Monday, December 29, 2008

Diabetes Game- Mild Confusion

Howdy From Hotlanta,

The end of the year is near, which will bring to close a great one on so many levels. For the time being things are slow, which is nice, but also boredom can set in. I am looking forward to that, as have had none of it in a long, long time.

So last week. Got to spend time with my brother Jack driving down to see mom for Xmas. It was really, really nice to have the family back together!!!

As for riding, 3hrs Tuesday, felt really tired. 3hrs Wednesday, felt good for 1hr, then really tired for 2.5 hours. Tired the rest of the day, tired all day xmas. It was kind of strange. So I took 2 days, where I just rode 1 hour to try and recover. Friday's 1 hour day was good. I have still been tinkering with this food and ride thing. I had gone up to 9 units of Lantus at night, which had been the highest in some time.
Saturday AM woke up for the WBL, winterbikeleague.com in Athens GA. I ate a big breakfast doing 2 units of Apidra (www.Apidra.com please check out, lots of cool new video of TT1 on the site,) which I rarely do before rides. Blood sugar started going up, and up, and up.... I usually like to sit in for the first part of these rides, and let the body warm up. But since the trend was going up on my FreeStyle Navigator kept going up, I decided to pull. I went to thr front with my buddy David Crowe, who has been punishing me for 8 solid years. Can't really believe I have been doing the WBL's for 8 years now... Lots of great memories of fun, suffering, more fun, and more suffering. So we pull for sometime which levels me off at 290. I am drinking water, and not eating. Then I slowly start coming down, and about 2 hours into the ride, I am at 240. At the store I drink a diet coke, diet red bull, and some water. Leave the store and get to the front with my boy Murph Dog (John Murphy) and he laughs at me as I pull. Pull for a while, get back in, then pull again, then sit, then pull... Oh yea, all this time on the front, so was John... He is flying right now, and prolly gonna impress some folks this year.
Pretty tired by the end of the ride, but so was everyone. Ate some good food, and saw Morgan Patton's new pad in Athens. She will like the town, as she can hang out/ride with people her age.

So the ride and food... 4 hours, pushed pretty hard, and 0 calories intake. Finished the ride at 190. So what am I thinking? I need more basal, and it would be better to eat. I do my 2nd dose of Lantus to 4 units to make it 13 total for the day, along with 6 units of Apidra to eat. Ate some food, stayed up there, and then did another 3 units in anticipation of a 2nd meal. We head to the GRit, no blous, but ate a salad, and some pita bread. Drive home, not much food, and then had 2 more salads, with Filet!!
9 units Lantus that night. Wake up high at 150 or so, bolus 2.5 units, eat oatmeal, go straight up, and then hit 180 before coming down. Ate 50gms of carbs for 3 hr ride, 6 unit bolus after, and 150gms carbs, 40 protein. Blood sugar on ride was 120-180, which was better. I decided I am going back to once a day Lantus, to test it out. To make the switch, I was doing a lot fo 1 unit boluses to reverse the upward trend. Did Yoga last night, and at 8:30 did 13 units of lantus, ate a bar, and went to bed. This am, woke up at 150, so I am going to do 14 units tonight.

Not sure what my body is burning for fuel on the rides right now, but it is not carbs. I am curious if i have gone ketonic on the rides, and thus would be burning fat. Does it take 4 weeks of exercise for the non-diabetic to do this too??? Studies to come.

Happy NEW YEAR! Time to make next year the best year ever! What are your goals? I have a few...
Ciao

Philpott
www.TeamType1.og

Wednesday, December 24, 2008

Diabetes Game: Exercise Resistance?

Howdy From Atlanta,

The game has taken a twist. If you recall, about 10 days ago I would have to eat everything in site, and then some on rides. Insulin was being cut drastically. I think that was my body being inefficient at fueling on the bike, as a major switch has happened.
I have had to increase basal a touch, and think I am going to get it up some more. The past 3 rides I have done, eating the normal goods before hand, oatmeal, my blood sugars have skyrocketed. I have been getting up to 250 on the rides, and then a slow drop down to the 180's, and if I eat, BS goes right back up. Yesterday for example, I had a total of 40 grams of carbs on a 3 hour ride.

