cycling

30 Years With Diabetes

Today’s Diabetes Blog Week topic is diabetes bloopers. You know, those things that make you go, “D’Oh!” and facepalm yourself. I’ve had my fair share of diabetes bloopers: Dropping & shattering glass vials of insulin, running off on trips without all of my diabetes supplies, forgetting to dose for a meal, forgetting that I already dosed for a meal, finding the cat playing with rogue pump tubing, catching the dog gnawing on a perfectly good tube of glucose tabs…the list goes on and on.

The blooper that is really on my mind today is the one that my pancreas made 30 years ago when it decided to quit working. Or maybe it was my immune system that decided to work too well. Or maybe it was because I had chicken pox. Or maybe it was because someone got me wet or fed me after midnight. Or maybe it was because a butterfly flapped its wings in China. 30 years after the fact there is so much more we know about diabetes, but what exactly causes it and how to cure it are still not on that list, despite what we were told about how close we were to a cure when we were diagnosed.

Today is a day of celebration, of blessings, thankfulness, and appreciation. I have learned more in my 30 years with diabetes than some people learn in a lifetime. Living with diabetes has taught me so much, and coupled with other life lessons, I would be remiss to not stop for just a moment and appreciate the gifts that I have been given…thanks to diabetes.

The 1^st 10 Years

If you’re low, anytime is snacktime.
Bananas and peanut butter on vanilla wafers is the best snack in the world.
You can’t go play when you blood sugar is high. But if you can sneak away when your parents aren’t looking, it’s fair game. The back door doesn’t squeak and make noise like the other ones do.
Swimming always makes you go low.
Visiting the cute nurses on the Pediatric floor at the hospital when you’re there for lab work is always a treat. They know you by name.
When you hear the term “A1C” you think of steak sauce and hamburgers.
You don’t know anyone else with diabetes.

The Teenage Years

If you’re low, it’s a nuisance, and you have to stop what you’re doing and take a break to feed it. Not always ideal when you’re being paid hourly at a part-time job.
Whatever is fast and convenient is the best snack in the world.
You hardly notice when your blood sugar is high. Until it makes you feel awful. Then it is all you notice.
Swimming still makes you go low.
Visiting the cute nurses on the Pediatric floor at the hospital when you’re there for lab work is still a treat. Other floors are acceptable as well, as long as there are cute nurses. You know THEM by name.
When you hear the term “A1C,” you also hear words like “goal” and “lower.” Those cute nurses are a good distraction.
You’ve heard of other people with diabetes, but you still don’t know anyone that has it.

The Last Ten Years

If you’re low, your CGM alarms and you drop everything and treat it. Except when you have low-brain and can’t seem to focus. Then it becomes more of a struggle, and is sometimes followed by a hangLOWver.
Cheese, nuts, and other low carb foods are the best snacks in the world.
Because you are in better control of your diabetes, you can feel a high blood sugar in the upper 100’s now. 200+ makes you feel like dog’s ass.
Swimming still makes you go low, and now you have to replace a pump site when you get done because the sticky doesn’t stay stuck in the water. You are able to ride a bike for over 100 miles in one day. You’ve discovered OTHER activities that have the same effect as swimming on your BG’s, and are just as much fun.
Visiting the cute nurses, wherever you can find them, has become a rarity. Now you mostly settle for Helga, the former wrestler with the mustache and gallon sized syringe and harpoon needle to do your lab work. She knows you as a number.
When you hear the term “A1C,” you start thinking all about decimal pointed numbers like 5.6 and 6.5.
You meet an amazing community of people online and in real life who also have diabetes. You start a blog, and start sharing your life with diabetes. They inspire you.

