The Scary Moments of being a Diabetic

Insulin is a funny thing in that a Diabetic needs it to stay alive and avoid major organ and circulatory issues over time, but also can cause more apparent and immediate problems when injected. Often I hear stories of people who don't wake up on their own and must be rushed to a hospital. Or the guy my dad worked with who was a Type 1 diabetic and addicted to Hershey's kisses. He would eat the candies all day, and dose heavy insulin all day. Thus causing extreme fluctuations in his blood sugars. He drove a motorcycle and would get to feeling funny, pull over and pass out. When he awoke he would mow down another bag of chocolates. On occasion he would wake up in an ambulance. This cycle continued and over time my dad recognized the decline in his coworkers overall health. Hopefully he changed his habits or I would expect he is not likely to be with us any longer.

I have either been a lucky Diabetic, or have kept the disease under good control for the 7 years that I've been using insulin. I have felt blood sugar lows. In fact when I was in the lobby of Diabetes Training Camp, I was embarrassed by the fact that I dropped to the 40's and broke out in a profuse sweat. A couple of weeks ago I noted that my BG was 240. So with that in mind I took 4u of Humalog - and ate a light snack figuring all would be well. I took an afternoon nap and when I woke up I seemed to be in some kind of haze, and could not understand anything. It was as if My thoughts were all truncated and I could only understand the surface of any subject. After laying on the couch bewildered for some unknown amount of time I finally gathered enough thought in my brain to test. 32! I have NEVER been that low. I was babbling incoherently and stood there for about 5 minutes until I heard myself say the word "Sugar." I opened the refrigerator door and spent several more minutes looking at food and not knowing what to do with it. Suddenly the extreme hunger that can hit you when you are low set in and I grabbed a cup of yogurt, pulled off the cap frantically and swallowed the whole thing in one gulp. Next I ate all the cheese I could find. Neither of these had much sugar in them, and suddenly I thought of those glucose tablets I bought several years ago and had only eaten 3 of. The problem was that my brain could not complete the thought and tell me where to find them even though they were in the cabinet directly in front of me. Then finally I saw a bundle of bananas on the counter. I ate 3 of them, each in one bite. The 4th one fell on the floor, and I did after it as well. Another 10 minutes or so of laying there trying to contemplate why I was there I got up, washed off the last banana and swallowed it whole as well...

I have never experienced anything like this before and to be in the situation was quite scary. My roommate was at work, my girlfriend was at her house, and my brain did not function well enough to think of calling paramedics. Luckily the flashes of brain function I did have pulled me through and I felt great the rest of the day. But I wonder, if my BG was just a tiny bit lower, what could have happened?

I know I made a lot of mistakes here. Most of it was due to lack of preparation for an episode like this. Since I have never found myself in such circumstances I was caught wholly off-guard. Just in case, I will get the Glucagon kit the doctor told me about when I was first diagnosed, but forgot to prescribe. I will keep glucose tabs handy. I will be more vigilant in making sure I am not dosing heavily on insulin without a significant food buffer in my system.

My ability to keep the blood sugars in better control since this incident is much better. Maybe I am just more aware and thinking about the consequences of my actions. Whatever it is I will have to keep this up!

Review: Michelin AirComp Latex Tubes

Ask any road cyclist what the most common problem they encounter is and they will invariably answer "Flatting!" without any hesitation. I have blown countless tubes over the last couple of years of riding. Everything from a simple snakebite caused by my hastily mounting the tube and tire ever so slightly off to a caribiner that ripped through my tire tube, and damaged my rim have left me stranded on the side of the road. Michelin AirComp Latex tubes to the rescue!

The Good
For those looking for the slightest advantage when racing this tube is one of the best options out there according to literature found across the net. From what I have read, the following is true:

These tubes are lightweight. At 65g you are saving up to 30g compared to standard road tubes. Continetal makes a butyl "Race Supersonic Tube" at 50g, but they are so thin that the likelihood of flatting is very high.

The rolling resistance of latex is lower than that of butyl. Less rolling resistance means you will not be working as hard to keep your speed.

Higher elasticity than butyl tubes. More elasticity means they are more compliant to foreign objects and will not flat as easy as a standard tube.