I think my body is now becoming more efficient, and I may be able to add some additional basal, or I may need a very small bolus (.5 unit of Apidra) with meal before ride. Today I am driving home to see mom, and should be on the bike by 11am for a 4hour ride. I am going to eat my oatmeal, with .5 units, and see what the reaction is. I do enjoy not having to stuff my face on the rides, however, I would much rather be between 140-180, than 180-220.

It is great having the FreeStyle Navigator, so I can really monitor these adjustments, and know immediately if I made the right call.

Although, I initially thought this is crazy, thinking back it happens every year. Insulin drop, drop, drop, and then all the sudden, add, add, add... If I can keep the training going without interruption this will be very helpful for racing, as I won't be stressing about low's.
It is also good for training, and my pockets won't be so stuffed full of food, and bars for my rides.

This is the start of week 4 of training post hamstring break. It took 2.5 weeks for the switch to happen. Could this be the same for non-diabetic metabolism? Has anyone out there with diabetes had similar experience with fueling?

Also, working with some top docs on potential research studies, and trying to find out more info for you. More details to come!!!
Very exciting step for me here, now time to fine tune it a little more to ensure I am at the best on the bike with both legs, and blood sugars.

Have a great day.
Merry Christmas, Happy Holiday, and Happy New Year to ALL!!!

Phil

Sunday, December 21, 2008

Diabetes Game- closer to the solution

Howdy from Atlanta,

How is everyone doing? Great question from Stella's mom, about why I wasn't back on the pump. In diabetes, there are a million ways to skin the cat. I had raced for 6 years on Lantus, and made a lot of mistakes, but more importantly learned a lot of lessons. So when I was on the pump, I found I was having a lot more lows on the bike, and then off the bike too which was causing me to eat way too much food. With Lantus, by making a 1 unit adjustment of Lantus/day, I can essentially make a .05 unit/hr basal adjustment, which is a big deal. I change my basal daily, and doing this on the pump for me is too much manual labor. I have done over 50,000 injections in my life, so 5-7 more a day, to me, is no big deal.

Also, why does exercise = less insulin: When exercising, the muscles become more sensitive to insulin, both basal and bolus. The body will naturally burn more calories per day, which means less basal needed, and the muscles are much more sensitive to insulin post exercise which = less bolus/meal. Not sure if there has been a science experiment, and I could be wrong, but that is my guess, and I have not had a doctor argue yet...

So the diabetes game: Last weekend I cut it a bit, and on Sunday was good. Blood sugars were up in the 200's, and I was eating a bit, but felt good. I have decided to start doing my 2nd shot of Lantus after my rides. So it is kind of a temp basal. Lately I have been doing 6 at night, and 3 in the afternoon. Tuesday I did that, and went pretty high on the ride up to 257, before I started trending down. I only had to eat about 400 calories on a 3 hour ride, and I was flying. Wed, I had a bit more basal, 7 units night, 3 in am. I went up to 220, before dropping to 150, and was eating a bit more. 800 calories on a 4 hour ride. After that ride I kept dropping, so I that night I dropped Lantus dose again to 6 units. Had to do a small bolus of .5 unit of Apidra in the middle of the night. Thursday was a 3 hour ride, and I can't really remember what was going on...ha Lots of activity this week. I have done yoga on Tues-Thurs, and Sunday this week. Stretching every am. Friday I only road for 1.5 hrs and was real tired, then Saturday did a mountain bike ride with my buddy John Martin!!! I figured this was going to be hard, and slowly rose my BG to 200 at the start. Within 20 minutes I ate a king size snickers, and 15 minutes later some other bar. Blood sugar was 220 trending up said the Navigator! So I began to drink water, until at some point I saw 287. For the last 2 hours, I did nothing but drink water, and dropped to 215. These #'s are a bit higher than I would like. I am obviously under insulinized, so I think the switch needs to be 7 units at night, and then 3 after ride of Lantus.