The Next Ten Years

Your diabetes is tightly controlled, and you don’t have any of the complications that others who don’t take their diabetes seriously often suffer from.
You’re slim, fit, and eat right so that you’re able to do the things you love and experience the world. You look fantastic naked.
You accept that there will always be things that make you go low. You’re prepared for them, and never let diabetes keep you from being able to do anything that you set your mind to.
You have a family now, and your diabetes is not the center of the universe, but just a piece that helps explain your awesomeness during bedtime stories.
You vow to only have lab work done from cute nurses in the future. You have diabetes, so you deserve it.
Your doctor rarely mentions the term “A1C” anymore. He’s more interested in what awesome things you did in the last three months so that he has success stories to share with his other diabetes patients.
You continue to write about diabetes, speak about diabetes, advocate for diabetes research and better treatments, and share your world with diabetes. You challenge others to take control of their own diabetes, and cherish those stories of how you inspired someone else to save their own life.

Today, May 11, 2011 is my 30th Diaversary. Thank you all for being such an amazing part of it.

“You only live once, but if you do it right, once is enough.” — Mae West

Allison, Caroline, me, and Brenda at a May 2011 D-Meetup in New York City

Master of Disaster

Exercise, for most folks, is hard to get around to doing. Our days are consumed by so many things that we simply don’t always feel there is enough time to add exercise to the mix. By the time we get up, get dressed, work all day, come home, make dinner, eat, wash dishes, chase the dog, pet the cat, do laundry, get a shower, and try to relax for five minutes, there often seems to be little time left to do much of anything else. That doesn’t even factor in those folks that have kids, and all the shenanigans that I can only imagine (for now) comes with offspring.

In the late Summer of 2005, Hurricane Wilma came roaring across the southern part of Florida and left most of us without power, transportation, and necessities for days, and in some areas even weeks. The local weather coverage had prompted everyone to be prepared for a “mild Tropical Storm,” but they did not anticipate that the storm would gain strength while crossing over the Florida Everglades and pound the opposite side of the state, where I was, as a Category 3 hurricane.

While nothing like the major disasters of Hurricane Katrina and the tsunamis in Indonesia and Japan, Hurricane Wilma still left us in a catastrophic predicament. Like fools, none of us had taken the forecast seriously after being told to expect nothing much more than a mild thunderstorm. Meanwhile, the gated archway at the entrance to my apartment community had succumbed to the winds and had landed in a heap of rubble (blocking our escape by car), roads were closed and impassable, power lines were laying on the ground with no indication as to whether or not they had electricity coursing through their veins, and a mandatory curfew was in place from dusk to dawn for all affected areas of southeastern Florida. Everything was a mess, and a dark mess too after sunset with no lights…anywhere. Because of all the lights, stars are not a sight you get to see in south Florida very often, so it was very surreal looking up and seeing them in all their sparkling glory.

Word eventually got to us that some areas had power and supplies, yet there was no way for me to get to them. I was an easy 200 pounds heavy at the time, out of shape (unless you consider “round” a shape), and hadn’t made exercise a part of my life since grad school. It was then that I realized the perils of my choices that had left me physically incapable of getting from points A to B, so I vowed that I would never get stuck in that same situation again.

That was when I started cycling. I went to a bike shop nearby and overpaid the owner for a bike that I could ride a fair distance, and would withstand the abuse of a 200 pound gargantuan (see also: fat ass). At first I couldn’t ride but maybe three miles before I would be out of breath and energy. But I kept riding, day after day, and I got stronger, and I stretched those three miles to four miles…

…then to six miles…

…then to ten miles…

…then to 13 miles…

…and by the following June I did my first 26 miles in an organized charity bike ride.

My 1st organized bike ride + hair + heft.

By the end of that Summer in 2006 I felt that I’d earned a better bike, so I got a Trek 1500 as my first road bike, and I have been pedaling ever since. I’ve wrote before about how cycling benefits me both physically and mentally, and long endurance riding comes with its own share of challenges, but I know now that in an emergency I could absolutely get from points A to B, and probably to C and back again if the situation called for it. Last April I completed my third 150-mile bike ride from Miami to Key Largo and back.

Outside of the Team Stormriders tent in Key Largo, my 3rd MS150 with the team.

