A couple of weeks ago, I had a swim lesson at Aquatic Park, which is a swimming area in the San Francisco Bay. It was a warm sunny day, but the water was still cold. After warming up for a few minutes, we started with some intervals to practice open water pacing. After a fast interval lasting several minutes, I brought the intensity down to an easy level. Normally, I would start to recover right away after backing off on the pace; this time, I was struggling to get my breath back. I swam for several minutes more and did not improve. By the time the set was over, I could not swim another stroke.
Once I got out of the water, I started coughing profusely and spitting up slightly pinkish froth (sorry, a little gross). I definitely had fluid in my lungs, and felt severely short of breath. I could still walk and talk, and didn't feel like I was in any imminent danger, but the coughing did not let up; nor did the frothy spit. Weird! I had to go back to work after my lesson and continued to cough and feel very tired.
After doing some research, I identified the event as an episode of swimming-induced pulmonary edema, or SIPE, which has been infrequently reported in medical journals. My symptoms fit exactly with other described cases. Conditions which lead to SIPE have been described as cold, open water swimming or diving at high intensities. The thought is that the cold water in addition to the position of the body during swimming causes central pooling of blood; during intense swimming the pressure in the pulmonary capillaries becomes too great and fluid and some red blood cells (along with some other large proteins) break through to enter the alveolar sacs in the lung. Where there is water, no air will be exchanged so this is not a good state to be in!
I actually contacted the authors of one of the papers and we may work together to collect some more data on this condition, especially in triathletes. If it becomes severe enough, it can be fatal through drowning. I was surprised that no one in the triathlon community (with whom I have spoken) has ever heard of this, especially considering that we all swim in very cold water frequently, and may often try to swim fast. (Cold water and intense swimming are typical contributing factors.)
Fortunately, the condition seems to resolve within a week, and some careful physiological tests done in one study show that within a month, it is impossible to distinguish those who had it from those who didn't. I felt mostly better the next morning and completely better by the day after. I've been able to complete further swim workouts without any problems like that; although I still need to get back in the Bay to see how that goes. Fortunately, I won't be swimming as hard as I was in Coeur d'Alene, and the lake water temperature there is warmer than at Aquatic Park.
Wednesday, May 30, 2007
Thursday, May 17, 2007
In the Thick of It
Things are getting busy! Last weekend I completed my first 112-mile bike ride followed by an 18-mile run the next day. Both went well, and I was a bit surprised that my body seemed to hold up through the long workouts. We rode up in Napa along the Silverado Trail to Calistoga and back, twice. It's a great place to ride, since it's mostly flat or rolling, with very tame hills compared to what we usually ride. I used Perpetuem again, using 6 scoops (total of 162 g carbs and about 780 calories) for the whole ride and also ate about 1 gel per hour. I set my basal rates to my race day profile and programmed in a bolus for the Perpetuem. My BG's were riding a little high but I was able to keep them stable through the use of my Dexcom. My strategy this time was to eat when I saw it falling and then wait a bit as the BG started to rise. I need to go back and look at the numbers, and I should also download the data from the Dexcom.
I also used the Dexcom on the run the next day, and things went well. Maybe I will try and use the thing during the race, after all. I seem to have problems with it coming out of the swims, though, even when I use the shower patches, and I don't want to waste a lot of time fiddling around with it. I have a swim-bike workout this weekend so I'll try it out then.
I also used the Dexcom on the run the next day, and things went well. Maybe I will try and use the thing during the race, after all. I seem to have problems with it coming out of the swims, though, even when I use the shower patches, and I don't want to waste a lot of time fiddling around with it. I have a swim-bike workout this weekend so I'll try it out then.
Tuesday, May 08, 2007
Two Down
After making 6 trips up and down stairs from my apartment yesterday, I unpacked the car from a weekend of camping and racing down at Lake San Antonio, Monterey County, CA.
I had arrived Thursday morning to a mostly empty camping ground, and started to set up camp with a few other friends from my triathlon club. People trickled in on Thursday and then started to pour in Friday afternoon. This race draws people from both northern and southern California, and is definitely the largest triathlon event in California, and the second largest in the U.S. (behind the Chicago Triathlon I am told). There are 3 events: the long course (1.2-mile swim, 56-mile bike, 13.1-mile run), the mountain bike course (sprint), and the Olympic course (1.5-km swim, 40-km bike, 10-km run). I was racing the long course on Saturday. Everyone was watching the forecast. The weather had been mild all week but the wind gusts were strong enough to nearly blow away my tent until I put the stakes in.
Race Planning
I spent several hours on Friday planning my basal rates and nutrition for the race. I decided to set up a special race day basal rate profile, with rates that gradually decreased as the day went on. My race started at 9:15 and I estimated my swim time to be around 50 minutes. For my morning swims, my basal rate is usually 0.55 U/hr but I often reduce by 30% and eat a GU before swimming. Normally, at 9:15, my basal rate is 0.35 U/hr so I settled on a rate of 0.3 U/hr. I also calculated my average basal rate--0.3 U/hr--from my last 100-mile bike ride and set that as my basal rate for the first couple hours of my ride. From training experience, I've noticed that, after a long ride, once I start running, my BG's start dropping rapidly. I decided that I would try reducing my basal rate during the latter half of my ride to reduce the risk of dropping low on the run. I would continue to taper my basal rate throughout the expected duration of my run. Normally, during the run of a half-ironman triathlon, I end up turning my pump off completely; I was hoping that I could reduce the need for this.