But the higher blood sugars are making me feel very, very good on the bike. But I don't want to completely sacrifice a good A1C for performance. If I could raise it to 5.8-6.0, I would be happy. Higher... not so sure. But that is me.

Yesterday a good friend got some great news, and I am happy for her. I got some bad news, and it was a rough day. All will be ok in the long run... The work week was pretty stressed. But the thing is, making time every day to ride, really, really helps. No matter how much crap is piled on, I have not given an inch when it comes to my riding, and yoga. So for anyone out there if the stress seems to pile up, I would encourage you to get out and ride a bike, take a walk, or bit the gym, as it puts everything else at ease.

Thanks for reading, and sorry for the jumble of #'s.
Have a great night, and Happy Holidays!!!

Phil

Sunday, December 14, 2008

Ride ride ride... Diabetes game is back

Howdy,

How is everyone? I appreciate the comments on my last post. We shall see what gets done. In regards to where the money may come from, we now have $14b not going to automakers, so why not make some good of it?? J/k

Training seems to be back on track. I have not done anything too crazy, but spend about 30 minutes every am doing exercises, then 2-3 hours on the bike, and 1-1.5hrs of yoga 3x a week. This has all really helped, as I am feeling smooth on the bike, and using muscles I didn't know existed... I have tried to stay ahead of the curve in the insulin drop, which has been good and bad. The good being, I have 0% below target for what is now 2 weeks of training. The bad being that blood sugars will run between 130-150 at night. I have cut my morning dose of Lantus to 3 units, and my PM dose is now 8 units of Lantus. I did do a 4.5 hour 87 mile WBL yesterday. It seems if I have 12 units of basal while riding, no matter what I start at, blood sugar will trend down, and I have to eat A LOT on the bike. Yesterday for example. I had eating the legendary Waffle House breakfast of a pecan waffle, grits, and 2 eggs. Did 3 units of Apidra at 8am, for this carb stacked breakfast, and from 8:30 to 10, I had a slow rise in blood sugar to 177 by the time I got on the bike. Road for 15 minutes to the start, and hung out for a few minutes. Look at my Navigator to see 128 with an arrow straight down. Banana, Dex4, and 500 calories of bars in the first 30 minutes of the ride to stop the drop and settle around 90. This is where I stayed. I continued eating appx 80gms carbs+/hr for the ride. At the store stop, I drank a coke, had a snickers, and then another snickers 20 minutes later. Stayed between 85-100... I did most of this group ride with 100 or so people talking to my buddy Steve Sevner. Sevy was one of the best back in the day, and is coming back to do an ironman. He gave me a lot of great advice for when the going gets tough in the races, and help me stay strong between the ears. Going to put that into use today as well.

Now those blood sugars are not all bad. The ride was not that hard, so I didn't need BS to be higher, and learning to train at that level, and push at that blood sugar will be good practice for if I do go low during a race, which is bound to happen at some point in time. But it is not where I want to be. Today comes a new test. I am going to skip my Lantus dose this morning. Which means I will have 8 units of basal on board, effectively giving a temp basal. My goal is that after I eat my 80 gms of carbs for breakfast with no insulin, and head out on the bike that I will get up to 220 or so, and proceed a slow drop to the 150's, where I will snack, but more along the lines of 20-40gms of carbs/hour. This ride will be similar to yesterday, with a little more time spent at the top end.

Stay tuned for the experiment results. New lessons every day, and always trying to get better. Real goal here is to see exactly how much basal I need, so that when race season comes, it is dialed in 100%!

Thanks for reading. Have a great day.

Phil

Tuesday, December 9, 2008

My RANT: Trips to pharmacy

Howdy everyone!!!

First, thanks Angela for the bit about sleep before midnight. It had been a few years since I last heard that. Makes it all crystal clear now, and I feel good about waking up the roosters:)

Second, training is going good. The lantus drop has been good. 5 units in the am, 7 units pm, and Blood sugars have been perfect. Saw the eye, and endo docs yesterday. All results were perfect. I had a better A1C than my endo, Bruce Bode...ha Sitting at 5.5 now with only 2% below target in 28 days. Best #'s ever. Ride on Sunday was amazing. Doing exercises every morning, yoga 3x a week, and massage and the difference is noticeable. I am very excited, and very motivated!!! Bigger week this week, with a few small tests. My guess is that by Saturday, total Lantus dose will be less than 10 units/day.

