exercise

Stuart Smalley

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.”

Stuart Smalley

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.

Skinny Caramel Latte

A Moment Without Diabetes

This past weekend was a working weekend. I spent the vast majority of my time on the computer and frequenting my local Starbucks for liquid motivation. I have a big work project that I’m trying to get finished ahead of schedule, so I had to make sacrifices at the expense of my weekend. If I wasn’t certain that the end project is going to be awesome, that might bother me more.

Coffee houses are very interesting places to do work. You get see all kinds of people come in and order their custom cup of Joe. My personal favorite (from Starbucks) is the skinny caramel latte. In my head it is a dark, sexy cup of deliciousness with just enough cream and candy sweetness to indulge in without too much guilt, equivalent to the joys of silk pajamas. In reality, it’s a latte made with sugar free caramel syrup and fat free milk. They would probably sell more of them if they went with my description, but that’s neither here nor there.

Skinny Caramel Latte

While I was sitting in Starbucks on Sunday, something interesting happened. Earlier in the afternoon I had gone to the gym and did hill climb intervals on the stationary bike, and managed to sweat off my CGM sensor. After the gym I went home and put the transmitter on the charger, got a shower, and immediately put a new CGM sensor in and reconnected.

Two hours later, while sitting at a table in Starbucks with my trusty laptop and mostly minding my own business, my CGM alarm screeched at me and notified me that it was time for a calibration. I grabbed my kit, did a finger prick, and took care of business. Nothing special there.

The special part was that, while doing this, I was having a conversation with a gentleman next to me about the oddness of the electrical outlets at this particular Starbucks being located behind the removable back cushions of the bench we were sitting on. Our conversation had taken place despite diabetes trying to interrupt. Neither he nor I had given diabetes the courtesy of the time of day.

Normally I feel like I have to hit the pause button on my life for these moments with diabetes. Even having had diabetes as long as I have, I notice them, like red flags on a green golf course. I have to hide the red blood drop from a squeamish passerby, or ask the person waiting on me to go somewhere to hold the door for just a few seconds so I can check my blood sugar first, or choke down a couple glucose tabs and wait a few minutes before finishing a conversation.

This was different. Although diabetes was there, this was a moment without diabetes, and it was so subtle that I almost missed it. It was nice, and I appreciate it, even if it was only for that one moment.

CGM Almost No-Hitter

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!

CGM Almost No-Hitter

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.

3 Stooges - Going for the Goal

2011 Goals & Resolutions

To me, there is a big difference between a resolution and a goal. In my mind, a resolution implies that something needs changing, like a bad habit that needs breaking. A goal, on the other hand, aspires to be something greater. I’m a believer that if you put something in writing it serves as a reminder, holds you more accountable, and is an investment in others being able to support you along the way.

So here are some of my 2011 goals and resolutions.

Goals
1. A1C <= 6.2. Less would be good.
2. Run (not walk) a 5K.
3. Start cycling with a group again, and get back into organized & scheduled rides.
4. Like everybody else on the planet, drop a few pounds. Goal weight: A stable 165 lbs.
5. Pay off at least two debts.
6. Have an adventure…regularly. Take pictures.

Resolutions
1. Wear my CGMS 24/7/365, and stop taking 2-3 day breaks in between sensor changes. (I could have titled this one “Stop being stupid Martin” but I felt I should be more specific.)
2. Realize that it’s okay (and encouraged!) to spend money on diabetes supplies before other bills.
3. Go to the ophthalmologist and dentist at least once this year.
4. Find excuses to exercise, instead of excuses not to.
5. Remember that any day can be a “No D-Day” if you want it to be.

3 Stooges - Going for the Goal

Go for the goal!

10-10-10 - photo by Woodley Wonderworks on Flickr

New Rule: 10-10-10

101010 - photo by Woodley Wonderworks on Flickr

10-10-10: 10 THINGS for you to take 10 MINUTES to share with 10 PEOPLE about your diabetes.