I also planned to eat my normal pre-race breakfast of a banana and a Luna Bar about 3-4 hours before the race, and take most, if not all, of my normal bolus. Additionally, I would drink some Hammer Heed to keep myself hydrated, and eat one gel right before the swim start. I planned to drink 160 g carb's from Perpetuem on the ride, with an additional 2 gels as needed. I planned to take 1.9 U insulin for the Perpetuem over 3.5 hours, my expected ride time, in a 10% immediate, 90% extended delivery mode. For the run, I planned to eat about 4-6 gels. I would supplement with electrolyte caplets as conditions warranted. (I.e., for warmer weather I would take more.)
Race Day!
So here's what I actually did! Saturday morning, around 5:15, I woke up, and ate breakfast and dosed according to plan. My BG skyrocketed like it always does race morning, but this time I didn't panic. Well, not much, anyway. It's hard to completely ignore a BG of 414. I took a small correction of 0.5 U and waited it out. By the time my race was an hour away, my BG was bumping around just below 200. I was drinking Heed so it was fluctuating a bit. I reduced my basal rate by 30% because I felt that the BG was trending downward. About 20 minutes before my swim, I ate a Hammergel and drank up a bit. We headed down to the start, seen before the race in the above picture, and zipped up our wetsuits. Only then did I realize I had forgotten to put BodyGlide on my neck. I hurried back to my transition area and got back a minute or two before our wave started our 5-minute warmup. I stuffed my two GU's in my wetsuit sleeves and smoothed them down. Soon enough, we were off!
The water was warm by comparison with Aquatic Park in San Francisco, and I was comfortable. I was happy to be keeping up with some of the pack for some time at least, and was hoping that maybe I would have a faster swim split. I had been practicing my sighting and hoped to shave off some time by avoiding my meandering swimming ways. After we turned southward, I started thinking, "Why are they letting boats out here?" since it felt like we were swimming through wakes from speedboats. Only after the turnaround did I realize that those were actually swells! We were swimming directly into a strong wind and it felt more like an Alcatraz swim than a nice swim in a lake. The swim dragged on but I was at least making slow progress. I tried to keep my focus and to stay relaxed, and to not get too disturbed by the overly aggressive swimmers passing me by. (Now if I am not swimming close to the buoys is it really necessary to swim over me? Sheesh. I had to give one gentleman a gentle "nudge" when I got completely fed up.) I finished the swim in about 50 minutes, no faster than my last race, but still feeling fairly fresh.
I hustled into transition, seen in this photo (before the race), and got assembled for the bike. I was happy to not have to reconnect my pump; I did, however, program in my planned bolus for the Perpetuem. I decided to test my BG once I got going up the first hill, and was on my way.
My BG was 217 after about 10 minutes on the bike but I had my extended bolus going, so I wasn't worried. I also had revived the Dexcom for the race and had it in my Bento box. It was reading 100 so I decided to disregard it. I was disappointed because I was hoping it could be useful on the ride and run. Less than 30 minutes later, the Dexcom was alarming that I was below 55 mg/dL. Although I knew the absolute measurement was wrong, I decided that I would trust the downward trend and drank a bit more Perpetuem, but not more than I planned to eat per hour. An hour later, I was absolutely shocked when I measured my BG at 417. Yikes!! What was going on? I took 0.8 U of insulin and stopped drinking the Perpetuem. About 30 minutes later, my BG had gone up to 488! Ugh. I was not a happy camper. I really needed to keep eating in order to make it through the day, and I was getting worried that my pump was broken, that my insulin was bad, or that my infusion site was bad. I had 2 infusion sites prepared and switched to the other one (which was actually the older site that I hadn't been using for about 18 hours). I took another 1 U insulin and hoped that things would improve. Finally, in another 30 minutes, I was relieved to see a BG reading of 432. I decided to eat in another half hour or so when I felt a pang of hunger, which is a pretty reliable cue that my BG is dropping (or that I am just hungry!). I knew that I had a 1.8 U bolus plus another 1.9 U accumulating plus my regular basal rate, and felt slightly more confident (or at least hopeful) that my BG would continue to come down. After my first high reading, I had decided to back off on the pace; normally, I try to push myself pretty hard, but that would have to wait for another race.
I had only drunk half of my Perpetuem, and hadn't eaten any gels, by the end of the bike. I did eat half a banana around mile 50. I finished the ride, slid into my running shoes, and grabbed my fuel belt pack and visor. I was off! I tested my BG at 138, and was happy to have a soft landing from my BG woes on the bike. I tested at 116 twenty minutes later and ate some Sports Beans and some Sharkies (fruit snacks). I wasn't feeling so hot at this point, since having high BG seems to upset my digestion. Plus, I was probably a little dehydrated. A half-hour later, my BG was down to 99 and I ate a GU and a Hammergel. I also turned off my pump for an hour. I started feeling better at this point and didn't test for another 40 minutes, at which point I was 153. My basal rate of 0.05 U/hr resumed shortly thereafter and I tested at 136 thirty minutes later. I continued to eat gels occasionally and also made myself drink a full cup of Gatorade Endurance at each water stop (every mile). I finished the race in 7 hours, 3 minutes, with a BG of 167. Not too shabby, considering everything that had happened.
