; still, once I can see that I am running low, I could immediately set a temporary reduction rather than slogging through lows for 5 hours.

Having stable BG's during exercise was the big victory for today and I hope that I can make some progress on the high/low problem following exercise. At least my numbers today were on the chart, and the period of high BG was only about 3 hours.