Back in San Francisco

Sliver of Moonshine on the Bridge
Originally uploaded by annetics

After a wonderful visit with my family over Christmas, I am back in San Francisco, and was welcomed with this sight from Fort Baker yesterday evening. I am looking forward to ending 2008 with a bike ride through Marin, and am grateful to live in a place where this is easy to do on December 31.

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...

Triabetes 2009

The day before the big race, September 6, 2008 (courtesy of Blair Ryan)

When Peter Nerothin asked me whether I'd like to continue with Triabetes in 2009, I knew the answer was inevitably "Yes." A few weeks ago I had the pleasure of reuniting with some friends from this year and meeting the new Triabetes team captains for 2009, as we volunteered for Ironman Arizona 2008 and signed up for the 2009 race. We have another group of amazing people, including some first-time triathletes coming from various athletic backgrounds as well as others who have already completed Ironman races. Okay, and I have to admit that I am pretty impressed by Seb, who decided to do an Ironman after CLIMBING MOUNT EVEREST! I remember when a woman spoke to our high school class and told us how she had lost a toe or two to frostbite climbing Mt. Everest, and that pretty much sealed the deal for me not doing it. I love the mountains and I love a good challenge but worrying about my insulin freezing on the top of a mountain that birds can hardly fly over (have you seen the Planet Earth episode on that?) seems pretty tough. As Seb said about the prospect of an Ironman, he is pretty good about dealing with blood sugar issues "under adverse conditions." Enough said!

Each teammate brings a unique background and I am honored to be training with all of them. Furthermore, it is a pleasure to continue with Triabetes to help support other diabetics in their desires to live active lives. I hope to stay connected to the 2008 crew as Triabetes continues to expand and reach more lives. If you or anyone you know with diabetes wants to get involved with Triabetes, it is now open to triathletes and wanna-be triathletes of all abilities and for all triathlon distances, and I would encourage anyone interested to sign up on the Triabetes website.

Triabetes 2009 Team Captains after signing up for Ironman Arizona 2009. We're committed now!

Run, Anne, Run!

I have some posts to catch up on but for now, her's an update of my on-again, off-again, now on-again marathon training. Earlier this year I was contacted by a friend with Children With Diabetes to run with them in January at the Disney World Marathon and Half Marathon weekend. Reluctant to commit to a marathon after a season of 2 Ironman races, I resisted. But as they say, "Resistance is futile!" I'm a sucker for signing up for races! And I loved the idea of running with CWD. I could have signed up for the half, but since I was traveling all the way to Florida, you know, I had to get my money's worth. (?)

Soo.... after Ironman Wisconsin was over and I gave myself some time to relax, I started to pick up the running again. I felt a little weary of training but figured I could get by with a weekly recipe of one tempo run, one track workout, one long run, maybe another easy run, a long ride and a couple swims. After all, I only ran 3 days per week for the entire season leading up to the Ironman events. Oh and I should say, I also planned on a couple days of light to moderate strength training. I get injuries if I don't include that. Well, despite not being Ironman training, it sort of felt like I was still training for an Ironman. I was losing my motivation.

But then, I saw the movie, Run Fatboy, Run, with my sister and her husband, and my game was back on! For some crazy reason, this movie about a guy who decides to run a marathon in order to get his girl back (after leaving her at the altar) inspired me to keep training! I can't exactly say why, because the main character isn't that inspiring as far as training is concerned. And he even had Mr. Ghoshdashtidar's spatula to keep him moving. But I guess, somehow, it reminded me why I love these events and I recommitted myself by running with my friend Rita a few weekends in a row, getting my mileage up to 18 for a long run. (Rita, by the way, just qualified for the Boston Marathon by killing her PR at the California International Marathon in Folsom/Sacramento. Congrats!)

I skipped my long run the weekend I was in Arizona, meeting my fabulous 2009 Triabetes teammates and racing through the desert in the Tour de Tucson 109-miler. (Much more on that soon!) I returned home eager to get some peak training done. I decided to add an extra run after my early-morning swim one day. I was running along, approaching an intersection when I had that horrible sensation of tripping, flying through the air and watching the pavement come up fast and hard! Argh! I was crumpled on the pavement and in a lot of pain. It sounds funny now, as tripping and falling usually does, but it was agonizing! I couldn't get up, really, and just lay there until a fellow runner came and helped me up. I had only been running about 60 seconds when I tripped, so I hobbled back to my car. I was bleeding and my elbow was very swollen.