Lessons Learned
I had arrived Thursday morning to a mostly empty camping ground, and started to set up camp with a few other friends from my triathlon club. People trickled in on Thursday and then started to pour in Friday afternoon. This race draws people from both northern and southern California, and is definitely the largest triathlon event in California, and the second largest in the U.S. (behind the Chicago Triathlon I am told). There are 3 events: the long course (1.2-mile swim, 56-mile bike, 13.1-mile run), the mountain bike course (sprint), and the Olympic course (1.5-km swim, 40-km bike, 10-km run). I was racing the long course on Saturday. Everyone was watching the forecast. The weather had been mild all week but the wind gusts were strong enough to nearly blow away my tent until I put the stakes in.
Race Planning
I spent several hours on Friday planning my basal rates and nutrition for the race. I decided to set up a special race day basal rate profile, with rates that gradually decreased as the day went on. My race started at 9:15 and I estimated my swim time to be around 50 minutes. For my morning swims, my basal rate is usually 0.55 U/hr but I often reduce by 30% and eat a GU before swimming. Normally, at 9:15, my basal rate is 0.35 U/hr so I settled on a rate of 0.3 U/hr. I also calculated my average basal rate--0.3 U/hr--from my last 100-mile bike ride and set that as my basal rate for the first couple hours of my ride. From training experience, I've noticed that, after a long ride, once I start running, my BG's start dropping rapidly. I decided that I would try reducing my basal rate during the latter half of my ride to reduce the risk of dropping low on the run. I would continue to taper my basal rate throughout the expected duration of my run. Normally, during the run of a half-ironman triathlon, I end up turning my pump off completely; I was hoping that I could reduce the need for this.
I also planned to eat my normal pre-race breakfast of a banana and a Luna Bar about 3-4 hours before the race, and take most, if not all, of my normal bolus. Additionally, I would drink some Hammer Heed to keep myself hydrated, and eat one gel right before the swim start. I planned to drink 160 g carb's from Perpetuem on the ride, with an additional 2 gels as needed. I planned to take 1.9 U insulin for the Perpetuem over 3.5 hours, my expected ride time, in a 10% immediate, 90% extended delivery mode. For the run, I planned to eat about 4-6 gels. I would supplement with electrolyte caplets as conditions warranted. (I.e., for warmer weather I would take more.)
Race Day!
So here's what I actually did! Saturday morning, around 5:15, I woke up, and ate breakfast and dosed according to plan. My BG skyrocketed like it always does race morning, but this time I didn't panic. Well, not much, anyway. It's hard to completely ignore a BG of 414. I took a small correction of 0.5 U and waited it out. By the time my race was an hour away, my BG was bumping around just below 200. I was drinking Heed so it was fluctuating a bit. I reduced my basal rate by 30% because I felt that the BG was trending downward. About 20 minutes before my swim, I ate a Hammergel and drank up a bit. We headed down to the start, seen before the race in the above picture, and zipped up our wetsuits. Only then did I realize I had forgotten to put BodyGlide on my neck. I hurried back to my transition area and got back a minute or two before our wave started our 5-minute warmup. I stuffed my two GU's in my wetsuit sleeves and smoothed them down. Soon enough, we were off!
The water was warm by comparison with Aquatic Park in San Francisco, and I was comfortable. I was happy to be keeping up with some of the pack for some time at least, and was hoping that maybe I would have a faster swim split. I had been practicing my sighting and hoped to shave off some time by avoiding my meandering swimming ways. After we turned southward, I started thinking, "Why are they letting boats out here?" since it felt like we were swimming through wakes from speedboats. Only after the turnaround did I realize that those were actually swells! We were swimming directly into a strong wind and it felt more like an Alcatraz swim than a nice swim in a lake. The swim dragged on but I was at least making slow progress. I tried to keep my focus and to stay relaxed, and to not get too disturbed by the overly aggressive swimmers passing me by. (Now if I am not swimming close to the buoys is it really necessary to swim over me? Sheesh. I had to give one gentleman a gentle "nudge" when I got completely fed up.) I finished the swim in about 50 minutes, no faster than my last race, but still feeling fairly fresh.
