Hypos and frustration

Tonight’s post is a bit of departure.  It’s not so much about physical activity.  More so, it’s a story about a terrible night, a chance to have a teachable moment, and also a chance to share with others that we all struggle with control whether we have tight or loose targets.

Tonight was a frustrating, exhausting night.  I had my second hypoglycaemia induced seizure.  When I got home for supper I felt really terrible.  It was coming on fast.  I sat down, ate a couple sugar pills, and my wife was very proactive and mixed up glucagon and called 911.  We had one fresh vial, and one “expired vial”.  Thank goodness – the fresh batch had the needle bend when she stabbed my quad, so she mixed up the second vial that worked.  Unlike my first hypo back a few years ago, I did not hallucinate.  I did seize up for a few minutes and bit my tongue quite viciously.  I was blood soaked.

Paramedics were great and got me to the hospital quickly (it’s only two blocks down the road).  The nurse staff were great.  However, I had a most frustrating doctor attending me, and this is one of the reasons I wrote this post.  She said to me “You need to ease up on your control, studies show that tight control is no longer the holy grail, and you need to do better”.  I snapped.

I told her that her advice is completely counter to every piece of literature I’ve read, that it’s easy for her to say this when she is not currently experiencing some of the complications (for me, non-proliferative retinopathy and some irregular blood counts), and that she doesn’t understand that insulin isn’t always the most predictable hormone.  I told her that her negativity is a stereotype that diabetics deal with 24/7, and that she could give me some damn credit for how well I control it the other 99.9% of the time instead of focusing on one stupid mistake.  She gave me a knowing smirk, it felt good to use that as a teachable moment to add some positivity to diabetes care.

Anyways, right now I am exhausted.  No hyperbole or exageration – the use of glucagon to dump my liver’s glucose is more exhausting than the marathon I ran this weekend, the two centuries I’ve cycled, climbing the Grand Teton or backpacking the grand canyon for 4 days.  It’s that tiring, and I’ll still be awake for a few more hours (it’s 11:40 PM now) nursing a high blood sugar (obviously I don’t want to be aggressive).

So a picture is worth a thousand words – this picture of me with about 10 electrodes (only a few visible) says it all.  Blood soaked shirt and all. :)

Not impressed at tonight's hypo

Not impressed at tonight’s hypo

So next time you get a negative comment, feel empowered to use it as a teachable moment. It’s the only way we can conquer stereotypes and negativity.

Animas Vibe or Dexcom Standalone Receiver?

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One of my criteria for my timing of moving back to Canada was approval of the Dexcom G4 in Canada.  I rely on the Dexcom so much it’s almost disturbing.  For me, it’s been crucial in management of blood sugar and hypo prevention during exercise.  However, I have yet to localize my CGMS receiver, so it still reads in mg/dL.  Since that’s an out of pocket expense, I wanted to see if it made sense to get a mmol/L receiver, or if the newly approved Animas Vibe would be sufficient.  For those not in the know, the Animas Vibe integrates the Dexcom G4 CGMS with the unit.  It’s basically an upgraded Ping (although some would argue losing the remote meter is a huge deal), with lots of UI and usability adjustments and CGMS on the unit.  Rather than review the Animas Vibe as a whole, what I wanted to do was review the Animas Vibe vs. the Dexcom G4 standalone receiver – which one is better for exercise?  Is there still a place for a Dexcom G4 receiver, or is it redundant?  Is there a place for both?  If I had to choose, which one would I go with? The Newfoundland Animas rep sent me a surprise e-mail on Wednesday offering me a loaner Animas Vibe.  She knew I was keen on trying it out.  The extra surprise – it’s an awesome pink unit.  So I made plans to do a long run this weekend to see how the Vibe would fare – running is the one activity where I sometimes find I run out of places to put things; and the fact that the Dexcom receiver is not waterproof makes it a necessity to carry it in a LokSak or ziploc bag depending on the weather. So without further ado, I powered it up, programmed it, and calibrated the CGMS the same as my receiver.  Since my receiver was already running the numbers were slightly different.  So Friday I took it on a bike ride, and thanks to the combo of old sensor and noise/friction from the wind jacket I lost the reception.  At least both units failed.  What’s interesting is the Vibe actually gave an error (and stopped the session), whereas the Dexcom receiver just showed a “lost signal”.  So I put a new sensor in and got them both running with the same calibration – good news, they showed the same results.  I’ve had this issue with Dexcom sensors before – it’s a combination of materials and sensor age that seem to lead to the lost communication.  You can just restart, wait two hours and grab a new calibration, but my sensor was plenty old. I also made plans to try and run my first marathon – why not go big or stay home! :)  I’ll write more about that in another post, but let’s try and trim this one down and write about what I liked and didn’t like and what I learned.  As usual, I started the run with my usual pre-run oatmeal.  You can see my multinational setup – mmol/L and mg/dL playing together!  Trust me, they are the same readings.

Pre race, real food, and diabetes tech

Pre race, real food, and diabetes tech

So, jokes aside, what did I think? Here’s a few talking points:

  • First of all, the best part – this screen.  It shows the time, your current CGMS blood glucose, the trend arrow, and the insulin on board.  This is almost everything you need to know, and the real value of having the units integrated.  It’s a great screen, and the one I leave hotkeyed on the pump.  Why do I say almost?  Well, sometimes my sugar can start creeping up ever so slowly – the Dexcom algorithms still say it’s flat, but really it’s a slow creep up until I hit a high.  So that flat can be misleading which is why it’s good to also actually see a few data points.  You only get that on the pure graph screens.  Still, if I am running, this is the main screen to see.
Best screen ever - CGMS, trend arrow and IOB