#1
That you have diabetes.
If you aren’t comfortable sharing it with a group, share it with just one person at a time. A friend, coworker, or roommate is a great start. You may need them one day, and awareness is in both of your best interests should that need arise.

#2
What type diabetes you have.
Each different type of diabetes requires a different set of rules and things to be aware of. An easy talking point is to share what type diabetes you have, and how it compares to others. It’s also always fun to baffle people with your expert knowledge that yes, you can indeed get “juvenile diabetes” (Type 1) as an adult. Mind blowing! Because it takes so much of our attention to manage our own diabetes, check the ADA web site if you need help educating yourself on the various types of diabetes.

#3
Your story.
Every one of us has a collection of diabetes stories. People can most identify with what you went through when you were diagnosed. Some of us, like me, were far too young to remember, but maybe your parents or loved ones passed these stories down to you. If not, share how your life has changed pre- and post-diagnosis. I have found that most people are very impressed by how much us diabetics know about our bodies. Toot your own horn!

#4
How you manage your diabetes.
Some of us use an insulin pump, continuous glucose monitoring (CGM), multiple daily injections (MDI), and hopefully all of us with diet and exercise. Share the tools and tricks of the diabetes management trade that work for you. You don’t have to go into the nitty gritty details, but sharing that you know what you’re talking about and how to manage your diabetes goes a long way into the comfort levels of all involved in being able to talk about it openly. I like to show off my insulin pump and BG meter when I am sharing, and curiosity usually gets the cats to talking. This is also when I like to point out that I can eat the same foods as everyone else, as long as I know my BG and count carbs. This goes a long way in warding off the Diabetes Police.

#5
The difference between a low and high blood sugar for YOU.
Although this can dance on the edge of being clinical, it’s something that most non-diabetics don’t know. Try to put into words what it feels like when you have a high or low BG. For example, when I am high, it feels like my blood has turned to molasses, and doing anything is like trying to do it while submerged in Jell-O. Most people can appreciate that description, unless they’ve never had Jell-O. And if that is the case, you get to make a new friend tomorrow by bringing them a Jell-O cup. I suggest Sugar Free Lime or Strawberry Banana.

#6
Symptoms of a low blood sugar.
As scary as a low BG can be, this is quite possibly the hardest part of the “I have diabetes…” conversation, because it is 100% serious REAL LIFE when it happens. Describe a low blood sugar in your own words, and include those symptoms that are most common to you and your diabetes. We’re not all the same. If, like me, you’re prone to nonsensical motor mouth as a symptom of a low BG, share that. Then, if you’re talking too much and annoying your friend, at least they have an out by suggesting that you go check you’re blood sugar so you’ll shut up. Winner, winner.

#7
How to treat a low blood sugar.
Share the important details, such as where you keep your glucose or Glucagon hidden, and that insulin does NOT make your blood sugar go up. I don’t know why so many people think that insulin makes blood sugar go up, but they do. Educate them. Let people know what works best for you to treat a low BG. If juice is your go to low BG fix-it-all, then tell them that, and where they can find it. Your life may depend on it, and it will reduce panic if you need an extra bit of help.

#8
Your medic alert identification.
Point out where it is, whether it is a bracelet, necklace, wallet card, or other form of medic alert. I have had diabetes nearly my entire life, and am as guilty as anyone of not wearing my medic alert ID like I should. So, dig it out of your underwear drawer (or jewelry box, if you’re a girl) and put the thing on. If you don’t have one, go buy one. No excuses. I’ll even guilt you into it: Don’t put the people around you in the position of having to answer a paramedic’s medical questions about you in the event of an emergency. Emergency personnel are trained to look for medical alert ID’s, so get after it.

#9
What you can do despite diabetes.
I think it is so important to let people know that diabetes is NOT a death sentence. It is so very far from a life ending condition, and as long as we manage it successfully, we can do anything that anyone else can. Thanks to modern technology and medicine, we can play sports, have a family, and even be a celebrity. We are only limited by our own imagination. Diabetes only holds us back as much as we allow it to, which coincidentally means that us people with diabetes (PWDs) are notoriously stubborn. I think that’s a side effect we can live with.