In my case, dropping the weight and getting fit was a side effect of my desire to be able to get to where I needed to go. In doing that, I discovered a passion for a sport that has partially defined who I am today. No matter your circumstances, don’t wait for a force of nature to force you to exercise. Get moving now, and be the master of your own disaster!

This post is my March entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/march-dsma-blog-carnival.

Endo Affirmations

When I set my goals at the beginning of this year, #1 on my list was to get my A1C down to a 6.2 or better. That is a formidable goal, trying to achieve an average blood glucose over time of around 120, depending on what research you consult. At my last endo appointment back in December of last year, my A1C was still reasonable, but it had ticked upwards. I couldn’t let that upward trend continue.

I had gotten my Continuous Glucose Monitor (CGM) and new pump just after my previous appointment in September of last year, and with all the change, I was burnt out. Or maybe just overwhelmed. But really, is there a difference?

I was wearing my CGM intermittently, and was dealing with major information overload with all the beeping and pricking and checking and counting and pumping and beeping and…I was exhausted.

After I wrote my A1C down in my notes, and realized that I had allowed my control to slip in the short three months since my previous appointment, I knew that I had to turn the ship around. I don’t want my A1C to continually creep northward, and me pay for it with problems down the road. I have too much life and dreams ahead of me to get lax with my diabetes management.

So I sat myself down and gave myself a stern talking to. I said to myself, “Self, all is not lost. I want you to look in that mirror, and I want you to repeat after me. I can do better. I have some awesome tools to help me get to where I know I can be. I can wear my CGM all the time, and not take several days off between sensor changes. I can carry around glucose tabs right there in my little pocket to treat a low. I don’t have to be a great diabetic. All I have to do is be the best Martin I can be. Because I’m good enough, I’m smart enough, and doggone it, people like me.”

Daily Affirmations with Stuart Smalley

I’m glad we had that talk. Since then, I’ve done really well with wearing my CGM. Every time the sensor battery runs out of juice, it hits the charger, and I’m already putting a new site in and getting everything ready for another round. I’ve gotten to where I really don’t enjoy being without my CGM, and am hoping that I didn’t do too much damage for all the years before now when amazing technology like this didn’t exist.

Lows are still creeping around occasionally, but they are manageable. Nothing a few glucose tabs can’t fix in a pinch. I expect my CDE and endo to want to make some adjustments, and I’m open to that. I’ve started a low-carb journey now, so I don’t expect that I need as much basal rate insulin at certain times of the day as I did with a diet heavier in starches.

Something else that I’m not happy with myself about is that I let myself get lazy, and stopped exercising the way I physically and mentally need to. The scale showed me the truth about that. So far I have lost six pounds, down to 184 lbs. It’s not a lot, but it’s progress, and that is the most important thing right now, to be moving forward. I’m making some big changes to my lifestyle to eat smarter and make better choices. I have my eye on my goal cycling weight, and to slim up and firm up so I look good naked, or at least in a swimsuit. Yes, I’m vain like that.

Back to the A1C, I know that we can’t base our entire diabetes report card on the A1C alone, but it still resonates with all of us where we are in our journey with diabetes when we see that number. I am confident about this upcoming appointment. I am determined. I have a plan. And it’s true, I don’t have to be the best diabetic. I just have to be the best Martin I can be. The rest will find its proper place.

The Difference A Day Makes

With the exception of a couple lows in the past few days, my blood sugar levels have been exemplary lately. I mean, in serious 2011-goal-A1C-of-6.2-or-better getting contention. I have my CGM rates set to alarm if I drop below 70 mg/dl or spike higher than 160. Just the other day I was 20 minutes (not units…MINUTES) away from getting a no-hitter in that tight range. The stupid dawn phenomenon managed to thwart my efforts in the early morning hours with a CGM reading of 165 around 4:00am before dropping back down to normal, preceded by an ever so slight low around bedtime the previous night. Vengeance will be mine!