Best screen ever – CGMS, trend arrow and IOB

  • When you zoom out, the CGM graph is actually kinda hard to read on the Vibe, and this is my major pet peeve.  The Dexcom screen is just bigger, and on top of that, they colour the dots white.  Also, note the Dexcom shows time stamps so you have an idea at what time your trends are firing off.  The markings are there on the vibe, but really not as easy to read.  If you wanted to be scientific with your trends, you’d have to look at the time (4:53 pm in this photo), then figure out the scale (3 hours, so 6 ticks, so each tick is 30 minutes), then back off from that.  At least on the Dexcom I can quick glance and see that around 1:30 PM I had a low alarm.  I also find the green just harder to read.  Dexcom’s colour scheme is red(low), white (in range) and yellow (high).  Maybe it’s just the change to green that messes me up, but I found it a bit harder to read.  Maybe it was my tinted sun glasses.  Finally, font size is much smaller, especially on this screen – the blood glucose value is just harder to read than Dexcoms (and also harder to read than the above screen that I love).  It’s all just a function of smaller screen real estate.
3 hour graph, less readable when you have tight control

3 hour graph, less readable when you have tight control

  • These problems become more exacerbated when you zoom out.  Now, for exercise purposes, you aren’t really going to be looking 6 hours (unless you’re doing an ultra) but for every day use this screen starts to lose it’s utility.  If you were trying to make decisions on your blood sugar management based off this it would be tricky – you’d be better served to upload it to try and read it.  I’ll touch on this later.

    6 hour trend

    6 hour trend

  • The final photo evidence useability feature I want to touch on is thickness.  The Dexcom G4 is svelte; it’s like an iPod.  I find it very easy to slide it in and out of my tights pockets.  All my running clothes are spandex – short tights and long.  The hip pockets on these tend to be quite snug/compressed against the leg.  The Dexcom easily slides in and out for a quick glance.  I found myself having to fight to pull the pump out.  This is also true of the Ping; however, I consult my Dexcom a fair amount and only pull the ping out to bolus.  So this meant I spend more time trying to slide this in and out of my pocket.   If you have numb fingers (like I did for the first half of this run) it can make it quite challenging!
Chunky!

Chunky!

So what else did I learn from a usability stand point.  Here’s a short list of pros and cons. For the Vibe:

  • Waterproof – you could use this during a tri and not worry about leaving the receiver in transition.  Also, you would not need to bag a receiver like I do on a wet day.
  • Integration means that if you need to action a BG you already have the pump out.  So there’s an efficiency there.
  • Glucose trend and IOB on one screen – pure gold
  • You can’t drop it – since you’re hooked up with tubing you really can’t drop it on the ground and loose it.  Well, at least you’d have to try really ahrd.

For the Dexcom:

  • Having a separate unit is perfect for sports like cycling where you can mount it.  It’s much more convenient on the bike than trying to read your glucose off the pump on a bike.  My pump sits in my jersey and rarely comes out.
  • Access to data – this is almost the key part to me.  To get your CGMS readings off the pump you need to use Diasend.  Diasend is an amazing website for integrating glucometers, cgms and pumps; however, it does not export data in raw formats like Dexcom Studio will.  Now, I do realize that the Tidepool project has ways of doing it, but this is not for the every day diabetic.  I love data, and the Dexcom’s USB port makes it possible to upload to Diasend AND Dexcom Studio.  Dexcom studio will dump any data available into a tab de-limited format.  I also like how Dexcom Studio does trends and identifies areas you are going high/low.
  • Readability – the separate receiver is just better to read
  • Range – I noticed the G4 receiver has a much longer range to communicate with the transmitter.  You may not think it a huge deal, but I can envision scenarios where one may disconnect and leave technology behind – like crack climbing.  I’ve been up an 80′ pitch and left my Dexcom on the ground and still had reception.  The Vibe just won’t – probably battery life related.
  • Form factor – if you frequently check your glucose, getting the Dexcom out to look can be much quicker and easier to do since it’s so small.
  • Speed – the screen refreshes on the Vibe are slow whereas the Dexcom renders much faster
  • Alarms – sometimes I don’t feel the vibration alarms; however, the Dexcom alarms are also extremely loud.

Overall, if I could only have one, I’d choose the Dexcom receiver.  It’s versatility to work well with every sport makes it a clear winner.  On top of that, readability is key.  Now I’m not saying the vibe isn’t an amazing product – it really is and I do hope to get one.  It makes running simpler to plan, and for a long run it makes blood glucose management even easier with that one magic screen.  However, that one screen, while amazing, is still no match for the total pack of the standalone receiver.  Besides, in every day life I like being able to set my CGMS on my desk and work away.  I don’t have to take my pump out to look at my levels.  That goes a long way to feeling like we have a “normal” life.  I plan to localize my CGMS receiver soon; and hopefully check a Vibe out in the near future.  Both are great, but the Dexcom is my first choice for CGMS usage.  I don’t think they are redundant – but I do feel like one is a better all-arounder. Summary:

  • Vibe is a great product, it really fixes a lot of usability issues with the Ping (but you loose remote bolus)
  • Dexcom receiver is a better all around CGMS receiver
  • For running and swimming, Vibe may be a better solution
  • For cycling and rock climbing, I’d rather the Dexcom
  • For every day use, the Dexcom is more useful to me

DBlogweek Favorite Things – Sunday Topic, DBlogweek 2014

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What a week!  I thought a week of writing blog topics would get difficult, but it wasn’t too hard.  Today’s topic should be easy but it’s difficult for me – my favourite things from the week.  It’s hard because there are so many things and also because I didn’t get to read as many blogs as I had hoped.  Maybe that’s my favourite thing – how much I’ve been exposed to and how many people I’ve met through it.  Still, I won’t cop out like that, so here’s a breakdown of my some of my favourites.  It’s not exhaustive, but it’s something.

Monday: Change the world

Jane at Running Without Sugar was a refreshing and great start to the week for me.  It hit on so many important topics to me; exercise, “equal” treatment of diabetics, and I especially liked the mental checklist. :)  She had a great message, having diabetes is not a limitation.  Thanks Jane!

