Grinding Away

I received the below email from Dr. B today after he reviewed my stats from my first 5 days back on a Dexcom. 

"Sensor tracings look GOOD! Strong work! I noticed a bit of a peak in am (likely post breakfast) so watch that area as you may need more insulin with that meal, otherwise if you keep this up your HbA1c will be much better by next check!"

Even though I've only recently gotten back on the blood sugar war path, the daily grind has been tough.  Waking up at 6:30 to make sure I get in a 4 mile run before work, eating the same breakfast each day, counting ever carb and fighting to find the right thing when eating out has been exhausting.  Last night I had a really long conversation with Katie letting her know what I'm going through.  It has been a long time since I've focused this strongly on getting my blood sugars under control so alot of the mental fatigue that goes along with that had been forgotten.

Currently we're living in a craptastic studio in Park Slope.  When I received my job offer from EDH I knew I wouldn't be able to stomach the 2+ hour commute each way from my parents to my office.  So I hopped on Craig's List to find an inexpensive stay for the month of May.  When I first went to see the apartment I think my blood sugar was slightly low because I thought the apartment was small but totally liveable.  When I returned with keys in hand, I nearly had a nervous break down as the girl I'm subletting from neglected to remove any of her stuff from the closet, didn't leave me a drawer to put anything and essentially has each and every crevice of this 10 x 10 studio packed to the gills.  To top things off we're both terrified to cook in the apartment and are forced to sleep seperately as there is only a full size lofted mattress and a futon in the apartment (two on the mattress is too close for comfort.)

So with the size of the apartment I'm unable to bring my bikes (besides Mr. Foldie) and am forced to eat out each night.  We fear Mothra will crawl out from the wall or one of the 1,000 empty shoe boxes to eat both us and our food if we attempt to cook.   Combine that with the news about my A1c and I'm living in a high stress diabetic zone.  That has led to a pretty melancholy Ed.  

Katie, as any reasonable person would think, assumed that I was either unhappy with my job, the move to NY or our relationship.  None of those could be further from the truth, I am incredibly happy to be back home, have found what I honestly think is my dream job and am thrilled to be starting a life here with her.  So for the first time she is really learning what it means to date a diabetic with all the ups and downs this disease can throw us.

What I explained to Katie last night is that the apartment has essentially taken away the tools I know how to use to manage my disease.  What has always worked best for me is cooking my meals, and riding my bike - neither of which is an option right now.  So that means each weekend we go away, or each day I'm forced to examine a new restaurant menu adds to the fear that my A1c will continue to rise.  Maybe it's an addiction, maybe it's a phobia but I'm terrified of letting this disease impact my life so each little thing that contributes to taking away my tools has really frustrated me.  

But, the daily grind is getting easier and starting next month we move to a different place where I can both cook and store my bike; then the daily grind will become routine and my #s will continue to stabilize.   For now I can just focus on turning my numbers around in a pretty difficult blood sugar management environment and know I'm doing the best I can.  And right now the best I can seems to be working.

No one said this would be easy...

Tired legs, a sore back and pesky lows; how I forgot about all those things in my training hiatus.  I had remained in reasonably good shape; my lab results indicate I ate healthy enough and while my weight went up a bit it's not as if I jumped 5 points on the BMI scale.  But man at times I feel like a washed up old journey man fighter in my path back to fitness and blood sugar glory (if an A1c under 6.5 counts as blood sugar glory).

Last week I had an outstanding week of training.  I got in 3 runs, 3 lifts, 2 bike rides to work and a solid training ride on Sunday.  The sublet I currently have is too small for the lady friend, el toro and me so the bull has to sit this one out up in Mahopac.  That means my rides during the week are limited to Mr. Foldie and me scrambling across the Brooklyn Bridge.  Nonetheless all the rides into work, morning runs and training sessions add up to have a profound impact on my basal rate.

For the past 48 hours I've been fighting off low after low.  30 miles into my ride yesterday I had to call it a day as my blood sugar kept dropping below 70.  That pattern continued throughout the night as I hit 50 three times from 6pm to 10:30 pm even though I treated with a cranberry juice and had a delicious sushi and rice dinner. 

Right now my basal rate is about 16 units per day, I suspect that it will drop by at least .75 units over the next 24 hours and continue to fall to about 13 units a day over the next 45 days.  Once my basal rate stabilizes I know my recovery time will decrease and my ability to push through endurance fatigue will increase.  Until then though this is going to be a long, slow, up hill climb.

Routine really matters

It's been about two weeks now since my life returned to the normal pace, flow and stresses that I had become accustomed to.  During my unemployment my biggest frustration was that I had no control over what great opportunity would let me take the next step in my career.  That forced me to search the internet and network for hours on end trying everything I could to take the next great leap.  The same intensity I put towards that effort also got me totally out of my eating and exercise routine.  Combining those factors is what I believe lead to my worst A1c yet.

