Active Diabetes Management - Please Forgive the Soapbox

I have had some questions recently from parents of kids with Type 1 diabetes who are active or are becoming more active. The question is usually, "How do we fix all these swings in blood glucose readings?". My answer usually starts with the benchmark questions of, "What was the last A1C?" which is the gold standard for how the diabetes is being managed. This question really gets to the core of Insulindependence and its foundation of ACTIVE diabetes management and not sedentary diabetes management. Before I started training really hard, I had NEVER had a low below 50 and now I am below that most days at some point. When I was first diagnosed, my brother encouraged me to force a low and a high while my wife was around and I had proper rescue foods and insulin nearby. He wanted me to experience it so that I knew how to deal with it. I could easily flatline my blood glucose numbers if I went to bed and got up the same time each day, ate the same food for my meals everyday and never did anything strenuous (sedentary mgmt). Is that really a life? Isn't that letting diabetes drive my life? I want and need to drive my life and I need an advanced degree in ACTIVE diabetes management and learn all of the techniques to keep my A1C under 6 while still living a full and crazy life which is currently being topped off by the peak of my Ironman training.

Here is a chart of my glucose readings over a 4 day period:

 
For a normal person looking at this, they would say that I am out of control. The reality is that I believe that this is good management because all of the highs and lows are quickly corrected. BTW, I have never had to be rescued by someone because I was too low and became incoherent.

Here are some interesting data points tied to my heart rate for the same period. This is the Carlsbad Half Marathon run showing corresponding heart rate and blood glucose readings for the same period of time. The race started at the peak of my glucose reading on the left and ended as it leveled out around 60.

Heart Rate during Carlsbad Half Marathon

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Here is more data from today's indoor base building ride. The first heart rate data is from my 4hr 30min ride and the second heart rate data is from a 30 min stepper brick. 

This is the associated blood glucose graph for the combined bike and stepper totaling 5 hours in duration. The exercise started at the peak from breakfast near the left side and ended at the red dot on the right.

So what, you ask, is my point in all this. My point is that this is not a flatline but it is good management and will hopefully result in an A1C under 6 at my Dr visit March 3rd.

Again, Insulindependence is all about ACTIVE diabetes management and living life to the fullest by dominating this disease. We want to Inspire diabetics to get out and live an active life, Educate diabetics about active diabetes mgmt and encourage them to get out and Explore all the possibilities open to them. This isn't 15 years ago when diabetics were considered frail and doomed to a variety of horrible outcomes. I am proud of my teammates and proud of Insulindependence for daring to push the boundaries to allow others to follow in our footsteps through mentoring from other diabetics who have been there and done that. For those living a sedentary lifestyle now, a brisk walk might drive you to a BG of 30. Just be prepared for it, turn it and keep doing it and the next thing you know it, you will be running, then cycling and then swimming and then becoming a Triabetes captain who now has the privilege to inspire others and the right to say, "follow me and I will join you in this journey!". DOMINATE DIABETES and LIVE!!!

All done now and stepping down off soapbox (up at 4:30am tomorrow for a 16 mile run 8-{ )

Brian

Catch Up Day

Today was a catch up day at work, at home and with training. I went on a business trip to Florenceville, New Brunswick Canada to visit McCain in the Potato Capital of the World. Before my flight on Monday, I was able to get in 3650 yds in the pool. The trip was crazy with no sleep so I had to take Tuesday and Wednesday off from training.

Bridge leaving Florenceville

POTATO WORLD

Driving in the North Country

Last night I caught up on sleep and went to bed at 8pm after fighting off a rapid on-set low. Today I caught up at work with all the reps that I work with, caught up with most things at home and after work did a 2 hr tempo ride followed by a brick into a 5 mile night run.

I had fun setting up a group on Facebook for all of my second cousins (all in their 60's and 70's). If you don't know my story, I was the extreme baby in our family and I was born when my brothers were 20 and 18 (same parents). My Dad was born in 1917. Anyway, my Dad's mom had 7 siblings and it is that family that I set up a group for and everyone seems to be having fun with it.