Tuesday: Poetry Tuesday

Laddie at Test Guess and Go was a shoe in for me.  I have an immense soft spot for our canine friends, and I love how she worked it into her poem.  I’ve really enjoyed Laddie’s blog throughout the week.  There were also some other great poems – I wish I could find them all, but I also loved “This is just to say” from Elizabeth at T1International

Wednesday: What Gets you Down

This was a hard day for me.  Mental health is not an easy topic, and ready a lot of blogs with so many sad emotions was very taxing.  I think this highlights how difficult a topic of mental health is.  I just don’t have a favourite from this day because I stopped reading after a bit – I couldn’t let myself go into that dark place.  It’s just a place I try to stay away from mentally.

Thursday: Mantras and More

This post by Daley at I Run on Batteries is awesome.  Look at the bright side.  The message in her post is exactly my experience – so I’m biased, who cares! :)

Friday: Diabetes Life Hacks

I loved the hacks Alberta Diabetic Girl shared; solely for the reminder that I need to keep a coin in my meter bag for when I have to change out batteries.  That, and her tip about infusion sites.  I do the same just in case my new site sucks (literally, if I have a blood filled vampire cannula).

Saturday: Snapshots

Two favourites – one is from The Diabetic Medic for her awesome photos of a year of diagnosis spent as a year thriving with diabetes.  Great photos!

The second – T1International’s post showing diabetes initiatives around the globe.  Words cannot describe, but I’m sure you understand why it’s a favorite.

My own favourites from the week

Monday, we adopted a new member in our family.  Winston the rescue!

Winston!

Winston!

And another amazing thing happened this week.  Team NovoNordisk had it’s first podium finish in the Amgen Tour of California!  They also captured the Most Courageous Rider jersey two days in a row! Way to go TNN!

So that’s my week, and that’s me signing out for Diabetes Blog 2014.  Thanks to all those who posted and those who read.  A special thanks to Karen at Bittersweet for putting this together.

I hope some of you stick around to read my (less frequent) updates. :)

Saturday Snapshots, (Active) Life with Diabetes – Friday Topic 2014 Diabetes Blog Week

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It’s hard to believe DBlog Week is almost over!  But here goes!

Today’s topic is what does life with diabetes look like.  My take, being an athletic themed diabetes blog, is to show what I did on this absolutely beautiful Newfoundland summer’s day!

I knew the weather would be great, but we got to bed late, so I had hoped to sleep until 6.  Well, the morning actually started with a 4:45 wake up call from Winston, the foster.  I got up, fed the three fur kids, then fed myself my usual pre-ride meal (oatmeal, yogurt, cappuccino).  Then I took the creatures out to pee and realized it was going to actually be a warm day.  This was a shocker since we had snow this week!  Anywho, I got my summer kit on, and got my ride goodies ready.  My plan was 3 two-bite pies (sourdough quick “crust”, blueberries with a strawberry preserve, creme cheese, and a bit of brown sugar – ~110 cal each, 21 g carb) and a bottle of skratch labs.  The plan was a 40ish mile bike ride with lots of hills, so I wanted to make sure I had enough glycogen for the climbs at hand.  Just in case I took 10 sugar pills and a sugar gel – they were not needed.  For once I took my blood meter because I figured the Dexcom wouldn’t mess up on me that way. :)

And of course, my pump in my trusty jersey pocket.

Diabetic riding kit

Diabetic riding kit

One of the many reasons I use 43" tubing!

One of the many reasons I use 43″ tubing!

My plan was to warm up the legs with 4 miles of easy, fast cycling, then hit some hill climbs (Cat 3 and Cat 4) on my way out to Cape Spear, the most eastern point in North America.  It’s a great and challenging ride.  The climbs are leg burners and the descents are epic.  Here’s a link to the route.  Anyways, it was an amazing ride as planned – definitely not as fast as Texas flats, but a hell of a lot more fun.  On the ride out to Cape Spear I spotted an iceberg in a little village called Blackhead, so I marked that for the return trip.  I did NOT want to loose momentum before the climb out of Blackhead.  After the final climb I descended into Cape Spear and fully spun out my gearing (50×12) and hit 73 km/h.  It was riveting!  You could hear me yelling this is *$)(% awesome the whole way in. :)  Anyways, a nice person out sightseeing at 6:30 AM snapped a photo of me, and I snapped a photo for the readers of the most eastern point in North America.

The Wilier with the furthest east point in the background

The Wilier with the furthest east point in the background

Sunrise at Cape Spear

Sunrise at Cape Spear

Me at Cape Spear

Me at Cape Spear

And of course, the diabetic portion of this post.  I took this chance to check in, about 1/4 way into my planned ride.  Blood glucose levels were perfect!  5 mmol/l, flat trend since breakfast onward.  Since it was about 40-50 minutes in, I popped a two bite pie, had a sip of skratch.  I tried to snag a photo of this, but alas, the sun glared out the Dexcom.

Diabetes and riding can be a tasty endeavour.

Diabetes and riding can be a tasty endeavour.

Next, I climbed back out of Cape Spear and descended into Blackhead.  I tapped on the brakes a bit on that descent.  It was super windy and the road quality was a bit sketchy.  I didn’t need road rash at 70 clicks an hour.  Here’s what greeted me and Wilier there:

Iceberg at Blackhead!

Iceberg at Blackhead!

I texted Meg to let her know how things were going, and then climbed out of Blackhead.  I turned towards Petty Harbour/Maddox Cove and met up with a runner jogging up one of the hills.  Great training.  I had a wonderful ride through Petty Harbour through to the Goulds.  That’s when I decided the day was just too beautiful and decided to ride out to Bay Bulls and back (~20 mile addition) – I also ate my second pie here.  It was great – I felt slow, but that was the wind in my face.  On the return (which I ate my third pie at) I was benefitting from that wind!  A majority of the end of the ride was spent at ~35 km/h, so I can’t complain! :)  I didn’t stop to snag any more photos because I was having too much fun.  I got back to the house just in time to head to the market in town.  All told, I got in 82.5 km (51 miles).  I contemplated going for a full metric (100k), but I didn’t want to be too selfish.