#10
Where they can learn more about diabetes.
As much as we know about our own diabetes, none of us knows everything about diabetes. Some great places to refer others to learn more about diabetes are the Juvenile Diabetes Research Foundation, American Diabetes Association, and the Joslin Diabetes Center.

Lake Ella at Dusk

No D-Day: Hit the Ground Running

Today, October 7, 2010 is “No D-Day”. The Diabetes Online Community is taking one single day away from diabetes. We will still be checking our BG’s, counting our carbs, dosing our insulin, and managing our diabetes, but we will not tweet about diabetes, we will not blog about diabetes, and we will not update Facebook about diabetes…for just one day. There is so much more to all of us than just diabetes. You can find all of the “No D-Day” posts on Twitter by searching for the the hashtag #noDday, or you can visit Ninjabetic.com for a list with links. I hope you enjoy this and all of the “No D-Day” posts today, and perhaps one day we can make every day a…

No D Day

Running and I are not friends. Running is hurtful, vindictive, and immature, and even tries to make me jealous by playing so well with others. Running is a complete bully towards me. It hurts my left ankle that I cracked when I was a kid. It hurts my knees, which get sore from time to time, especially when I’m really training hard for cycling. Being honest, it really hurts all of my leg muscles. But last Friday, something changed with mine and running’s long term tepid relationship.

As I was spending all of my energy on chores last Friday, taking clothes to the laundromat, sweeping floors, washing dishes, putting clean (and warm!) sheets on my bed, I got the notion to stop working so hard and go do something I enjoy: Exercise.

The Fall season is just arriving here in north Florida, the humidity levels are down, and the temperatures are dropping (not to my liking, I might add!), so it was a good evening to get outside of the house. I dawned my workout clothes, grabbed the iPod, and went a couple blocks away to Lake Ella, which has a nice paved sidewalk all the way around it that totals 6/10 of a mile per lap.

Lake Ella at Dusk

I started out with an easy walk. Although I’m an avid cyclist, I haven’t deliberately gone for a run in years, so I didn’t want to just take off running right out of the gate and injure myself. That might result in me not being able to go on a bike ride, and that simply cannot happen. I need my bike rides. Got to have priorities in this world people, even when it comes to exercise.

So I started walking. The cool thing about Lake Ella is that there are always a lot of people there to ogle. That makes walking around and around the lake a lot less monotonous. Pretty soon I got good and warmed up, iPod playing in my ears, and I started to become aware of people passing me.

Now, perhaps I was a race horse in a former life, but the competitive nature in me was starting to get antsy. I’m a cyclist. I can pedal 33 miles in less than two hours on the St. Marks Trail. I’ve completed the Five Boro Bike Tour in New York City. I’ve done the MS150 from Miami to Key Largo and back three times. Surely I can pick it up enough to keep up with everyone else, right?

Wrong.

For the record, running is not cycling. It uses a completely different set of muscles, many of which I’ve learned that I’ve been neglecting for too long. Now, I’m no Calvin Klein underwear model or a perfect 10 on the “OMG he’s dead sexy!” meter (I’m a humble 9.5), but some of the folks that were passing me as I was jogging like a pirate with two peg legs looked to be much heavier and not in near as good of shape as I am in. This ties back to the start of this post, about how running makes me jealous by playing so well with others. How do they do it, keep up the pace, and make it look so easy?

I still don’t have an answer to that multifaceted question. But I do know that I had a fantastic time dragging my limping carcass around Lake Ella for 5K last Friday evening. So much so that I did it again on Monday. And I vow to continue to push through the pain of running, and find that common ground where running and I can coexist without arguing so much, and hopefully one day the two of us will inspire enough jealousy in others for them to want to push through the pain too.

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

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)

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