When I got home, I was sure I had broken my arm but after a while the swelling went down. I think the pain was due to my landing hard on the nerve that runs along the outside of the elbow. My knee was another story. It was stiff so much so that I couldn't walk much for a couple days, and wasn't able to really do much for about 5 days. My blood sugar was going wild and the no-exercise moodiness was in full force. I was feeling pretty much done with the whole affair. I decided to give it one last shot last weekend with a long run. With the race a month away, I would need to get in a few more unless I wanted to be completely miserable on race day. My 19-miler went much better than I expected and I actually enjoyed my run through Portola Valley. And being out there for a few hours did not seem as long as it did in pre-IM days. My knee has remained a bit achy, but seems mostly healed.

So, I am back in. I received my sweet Nike race shirt from Laura at CWD and am going to give it a spin this weekend. I don't expect to pull in a Boston qualifying time in January, but I do look forward to meeting up with the CWD folks and having a chance to run with Goofy for a bit. And I definitely would not have been doing intervals on the track this morning without a marathon looming close!

Research News Flash: Gleevec and Sutent

Thanks to Peter Nerothin and Kerri Morrone Sparling for the tip-off. An article published in the December 2, 2008 PNAS journal (with early release today) showed that 2 leukemia drugs--imatinib (Gleevec) and sunitinib (Sutent)--had potent effects in preventing and reversing new-onset diabetes in NOD mice. Of course it hasn't been shown to work in people yet, but this does seem like a very exciting development, in particular because Gleevec and Sutent are already FDA-approved drugs. Another exciting finding was that one course of treatment (albeit a 10-week course) had long-lasting effects, suggesting that the drugs had a modulatory effect on the immune system--not just a more temporary, suppressive one.

I went to an informative talk today on the cell/molecular biology of diabetes and routes to a cure, given by Jeff Bluestone and Steve Gitelman of UCSF. I missed the first part of it so perhaps they discussed it then, but it seems like perhaps they didn't want to spill the beans. Dr. Bluestone was quoted in related news stories and is one of the main authors.

I am optimistic about the state of research, but will make sure to keep stocked up on insulin and test strips for the foreseeable future.

World Diabetes Day Today!

Today is the annual commemoration of World Diabetes Day. One of the goals of this event is to raise awareness about diabetes in the developing world. The International Diabetes Federation has a program, "Life for a Child," to help children in developing countries gain access to insulin, blood glucose testing and diabetes medical care. Another goal of World Diabetes Day is to educate people on the warning signs of diabetes; catching diabetes early can help to delay and possibly significantly reduce complications. I have heard of many instances where type 1 diabetes was missed in infants, almost until it was too late. Read about the warning signs of diabetes and more about the IDF mission here. I should note that type 2 diabetes usually has different warning signs than type 1. Know them, especially if you are at higher risk.

As part of WDD, many monuments and buildings around the world are being lit up in blue. The Civic Center will be lit up in San Francisco today around 5:00 PM.

Symlin Observations

I've been taking Symlin again for several weeks and have noticed some significant changes in how my blood glucose responds to food, insulin and exercise. After the suggested ramp-up period, I am now taking 10 units, or 60 micrograms, or Symlin at breakfast, lunch and dinner, and have been very consistent about taking it (e.g., I am not skipping doses if I just exercised or plan to exercise after work). These are some of my observations, which may be confounded because I also cut down my weekly long ride from 90+ to about 45 miles, and similarly reduced my long runs from 16-20 miles to 8-12. I am still exercising nearly every day, although the daily volume is somewhat reduced as well. Another possible confound is that I am trying to eat a lot less, in general, but during exercise in particular.

• I have had to change my carb ratio from about 9g:1U to 15-20g:1U and must take an extended bolus anywhere from 90-120 minutes with only 15-25% of insulin upfront (typically). If I am on the low side, I will take less upfront and if my BG is high, I'll increase the upfront amount accordingly. (Thanks, Scott, for the tip on extending the bolus from an hour to 90 minutes.)
  
• I tend to go high in the evenings so take a longer extended bolus after dinner than after breakfast. Maybe this is a basal rate problem; I'm not sure.
• I must reduce my basal rates by 30-50% an hour before exercise; previously I could pretty much keep my basal right where it was. I have a sense that this is not just due to the fact that I am eating less, because I am not spiking as much during intense workouts, either. Previously, this was a pretty reliable response for me, regardless of whether I ate anything. I had feared that I would have have a lot of bad lows during exercise but have been okay as long as I reduce the basals in advance. For example, this morning, I reduced my basal rate from 0.7 to 0.575 one hour before going for a very early 45-mile bike ride. I didn't eat anything the entire 3 hours and was 142 at the start and 82 at the finish. It was an interesting test.
  