My Almost No-Hitter

On Saturday of this past weekend I went to the gym, something I’ve started recently as part of a one month trial with a gym here in my neighborhood to get back in the habit of exercising regularly. I’ve been hitting the weights, trying to get my muscles to wake up and remember what they are there for, and the past couple visits I’ve added cardio back into the mix.

Cardio plays all kinds of tricks on my BG’s, usually with sneaky lows during and sometimes hours after the actity. I have had issues in the past of pushing myself too hard while exercising, especially cycling, and seeing numbers on my meter that are too low for me to continue, so the CGM really helps me and allows me to correct problems before they get out of hand. The CGM is another valuable tool in my arsenal that I use to control this diabetes beast within, and on Saturday it was working great.

The thing about cardio is that I sweat…a lot. I get into it, get my heart rate up into that aerobic calorie burn zone, and really push my limits. I enjoy the stationary bike in the gym, and I challenge myself while trying to hold a particular cadence (rate of pedaling) or speed for a certain amount of time on the bike. It’s an absolute blast for me to rock out with my iPod in my ears while conquering a ride intensity level that I’ve set into the computer of the bike. It’s not as much fun as a real ride, but for training and gym work, it keeps my attention.

So I did my bike work on Saturday, got home, and after a rest I realized that the sticky on my CGM sensor was just barely hanging on after all the sweating and training. I went ahead and removed it, as it was starting to irritate me, and since it was late I decided to take the night off before putting a new one in. That was stupidity on my part, and not the first time I’ve done it.

On Sunday morning I woke up later than ideal to get ready for a family event that I needed to get to, and I was in a rush and didn’t take the time to put a new CGM sensor in before I left the house. I went about my business at full throttle all day, and didn’t take a break to eat anything. By the time I finally got around to eating something for an early dinner, my BG was 43. I sat there cramming carbs like it was my job, and didn’t bolus enough to cover them. On top of the that, I’m trying really hard to ween myself off of carbs, so my body seems to be very hypersensitive when I do eat them, causing my BG’s to spike through the roof. By the time I got home and settled a couple of hours later, my BG was 292.

Both the low and the high could have probably been avoided, or at least better acted upon, had I taken the time to put a new CGM sensor in immediately after removing the old one. This is a challenge that I seem to continuously battle. I love it when I have the CGM, and I am a bit of an addict about keeping my BG’s within normal range. I’ve been doing SO GOOD! But once in awhile I convince myself that I need a break, and I take it, and then I regret it when my BG’s decide to go all random on me, with a stubborn high here and a severe low there, which was what happened on Sunday.

One day with CGM and I can keep my BG’s in tight control and quickly react to changes in blood sugar levels, whether they start to sneak up from an inaccurate count in carbs or drop from excessive activity.

One day without CGM and I have severe lows and highs that make me feel like I’m the world’s worst at managing diabetes, guilt trip included.

One day, I’ll learn.

In Spite of Diabetes

I am part of the Diabetes Social Media Advocacy community, and each Wednesday night we have a live chat via Twitter where we answer questions and discuss topics relating to life with diabetes, followed by a live internet radio call in show on BlogTalk Radio on Thursday nights. The following blog post is the newest diabetes advocacy initiative of DSMA, the DSMA Blog Carnival. Each month a question will be featured, and participants are given the opportunity to expand on the answer with a dedicated blog post. Here is my contribution for February 2011.

“The most awesome thing I’ve done in spite of diabetes is…”

Everything that I can ever remember doing in my life has been in spite of diabetes, and it is a laundry list of awesomeness. That is what makes this post a challenge, because I don’t have the perspective that some others have of a life before and after being diagnosed with diabetes. My life is simply “with diabetes.”

I remember being a child in elementary school and seeing my friends eat candy bars and gummie bears, drink their little juices, trade snacks, and even barter for Moon Pies. On Halloween and Valentine’s Day they would bring in candy and trade, or hand out candy canes at Christmas. I would always accept the candy, and be part of the group, but I’d never eat it. I would take it home and it would get tossed in a drawer or a basket, and eventually find its way to the garbage due to old age. I didn’t feel out of place or like an oddball during those days. It was just the way it was. I didn’t know any better, and quietly accepted the way things were.