So how did my blood sugar do?  I could not have asked for a better blood sugar day!  My alarm levels are 70-140 mg/dL – yes, I know, I’m Canadian.  I got the Dexcom in the USA, and haven’t paid to switch to a mmol/L unit yet.  For the metric readers, that is 3.9-7.8.  Anyways, by monitoring my CGMS, my HR and planning my nutrition I was able to get in this amazing ride and not once did diabetes get in the way.  This is what the point of this blog is – yes, it’s a lot of work.  But when you get it figured out, you can really knock it out of the park!  This is what a day in the life of an active diabetic can look like.  It’s not every day, some just don’t work, but I promise you, we can do this – we can manage this disease so it doesn’t get in the way, and we can have a hell of a good time in the process.

Now back to this beautiful day!

Perfection!

Perfection!

So, total stats:

Calories Burned: 1843 cal (per Garmin, Strava too optimistic)

Calories Consumed on Ride: 446 calories (not counting breakfast)

Carbohydrates Consumed on Ride: 89g total, 3g fibre, 86 g net carb

Insulin Bolused: None; I had a temp bolus running from breakfast that covered these carbs and made sure it went to the muscles

Enjoyment: Immeasurable

 

Diabetes Life Hacks – Friday Topic 2014 Diabetes Blog Week

 

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I swear as this week goes on I’m finding less and less free time to do this!  Eep!  I hope some of you readers/D-bloggers feel the same.  Anwyays, here goes.  Below is a list of how I’ve adapted things to suit my diabetes technology (mostly).

First up is for cycling.  This is the Tally Gear Dexcom G4 bike case (yes, that is me she has on her webpage).  This is a key hack for me because I can see my BG anytime I look at my bike computer.  I don’t have to fish around in my jersey.  I also hate riding with a lot of stuff on my bike (it violate the rules of style) - so I really have anywhere else to put it. :)  She made adjustments to the case to help it fit my road bars,  Right now it fits great on the flats, but my wife is going to make me longer straps so that I can mount it sideways on the stem itself.  I rarely used the flats in Texas; however, in the hilly terrain of Newfoundland I’ve found myself wanting those flats for some of the climbs.  Still, it’s a great case, and has fended off lots of drizzle and fog.

Tallygear Dexcom Bike Case

Tallygear Dexcom Bike Case

Next up is for rock climbing, but also works for running and other sports.  The SPIbelt (small personal item).  When I am lead climbing I was finding the tubing forever getting in the way of various pieces of protection.  Nothing like trying to untangle tubing from a cam whilst pumping out on lead. :)  I usually wear the spibelt under my shirt (tucked into the harness), so this is one instance I’ll use my Ping meter.  It’s also great for ice climbing when you need to keep stuff toasty warm.  I’ve used the SPI for running and holding my food.

SPIbelt with pump

SPIbelt with pump

Next up is my meter case.  Here’s where I seem to differ from most of the D-community I’ve met.  I don’t have a “D-bag” (though I’ve been called one).  I hate bulky diabetes stuff.  The ping meter drove me mental with how huge it was – so I switched to the Verio IQ, and I swear the damn meter bag for that was even BIGGER than the ping bag.  Something had to give.  For now I’m using a Moleskine Shell XS, and it fits much smaller.  Still, I’m looking to go ultralight, so if anyone has any other ideas, let me know!

Moleskine open

Moleskine open

Moleskine closed

Moleskine closed

Finally, the last two are sleep related.  I hate getting tangled up in tubing.  But it always happens – at least until now!  I backed a kickstarter project for Underfuse - little iPhone size iron on pouches.  To them, I added velcro to keep the pocked closed, and then ironed them on to some cheap boxer shorts.  Presto, whamo, no more pump falling out of pocket, tying me in knots, then waking me up with a jolt when I pull to hard on the tubing in my sleep.  It aint pretty, but it works!

Underfused underwear

Underfused underwear

Finally, my wife made me this D-pouch for the side of our bed.  In it, I store my sugar pills, my CGMS, and whatever else I need close to me.  It’s great because I don’t have a bedside table, and it keeps thing nice and clean.  Plus, if the CGMS vibrates it makes a hell of a racket against the bed frame.  The inspiration for this – sofa remote control holders!

Meg's bedside pouch

Meg’s bedside pouch

 

 

Mantras and More – What Gets you Through a Tough Diabetes Day

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I was out for a lot of cycling today (4 rides!), so I had little time to prep this.  I feel terrible because I haven’t read any of yesterdays posts, so if you are reading this – I’m sorry, I’ll get around to reading the Wednesday posts soon!

So for today I have three things that get me through a tough diabetes day.

I am not alone

While it’s only been recent that I’ve gotten involved in local and online diabetes community, I have never felt alone in this disease.  Anytime I’m stressed, ticked off, angry, whatever – I know I have my wonderful wife, my type 3 to rely on.  So how do I get through a tough diabetes day – I sound off to her.  She may have a fully functioning pancreas, but she’s listened and learned so much of what I do that she can suggest and help me through, and listen when I’m in a D-rage.  Thanks Meg, you’re the best!  She get’s me through a D-day.  Having family support is so important, and I hope each and every one of my readers has someone like this they can fall back on.  If not, you have the diabetes online community – remember, you are not alone.

My wonderful Type 3 wife.  Nothing like a mid-air kiss.

My wonderful Type 3 wife. Nothing like a mid-air kiss.

And a special shout out to the other creatures who remind me I am not alone and to not take life too seriously – our fur kids.  Molly and Gus, and we’ve just recently added Winston to our pack.  They are my unsung d-support heroes.

Hiking with Molly and Gus

Hiking with Molly and Gus

Winston, our senior rescue dog, and latest diabetes cheerleader.  Welcome to the family dude.