The Bad
The valves are not particularly impressive. They only come in 2 sizes that I have seen. 38 and 60mm. Neither are long enough to fit on a pair of Zipp 404's without the use of valve extenders. And the 38 is so short that many standard floor pumps can't even clamp onto it on a standard WH-R500 Shimano rim. Also they are not threaded. So you can not clamp down the tube onto the rim like I am accusotmed to. Although I do not know if there is any benefit to having a threaded valve stem at all.

The latex is porous. If you like to jump on your bike, without a care in the world, this tube may not work for you. If you are like me however, and check your air pressure before every ride, this is fine. Because the latex is porous, they deflate rather quickly in comparison to butyl. The pressure will last as long as you can ride in a day, but after 2 days I generaly have to put about 10-15 lbs. of pressure back into them.

The Verdict
I love these tubes. I may be dooming myself to a terrible onslought of flats by stating this, but I have not had a single flat on my latex tubes while riding. The only flat I have suffered from them is when I mounted the tube wrong and inflated the crap out of it wondering why the air pressure was staying low. Once my tire came completely off the rim the tube exploded. I have been riding with them as my main tubes for about 6 months now - and that is quite a feat!

In contrast, my new Kestrel came with butyl tubes, and one flatted the first day! Needless to say I have since outfitted the bike with latex tubes and have been quite happy.


I gave the latex tubes only 4 of 5 syringes because I have to pump them up pretty much every single time I ride them. On race morning I am forced to pump the tires up. An added step I'd prefer to do at home. Otherwise I won't even ride butyl tubes unless I have to (or just too lazy to swap them out)!

Getting a coach

After months of considering all of my options, I came to the conclusion that I need a coach. I felt I have reached a sort of fitness plateau with my current unstructured workout routine of simply going out for a long bike ride, a long run, or swimming 30 laps in the pool. Don't get me wrong, this does work to keep me fit, but I want to actually improve, and become a more competitive athlete.

On the recommendation of several others in the Triabetes program I signed up at Endurance Corner. This main coach is Gordon Byrn - or for those in the know "Gordo" and staffed by several experienced coaches. He may be best known for co-authoring "Going Long" with possibly the most well known author in the sport of triathlon, Joe Friel.

So far I have learned that even my current base training has been too fast! I have been doing my slow run with a heart rate in the mid 150's and now I dropping it down to the crawling rate of 140. I've seen his results, and those of the other athletes he has coached so I have faith that if I follow his philosophy I will improve.

So far so good...

Triabetes Podcast!

For those of you out there that may not be aware, Triabetes Team Captains Casey Boren and David Bourdon host a Podcast all about diabetes, life and training. Hear their experiences and and opinions about all sorts of subjects, as well as interviews.

Episode one they interviewed Denise Ricci - an incredible woman that has competed in several Ironmans. She gives the good, bad and ugly about her experiences and what she has learned along the way.

Episode two they interview Peter Nerothan, Triabetes Manager extraordinaire. He explains what Triabetes is all about, and tells what he is up to himself (including his training for a 100 mile run!).

Be sure to check them out at Triabetes Radio

Trials of the PHARMACY!

Anyone with an ongoing condition, whether it be Male Pattern Alopecia or Type 1 Diabetes, will be able to sympathize with these words.

WHY IS IT SUCH A PAIN IN THE ARSE TO FILL A PRESCRIPTION?

Wal-Mart's Pharmacy is one of the very worst I have ever dealt with, but nearly every Pharmacy seems to want to keep your medications from you. Read some examples of my experiences:

We will stop hardcore drug users!

Years ago I stopped into Osco Drug because I was out of lancets for my testing device. I figured I could pick up a box over the counter, but for some reason the Pharmacist had them in with all the meds. So I asked him for a bix to which he replied "I need your prescription."

"Prescription? These are just LANCETS!" I replied.

"You must have a prescrition, otherwise drug addicts could come in here and use them." He stated. I thought maybe, just maybe he had an argument if I was buying syringes to use for my Heroin habit (even then I believe they should distribute the syringes with no prescription to prevent transmission of blood borne diseases through the use of dirty needles) - but not lancets! I can't think of any possible way a drug user could make use of lancets.

Fax YOU!