Ok, so now for the rant. I have been going to the pharmacy once a month for my entire life to get supplies. Every month I get the same thing: Apidra, Lantus, Freestyle Strips, Syringes, and Pen Needles. I get the same quantity every time, yet for some reason each and every time I go in the pharmacy, I never leave in less than 30 minutes. It has always been like this. I am not going to name bash, but they all seem to be about the same. Yesterday I went in to get the same 5 items as always, that I called in and requested, and then verified via phone before going in, and then I get my order minus 2 big boxes. No Syringes. I ask the guy, and he said insurance isn't covering them.
"Excuse me" I say.
"Well, your insurance isn't going to pay." he says
"I still need the needles" Wondering here why he didn't tell me this was the reason I had no needles instead of just not giving them to me.
"You have to pay cash"
"Ok, I want to keep my eye-sight, I will take the needles..."
So I pay my $30/box for needles, but decided to prolong the trip by calling my insurance company, United Health Care, who initially denied the coverage. The ironic thing is on the on-going message while I was on hold, the first thing it said was "Properly managed diabetes can significantly reduce the risk of complications, such as blindness." I found it quite funny that they are telling me to properly manage my disease, but refuse to pay for syringes that I need to give injections to ensure I do not have complications.
The lady on customer service was very nice, and ended up taking care of it, so I waited another 20 minutes while the "script" was filled, and then got my boxes for $15 a pop. All in all, just getting the diabetes supplies was $250, and this is the same cost every month.

I hope President Obama does act on his plans to help people get the tools. I have faith that he will. What if it was an underprivileged family, who could not swing $60 for needles, or didn't have a cell phone to call the insurance company, or even worse, did not have insurance to pay for the supplies???

I know exactly what would happen:
The person would be forced to check less, due to cost, not desire. He/she would be forced to do fewer injections, use inferior insulin, and/or use dirty needles, which could cause infection. This person probably sees an endo 2x/year at best, and has an A1C over 10, purely because of $$.

Diabetes, as you know, is a disease where management is everything. We have to take care of it, and having the best treatment (insulin) and technology will enable us to avoid complications.
Not having the tools is not an option, and if any reader out there has a contact in the House, Senate, or Oval Office, I would truly appreciate an introduction to try and make change.

I propose a $26 Billion Dollar "Supply Campaign" where we provide supplies to people with diabetes around the world, provide the best cancer treatment to those in need, and help people who cannot afford to help themselves. Maybe we start here, and see the impact it has, and then move outwards.

Together we can do it.
Thanks for listening to my RANT.

Have a great day.

Phil

Sunday, December 7, 2008

Back Baby! early rising??

Howdy!

Things have been good as of late, and my respect for those who gain their fitness from riding inside has sky-rocketed. Why? So this was comeback week for me. Sunday, I got to ride inside for 1 hour, and was counting the seconds. Tuesday I had big plans to ride outside, but it was freezing, so I opted to ride inside again. Made it 1 hour, and wondered why I do this? Did some Yoga that night, which was refreshing. The mediation part at the end is really good for me, and at least I know for 4-6 minutes a few times a week, nothing matters. It rocks!!
Wed, was able to ride outside for 1.5 hours, and then Thurs had plans to ride with my buddy John Martin, when the sky bottomed out. Back to the rollers. Again the longest hour of my life.
Wed, I got some acupuncture, and massage, as well as trying gyrotonics and Pilates, which were good! All this time, insulin requirements are dropping. It really is cool to see the effect exercise has on my metabolism. Going from 15 units of Lantus early in the week, down to 12 last night.

I saw my chiro on Thursday, and he straightened me out, which anyone who has ridden with me over the past few years will attest to the miracle that it is... I have been pretty crooked for some time, and I believe it is due to the blood flow discrepancy that has now been fixed, but it has been tricky to re-train the body to think straight.