Winston, our senior rescue dog, and latest diabetes cheerleader. Welcome to the family dude.

 

My second mantra which I’m trying really hard to practice is:

You are more than a number

Yesterday I posted about holding myself to tough standards.  Well, in prepping for this post, I realized that I need to take a step back.  I was re-reading “The Rock Warriors Way” and I stumbled onto this quote:

In both success and failure anxiety, you lose focus.  By over-valuing the outcome and under valuing the process, you focus on the destination.

Basically, I’m worrying too much about one simple test and not focusing on how positive my life has changed, and how much my quality of life has improved.  This made me go “Woah” today.  A light bulb went off.  It’s very hard for me, being an engineer, to not focus on each blood glucose number and scrutinize it and be a lunatic about it.  Now that’s not an excuse to forget the value of each test, but rather in order to be “more than a number”, I need to take a step back, digest the number as data, learn from it, but not lose sight of the bigger picture.  To get through a tough D-day I need to remember that I am more than just a number.

View from a morning run - this  is why I do it!

View from a morning run – this is why I do it!

I am in control

My final mantra may seem counter intuitive when I’m having a tough diabetes day and it feels like everything is spiralling out of control.  I remind myself that, in the grand scheme of things, I have more control now than I ever did.  I choose to wake up early to exercise.  I choose to count my carbohydrates, my protein, and bolus accordingly.  I choose to wear a CGM and be vigilant with the results.  I choose my weight goals.  The fact that I am having a tough D-day is because everything isn’t working out according to plan.  So I remind myself that I better for it, and while I may not seem like I have control in the moment, I am doing better overall.  If I can be happy with my progress, then I am in control.

 

What gets you down? – Wednesday Topic 2014 Diabetes Blog Week

I’m going to admit, I pre-wrote this post last week.  The mood struck me.  The theme of todays post is “What gets you down”, so without further ado, here goes:

Yesterday was a tough day.  Not because my sugar was high or I had something terrible happen.  It was a bad day because I am my own worst critic.  In trying to balance weight management, insulin intake and eating habits I let myself lose it.  I set my standards fairly high, and they sometimes seem like conflicting goals, but here they are:

  1. Blood sugar must be between 3.9 – 7.9 mmol/L at all times
  2. Exercise 5-6 days a week
  3. Caloric intake ~ 2300 calories (based on a moderate caloric deficit, and average exercise burning ~600-700 calories)
  4. Reduce/maintain total daily dosage (TDD) of insulin below 35 units
  5. Space meals at least 3 hours apart to prevent carbohydrate and insulin stacking

Yes, I’m one of “those” diabetics.  I try to manage everything about this disease.  Sometimes it’s a bit taxing, but I remind myself that so many others have it so much worse, so I put my head down, keep on trucking and HTFU!  :)  This disease doesn’t stop, it doesn’t take a break, so why should I?  I’ve already started to have some complications (non-proliferative retinopathy), so I choose to be vigilant because I want to do all I can to stave off further complications.

Yesterday my mood wasn’t 100%.  I was already a bit “not there” diabetes wise, but more on that later.  In the mid-afternoon I was hungry.  Fresh bread, white chocolate bark and other treats were left in the break room.  I indulged, not even that much, but maybe 45g of carbs worth.  I bolused, but when after the fact I checked my TDD calculations.  We preplan our meal days, so we basically know what we’re eating.  I saw how my TDD was going to be >35 (goal failed).  Furthermore, I ate an unplanned snack (goal failed) less than 3 hours from lunch. It was going to put me over my caloric intake (fail).  I let this get to me.  I got snippy with others, including my wife – the best type 3 I know!  So what gets me down?  When I feel like I’ve failed myself.  I don’t make excuses.  This was my own fault.  I don’t really get diabetes burn out though, I get diabetes rage.  I was angry that I didn’t just walk past the food.  I was angry that I was countering my own goals.  So yeah, I kinda got down.

So what did I do about it.  Well first of all, I apologized to everyone I was snippy with.  They don’t need to put up with that!  Then I worked with my wife to rejig our meal plan for supper.  Items were substituted, spinach instead of freekah for a base, recipes adjusted, and at least I could get my TDD closer to where I wanted, my caloric intake more in line, and I didn’t feel like a failure.  This is how I get out of the funk – I realize that while this disease isn’t a choice, how I manage it is.  Yes, I may have “failed” my goals, but the power is in how I adapt my plans to get as close to my goals and move on.  I feel a lot of empowerment when I stop making excuses and start taking action.  I am accountable to myself.  And, relying on the support of others, like my wife, helps me manage.

My type 3 wife - we can't do this alone.  This disease is so much easier with the help of others.

My type 3 wife – we can’t do this alone. This disease is so much easier with the help of others.

So earlier I mentioned about my mind not being totally there?  During my lunch I was reading  the book “The Diabetes Manifesto” by Lynn Crowe and Julie Stachowiak.  This is considered by some to be crucial reading. The medical content in the book does seem to be quite great.  I’m still working through it.  I really enjoy reading other diabetes books to gain a perspective on how other diabetics think, feel, and live.  However, in Lynn Crowe’s book, right in the very first chapter she made a very polarizing statement:

“Some people make diabetes the headliner.  I have met many of these people over the years through my work and in other situations.  You may know some of them – all they seem to be able to talk about is diabetes – a delicious gourmet dinner set in front of them becomes a plate of carb counts, a vacation to an exotic locale is described as a detailed account of the challenges of managing blood glucose in a foreign setting, with no mention of culture or scenery.  It’s “all diabetes, all the time” with these people.  To be honest, I find this extremely boring.  To be really honest, I avoid these people like the plague.”

And there you have it.  Talk about a gut punch.  So the other thing that gets me down about diabetes?  The stupid, unnecessary politics and pissing contests that erupt when diabetics compare each other, label each other, or choose to treat each other differently.  The politics, the in-fighting, the “types”, the classification, the judgement.  We all have a chronic disease, we’re all different, can we at least work together instead of picking fights with each other?  We’re not doing any favours to the cause when we stereotype and typecast each other.

