Wednesday, October 28, 2009

Diabetes Game: Game Changes...

Howdy from Atlanta,

Yes, I said it, from Atlanta. These past few months have been nothing short of crazy, but awesome at the same time. I am in the middle of an 11 day stretch at home. Out of curiosity I took a look at the calendar, and prior to this stretch, I have only had 11 days at home since Aug 11, however I have got to take 32 different flights to who knows where. Lots of exciting trips, big planning, and hopes to make the team bigger, better, and stronger, and change the world at the same time.

So I last said my program for heading over seas. To do this I would take my basal insulin in 2 doses, and then do an increase of rapid. Out of laziness, it has taken some time to get back to my normal 1x day basal. For some reason or another my morning dose got to be bigger than my night dose. This was good for a while, but then sometime last week, I started going into the 160-180's at 4am. I had taken a break from Navigator, just to go to make sure I still had the talent via BS testing. Brutal reality is that I don't. I had more highs, and more lows than I have had in the last 4 months. It is just challenging to have full control when only seeing snap shots of where you are. The thing I like most about the CGM is that it is a movie, and it tells you a bit about the future, so that you can make these adjustments before there are issues. So I get back from Montreal and immediately put Navi back on. I see that it is 4am where the trend goes up. I try increase in basal, and no avail. My doc Bruce Bode told me I was having some growth hormone spikes in the night. No simple suggestions other than to get up and do a shot at that time. So on Sunday, I was slated to do the 100 mile Spin for Kids Ride. I backed my basal off by 3 units in the am to prep my body for the beating it was not prepared for. To make up for it that night, I did an increase of 3 units, and what do you know, perfect BG all night. Two possibilities here.
1. Bike riding is very good for blood sugar, and the increase in metabolism helped this happen.
2. Basal increase at night was the factor.

So to further this study, I took a few days off the bike, and kept the insulin constant to see. Granted, the metabolism stays hot for a few days after riding, but taking the time off should do the trick. So the next night, perfect BS again, and then the same again last night. So I am now working towards getting back to once a day. I will stay 2 days on this current dose, and then do a decrease in the am, and increase in pm. I should be back to once per day by Sunday, and I am hoping to get 2 good rides in this weekend.

I know I mentioned Montreal earlier, but I did not speak of the sense of accomplishment I got for getting there. In my world of not knowing where I am, I tend to forget some small things from time to time. This time, not so small. I get to the airport with 1hr 15 minutes to spare, which is plenty of time, only to realize I left my suits at home. I call Delta to learn that the next flight is in the am, which would mean missing some very important meetings with great people. So I begin the race home, grab my suit bag, and with 43 minutes before my flight (33 minutes before they close the door,) left buckhead to head to the airport (Mapquest says 25 minutes.) I somehow get parked, and get to the check in with 23 minutes pre-flight, get my ticket with 21 minutes to go, and take off in a sprint. I get to the long line at security, and pulled a Tommy-Boy yelling EXCUSE ME... The wonderful people in that line let me cut, I got through, and then a full sprint to A30. As I get to Gate A24, I cracked. I was winded, dead, and back was killing me from running with 3 bags. I dug real deep, and resumed the sprint seeing the door at A30 closing... So I scream from 100 yards away "Montreal, Montreal, Montreal!!!" only to see a hand come through and the door open, and I got on my flight. My buddy Christian of Dex4, put all bets against me, knowing I would never make it, so it was high fives all around. My door, to my seat on the plane in 33 minutes, which I believe is a world record that will never be seen in Guiness... I felt about as good as one could feel in that moment, and it really did set the tone for the entire week.

So back to that diabetes game. I think the lesson to be learned here, is that we are always going to change, and we always have to adapt. You have to try new things to get the control you want. It is important to look for the trends, and then find a way to get ahead of that trend. My problem was 4am, and it was either going to be play with my basal, or to get up at 3am and bolus. I am kind of partial to my sleep, so decided to play with the basal.

All in all, great to be home for a few days, and glad to be back on the bike. I really can't put into words the good feeling you get from spending a few hours out there with your buddies, and going into that hurt box. It may sound sadistic, but the pain on the bike turns into stories later, and a overall great feeling. So I am back on the bike, loving it, and will continue to ride for fun.

Have a great night, and thanks for reading!!

Phil
@philsoutherland

Monday, October 5, 2009

Diabetes Game and overseas...