Me & my wife, Pam, with my 2nd Cousins at a 2006 Reunion. I was the youngest at 41 (in 2006) and my oldest 2nd cousin was 75 years old (in 2006)

I also went to the gym today and got a Fit Point. I was excellent in stretching, strength and VO2 and average on fat (21%). Not happy with that fat percentage only because I was about 14% before I started training for Ironman and about 10 lbs lighter. I have been told to only worry about fueling my body and not cutting back on needed calories. I am sticking with the program until May, then I go onto my program and get back to where I want to be. I must admit I feel very fast in the water right now and very strong on the bike.

Here is an ad by Peyton Manning that summarizes my battle as a 46 yr old guy:

Peyton Manning Pep Talk on Rock Hard Abs

I am also VERY excited because I entered a swim meet in Palo Alto, CA in three weeks. I will wear my Triabetes cap for the 1000 yd free because that is what it represents. I will then switch to my Visalia VFibs cap for my sprint events (50 free, 100 free, 100 back and 50 fly). I am very excited to see my swimming friends from my youth again and get together at a meet to have a great time. I am also very excited about some of the spectators who will be there to support us. One swam with us as kids and is battling cancer right now - I am sure that we will swim extra fast so that we don't let down the team in the stands.

Visalia VFibs Swim Cap - Designed by Scott Vieira. I really enjoy the flatline at the end of the heart rhythm 

Some Vfibers at our first swim meet together in November 2009. The guy on the right is Scott Vieira who designed the cap and the guy on the right is my brother, Roger, with a Dexcom CGM transmitter.

This is the cap I will be wearing in the 1000 free at the meet to represent the endurance challenges of Triabetes

Thanks

Brian Phelps

Winding Up & Winding Down

The workouts are winding into the crazy phase which means that it is almost over. I vaguely see the light at the end of the tunnel on the 5+ hrs on the bike the 3+ hrs running and the 4000 yd straight swims. I did a 4000yd straight swim Friday followed by my first massage, a hike with diabetics Saturday followed by a 5hr 30min bike followed by a short run. Started today with a 14 mile run, then church then Yoga with my wife. The massage and the Yoga are new additions that I have been told that I need. I already explained why on the massage and the Yoga was added to fill in the gaps with my small muscles. I am also getting fairly good at dealing with lows before they affect me which are brought on by the many hours of training. I think that I have dipped into the 40's on seven different occasions today and successfully turned each one.

On a funner topic, I was greatly entertained with the latest (March) issue of Triathlete magazine. On page 26 is one of my diabetic peeps that we had the privilege to spend time with last month in California. Her name is Jen Davino:

Article About Jen Davino in Triathlete Magazine

In the same issue of Triathlete magazine there is a section starting on page 79 titled, "Top Races for 23 Triathlete Types". The three categories that caught my attention were Strong Swimmer, Strong Cyclist and Strong Runner.

Strong Swimmer is in Vermont (Aquaman Even Up Kingdom Tri), 3.5 mile swim, 30 mile ride and 13 mile run - supposed to be approximately even amounts of time on each discipline (I will go to this one someday).

Strong Cyclist is in France (Alpe d'Huez Tri) - No explaining needed here - just Google Alpe d'Huez and Tour de France - nuf said.

Strong Runner (drum roll please) is in a place called St George, Utah at Ironman St George. It says, " While Wildflower has been a contender in this category, with its brutally hilly trail run and predictable hot and dusty conditions, the newly launched Ironman St George instantly gained fame as having the toughest Ironman run on the circuit. Just looking at the online course profile is intimidating enough, much less traversing the steeply sloped loop two times through. One strong-running competitor in the inaugural 2010 event called the course "pure evil" on her way to a hard-earned Ironman PR". Yes, the running of Ironman St George has been put in the same category as Alpe d'Huez in the cycling category of Tri's. ROCK ON!!! BRING IT ON!!!!!

Yes my friends, this swimmer is doing the Ironman course that "strong runners" should choose ;-> That's okay, though, because when I finish, I won't wonder about whether I could have done any of the other courses. This means that YOU HAVE TO JOIN ME IN Saint George to witness this event that is the culmination of everything that you have supported me through to try to Inspire and Educate the diabetic community and encourage them to Explore all of the exercise and adventure options available to them because they can do anything.