• My BG's are much more stable, and the Dexcom has been really important in my being able to fine-tune the symlin/insulin strategy. I initially would have a low after bolusing, then rebound with a bad high about an hour later. The extended bolus has pretty much resolved this.
• Sometimes my blood sugar seems to randomly take off more than a few hours after eating. The Dexcom shows a straight line with a steady positive slope. I'm not sure what is going on here but this seems to happen every now and then. Perhaps it is related to what I ate but I don't have a good explanation.
• I still have some nausea and occasionally wake up sickeningly hungry. You know that feeling when you are so hungry you could almost throw up? I try to ignore it and go back to sleep. Don't worry; I am definitely eating enough.
• Symlin really stings! And I don't like shots after all. I think the rubber is so thick on the vial top that it slightly dulls the needle going in. I remember this from before. I am injecting mostly in my arm and thigh since my abdomen is already crowded with my pump infusion site and the Dexcom sensor. I know there is a Symlin pen now, but I will have to wait until I use up my current supply.
• It takes longer to recover from lows. I try to avoid getting low in the first place by watching the Dexcom.

My experience has been much more positive this time around, but I still have some reservations about using Symlin for safety reasons. Although amylin is naturally produced in the body, Symlin is an analogue and I feel like I am basically a guinea pig here. (I know they do safety studies on it but how many other drugs have been pulled even after the safety studies were satisfied?) I don't like having to pull out a needle before eating, though, and am not sure if I have really committed myself for the long haul with Symlin. We'll see!

Triabetes Project by Andiamo Productions: Highlight Reel

I am excited to share this video, which shows some highlights from Ironman Wisconsin in September. Bascom Hill Band generously provided the music and the production costs were graciously donated by LifeScan, maker of the OneTouch glucose meter. From Steve Parker, diagnosed after signing up for the race, to Larry Smith, who decided to race to celebrate his 60th birthday and has had diabetes for 47 years, and from Dave Shack, with little athletic background, to Bill Carlson, a seasoned athlete with countless achievements, we had a diverse group. Special thanks naturally go to Andiamo Productions, who immediately understood the vision of this project, and have worked tirelessly and expertly throughout the past year. Keep posted for upcoming announcements regarding the 2009 Triabetes team!


Diabetes and Athletes: The Triabetes Project from Andiamo Productions on Vimeo.

Symlin-ing Again

I decided a few weeks ago to try Symlin yet again. Despite some lasting fears induced by a couple scary episodes of severe Symlin-induced lows, I felt like perhaps now might be a better time to really test it. My training schedule is a bit more mellow, and with no big races coming up, I am a more willing to do some experimentation which might result in me having to cut short some workouts. I have been taking Symlin for a few weeks and built up to my current dose of 5 units, which I take at each meal. Initially, I took a regular bolus with the Symlin but have found that, for me, it works better if I do a dual-wave bolus with 30-70% of the insulin upfront and the rest extended over an hour. Otherwise, I was getting low within the hour, having a hard time pulling out, and then shooting up over the following hour. So far, I am happy with the results although I definitely have to make bigger reductions in my basal rates before exercising. Of course, with diabetes, it can be pretty tough to pick out what is causing what, so I won't make any big conclusions yet (especially since my basal rates are in a state of flux since the Ironman, then my recovery and now getting back into training). I am still feeling some nausea but that seems to be lessening; also, I have felt more sated after meals although sometimes I wonder if I am just experiencing nausea. It's a feeling somewhere between feeling satisfied and feeling pukey. I do still worry whether this is safe to take since it's relatively new.

Note: I am not a doctor and this is not medical advice. Consult your doctor for help with Symlin.

Riding along Ridgecrest in Triabetes gear

Here's a picture from the race on Saturday, which the race photographers sold for a reasonable $4.50. (Hello triathlon photographers! How do you justify your ridiculous prices? Ironman Wisconsin high res images are currently $35 each whereas photos for this race were $15 for high-res and a reasonable $4.50 for a lower-res version. I know it's an Ironman but come on...)

As you can see, September is a pretty dry month in California. I was reflecting on how green San Francisco is year-round and had to admit that I guess I am okay with all the fog after all, and that I suppose it is better than getting rained on all the time. I just love wearing my Triabets jersey, which reminds me... Is there anyone out there that would be interested in purchasing a bike jersey if they were made available? Just wondering.