Recently I had my doctor fax a prescription to the pharmacy. When I called the pharmacy they said they never got the fax. So I asked my doc to fax it again, and also fax them to me at the same time. When I called the pharmacy they claimed they never recieved the fax. So I suggested I could fax it to them, or even bring in the duplicate I had my doctor fax me. They said "No, it has to come from the doctor." How could I win? So I used the doctor's cover letter, faxed it as if I were the doctor putting nothing that showed it was actually coming from me and they finally accepted it.


How many trips does it take to get one script filled anyhow?

Wal-Mart Pharmacy is the worst I have ever dealt with. I have literally gone to the pharmacy 6 times to fill one script there in the past. Every time I would call ahead and they would tell me my script was filled. Every time I came in it was filled with the wrong amount of insulin, the wrong type of syringes, charged me the wrong amount, or in the first two attempts was never filled at all saying they needed some more verification from my doctor or insurance company.

I don't believe I have ever filled a prescriptiion with them in one visit. It always takes at least 2. And they default to generic syringes even when the prescription is very specific in my preference of 31 gage BD syringes.

How about you?

I'd be curious to hear your stories of Pharmacy idiocy. I am sure my stories pale in comparison to some of your's out there. Mail your story to me, and I'll post them up in another follow-up blog sometime. My email is kemp772@cox.net - I know, posting that I am ready for the onslaught of spam that will inevitably follow.

Testing and Training

During my training over the course of the last few months I have noticed a couple of things that make testing while training or racing a tad bit easier and more accurate. You may wish to incorporate some of these into your own personal training routine as you see fit.

1) Test with one hand, grab drinks and food with the other.
When you go on long rides and runs you need to bring food and drinks to keep you alive. Gatorade, gel packs, and protein bars sure can get messy! All of this mess can cause sugar to get into your blood sample, resulting in inaccurate test results. I use the fingers on my right hand for testing, so I make a point to grab all fuels with my left.

2) Clean the test site with water.

Sometimes Gatorade just blasts all over the place if you hit a pothole on your bike. Other times you may inadvertently use both hands for ripping tops off of gel packs, or opening food containers. If you think you may have something on your testing hand, use regular water and rinse it off. I always have a bottle of plain water for just such an occasion.

3) Set the tester to it's brightest setting.

If your tester has an LCD display set the contrast as high as you can, if it has LED display like my Accu-Chek Compact Plus, turn up the brightness as high as possible. This really only applies in sunny areas like AZ, but what you should do is go outside while wearing your training sunglasses and set the display to be as visible as possible. It can be quite difficult to read those displays in your typical weather conditions.

4) Squeeze copious amounts of blood from your finger.

When running this isn't as necessary, but while biking it is very difficult to place that tiny blood droplet on your test strip. I typically have my entire fingertip covered in blood to ensure enough of a sample will make it to the test strip and just rub it all over the test strip. Of course this can be messy, but it keeps you from having to jump off the bike and test on the side of the road while all of those people you just passed up whip by you again.

5) Practice!

The first time you try testing while in the middle of a run or bike you are bound to end up with an ERR-5, drop a test strip on the ground, or some other unforeseen problem. The more you test while training, the easier it will become.

Deuceman and renewed inspiration

Yesterday teammate David Bourdon and I competed in the Deuceman Half Iron distance Triathlon in Show Low, Az. David had prearranged a campsite near the race so accommodations would be inexpensive, the location was only 3.5 hours from home, and the elevation (6,347 ft.) made the climate very favorable for a great race day.

Preparation
Having not focused my training around this race I did not have the highest of expectations. Typically a racer will set up a workout regimen for the months leading up to a race and call it an "A" race. My "A" race will be Ironman Arizona so my training has been sort of non-existent with the expectation that I will work out a program after the Deuceman to put me in the best shape I can be for that. With that said, I fully expected to be a train wreck by race end, as I have been in both of my previous half Iron distance races. Other than this, my prep for the trip was quite well, with one minor caveat. I had packed my tent, and some how neglected to bring my tent poles. So when I went to lay out my fancy 5-person Coleman tent I realized I only had the outer shell, with nothing to hold it up! Luckily David was doubly prepared and had brought an extra tent "just in case."

The night before the race the Accu-Chek Compact Plus monitor I had prepped to use for the race decided to abruptly stop functioning! Odd, as I have 4 of them, and two have suddenly died in the last week. Due to this I had to go to a 24-hour Walmart and pick up a replacement. Luckily the regular charge without insurance is only $18 so it didn't break the bank. I thought I was screwed imagingin doing a race without knowing my blood sugars for the entire day. Now my race was saved!