Yes, I live and breathe diabetes, but what Lynn Crowe fails to acknowledge in people like me is that we do actually live.  I will eat and enjoy a gourmet meal, but I have diabetes so yes, I do try to count the carbs and the protein, adjust for timings, etc so that I don’t spend the whole night riding a hypo/hyper roller coaster only to feel like crap the next day and make my everyone around me suffer in the process.  Yes, I love vacations and I do take everything diabetes into account because I don’t want the shit to hit the fan and leave my wife calling 911 because her husband is seizuring in a strange locale.  Because of this vigilance during vacations I’ve been to the top of the Grand Teton to the bottom of the Grand Canyon and I loved every minute of it.  These were lifelong dreams realized.  They were a euphoric experience.  They were only possible because I was so vigilant about my care and treatment.  They were possible because I made diabetes the “main event”.  By doing this I gain some modicum of control and take power away from the disease.  Maybe the author could benefit from not avoiding us and instead understand that we are actually not just living, but thriving in spite of this disease, that we have different goals and embrace us as a part of her community rather than ostracize us as if we have the plague (and interesting choice of words given that we are afflicted with a chronic disease).  I am utterly sick of the infighting that diabetics have.  It’s not doing us any good, so let’s get over it and move on.  By setting rules on behaviour and adding politics, we just give the disease power.  So yeah, yesterday I was frustrated and I let this get to me in a bad way.

On top of the Grand Teton (17,770'); a lifelong dream realized (with no hypoglycemia and no hyper glycemia to boot!)

On top of the Grand Teton (17,770′); a lifelong dream realized (with no hypoglycemia and no hyper glycemia to boot!)

But the goal of this post is to talk about what gets us down, and then what helps us through it.  Problem and solution.  That’s a good way to structure it – why complain if you don’t have a plan to deal with it.  Perfect!  So what helps me out of the funk.  I could get mad about all this infighting, but what’s the point.  It just makes me mad, and like I said above, that doesn’t put me in a good place.  Instead I think back to the Tour de Cure training rides I took part in while preparing for the DFW 2013 Tour de Cure.  We had Type 1′s, Type 2′s, and lots of non-diabetics show out.  People of all sorts of experience with cycling and their diabetes.  People who were “always on” were sharing tips with people who were “never on” and everything in between.  We shared with each other and we learned from each other.  Things like that help me move past the negativity - working together instead of pushing off fellow diabetics because they are too lax or too uptight in their treatment.  Also, this blog has been a great thing for helping me out of the “lows”. I choose to share my experiences about being an active diabetic – what I’ve learned, how I got to this place (seriously, I was a poster child of inactivity), and maybe hopefully I can help others out or at least open up a dialog.  Writing about how I am empowered in the management of this disease helps me feel even better about it, so I keep writing.

My first Tour de Cure training ride, filled with Type 1's, Type 2's and non-diabetics.  A true community experience that I won't forget.  And yes, I was riding a hybrid at the time. :)

My first Tour de Cure training ride, filled with Type 1′s, Type 2′s and non-diabetics. A true community experience that I won’t forget. And yes, I was riding a hybrid at the time. :)

This is a bit more touchy-feely than I planned to write, but I do think it’s a good topic and thought I should stray from my normal posts plotting data and what not.  So fellow diabetics, what gets you down?  How do you move past it?  What are your management goals?

Poetry Tuesday, Engineer doing poetry… help us all – Tuesday Topic 2014 Diabetes Blog Week

Today’s Diabetes Blog Week topic is diabetes poetry.  This is probably the hardest topic for me to write about because I am not a creative person.  But I did think up a few based on some thoughts or photos I have.  And you know what, I had fun in the process.  So here goes! It’s either free form or haiku’s.  I don’t have enough skill to rhyme! :)

Photobombed

Every picture I take

It keeps cropping up

Pump bump, CGMS lump

It’s just sugar pills, I’m not that happy to see you

No point trying to crop these out

I’m proud of my photobombing, life sustaining friends

Inspiration for Photobombed, my CGMS hanging out ;)

Inspiration for Photobombed, my CGMS hanging out ;)

 

Diabetes Haiku #1

We are pin cushions

Rotate, avoid scar tissue

Dwindling real estate

 

Diabetes Haiku #2

The quantified self

Endless batteries of test

Guide for a long life

 

Silence

Alarm! Buzz! Awake again at night

Test, Bolus, treat the high, pop another sugar pill, treat the low

Insulin, CGM, Glucometer

Our minds, always filled with these thoughts, no room for more

Never quiet, always there

We all need some release

A freedom, a silence, some peace

5 AM, morning frost, out the door

Feet pounding, heart racing

Pushing harder, breathing faster

The fog clears, the mind sharpens, focuses

The world shrinks, becomes the moment

Consumed in my breath, connect with my body

Finally, that solitude, that release, I only exist in this moment

And there it is

Silence, my moment of freedom, fleeting, but attainable

It ends too soon, Alarm! Buzz!

Inspiration for Silence

Inspiration for Silence

 

Change the World – What am I passionate about – Monday Topic 2014 Diabetes Blog Week

Welcome to my attempt at Diabetes Blog Week 2014.  I signed up for Diabetes Blog Week to become a part of the larger diabetes online community and provide some inspiration for some interesting topics.  So that being said, let’s get started!  We kick the week off with the topic post – “Change the World”.  Or, in other words, what causes am I passionate about, what gets me fired up?  Well, judging from the title of this blog, I think one of the main causes that gets me fired up is physical activity.  But it’s more than that.  Physical activity is just one of the many ways that diabetics can wrest back control from this disease.  What I truly am passionate about is becoming an empowered diabetic and helping other people develop the energy and the ability to take control of this disease.