I hustled into transition, seen in this photo (before the race), and got assembled for the bike. I was happy to not have to reconnect my pump; I did, however, program in my planned bolus for the Perpetuem. I decided to test my BG once I got going up the first hill, and was on my way.My BG was 217 after about 10 minutes on the bike but I had my extended bolus going, so I wasn't worried. I also had revived the Dexcom for the race and had it in my Bento box. It was reading 100 so I decided to disregard it. I was disappointed because I was hoping it could be useful on the ride and run. Less than 30 minutes later, the Dexcom was alarming that I was below 55 mg/dL. Although I knew the absolute measurement was wrong, I decided that I would trust the downward trend and drank a bit more Perpetuem, but not more than I planned to eat per hour. An hour later, I was absolutely shocked when I measured my BG at 417. Yikes!! What was going on? I took 0.8 U of insulin and stopped drinking the Perpetuem. About 30 minutes later, my BG had gone up to 488! Ugh. I was not a happy camper. I really needed to keep eating in order to make it through the day, and I was getting worried that my pump was broken, that my insulin was bad, or that my infusion site was bad. I had 2 infusion sites prepared and switched to the other one (which was actually the older site that I hadn't been using for about 18 hours). I took another 1 U insulin and hoped that things would improve. Finally, in another 30 minutes, I was relieved to see a BG reading of 432. I decided to eat in another half hour or so when I felt a pang of hunger, which is a pretty reliable cue that my BG is dropping (or that I am just hungry!). I knew that I had a 1.8 U bolus plus another 1.9 U accumulating plus my regular basal rate, and felt slightly more confident (or at least hopeful) that my BG would continue to come down. After my first high reading, I had decided to back off on the pace; normally, I try to push myself pretty hard, but that would have to wait for another race.
I had only drunk half of my Perpetuem, and hadn't eaten any gels, by the end of the bike. I did eat half a banana around mile 50. I finished the ride, slid into my running shoes, and grabbed my fuel belt pack and visor. I was off! I tested my BG at 138, and was happy to have a soft landing from my BG woes on the bike. I tested at 116 twenty minutes later and ate some Sports Beans and some Sharkies (fruit snacks). I wasn't feeling so hot at this point, since having high BG seems to upset my digestion. Plus, I was probably a little dehydrated. A half-hour later, my BG was down to 99 and I ate a GU and a Hammergel. I also turned off my pump for an hour. I started feeling better at this point and didn't test for another 40 minutes, at which point I was 153. My basal rate of 0.05 U/hr resumed shortly thereafter and I tested at 136 thirty minutes later. I continued to eat gels occasionally and also made myself drink a full cup of Gatorade Endurance at each water stop (every mile). I finished the race in 7 hours, 3 minutes, with a BG of 167. Not too shabby, considering everything that had happened.
Lessons Learned
- I should probably take more insulin at the beginning of my ride and use a bigger insulin:carb ratio. Taking a 30:70 extended bolus (instead of 10:90) might be a good idea if I plan to eat at the beginning of a ride. Also, maybe I could try increasing my basal rate a bit at the end of my swim or beginning of my ride.
- I think having the tapered basal rate profile works well, although it's tough to know exactly how different conditions will affect how much insulin I need.
- If my BG gets high, it is especially important to drink lots of fluids. I didn't take that into account and was probably fairly dehydrated by the end of the ride.
- I usually pop up really high before the race. To avoid starting the race with a high BG, I should eat breakfast 4 hours beforehand, and take my normal bolus. A meal of 45 g carbs is good. If I go high, I shouldn't panic too much since it will most likely come down before the race.
- I still need to figure out how to do the run without fighting off low BG the whole time. I am afraid of what would happen if my digestion slowed down for some reason.
Tuesday, May 01, 2007
Don't Procrastinate
So last Saturday, I thought I would try out my new plan: use the 1:80 ins-to-carb ratio but take it over 3 hours instead of 4 or 4.5. Compared to my first 100-mile ride, I was effectively taking .45 U/hour last weekend instead of .65 U/hour in addition to my regular basal rate, and eating 36 g/hour instead of 47 g/hour. Hmm...this seems reasonable. After about 2 hours on my ride, I got low and actually had to stop riding to get my BG back up. I mean, I had to get off my bike completely. I tried just coasting and pedaling now and then (fortunately I was on flat road), but my body resisted.
Anyway, I can't really pinpoint what happened, except that I didn't supplement with any extra gels the first 2 hours, and I had felt a hunger pang that I ignored. And, I must not have been eating enough.
Okay, I think the real reason I went low is because I was on a rolling hill section with no stop signs or lights and I just hate stopping there. Plus, everyone would catch up and pass me if I did!! No fair! But I should have at the least pulled out a gel when I felt that hunger pang. Argh. Basically I got in trouble because I was procrastinating eating!
I think to simplify things in the future, I will try to manage my BGs with basal rates only, and no boluses. Maybe, then, I can have basal rates for hilly rides, flat rides, etc. I might also try to use the calorie count feature on my bike computer to estimate how much food + insulin I should be taking in. Maybe I should get a power meter for my bike; that could be insightful.
Other totally random things:
Gatorade upsets my stomach on long rides. So do PowerGels. But I really like the chocolate PowerGel (tastes like frosting) so I might eat them anyway. Hammergels are slower to absorb than GU's, which taste the best. ClifShots taste salty and don't help me pull out of a low easily (then again, I could blame the Symlin for that). Perpetuem is surprisingly filling, and helps to keep my BGs stable. It also goes down really well with a bit of water. Sharkies are really yummy and it's easiest if I put them in a ziploc before I ride. Ziplocs are handy for all sorts of other things, including my BG meter. I can test my BG while riding if I chose a spot with a slight incline and do things very slowly and carefully. I should also drink more water than I want to, and I will probably feel better than I would expect as a result.