We all awoke early race morning after freezing our asses off in the 40 degree temperatures overnight and headed out to the race site. For some reason, probably due to limited sleep freezing throughout the night, I was not in the correct mindset. I saw my awakening BG was rather high, at 323. I ate breakfast of a bagel and a cup of yogurt and took 7u of Humalog thinking a smaller dose would be good. Wrong! I had wasted so much time wandering around that suddenly I was in a rush to get to the race site and prep! On the way, I stopped in to a convenience store to put on my contact lenses, possibly leaving my glasses in their bathroom. I got to the race site, set up my bike, and started putting on my wetsuit. When the legs were already on I remembered I needed sunscreen.

"Dummy, you need to put on sunscreen before you put on your suit!" I thought. Oh well, my legs don't burn too bad so I just applied the spray on SPF 30 to my shoulders, middle of my back, and neck. After pulling my wetsuit all the way on and walking over to the start area I realized I had neglected to use any body glide. DUMB MISTAKE if you value your...erm...valuables. Just before leaving I noticed another dumb mistake. On my final BG check before the start I was now at 408! I decided not to eat the banana I had on hand to get me through the swim and put a little Potassium into my system. I promptly jumped into the water and the race began!

The Dreaded Swim
I loved the swim start. It was easily the most brutal crowd of triathletes I have shared the water with to date. Early on I got a fist to the chin, and was overall pounded by guys in just about every part of my body with open hands and legs. As stated before I am a slow swimmer, so once the crowd left me in their water dust I came out smiling. The fact I came out unscathed gave me more confidence. At around the halfway point the second wave started to overtake me. I thought this to be odd, as normally they overtake me much earlier. As I got out of the water I noticed that the zipper on my wetsuit was all the way down already. This must be what kept my neck from chafing as it normally does when wearing the suit.

Official 1.2 mile swim time: 45:23. My fastest half-iron swim yet, and 12 minutes faster than my last miserable Olympic distance swim 2 weeks ago and only 15 minutes behind the first guy in my age group. I was very happy with that result.

The bike has wings!
Once I jumped on the bike I waited about 10 minutes and checked my BG. 274 - it had gone down, but I knew I would need to eat to be able to keep my body going for the rest of the day. I opted to just drink water for a bit and test again. A half hour later it was still 264 so I decided to try injecting 2u of Humalog from a new pen injector I had procured 2 days before. I slowed down, stopped pedaling, and shoved the tip in my thigh. Perfect! Except I had now bent the needle tip and could not reuse the needle. Mental note: I need to practice removal of the pen needle so as not to destroy it. Also, take heed that the manufacturer advises to use each needle only once, but in race conditions changing a needle tip would be a pain in the rear. I then started eating my gel packs. I had brought 4 for the ride, and felt as though 5 would have been better to keep me from getting too hungry. Also, I was drinking Gatorade Endurance, with its high levels of Sodium and Potassium I hoped it would help me from cramping up later on in the race. The next test was 193 - I was happy to see it decrease and continued eating and drinking as I had planned. Just before I jumped off the bike I tested one last time. 117. WOW! I was perfect to start running. While still in transition, Peter Nerothan asked me "How's your blood sugars?" To which I replied "GREAT!" and "Oh yeah, I better grab the monitor off my bike!"

Official 56 mile bike time: 2:51:54

Running it in
With great BG numbers showing I ate what my body told me I needed, which was a pretty good amount of food. A mix of Sport beans, Gu gel packs provided by the race, and Luna Moons. Although Luna Moons are created for women, I like them and just hope they don't cause me any hormonal changes...lol. At the 7 mile marker I tested again. There was an aid station worker that asked "Water of Gatorade?" to which I replied "I'll let this meter decide." She went on to say she knew exactly how it goes, as her husband is Diabetic. The result was 157 so I took both water and Gatorade. I started to lose my pace and it took everything I had to keep running up the hills but I did. I am not sure if it was simply the fatigue of racing all day or my final BG result of 259 at the race end that slowed me down but probably a combination of the two. The last quarter mile I decided to up the pace, even though there was no one in front of me, and right then my calved both started cramping up. In agony I kept the faster pace and ran through the finish line.