I refuse to subscribe to a victim mentality.  But I wasn’t always this way.  In fact, I was the poster child of someone with a victim mentality.  I ate poorly, I rarely exercised, I had poor control and I actually used my diabetes as an excuse at times.  One of my favourite climbing books is  “The Rock Warriors Way” by Arngo Ilgner.  It’s a wonderful book on realizing your mental boundaries and pushing past them.  It’s a wonderful treatise for the mental aspects of rock climbing, but many of the lessons in it can be applied to everyday life and the challenges we face.  The chapter on “Accepting Responsibility”  really spoke to me.  Here’s one gold nugget, “In Accepting Responsibility, you will use your attention – your power – to cut through delusions and misconceptions in the situation facing you, replacing them with useful facts and an empowered approach.”  So much of this chapter speaks to me as someone living with a chronic disease and not just a rock climber trying to figure out how to deal with issues of imminent mortality on the sharp end of the rope.  This quote, to me, says it all, “The most passive of all delusions is victim thinking.  We pretend that so much misfortune has befallen us that we can no longer be held responsible for taking charge of our lives and improving our situations.”  When I read that chapter, I was gob smacked.  It hit home.  It wasn’t an overnight shift (more like several years), but I began to work on taking responsibility for my actions, empowering myself as a diabetic, and to stop making excuses and start taking action.  All of a “sudden” I felt like I had wrested control of this disease and my future back into my own hands.  How did this happen?

I started become truly aware of my poor control.  I had all the tools in the world to manage this disease.  So why couldn’t I?  I was FILLED with excuses – “I don’t have time” – but I still watched TV and played video games.  “It’s hard” – but I never tried more than once.  So I started incorporating more things into my lifesetyle – I was already climbing at the time, but we started pushing our limits more, and took up outdoor climbing.  We got hiking more, and even though I feared the low’s at time, I stopped using those as an excuse to eat more, and started adjusting my insulin management to better plan.  I started taking ownership and adapting.  I empowered myself, rather than making excuses.  I started noticing I was enjoying physical activity more and more, and adapting my diet to help with optimal performance.  It’s easier to climb when you have less weight to pull up. :)  I started finding that anytime I sat down to watch TV I felt guilty.  I felt like “I should be moving”.  Video games began to feel like the biggest waste of time I ever took part in (Note: I still play an IPad game every now and again ;) ).  That’s around the time I started adding new activities – running, cycling, swimming, you name it.  But as any diabetic will tell you, a new sport is just another opportunity to ride a roller coast of high’s and lows.  And it was frustrating.

Learning how to empower myself, I had numerous lows and ate way too much on this hike, but I learned!

Learning how to empower myself, I had numerous lows and ate way too much on this hike, but I learned!

And this is the point of this post – what am I passionate about – well, around this time I found the community of diabetics.  I discovered the power of “the village”.  I learned how fellow diabetics can empower each other to help ease the fear and confusion around exercise.  You see, as I got into cycling I met a great group of folks.  These were the Dallas-Fort Worth Red Riders.  A “Red Rider” is a diabetic cyclist in the many American Diabetes Association Tour de Cure events.  It’s a wonderful gesture to recognize every one of us – it’s emotional seeing so many people in red, out there, doing their part to fight the disease for themselves and others.  The DFW Red Rider’s would organize training rides to help out other diabetics.  For me, it was the very first time I interacted with another group of diabetics and it was a truly gratifying experience.  People would talk about blood sugars.  Stops would be made to test.  Dosing strategies were shared just as frequently as sugar pills and stinger waffles. This was a pivotal moment for me – I was so inspired by it that I changed from being a recreational cyclist on a hybrid to a full fledged roadie. :)

Red Riders lining up at the TdC in DFW

Red Riders lining up at the TdC in DFW

I hope to some day have a guest post from my true inspiration and mentor, Lew Alexander, who drove me to my first training ride, but suffice to say that active diabetics helping out each other is what I am passionate about.  Lew showed me how to take that passion and channel it into advocacy.  I learned so much from all my newfound diabetic friends – it helped me not just participate, but excel.

One of the best moments of 2013 - finishing the San Antonio Tour de Cure alongside my mentor and role model, Lew Alexander

One of the best moments of 2013 – finishing the San Antonio Tour de Cure alongside my mentor and role model, Lew Alexander

My wife and I became involved with the ADA – she volunteered and organized the food for the 2013 TdC, feeding over 1200 riders and families, while I rode in two (supposed to be 3, Houston rescheduled for weather) TdC’s to get the message out, all the while raising over 6500$ for the cause.  We believed in the TdC because of the message – physical activity is a corner stone for a life well lived.  And me?  I lost weight, I got way better control, I became active in the local diabetic community, and I just felt like I had a better life.

The end result of being an empowered diabetic

The end result of being an empowered diabetic

At the end of 2013 we moved back to Canada.  We are happily located in St. John’s, Newfoundland.  We’ve traded tornados for fog, sweltering 100F weather for rain and drizzle.  We love it here.  However, the support groups that I had become a part of in DFW had not quite evolved yet. However, I’ve luckily met some wonderful diabetics (Penney, Allison, Ashley, Morgan, Megan) who I who have come out on weekly training runs to help inspire an active lifestyle.  This branched off from work Penney was doing to make a Type 1 Diabetic Adults Networking/Support group.  These efforts have been phenomenal, and I’m so glad to have met these wonderful individuals.  I am very passionate about these efforts, and I will continue to pursue them and hopefully make a dent in Newfoundland’s diabetes stats – which are unfortunately not good (highest per capita diabetes rate in the country).  Still, the efforts of these people give me hope that we can start something big!

Active Newfoundland Diabetics!

Active Newfoundland Diabetics!