Here's another picture from last year's Wildflower race. There are thousands of athletes who compete in these events. My race is on Saturday! Did I mention that already?
Anyway, I can't really pinpoint what happened, except that I didn't supplement with any extra gels the first 2 hours, and I had felt a hunger pang that I ignored. And, I must not have been eating enough.
Okay, I think the real reason I went low is because I was on a rolling hill section with no stop signs or lights and I just hate stopping there. Plus, everyone would catch up and pass me if I did!! No fair! But I should have at the least pulled out a gel when I felt that hunger pang. Argh. Basically I got in trouble because I was procrastinating eating!
I think to simplify things in the future, I will try to manage my BGs with basal rates only, and no boluses. Maybe, then, I can have basal rates for hilly rides, flat rides, etc. I might also try to use the calorie count feature on my bike computer to estimate how much food + insulin I should be taking in. Maybe I should get a power meter for my bike; that could be insightful.
Other totally random things:
Gatorade upsets my stomach on long rides. So do PowerGels. But I really like the chocolate PowerGel (tastes like frosting) so I might eat them anyway. Hammergels are slower to absorb than GU's, which taste the best. ClifShots taste salty and don't help me pull out of a low easily (then again, I could blame the Symlin for that). Perpetuem is surprisingly filling, and helps to keep my BGs stable. It also goes down really well with a bit of water. Sharkies are really yummy and it's easiest if I put them in a ziploc before I ride. Ziplocs are handy for all sorts of other things, including my BG meter. I can test my BG while riding if I chose a spot with a slight incline and do things very slowly and carefully. I should also drink more water than I want to, and I will probably feel better than I would expect as a result.
Here's another picture from last year's Wildflower race. There are thousands of athletes who compete in these events. My race is on Saturday! Did I mention that already?
Friday, April 27, 2007
Random Training Observations
Well, I have less than 2 months now before the big race (Ironman Coeur d'Alene)! In the past couple of weeks, I have felt things starting to come together. Mind you, if you were to ask me (as some people do), "Are you ready," I would give you a quizzical look and say, "Noooo." But I do feel like I am on target to be ready. I have the next 5 weeks or so to build up distances for all 3 sports. I feel like my biking is ahead of my swimming and running; although, I am more confident that the running will be in place. I'm still pretty scared, though! Yikes!
Last weekend, I swam (in a pool) for 3000 yards, then biked 80 miles and then ran for about 30 minutes, and felt pretty good. Tomorrow will be a bit lighter, since we have our second big race of the season on May 5. Anyway, here are some random tips & observations from my training thus far.
Swim
I have started to use my pump during my swims, with much improved results. It really helps me to avoid the post-swim highs I was experiencing before. I am still fine-tuning how much to eat and how much to adjust my basal rate. These depend on what time of day I am swimming, where my BG is at the start, and how much I have exercised in the past 24 hours. For example, I swam Wednesday morning, starting with a BG of 111. I ate one gel before getting in the pool and took a 0.3 U bolus (50% immediate and the rest delivered over the next half hour). When I tested afterward, my BG was 111! When does that happen? In contrast, this morning I started at 142, ate a gel and took a 0.2 U bolus spread out the same way. I had to eat another gel during the swim (didn't test BG but knew the signs--my splits get slower for no obvious reason). I finished with a BG of 115. I was swimming at the same time of day. The difference, I believe, is that on Tuesday evening, I had a relatively light workout (weight training in the gym) as opposed to a very strenuous 80-minute bike class + 15 minute run last night. I don't think my body had enough time to fully recover from the bike class, and so my muscle glycogen was probably a bit low. So, I need to remember to think about these things...
Bike
I tend to have few problems with low BGs on the bike. It is easier to eat than during a swim, and easier to digest food than on a run. I have been using Perpetuem from Hammer for the past few long rides. For rides 5+ hours, I mix up 6 scoops of the stuff, for a total carb count of 162g. I mentioned this previously, but anyway, the stuff is great. I drink a few sips now and then and estimate how much of the bottle should be gone every hour. Maybe I will label a bottle, or buy one that has ounce markings. It all sort of reminds me of baby formula... I keep my second water bottle filled with water, and refill it when necessary.
I am still playing with my carb:insulin ratio for the rides. The first time I tried 1U:55g and that was too high; last weekend, I tried 1U:80g carbs and that was too low (my BG's were running too high and I had to correct). So this weekend, I will try 1U:70g and see how that goes. I may also try using the 1:80 ratio but take the insulin over a shorter time, since I usually don't need any additional insulin after about the 3rd or 4th hour of riding. I like to keep some basal rate going, though.
Also, I usually supplement now and then with a Hammer gel or some snack, like Sharkies (my new favorite energy food, aka fruit snacks for athletes). The only problem with Sharkies is that they don't always make it to my Saturday rides... I don't know how they keep disappearing!