Official 13.1 mile run time: 2:06:22. Not the fastest I have done, but this was a rather hilly run course and was pretty much what I wanted.

Official finish time of 5:49:15

Race analysis
This is the closest to a balanced race I have been in thus far. There were 19 age groupers in the 30-34 year old range. I placed 14th on the swim, 9th on the bike, and 9th on the run to end with a 9th place finish. Looking at all of my competitors times I was the first of the group that would not be considered blazing fast. So if you look at it through my rose colored glasses I was first place amongst all of the people that I had any chance against. 8th place was 35 minutes ahead of me with a 5:15 finish - a time that realistically I can not do without another year of hardcore training under my belt. The top 8 were lightning fast, and before the race I had looked up my competition on Athlinks and knew that that they were competing at a whole other level as they were multiple ironman finishers with posted half distance times that were under 5 hours.

This was the first race I had ever used insulin. Also, it is the first race I had taken regular BG tests. The result was that I finished without the wheels falling off the wagon. A first for an endurance event of this length for me. It renewed my confidence that I will learn enough over the next 6 months to successfully complete Ironman Arizona and look good doing it! Using the insulin pen made insulin delivery much easier than a typical syringe would have been. With practice I should be able to deliver my insulin without destroying the needle, but in longer races I should consider loading 2 pens up just in case. I purchased a Duo Pen Wallet from Cooler Concepts and shoved it into my saddle rails with the opening facing the rear. This made it easy to pull the pen out, but putting it back after use was a little difficult. I will work on this setup to make it easier, but I think this will work perfectly once I iron out the bugs. I will of course include photos of the final position for you blog readers out there. Knowing my BG and taking action during the race, instead of after, opens my eyes and helps drastically to improve my performance.

The race kits provided to the Triabetes team by Kestrel and Giro are awesome! Out of the water I was 14th place. I passed 4 of my competitors on the bike leg of this race and kept a 19.5mph pace. Given the course, altitude, and my previous races my time would have averaged under under 18.5. Those bikes, wheels, helmets, and sunglasses realy do make you a touch faster - and even more they make you feel like a predator out there taking out competitors 1 by 1. The last guy I passed by was on the run. He looked horribly uncomfortable, but the Sugoi tri-suit (that you too can get your hands on at the Triabetes Store) I was wearing not only looked great, but kept me comfortable the entire race. I really do recommend the Sugoi gear.

The Gatorade Endurance that I had procured at REI is thus far the best electrolyte replacement drink I have used during a long ride. The flavor (Lemon Lime) was good and did not seem overpoweringly sweet. My legs didn't cramp up in the run portion of the race which is often attributed to low Potassium and Sodium levels so for now I will use that product. The formula of this product was similar to other endurance powders like CytoMax and Heed - but the quantity in the package per cost of the container leaned heavily in the favor of the Gatorade.

Things I learned
1) Take time in preparation or YOU WILL PAY! Using no bodyglide left me with a crotch burn that looks pretty heinous. Losing my glasses will cost me a couple hundred dollars. Forgetting sunscreen on parts of my body leave me more susceptible to skin cancer in the future and Diabetes is enough to deal with!

2) I am sold on the Insulin pen. The ease of delivery while biking made my $40 (after insurance) well worthwhile. It seems to be good to just have handy too, so I don't have to keep syringes in my pockets. Combined with the Frio bag for cooling, this is a great way to travel.

3) The importance of remaining in the aero position on the bike. Everyone I passed on the bike seemed to be in and out of their aero position a lot. I made a point to remain tucked away as much as possible. In fact, look for a future blog about the aero position and the advise given to me directly from the mouth of Steve Hed - of Hed Wheels fame.

4) And most importantly, that proper insulin therapy while racing is very important. Even if your numbers don't remain exactly at 107 the entire race, doing what you can to correct them makes a huge amount of difference in the ability to compete at a higher level.

So what's next?
I see the Mountain Man Half distance Triathlon is coming up in July. David is competing there, and registration is $180. Time to reassess the finances!

Thanks go out
First off I must thank TriSports Racing, for putting on such a fantastic event. Their events tend to be some of the best organized and fun events I have competed in. Plus they are a Triabetes sponsor, and without them I wouldn't be writing this today! Also the support of Peter Nerothan, Erica, and Lara. Without all of them the race would have been much more arduous, and not as much fun for David and I!