However, I've seen a HUGE change in my blood sugar stability, energy levels and overall health since I've returned to work, settled into a sublet and gotten back to my hour + of exercise a day.  Yesterday for example my blood sugar was never higher than 165 and I only hit one low (68) after my bike ride home post lifting.  Numbers like 91, 98, 107 and 117 are visiting my meter much more frequently than numbers like 57, 237, 312 and 192.  Variability is bad for business as a diabetic so the more consistent I stick to my routine the better off I am. 

Thus far since I've refocused my blood sugar management efforts I've really only had one bad day of finger pricks.  On a business trip to Pittsburgh earlier this week my blood sugar went haywire.  I ran about 4 miles in the morning starting with a blood sugar of 210 but I finished with a blood sugar of 208; after taking in a decent amount of insulin my blood sugar had climbed to 268 and was still in the mid 200s at lunch time.  I struggled for most of the day getting my bs in check and may have over corrected as I dropped to 50 right before my plane ride home.  A frustrating day, but I'll take it, if I can hit my #s 9 out of 10 days I'm in a much better place than I was.

Also, I apparently decided to make my return to d-blogging on world diabetes week; pretty happy to be back.

It's different the second time around

Last evening I was writing an email to my local Animas rep to get hooked up with pump supplies when it struck me how much I've learned over the past few years.  The first time I chose a pump I scoured the internet, blogs and articles for hours on end to learn anything I could about the differences between pumps.  I picked other t1d's brains about the type of infusion set they were using, the ease of using the pump and even talked a couple companies into letting me try out a pump with saline.  My way of coping with my diagnosis was to bury myself as deeply as I could into understanding how to manage the disease.

Fast forward six years and in my email to my Animas rep I knew exactly what to say and exactly what I needed.  In a brief 2 sentence and 2 bullet point email I emailed my rep with the infusion set and reservoir that I needed.  No fan fare, no worries, just a calm knowledge that I have this thing (at least the ordering of supplies under control).  Now had you asked me a month ago when I was still without health insurance I would have been more frantic, but the details have become common place, it's the management that remains hard.

Back to Basics

It's time to come clean, I was burnt out. 

For the first four years after my diagnosis I did everything right, I obseviely calculated the carbohydrates in a meal, tracked every second of exercise and was so regimented about logging I had automated excel models that would predict my future blood sugar.  Due to all that I was obsessive, I wanted my blood sugar to be perfect every single time I tested and when it wasn't I would either work out like a fiend or spend an hour working out a new predictive formula.  That in the end had me burn out from the daily tracking and hard core exercising that had made me so successful in the management of my disease; that is also what lead me to stop blogging except for the occasional outburst here and there.  I simply couldn't focus on the disease with the same intensity I had in the past and needed a break.

Fast forward to the end of 2011/ start of 2012.  I had lost my job and began to seriously doubt the value of my MBA.  I was determined to pursue my mission of helping people live healthier lives and to pursue a career that personally meant something but my dream had seemed to vanish.  I was unemployed for 6 months, and was facing a huge decision about where to move to.  While in San Francisco I met the most wonderful woman I could imagine and no longer was thinking just for myself so couldn't just jump at the next risky and interesting opportunity, I had to analyze the consequences and make a real adult decision.  That landed me back in NY, back where I belong (as I've come to truly believe over the past month).

Given all the stress and the travel that Katie and I did my blood sugars were thrown into dissary.  If my parents offered help for a high or a low I couldn't handle it, I simply didn't want people to be concerned about my disease because it was one more responsibility I couldn't focus on.  Thankfully I stock piled insulin and pump supplies but not a day went by where I didn't feel like I had to ration my insulin intake or test strip usage.  Add to that the constant job search had me cutting back on workouts for fear I would miss a phone call that would get me off a pay check from Uncle Sam.  I was still exercising and doing the occasional bike race but overall I wasn't the same active, happy guy that people have come to know.

When we hit mid-March I began to really worry.  I had some kindles in the fire but I really didn't know when the job thing would flush out.  I had to contact an old endo to write me a script for Novolog which my parent's so generously paid for.  I was finding cheap test strips online so that my Dad could still be compliant with his type 2 diabetes.  My sleep cycle was off and I was fearful that I would never recover from the mountain of student debt I accrued during my time at Darden.  I was perhaps, for the first time, lost.

I did the best I could to muster enough energy for one last big push to find a job I still believed in.  I had been networking with a few companies but the process was slow and agonizing.  But I pushed hard knowing that I wanted to be back in NY and knowing that I still wanted to be in healthcare.  Finally in late April I was offered what I truly consider to be my dream job or launching pad to something great, and I finally got to return to the city I love.