Run
I have been running since I was diagnosed with diabetes, and feel most comfortable managing this sport. Still, running after swimming and biking for hours is relatively new for me. At least, running after biking >100 miles will be completely new. I have a tendency to drop low on the run for half-Ironman distance triathlons, and for brick runs after a long bike ride. I'm not sure yet what the best approach to prevent this is. I may need to be more aggressive about reducing my basal rate, perhaps up to an hour before I get off the bike, and perhaps eating a bit more food 30 minutes or so before I expect to finish riding. So far, I have been able to recover on my runs, as long as I am not taking Symlin (which I never do for my long workout days). I'm not sure yet how I'm going to manage my BGs for the marathon after the Ironman swim + bike. I would love some tips from anybody out there on this...
Normally when I run first thing in the morning, I don't have to eat or reduce my basal rate, and my BGs will remain practically flat. If I'm running a bit longer, this is not ideal because I get hungry and don't run as well. I've been trying to eat more and at the same time trying to figure out how much to bolus without causing a crash but preventing a high BG. Usually, my approach is to just eat within 10-15 minutes of beginning exercise.
Next weekend I will get to test some of my new diabetes approaches, as well as my physical fitness in my first attempt at the Wildflower Triathlons infamous Long Course! I swore to myself for the past 3 years that I would never do it! What happened?
Here's a picture of the transition area and swim course from last year's race.
Last weekend, I swam (in a pool) for 3000 yards, then biked 80 miles and then ran for about 30 minutes, and felt pretty good. Tomorrow will be a bit lighter, since we have our second big race of the season on May 5. Anyway, here are some random tips & observations from my training thus far.
Swim
I have started to use my pump during my swims, with much improved results. It really helps me to avoid the post-swim highs I was experiencing before. I am still fine-tuning how much to eat and how much to adjust my basal rate. These depend on what time of day I am swimming, where my BG is at the start, and how much I have exercised in the past 24 hours. For example, I swam Wednesday morning, starting with a BG of 111. I ate one gel before getting in the pool and took a 0.3 U bolus (50% immediate and the rest delivered over the next half hour). When I tested afterward, my BG was 111! When does that happen? In contrast, this morning I started at 142, ate a gel and took a 0.2 U bolus spread out the same way. I had to eat another gel during the swim (didn't test BG but knew the signs--my splits get slower for no obvious reason). I finished with a BG of 115. I was swimming at the same time of day. The difference, I believe, is that on Tuesday evening, I had a relatively light workout (weight training in the gym) as opposed to a very strenuous 80-minute bike class + 15 minute run last night. I don't think my body had enough time to fully recover from the bike class, and so my muscle glycogen was probably a bit low. So, I need to remember to think about these things...
Bike
I tend to have few problems with low BGs on the bike. It is easier to eat than during a swim, and easier to digest food than on a run. I have been using Perpetuem from Hammer for the past few long rides. For rides 5+ hours, I mix up 6 scoops of the stuff, for a total carb count of 162g. I mentioned this previously, but anyway, the stuff is great. I drink a few sips now and then and estimate how much of the bottle should be gone every hour. Maybe I will label a bottle, or buy one that has ounce markings. It all sort of reminds me of baby formula... I keep my second water bottle filled with water, and refill it when necessary.
I am still playing with my carb:insulin ratio for the rides. The first time I tried 1U:55g and that was too high; last weekend, I tried 1U:80g carbs and that was too low (my BG's were running too high and I had to correct). So this weekend, I will try 1U:70g and see how that goes. I may also try using the 1:80 ratio but take the insulin over a shorter time, since I usually don't need any additional insulin after about the 3rd or 4th hour of riding. I like to keep some basal rate going, though.
Also, I usually supplement now and then with a Hammer gel or some snack, like Sharkies (my new favorite energy food, aka fruit snacks for athletes). The only problem with Sharkies is that they don't always make it to my Saturday rides... I don't know how they keep disappearing!
Run
I have been running since I was diagnosed with diabetes, and feel most comfortable managing this sport. Still, running after swimming and biking for hours is relatively new for me. At least, running after biking >100 miles will be completely new. I have a tendency to drop low on the run for half-Ironman distance triathlons, and for brick runs after a long bike ride. I'm not sure yet what the best approach to prevent this is. I may need to be more aggressive about reducing my basal rate, perhaps up to an hour before I get off the bike, and perhaps eating a bit more food 30 minutes or so before I expect to finish riding. So far, I have been able to recover on my runs, as long as I am not taking Symlin (which I never do for my long workout days). I'm not sure yet how I'm going to manage my BGs for the marathon after the Ironman swim + bike. I would love some tips from anybody out there on this...
Normally when I run first thing in the morning, I don't have to eat or reduce my basal rate, and my BGs will remain practically flat. If I'm running a bit longer, this is not ideal because I get hungry and don't run as well. I've been trying to eat more and at the same time trying to figure out how much to bolus without causing a crash but preventing a high BG. Usually, my approach is to just eat within 10-15 minutes of beginning exercise.
Next weekend I will get to test some of my new diabetes approaches, as well as my physical fitness in my first attempt at the Wildflower Triathlons infamous Long Course! I swore to myself for the past 3 years that I would never do it! What happened?