Howdy from Munich,

Past week has been pretty rocking. First was EASD in Vienna which gave some great promise to our Euro/World Wide expansion, but also to know that there is still much work to be done so that the diabetes world over here learns about Team Type 1. Had great meetings, hung out with my buddy Kyle Rose, Jay D. (who taught me of a few "Dunniganisms") and many others. It was a grand time for sure.

I read the comment by "jpnairn"
re: goal of sub 5 A1c for type 1 diabetic.
Reminds me of anorexia.
Sub 6, I'd give you an Attaboy. Sub-5, I can't encourage. Sure you can do it. You could probably go sub 4 if you really tried.
The goal should not be to get it as low as it can go. The goal should be to get it to a healthy level.

If I had a 4.8 with a lot of dangerous lows, then I would agree. But, I use "The Best" treatment and technology out there. I do not suggest anyone set their goal at sub 5, and if they did aim for that, to use the exact same stuff (FreeStyle Navigator, basal and fast acting insulin, Dex4) that I do. I am OCD, and I channel that OCD behavior towards my blood sugar. 69 is too low, 119 is too high. I check, and I correct. Some days things are smooth, and that means I do 5 shots. Some days (yesterday) things are tricky and I do 13 shots.
My 28 day average is 102, with 38 mg/dl standard deviation, 88% in target, 4% above target, and 8% below target.
I am trying to lower the standard deviation, and the time below target. My last Glycomark test, which measure the variability in your blood sugar was 11.1, and above 10 is considered excellent.

The motto of Team Type 1 is "A1C: Strive for 6.5" I stand by that. If you can get to 6.5 successfully and safely, then aim for 6.3, then 6.1. The fact of the matter is, that people without diabetes have A1C's between 4.0-6.0. If you can get to that range, then odds are you will have 0 complications just like they do.

Lastly, I am on my 9,900th day as a person with diabetes. I want to be the best I can be, and stay motivated. For me, motivation comes with goal setting, and working towards them. If I set an easy goal, then it is not really worth the effort to achieve it. Goals are meant to be challenging, meant to push, and it was no easy task to lower my A1C like that. It took work, and I am damn proud of the result for my efforts.

So about this travel thing: Flying for a 6 hour time difference can mess things up. Being on an Omni-Pod is easy, as the basal stays the same, or can be micro adjusted. Using basal insulin can be a bit more tricky. So after screwing up a few times, I decided to split dose my basal insulin. This started a week before the trip to get each dose to about even. And then on the night time dose on the plane, I did 1 extra unit to make up for the lack of activity. Then the morning dose was also 1 extra unit, which was too much of an increase, so I was correcting via food a lot...

A couple of runs the first 2 days, and jet lag was gone. Funny enough, my body is so not used to running so both times required a big bolus after even though I ate nothing during the run. I reckon as I get back in shape (long way to go) that this will stop eventually stop. So now the fun begins of trying new stuff, screwing up, adapting, and getting on track. Gotta do something to keep this diabetes game fresh and fun! In the end, I know that running will help all work well again, so really can't wait.

So whatever your A1C is, that is great cause that is where you are. But where you choose to be 1 month from now, a day from now, a year from now is all up to you. If your goal is to get from 10 to 8, that is great. From 8 to 7, congrats. I would say to set a goal that will push you to make the adjustments necessary to get there. Good luck!!

And Have a great day!!!

Phil

Saturday, September 26, 2009

Long awaited update on the diabetes game

Howdy from the air! (btwn Las Vegas and Atl)

So it has been about 2 years since I last wrote, and for that I apologize. Lots has been going on for TT1 and myself. From Winning the KOM jersey in Ireland, to Tour of Missouri, and wins at the Tour of Utah. All this coupled in with great meetings with our sponsors about the future. Then there was losing my insulin, trying to keep control with NO exercise, and the 22 different places I have stayed in September….

Losing the insulin was a bit of a problem. It had been about 34 hours straight of travel, and somehow or another, my fast acting insulin disappeared, and I had no back up (idiot!) but it happens. So we are in the team car (for 5hrs,) and I had just committed to not eating, but the metabolism shut down caused me to go from 71 to 220, event though I was injecting insulin like crazy. At the end of the race, the Race Doctor walked me to the pharmacy, I picked up a 5pack of insulin pens, and 20 minutes later the FreeStyle Navigator said I was back in business.