Being back in NY has me re-energized, it has me in a place where I am comfortable and happy and in a place where I am so excited to start the next chapter in my life.  That wonderful woman is still with me, and things are about as serious as they get and I know I couldn't have gotten through those dark months without her, and that family of mine has always supported me with everything they have and of course this time was no different.  They were there for me like they never have been before (maybe because they never really had to be there for me like this before). 

On Tuesday I got in to see my old endo, Dr. Baker.  I have an amazing relationship with Dr. B and believe he is one of the greatest doctors out there.  The numbers in his office didn't lie, it showed how much focus I had lost over the past 6 months.  My weight was 200 lbs, the first time I have reached that number in 5 years (normally I'm around 190), my A1c was 7, the highest it has been since I gained control of blood sugars after diagnosis.  That visit served as a wake up call and this city is serving as a platform for me to Ring The Bolus again.

I spoke with Dr. Baker and have 3 simple goals for my August re-visit.  I will be 190 lbs or lighter, I will have an A1c below 6.5 and I will reduce my daily basal rate by at least 10%.  I am signing up for 3 triathlons this summer, 2 olympics and 1 half iron and I am starting to bike into work again.  I have already seen a change in my blood sugar consistency after running 3 mornings this week and I am getting back into the weight room later today.  It's time to get back to basics, gain control of my disease and return to sharing my story about how I fight to control it. 

Hello again.

The ADA just doesn't get it

Today the ADA will launch new guidelines for blood sugar management goals.  As usual the article focuses on type 2 diabetics but I'm going to assume that the new guidelines will not discriminate between the two diseases.  Historically, I firmly believe, the ADA has focused on type 2 diabetes with both their research and guideline efforts.  As a disclaimer this organization frustrates me to no end and I think the JDRF is way more valuable, ethical and with it but that's beside the point.

In this NPR article the ADA is now stating that for older/ existing cases of diabetes the target A1c can be 8 and that for newly diagnosed type 2 diabetics an A1c of 7 is ok.  As a type 1 diabetic or someone who produces no insulin, who even if they ran on a hamster wheel continuously without insulin would still have blood sugar spikes well above 300 an A1c of 8 would be an incredible failure, incredibly dangerous and overall poor for my lifestyle!

To explain, A1c is kind of the 3 month moving average of daily blood sugar values.  A person with neither type 1 nor type 2 diabetes has an A1c of around 5 which equates to an average blood sugar of 90 - 100.  An A1c of 8 equates to an average blood sugar of 183!  How that is deemed medically safe is beyond me.  If my average blood sugar is above 160 I become dehydrated, urinate more frequently, will have low level headaches and overall be flat out miserable.  I strive to achieve an A1c below 6 but at my last test my A1c was 6.3. 

I would love to know how the ADA came to this conclusion rather than suggesting more stringent guidelines to suggest better eating, exercise and lifestyle habits.  They really frustrate me to no end.

A Special Egg

My foray into endurance sports all started standing in line to register for Ironman Lake Placid.  The day prior I was working an aid station on the run course when the girl I was dating at the time gave some woman with a big smile and a running skirt a huge hug.  I had no idea who this mysterious woman was at the time but her enthusiasm was infectious so I gave her a hug just the same.

The next day that same woman happened to be standing behind us in line to register; her joy at the race was a big motivation for me to sign up for IMLP '08.  Later on that woman became my first triathlon coach and someone who provided an amazing amount of emotional support during my first year with type 1 diabetes.  Her name, Mary Eggers, or to me the Egg.

Egg has always had crazy ambitions; she never doubted that I would finish my first IM with a smile on my face (having never done an endurance event when I first signed up for IMLP), she never doubted that I could push myself beyond perceivable limits and she never doubted my ability to tackle diabetes.  She has brought that same support and enthusiasm to Teens Living with Cancer; a non-profit devoted to helping kids fighting cancer.

So it came as no surprise to me when she called out none other than Lance Armstrong to a kick off in buffalo on April 28th.  Lance will be in Buffalo for a public speaking opportunity so the Egg thought nothing of it when she challenged him on Twitter and wrote this amazing blog post challenging LA.  When Egg gets an idea in her head it's pretty tough to convince her otherwise.  So it also came as no surprise to me that Lance RESPONDED TO MARY EGGERS ON TWITTER!

Armstrong v Eggers will go down in late April in Buffalo.  This excites me for a ton of reasons, it shows the good that social media can bring, it shows how an ambitious woman's idea can bring help and joy to others and it shows that when someone is committed to doing great things for others all the tools we need are right there in front of us.  Good luck Egg, I'll be cheering you on and I don't see how its possible not to get excited about what you just accomplished.  Readers, check out the charity, check out the challenge and if you knew this woman as well as I do you'd expect nothing else from her.