Friday and Saturday were both 3 hour rides, and I have begun to feel good on the bike again. Let's just say I am very motivated to do everything humanly possible to be the best I can be.

This time getting back into training, I have been staying one step ahead of the game with my Lantus drop. Sticking with 5 units in the am and have gone from 10 at night down to 7 last night. I have been determined not to go hypo. So it has meant some rises in the night, and small corrections in the middle of the night. I plan to do 4 hours today, and will most likely stick with 7, as I went up to 155 by 4am, did .5 unit of Apidra and had a nice slow drop to 105 where I am sitting now. Just did the Lantus, and in will snack on some fruit, until about 9am. At 9 I will eat 2 packets of Oatmeal to get the trend going up, and then hit the road at 9:30. I am hoping that I won't have to eat as much on the rides as the past few days. Yesterday I had to eat 1000 calories on a 3 hour ride. My Blood sugar was between 80-110 the entire time, but I would have preferred 110-130, or even 130-150 with less food. This is normal as the body is learning to fuel during exercise. I think by this time next week, I will be able to do the same ride with only 500 calories.

Last thing before my ramble ends... Can someone explain to me what has happened? I used to enjoy sleep, and could sleep until 8,9 in the morning no problem. This week, Mon-Fri I have woken up between 5-6 every day. Granted I am going to bed earlier than normal, but this is making me wonder....ha Not to say it has been a bad thing. I am up, and can get 50 emails out of the way, and am caught up by 8am every day. Then I spend the day staying on top of them as possible before the inevitable fall behind...

Thanks for reading, and any thoughts on these new sleep habits would be much appreciated.
Have a great day!

Phil
www.teamtype1.org

Tuesday, December 2, 2008

Riding inside=counting grains of sand on the beach

Howdy from HotLanta...

So things have been working again. Hamstring is feeling better. I have seen a lot of specialist in the past week to get this rolling. Massage, ultrasound, cold laser, stretching, acupuncture, yoga all with the hope of being able to ride again. Sunday, I was given clearance to ride on Monday. I was stoked to do it again...

Then there ended up being a high of 45, and even snow during the day. Normally this is no problem, I enjoy training in the rain and cold cause for some reason I think it makes me tuff! But coming back from Injury, I didn't want to stress a muscle with the cold, which meant riding inside on the rollers. Why do I like to ride? So I can be out there, away from everything, and always choosing a new path as I see fit, usually having no set route. Sometimes I can be gone for 5 hours, and it seems like only minutes. Then you put me inside on a bike, and it is about as boring as can be. I put music on, as well as the tv, and for some reason every second takes a minute. Going nowhere slowly...

But, it has to be done. As much as I think riding in the nasty weather makes you tough, I think the rollers are about =. It is truly taxing to the mind, and takes away a lot of the enjoyment of riding. Then I think of everyone who lives North of the Mason Dixon line, who if they want to be fit for spring races, will spend hour after hour inside staring at walls, I feel like a punk.
Did it again today, and it was a bit better. Tomorrow the weather is looking good, so I plan to ride outside!!! yee-ha!!

What about the diabetes game? Things have been good. For the last 14 days, My FreeStyle Navigator has my avg blood sugar is 118, with 5% above target, 94% in, and 1% below target. That is the best below target I think I have ever had, and still BS equates to an A1C of 5.4ish.
Still doing split dose of lantus. I was doing 3 in the am, and 10 in pm. Now that I am training again, I am going to slowly try to get back to the even split. This morning I did 4 units, and tonight I will do 10. Tomorrow, 5 units, and then 9 at night, as I plan to train for 2 hours tomorrow.

Also started doing Yoga. Have done 1 class, and plan to go back tonight. It was amazing to see how much flexibility changed by the end of the class. Of course I have spent the last 2 days in pain from using muscles I did not know existed. Wednesday I am going to give Gyrotonics and Pilates a test. Racing a bike is a lot more than just legs. It is mostly the head that controls success, followed by endurance, speed, and a strong core, which helps create more power. I am focusing a big effort on doing that, in hopes of being better than ever next year!

Thanks for reading!
Have a great day.

Philpott
www.teamtype1.org