I did get to take a day to myself in Dublin. Went to see my favorite spot: The Guinness St. James Brewery. Who knew that Arthur Guinness signed a 9000 year lease on the property. Needless to say, The Stout is hear to stay. It was cool, as when I told the bartender I was hear for the Tour of Ireland, and we won the KOM, my 1 free pint turned into 3 free ones. This was about the 4th week now that I was walking around with every step being agony. I had seen a good handful of docs, all of who didn’t really think I could have broken my Fibula. But getting back from Ireland, and in one place for 3 days, I was able to get the confirmation… So then a space boot to keep it stabilized and help with repair. It was around this time, that I re-committed to “tight control.”

When I was running 5-6 days a week, control was a breeze. The only pain was when sometimes I was too sensitive to my insulin, and had to eat a lot more. No exercise, big adjustments. I had to change my diet, eat less carbs, and just be really watchful of what I put into my body. My 28 day avg on Navigator had gotten up to 118, which is not within “my goal.” Now if that is your goal, and you get there, that is awesome! My goals would often be viewed as too aggressive, but I have the best tools in the business, so can work towards them, and do it safely. At the beginning of the summer, when my buddies Kevin and KR beat me in the A1C competition, I got pissed. (please note: neither Kevin or KR have diabetes) Still, I beat them last year, and wanted it again. Mine was 5.9 in June, and getting beat spurred me to set a new goal, and a new focus. I had never had an A1C less than 5, so committed to doing it! Running made it easy to get on track, but the fracture set me back. Then it became a lifestyle adjustment to do it. 2 months later, at the ADA I had an A1C of 5.0. I was PUMPED, but still not to goal. This is right when the fracture happened, so I just went into super diet mode. Focused, and ate wisely, and then 2 weeks ago at the Diabetes Research Institute, I got 17 vials of blood drawn for a study about diabetes and exercise long term. 5 days later the results are back: A1C: 4.8! How bout dem apples. If I had set my goal at 6.5, and got there, it would have been the same level of satisfaction. So what are your goals? What can you do differently to achieve them?

I would say first and foremost is exercise. It is SOOOO much easier when doing some sort of activity. I think the last month proves that it can be done no matter the lifestyle. Right now my A1C is better than I would have ever thought 2 years ago. I kid you not, I didn’t think sub 5 was possible, until I did this June. Then it was working to make the impossible possible. I do use a FreeStyle Navigator, and I probably press the button to check my BS 100 times per day. I am always looking for the trend, and trying to be ahead of the trend with my fast acting insulin and my Dex4. A blood sugar of 120 is no longer satisfactory, and I am ALWAYS thinking about where my blood sugar is going. This may or may not be healthy. I would say odds are, that it is not. Too much stress, to much pressure to be on all the time.

Now it is time to focus on the rest of health. I fly to Vienna on Monday for EASD, where I get to meet with Global Leaders in Diabetes. I have plans to change the world, and I need the help of some people there to achieve it.

Life goal: Everyone in the world has insulin and test strips

Sporting Goals: 2011 Giro d’Itallia, and 2012 Tour de France

Diabetes Goals: Lower standard deviation

After Vienna, I get a 2 week vacation traveling around Europe by myself and reading a lot of books. I plan to eat well, sleep well, and come back strong. Lots going on with our current partners, future partners, and operations for the Team. Between TT1, TT2, we now have 80 people in the organization, and it will be run out of Atlanta.

I believe I have gone on too long now, but like to leave with this: Whatever diabetes goal you want to set, do it with the help of your doctor, and your friend. I would highly recommend some goal around the A1C: It is the goal, that gives you a reason to check, to correct, to skip desert, or to make time for exercise. Set that goal, and take the steps to get there. Have fun in the process tooJ


Thanks so much for reading, and for all of your support for Team Type 1 and Team Type 2!!!


Have a great day.


Phil

P.S. Team Clothing still available on www.teamtype1.org

Thanks for the support!!!

Friday, September 18, 2009

Interview in Milwaukee

Milwaukee WMYX-FM host Tony Loreno talks to me about the teams. I am attending a TCOYD (that is Take Control of Your Diabetes) Conference in Milwaukee. Everyone is great. We have the same goal.