Here's a picture of the transition area and swim course from last year's race.
Wednesday, April 18, 2007
100 miles
Life's been busy and I never finished my race report. I guess I'll sum it up here--it went great (mostly)! My swim was slow as usual but I didn't feel too tired afterward. The bike and run were both comfortable, and I was happy to keep my BG's in a decent range. My finishing time was 6hours20min.
Now for more recent news. Last weekend, I did my first 100-mile ride in preparation for my Ironman race. I started in Santa Cruz, rode up Route 1 along the Pacific to Moss Beach (a small town just north of Half Moon Bay) and back. The ride up took 4hr40min. The ride back took 2hr30min. Yes, there was a headwind! (My actual ride time was 6:29 but I took some BG testing breaks!) I was lucky to have a good friend who volunteered to sag me the whole way--what a champ! I tried Hammer's drink, Perpetuem, for the first time. My approach was to eat sort of steadily, instead of ingesting huge carb-bombs every now and then. I figured out the total grams of carb in the whole bottle (162 g) and used a carb ratio of about 50g:1U insulin and spread it out over about 4 1/2 hours. I didn't think of this idea until about an hour into the ride, when my BG was climbing. But, it seemed to work pretty well. I also supplemented with gels and bananas as needed. Perpetuem has protein and a little fat in it, and is more like food than sports drinks. I liked the flavor (orange creamsicle) and it is actually pretty filling. I didn't have any GI discomfort from it, either. Yay.
After the ride, I decided to calculate the total amount of insulin used and the total amount of carbs eaten; I then calculated a "biking basal rate" that assumes I will be eating 47 g carbs per hour. This turned out to be 0.7-0.8 U/hr. I'm thinking of just setting my basal rate to that level and not bolusing at all for any food. Actually, that rate probably will need to go down the longer I ride.
If I can do enough testing, and I can estimate my times reasonably well for the race, maybe I can set up a race day basal rate profile based on what I plan to eat throughout the day, and just avoid bolusing all together. (My biggest fears are dropping low during the race and being unable to absorb carbs.)
I also did some calculations to figure out my carb:insulin ratio during the ride and, depending whether I take into account pre-ride insulin and food (and BG corrections), and whether I lump the basal rate into everything, the rate varies from about 55g:1U to 85-90g:1U. More testing is definitely needed.
Currently, I am predicting about 1:30 for the swim, 7:00-7:30 for the bike and 4:40 for the marathon. Well, we'll see about that last one. My best marathon time is 3:39 but that was not with a 2.4 mile swim and 112 mile ride beforehand!
Now for more recent news. Last weekend, I did my first 100-mile ride in preparation for my Ironman race. I started in Santa Cruz, rode up Route 1 along the Pacific to Moss Beach (a small town just north of Half Moon Bay) and back. The ride up took 4hr40min. The ride back took 2hr30min. Yes, there was a headwind! (My actual ride time was 6:29 but I took some BG testing breaks!) I was lucky to have a good friend who volunteered to sag me the whole way--what a champ! I tried Hammer's drink, Perpetuem, for the first time. My approach was to eat sort of steadily, instead of ingesting huge carb-bombs every now and then. I figured out the total grams of carb in the whole bottle (162 g) and used a carb ratio of about 50g:1U insulin and spread it out over about 4 1/2 hours. I didn't think of this idea until about an hour into the ride, when my BG was climbing. But, it seemed to work pretty well. I also supplemented with gels and bananas as needed. Perpetuem has protein and a little fat in it, and is more like food than sports drinks. I liked the flavor (orange creamsicle) and it is actually pretty filling. I didn't have any GI discomfort from it, either. Yay.
After the ride, I decided to calculate the total amount of insulin used and the total amount of carbs eaten; I then calculated a "biking basal rate" that assumes I will be eating 47 g carbs per hour. This turned out to be 0.7-0.8 U/hr. I'm thinking of just setting my basal rate to that level and not bolusing at all for any food. Actually, that rate probably will need to go down the longer I ride.
If I can do enough testing, and I can estimate my times reasonably well for the race, maybe I can set up a race day basal rate profile based on what I plan to eat throughout the day, and just avoid bolusing all together. (My biggest fears are dropping low during the race and being unable to absorb carbs.)
I also did some calculations to figure out my carb:insulin ratio during the ride and, depending whether I take into account pre-ride insulin and food (and BG corrections), and whether I lump the basal rate into everything, the rate varies from about 55g:1U to 85-90g:1U. More testing is definitely needed.
Currently, I am predicting about 1:30 for the swim, 7:00-7:30 for the bike and 4:40 for the marathon. Well, we'll see about that last one. My best marathon time is 3:39 but that was not with a 2.4 mile swim and 112 mile ride beforehand!
Friday, April 06, 2007
new template
Well, I got bored with the old one. I'd really like to customize my own but I don't know how and it hasn't made it to my top ten priority list. We'll try this one out for now. Maybe it's a little too loud.