As an adult, I don’t accept things quite that easy. Where some doctors or diabetes “experts” say that you have to limit yourself because of diabetes, I ask, “Why?” I find absolutely no logical reason why I have to limit myself to anything in this world that I want to achieve strictly because I have diabetes.

As an adult with diabetes, I have become a cyclist, pedaling thousands of miles on my bike and keeping up with people both younger and older than me in quests for a finish line that is often many miles away.

I have become a librarian, teaching people how to find information that they can use to do everything from satisfy curiosity to save a life.

I have become an adventurer, exploring cities like Miami, Ft. Lauderdale, New York, Las Vegas, and Washington D.C. without limits.

I have become a contributing member of the Diabetes Online Community, a blogger, a voice, and a soldier in an army of People With Diabetes.

I have become ME, and that is the most awesome thing that I have done in spite of diabetes.

Five Boro Bike Tour 2010 - New York City

This post is my February entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/introducing-the-dsma-blog-carnival.

Wandering and Wondering

I needed to go for a walk a few nights ago. I didn’t have any particular destination in mind, I just needed to wander and get some air. My blood sugars weren’t low, and I wasn’t roaming incoherently. I was just regular roaming, like when you go to the mall and wander around and don’t buy anything. Just alone with my thoughts, listening to the sound of traffic, watching the passing cars, and considering everything that is going on in my world.

It’s important sometimes to just find that peaceful place you can hang out, if only for a few minutes. It’s like diabetes nirvana, where you can eat practically whatever you want and still maintain that perfect level blood sugar. For me, that’s somewhere between 80 and 120, but YDMV. You don’t have to share that place with anyone, you don’t have to fill it with distractions, you can just be, in that moment.

Right now in my day-to-day I’m swamped, so I need those peaceful moments whenever I can get them. My days are filled with phones that ring off the hook, a flood of emails, meetings, research, a lot of puzzles in the forms of invoices, budgets, reports and spreadsheets, a task list that somehow continues to get longer and longer no matter how hard I work on shortening it, and the overwhelming pressure to demonstrate leadership ability, progress, and that I have things under control. Maybe it’s the Fall season, and everyone trying to get everything wrapped up before the holidays get here and people scatter to the four corners of the world. Or maybe it’s the ghosts of deadlines passed.

In any case, when we’re so busy, the animal that is diabetes that we try to keep on a leash likes to try and show it’s ugly side. We’re teased with perfect blood sugars for hours on end, just to do a quick check before dinner to see a BG so high it would make an angel get vertigo. Yesterday afternoon for example, I lowered my basal rates for about three hours because I was too active and my BG was dropping too quickly. Perfection, until I checked a few hours later, and spiked harder than Misty May in a beach volleyball tournament.

Then there is the flip side. The activity of the days and nights catches up, and we wake up in the middle of the night plowing into the refrigerator for anything we can find to treat a low BG, including those week old leftovers that we’ll regret eating by morning. Stress and being stretched too thin results in a lot of flux in our capacitors. We’re working so hard to get to the future that the past catches up with us and knocks us flat on our DeLorean. (I also went to see Back to the Future on the big screen for its 25th Anniversary last week, which was beyond awesome!)

I don’t know what the secret is to managing and staying on top of diabetes, stress, workload, bills, relationships, and all the other responsibilities of life. I believe a lot of life is change management, and I strive with all the changes that life throws my way to make the choices that are positive and move me in the direction that I want to go. That works, most of the time, but I still stumble. Sometimes I excel in one aspect of my life just to see another suffer from lack of attention. It’s a seesaw, and one minute I’m on the ground with my feet firmly planted and everything is as it should be, then the next up up in the air with my feet dangling and trying to hold on for dear life to those things that are most important and trying not to fall off the edge.