Sunday, August 9, 2009

Diabetes Game: Victory Running Game: Ouch

Howdy from Hotlanta (yes it is living up to its name)

A1C: 5.0! That is my personal best, and I am thrilled to death with it. How was it done? Slight adjustments, pushing the envelope, exercise, insulin, FreeStyle Navigator, Dex4 Glucose. I have had close to two years now of using the Navigator, and have learned how to use it to get better. I am not content with a blood sugar of 130 if it is there for more than 20 minutes. If I see 130, and then 131, then 132 I know I am trending up, and will give a slight correction with fast acting insulin. I would rather hover at 70, than at 130. Then again, if I saw 77, then 76, then 72 all in a 10 minute span I would pop some Dex4 tabs to try and bring it up. I use the tools that I have, and I may just be a little OCD about it. I am curious to know how many times a day I actually press the button that shows my blood sugar.
My guess would be about 125. Some days maybe more, some maybe less, but to get a blood sugar, and a trend 100+ times a day gives me a big edge in always being 1 step ahead of the curve. If I have insulin going in before I have a chance to get high, then I don't get high blood sugars. If sugar is going in before I have a chance to get low, then no hypos. I will say that the running has helped, eating well has helped. My schedule is never the same 2 days in a row. It is on a plane, in a car, on the phone, on the computer, so seeing the trend is invaluable to me.
Right now my 28 day average is 100, with 91% in target, 4 above, and 5 below. So I can still get better. I have had some hard times before. I spent Christmas when I was 9 years old in the hospital because of the flu, which turned into ketones. In 8th grade I went in a movie theatre with my mom to see Twister, and woke up in the hospital, but it is those life lessons that drive me to have the best control I can possibly have. When it comes down to it, this is The ONE thing in life I own 100%, the ONE thing I know I can control. My reward is getting to talk about, getting to try and help people.

So this past week I got a few special experiences. First was Camp Kudzu, which rocked. It is great to have a few days where I can talk to kids, talk to people with diabetes, dance, play, and get dirty. I had one young lady come up to me and make my week. She was 18 years old, and about to be a freshman in college, and is now a CIT at camp. She said, I just want you to know you inspired me to take control. She heard my talk 3 years ago at camp, and after that began to check 5-6 more times per day, exercise a bit more, and that her last 3 A1C's have all been 5.9. Awesome, eh? So I got to have a lot of these conversations, and then cap it off with a talk to the teenagers Tuesday night. Then it was the most painful part of the week in leaving camp. It really killed me that I had to leave. Next up was AADE, which I also love. I got to see 10 others on Team Type 1, and Team Type 2 (Nathan, Joe, Kyle, Laura, Saul, John, Jeff, Adam, Tom,) and connect with friends who are Educators, doctors, industry, and a lot of others with diabetes (TJ!!) It is really cool to see so many people who have a passion for making a difference. It was awesome to reconnect with so many who say they use us as an example to all their patients.

Now how about the running: Injured. This has been frustrating, as I was just starting to really feel good out there. Running finally felt natural, and I was getting stronger, getting faster, and enjoying it. I strained something, which I hope to get fixed tomorrow, but it has now been 7 days with no running. By the end of the week it got frustrating, so I decided yesterday to ride. I got 2 days of riding in, and have never felt so awkward on a bike... Recap on this, which I just have to laugh about: Ride lots, get injured, start to run, which is very awkward. Then get injured on run, get out and ride, which now feels very awkward. I feel like a ping pong... I hope to be back on my feet speeding away here soon.

I am still on track for NY Marathon Nov 1. I will do a half marathon in Munich to warm up for it on Oct 11. I have never been to Germany. This is part work, part vacation, and I can't wait. Last year was solo for most of it. This time I hope to hook up with friends while over there. I guess I have rambled on long enough, and would not like to ask a favor if you made it this far.

If you have gotten any help from this blog, any take aways that have helped you manage your diabetes better, or live a better life, then I ask to please pay it forward. Use your skills, and your knowledge to help somebody else do it better. It may be as simple as forwarding this on, as bold as talking to a local support group. Let's be the domino's that change the big D!

One last time, and then I will quit bragging: My A1C was 5.0. What is yours, and where do you want it to be? The past is the past, but the future you control.

Off to Santa Barbara Tuesday for some athlete days, and R+R.

Thanks for reading, and for all your support.
Have a great day.