So what am I passionate about?  Taking ownership of this disease, wresting control back, and realizing we have the power to conquer it all.  We can’t all run across Canada like my newfound idol and fellow Canadian T1 diabetic, Sebastian Sassesville, but we can choose to get off the coach and walk around the block, jog a 5k, or hell, train up to run across the country.  You can wake up each day and say “I’m going to succeed” or “I’m going to fail”, and either way you’d be right.  You are what you want to be.  What I am passionate about is helping people get to that mental state where they know they can make a positive impact on this disease and start the thrive in their own individual ways.

Race Prep – Still Learning

I’m new to the whole racing scene.  Today I ran my second race, the Harbour Front 10k.  I learned a lot about diabetes management on race day, and I have a lot more learning to do!  What I thought I knew, I had no clue! :) So let’s get down to it.  I ran my first race, a 5k, back on April 13.  I had decent management of my diabetes then, but I really couldn’t learn much because I was sick as a dog and was mostly in sick day management mood with temporary basals, and what not.

So, what did I learn for the 10k prep?  I was actually a bit nervous about the 10k – it’s long enough that I have to start managing my pace a bit more, and it’s long enough that a hypo can hit me.  I’ve run lots of 10k’s on my own time, but I just didn’t know what I’d do in a race.  That’s why we run them!  So I set some goals.  I knew from the 5k race that I was going to beat my training run PB’s – which was ~41:30.  So I set a goal of 40 minutes.  I pre-ran most of the course (well, the hilly section) and knew that this was possible.  But for some reason pace kept nagging at me.  I pushed it to the back of my mind, or so I thought.

Next up was pre-race feeding.  I tend to have a diet that is 40% carbohydrates, and a 10k doesn’t really demand serious carb-o-loading.  For my planned marathon I’ll be bumping my carbs up to ~60% at least 2 weeks pre-race.  That being said, I did have a someone carb intensive supper.  I had an awesome savoury oatmeal – steel cut oats, miso, soya, lightly pan fried veggies, spinach, avocado and a poached egg.  It was delicious with a side of “ginger ale” (1 tbsp fresh lemon juice, ~1 tbsp fresh grated ginger, top with soda water).

Mmmm Miso Oatmeal

Mmmm Miso Oatmeal

My blood sugar was doing great post meal, or so I thought.  My wife then setup a restorative yoga session – aimed at stretching out my hamstrings, opening up my chest, and relaxing me.  It was perfect.  I was so sleepy and ready to hit the hay early to get up at 5 AM.  Then I tested my sugar.  WOWSERS.  Turns out that as I was starting to think more and more about the race I started getting stressed.

Race Glucose

Race Glucose

I had always read that pre-race stress can cause blood sugar to spike, and to plan a temporary basal accordingly.  Well, boy did that ever creep up on me.  I had 4 overnight boluses to try and correct my peak down.  My sugar has not been that high in months!  I was livid – because my sugar went so high and that I was waking up every hour to test and adjust.  I am highly insulin resistant at night, so I was taking large boluses, and then I was terrified of going low.  Anyways, around 2:30 things started looking better and I got to sleep until around 5 AM.  For me, I need to have my sugars in range when I’m exerting myself.  I just perform that much better when my glucose levels are balanced.  My brain is getting the right amount of insulin, my nerves aren’t being stressed, and my muscles are getting glucose from the blood stream.  It’s a win-win.

When I woke up I was happy with my blood sugar, and went about my plans to have my race day breakfast; steel cut oats with chia seed, 1/2 a banana, and an egg cracked into it egg drop soup style.  My mantra is “Eat real food, run fast”.  Of course I had my coffee, and missing from the shot is my morning cappuccino.  This is pretty much my breakfast every morning (except no banana, that’s an event day treat).  I bolused accordingly, and as you saw from the plot above I did fine (well, I drifted close to my low limit once).  I also turned my pump up 40% on the basal program because I knew I was getting a bit nervous.  As I was lining up at the start line my glucose was ~6 mmol/L.  I knew I was going to run the race hard, so I ate a sourdough, PB&J sandwich I took with me for just such an occasion.

Pre-race oatmeal at 5:30 AM, give it time to prime the glycogen pumps

Pre-race oatmeal at 5:30 AM, give it time to prime the glycogen pumps

Now, I’d love to share with you race blood sugar levels overlayed with my HRM data; however, my Dexcom did not report a single sugar during the race.  Maybe it’s because of how tight my muscles may have been (I wear it in my arm), maybe it was a combo of clothing and friction – it’s been known to cause issues.  Maybe having the transmitter in my tights in a plastic bag (it was raining) was blocking the signal.  I don’t know, and it’s going to be another blog topic at a later time, but I am sad to report – no data. :(  My average HR for the run was 172, so I was pretty high in the threshold/anaerobic zones and was burning glycogen fast.  Still, post race it popped back on at 7.8 mmol/L and started to creep up.  That means I probably didn’t need the whole sandwich or I should’ve bolused, but lesson learned for next time.  Also, there was probably some anaerobic spiking going on there, but without the data in the middle it’s hard to say.  I wasn’t too far out of my desired zone during the race, and my time showed it.  I finished the 10k well under my goal at 38:02, coming in 11th overall and 5th in my age group.  It was a great day! :)  Post race I did have one other small peak from eating a bit of recovery food, but it quickly came down as my metabolism was all fired up

So fast I'm a blur! :)

So fast I’m a blur! :)

So, it’s still a work in progress, but here’s what I learned:

  1. Pre-race; plan to start an increased temporary basal early – as early as supper time the night before;
  2. Run some more runs at race pace without fueling to see how I respond (do I get an aerobic peak);
  3. Test ALL clothing combinations for Dexcom compatibility; I think this may have been the plastic bag as that was the only new variable in the equation;
  4. You can’t always rely on your CGMS. Have a plan for longer runs;
  5. Run more races prior to the August marathon by the sea;
  6. Continue to eat real food for races.  It works. :)

13849112974_b64422ab60_o

In closing, just a heads up that I am taking part in the Diabetes Blog Week starting tomorrow.  It’s a post a day on various topics.  It should be fun!

 

 

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