People deal with stress and being overwhelmed in a lot of different ways. A long bike ride helps me sort things out. Sometimes I just need some quiet time to myself. I’m naturally an extrovert that draws energy from engaging with other people, but I can’t be the entertainer all the time. Sometimes I’ve got to get a little discontented so that I can find the fuel to push through obstacles. I try to find a healthy balance that favors positivity.

It’s that balance that we struggle with, in life, with diabetes…with everything. Things can’t be sunshine and daffodils all the time, but it also can’t rain all the time either. It can be hard work to climb over those obstacles that are holding you back from whatever next step you are trying to get to. It is especially hard to cut out those things that are bad habits that allow us to escape or provide a sense of security, even a false sense of security.

But it’s worth it to try, even if you don’t succeed every time. The more you try, the more success you’ll have. Nobody has ever achieved their dreams by sitting around waiting on them to come true.

With diabetes, I get aggravated when a day of low BG’s collides with a night of high BG’s that keep me up all night. I have to remember though that most days I am more in tune with my body than most people are. I have tools and technology that help me to be able to make educated decisions that keep me alive.

I save my life every single day by the decisions that I make. Can you say that? I hope you can. If not, maybe it’s time to make some changes.

Bike Ride & Motivation

I sent my friend and colleague an email, with the subject line: Need. Bike. Ride. It wasn’t long before he replied with a similar sentiment, and we both made the dash to our respective homes at lunch to grab our bike gear.

I love cycling. I love it like my dog loves Milk Bones, or my cat loves a bright patch of sunshine. It brings me joy, it makes me feel better about myself, and it helps me manage my stress. I’ve always said that one of the best things about a bicycle is that there is no room for “baggage” on it. When I get on a bike, the stress just seems to fall off as the miles click by. Cycling also helps me stay in shape, push my limits, and meet new and interesting people. My best friend got me into road biking several years ago, and I’m so glad he did, because it has brought me so many stories and adventures since.

Today was almost an adventure unto itself. As we were just about to take off from the start of the ride, I did a quick BG test to make sure things were copacetic. They weren’t. My blood sugar was 36 mg/dl…and I did not feel it even the slightest. That frightened me, because normally I can feel it, especially one that low. I played it off so as not to freak out my friend, because good or bad, that’s what I’ve done most of my life, hide it. However, I did make him aware that my BG was low so he could understand our delayed start, and I got a glucose gel down, suspended my basal insulin delivery on my pump, and managed to get my BG up to a modest 74 before feeling confident and safe enough to get on the bike. About 10 miles into the ride we stopped at a convenience store, and I added an orange Gatorade to my arsenal, just to make sure that things didn’t sink back down with all of the activity.

At the halfway point (16.5 miles) my BG was holding at 74, which given the activity and fact that my pump was suspended, seemed about right. I continued to drink my orange Gatorode (which by the way, is quite delicious when you don’t get it on a regular basis), and by the time I finished the 33 mile ride, my BG had risen to a solid 147.

Earlier today Kerri (@sixuntilme) wrote a great post about fear and hope, and what motivates us. I hope that I can be strong, athletic, and continue to do bike rides like this (and even longer distances) for years and years to come. I want to be retired and able to blow the doors off some young whipper snappers who think they are lightning on wheels. Being on two wheels, pedaling for miles, and as a Type 1 crossing finish lines that most people say “I could never do that” about, that makes me happy. I love the endurance, the challenge, and the sense of accomplishment when I cross the finish line. But while I have that hope, I also have the fear of that one low BG that sneaks up on me and is one that I can’t manage on my own. I hope so much that if/when it happens, that it doesn’t ruin for me the sport that I love so much. That mix of hope and fear is one of the things that motivates me, and encourages me to stay @woodonwheels.

Crossing the 150-mile Finish Line with my team (Team StormRiders)

	Rick Phillips on I Lied
	Tina on A Bunch of Sensitive Pric…
	Heather Gabel on Diabetes as a Disability
	Martin on Diabetes as a Disability
	Heather Gabel on Diabetes as a Disability