Phil

Team Clothing is going fast: Get it while it's hot at TeamType1.org
follow me on twitter: @philsoutherland
Ciao!

Tuesday, July 28, 2009

The Diabetes Game: Time Zones...

Howdy from Tally,

Back to the original home for a few days. A lot has gone on since I last wrote, and I last wrote so long ago, cause lots has been going on.
I have been in a few different spots: Boise, Atlanta, Seattle, Atlanta, Tallahassee, and maybe some others too. Boise was AWESOME! Had a great time with Tim Schaub of Sanofi-Aventis, and then it was crit time. It was good to see the guys, the crew, and the fans.
I was talking to Joe right before the race about the Blood sugar. 200 30 minutes prior, and 200 10 minutes, so a level trend. He was good to go, and the race proved it. All the guys (Ken, Aldo, Creed, Holt, and Joe) were super aggressive. It seemed like every lap we had a guy in a move, until the critical point. 8 laps to go, 2 guys had 20 seconds. 5 to go, they had 17, 4 to go 22, then TT1 went to the front. Creed got the gap down to 17 seconds in 1 lap, then Joe came through like a freight train for a 1 lap effort that got it down to 10 seconds. Dan brought it down to 5, and then the guys got jumped. Ken and Aldo just so happened to be fresh, and ready so jumped on, and proceeded to blow it out taking 1-2 by about 20 bike lengths. It was great to watch, and I was soooo pumped for everyone, Joe in particular. In all his years on the bike, this was by far the BEST I have ever witnessed him ride. It just goes to show that with hard work, sacrifice, and time, anything is possible. Sure to see him on the top step of the podium very soon.

So yeah, this running thing... Here is what I have learned as of late:
If I give any rapid acting insulin within 2.5 hours of a run, I will drop rapidly.
If no rapid acting insulin within 2.5-3.5 hours I stay steady.

Is this important info: For me, yes. I know if I do give insulin to close, then I need to prepare for the run by bringing extra food, and also taking blood sugar higher before the start. The extra food is only in case of the crash. If I timed the insulin right, it is all about the slow rise within 30 minutes before the start. Getting it up to 150-175, and then taking Dex4 tabs as needed. I have been getting longer runs in, and faster ones in. It is starting to get to the point where I can push myself, suffer, and for some reason or another I like that. Pain is good, pain is addicting. Last week on my tempo run I left at 165 trending up, finished at 208 with 6 Dex4 tabs in there. It was a 6 mile run, with 4 tempo miles, and I did one of em at a 5:40ish pace...
At this point my metabolism was FLYING. Not sure what the deal is, but I was doing less than 25 units and eating a good bit. 2 units covered 90 grams of carbs one morning.
This took some adjusting to, but I have it down now, kind of...

So about 1 month ago I made some crazy diabetes goals. I was looking at my 1,3,7,14,21, and 28 day averages on my Navigator and saw in the 110-125 range, and decided: I can be better, or at least have better numbers. I made it a goal to get all of my averages into the 90's, and do so without HYPO, which is no small feat. So it has taken work, in constantly looking at the number, and the trend. Always trying to be 1 step ahead of my blood sugar. Learning what food, and what the activity will do. Progress came. Bit by bit I have been able to get better. I have gotten to where my 21 day average is at 99, with 3% below 60, 95% between 60-170, and 2% above 170. I would like to compare with a non-diabetic and see where we stand. I think with these #'s I should be able to have an A1C less than 5.0. I have another 10 days until the A1C test, and I hope to have achieved the number with the 28 day avg by then.

I thought these were crazy at first, but now it is doable. My question to you: What is your diabetes goal? If it is an average of 155, that is great, if 130, that is great. Having a goal in mind in regard to the every day #'s gives purpose to diabetes. It makes you learn, adjust, and adapt.

Home for 1 more day. About to go run with my buddy Andy Roberts, and then a few days in Atlanta before 3 days at Camp Kudzu, and then AADE, then Cali, DC, Ireland, and who knows where...

Thanks for reading, and I hope that I can get back more soon. Lots of exciting things going for Team Type 1 and Team Type 2 for the future. Thanks for being a part of it!!

Phil

P.S. TJ: No, not cozy in the 60's. Anytime I get into the 60's I try to eat just a little so that I can bring it back to the 80's and 90's. Sometimes gotta push the envelope though...
Later!