Wednesday, April 04, 2007
Race Report: Ralph's (California 70.3) 2007
Before the raceAfter a 2-day journey from San Francisco, I arrived in Oceanside last Friday, excited to race in the 2007 Ralph's Triathlon. Okay, well, it's actually now called the Ironman 70.3 California since Ironman took charge a couple years ago. Anyway, I checked into my hotel and made my way to the registration near the Oceanside pier, seen in the picture here. Most of the race volunteers were U.S. Marines from the nearby base, Camp Pendleton. They were young, friendly, but strict! When I tried to exit the wrong door, my request was politely but firmly denied! Anyway, I wondered, as they were helping us get ready for this race, what they thought about all of these athletes, so serious about a race when many of their friends' lives were in daily peril in Iraq. Would they be leaving for Iraq soon also?
I checked out the orientation movie, which was actually pretty funny as it poked fun of some of the more uptight behaviors seen at these events. Regarding a dangerous descent with a no-pass zone and a speed limit of 25 MPH, they imitated an athlete saying, "But if I have to slow down, that will totally ruin my chances for Konaaa..."
We grabbed dinner at a restaurant along the harbor called Dominic's Pizza. The pasta I ordered--eggplant with mushrooms and chicken--and the caprese salad we shared were both delicious, albeit a little pricey. Our server was fantastic, though, and accommodated our larger group with ease. I would definitely return again.
After dinner, we walked over to the transition area, still being set up, and scoped out the swim buoys. They always seem to stretch out way too far! The water was calm, and I didn't see any evidence of the truck and boat that had sunk in the harbor earlier that day!
Race dayI woke up by about 5:00 AM, ate a banana and half of a Clif bar, and took about 2/3 of a regular insulin bolus. I double-checked to make sure I had everything, and loaded up my very huge triathlon backpack. It was still dark when I left around 5:40, but I made it safely to the transition area, about a mile away. My rack was already about 1/2 full so I found a spot midway down. I laid out my towel and various shoes and food. I was determined that I would have fast transitions this time around by really planning out my food and having everything ready, as opposed to deciding how much food to bring based on my blood sugar at T1 or T2. For the bike, I stocked the seat pack with enough carbs to rescue me from a serious blood glucose (BG) crash, and taped about 5 gels to my top tube. I also had, in ziploc baggies, 2 packages of Sharkies, a broken-up Clif bar, and a few salt tablets & some Advil. For the run, I had my visor, and my Fuel Belt loaded with gels and some sharkies, as well as another bag of salt tablets & Advil. I can also stick my Ultra BG meter on the side of the Fuel Belt, in one of the spots normally used for a small water bottle. The plan was to, after the swim, test my BG and then throw that meter, in a ziploc baggie, into the side pocket of my tri top; I would grab the other baggies and put them in the other pocket, throw on my race belt, helmet, sunglasses and shoes, and be on my way. Oh yeah, I would also need to put my pump back on at some point. I looked over everything and, satisfied, left for the Long Line, meaning the endless line for a portapotty.
Okay, I have to stop for now. I'll post Part 2: the race! soon.
Tuesday, March 13, 2007
A great run today
This morning I was scheduled to run 60 minutes, including two 20-minute tempo intervals at heart rate zone 4. What does this mean? My heart rate zone 4 is anywhere between 169 and 179 beats per minute, which I measure with my Polar heart rate monitor. I went for my run this morning after waking up with a BG of about 90 (yay!). I was a little concerned that I might drop, so I ate half of a banana, which brought me up to about 110 by the time I started running. After 16 minutes of warmup, I began the first 20-minute tempo interval. I was feeling the slightest bit low but assumed I wasn't low for two reasons: I ate the banana (well, half) and I rarely drop low when I exercise first thing in the morning (before taking any boluses). Nonetheless, I decided to take some preventive action and ate a ClifShot a few minutes in, and turned my basal down 40% for an hour. (I had a really horrible low 2 weeks ago that took me 20 minutes to recover from during a similar run; while waiting, there was a freakish hail storm and I was stuck there under a big tree, trying to stay dry while obsessively checking my BG every 45 seconds. This run was during the lunch hour--not early morning like today--so I wasn't terribly concerned about a repeat event.) Anyway, I tested after the first interval and I was 174, which was acceptable. I usually like to let the BG drift up a little, just because I hate having lows so much while exercising. Still, I wish I could figure out how to have a BG of 120 all the time while exercising! Is this even remotely possible? The second interval was slightly uphill, which made it a little easier to keep my heart rate up in HR zone 4. My average HR for this interval was 173 or so. Following my run, my BG was about 240 so I took a corrective bolus. I think that it was probably only necessary to reduce my basal for the first half hour, while I was still close to 100, or to not eat the snack. I was in the groove and didn't feel like pulling out my BG meter during the first interval; this would have been the better solution. (Even better would be to have my Dexcom working again. I need to order some additional sensors.)
Here Comes the Fog
I took these pictures while walking around my neighborhood this morning. I love it when the fog spills over the hills in San Francisco. I'm happy, too, when I'm viewing it from the sunny side! The second photo shows the Big Wall of Fog coming in from the Pacific. Scary! (Sorry for the poor image quality; the pictures are from my cell phone.)
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