 First person (from Australia) out of the water last year in St George 

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More people coming out of the water at the 1hr 4min mark (you have a maximum of 2hrs 20min to finish the swim)

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The last two finishers of Ironman St George last year (cutoff is 17 hrs) 2 minutes before midnight after a 7am swim start

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Thanks and I will see you, YES YOU, in St George, Utah sometime before 7am Saturday May 7th. You had better be cheering your face off when I exit the water sometime just before 8am (assuming race goes as planned)

Brian

Bad JuJu is Released - Now flushing out of my body

I'll start with the end once again. I had my first mandatory deep tissue/athletic massage today. New and interesting levels of pain. I am now in the midst of drinking 135 ozs of fluid to flush the bad  juju out from the massage releasing garbage from deep within my muscles. Its been a decent week of workouts and this weekend has 6 hours of riding and 14 miles of running in store for me. I was very encouraged watching two videos this week. One was of my teammate Vic whose daughter was diagnosed with Type 1 diabetes last week and the other was a video of one of my younger teammates, Sarah, in Minnesota who is about the age of our oldest kid. She is the one who said that I had to get a monthly massage.

Vic Kinnunen - Triabetes Captain from Atlanta

Sarah Hankel - Triabetes Captain

My Triabuddy, Zyler, is doing great with his blood sugars and has beat me overall the last couple of days as we compare our highs and lows for the day.

Without going into too much detail, I had a very stressful day yesterday into the morning which finished with some honestly that released all of the stress. I can not express deeply enough how much that I love my good friends. They stepped in and really let me talk and release. One friend actually contacted me out of no where and asked what was going on. He said that he couldn't get me off his mind and that he was praying for me. You will never convince me that God's still small voice is powerful and is there for people who are listening. I spent quite awhile last night literally on my face in prayer for loved ones and strength for me to get through it. Again, it ended well but God is reminding me that he is in control and I need to stay in contact.

Different topic, but I am really happy with the contingent of people that will be coming to Ironman St George to cheer/jeer me on. The list is currently me, Pam, Megan Michelle, Mark, Steve, Joel (maybe), Anita, Ken, Ernie, Debby, Mike, Heidi, Ashlee, Jeannie, Melissa, Zyler, Terra & Michael with maybe's from Ben, Erica, Erica, Gerry, Grayson, Igor, Joanna, Kevin, Mark, Melanie, Morgan, Nathan, and Sally. I am going for broke and hoping for 100 people to come and watch me suffer and get extremely motivated by the courageous efforts of my teammates as we push through barriers that we have never experienced before. You can Beat the Betes and we are going to rock the house.

Thanks and I hope to blog a little sooner next time

Brian Phelps

Therein lies the Rub

I thought that this was an appropriate title for today's blog. It was going to be a bit more humorous and sarcastic but my mood went a bit sour when I found out that the daughter of one of my teammates was in the hospital with what appears to be the onset of Type 1 diabetes. Therein lies the rub. This never stops. Thank God her Dad is an expert in diabetes management (because he has been one for a long time). What about those families who never see it coming and don't know what to do? I believe that we may be able to eventually keep people from triggering their immune system and prevent Type 1 from starting. For those of us who have already triggered their immune system, it is all about education and inspiration. We have the tools to dominate this disease today and we need education and inspiration from others already winning this war in their own lives.

Today I did a training ride of 90 minutes indoors (its supposed to go below -20 degrees F tonight). It was rather enjoyable as it was a tempo ride which means that I got to "go for it" for the middle 50 minutes. After creating a lake of sweat on the mat under my bike I went outside to cool off in -2 degrees. My CGM didn't reflect all the carbs that I loaded but I loved the photo next to the thermometer before going outside. Once outside, my wife had to take a video because of all the steam that I was generating in the wind in sub-zero temps.

I tested and was actually okay and rising on the BG but I thought it was a good photo before I went outside

Video of me after my ride standing outside when it was about -2 degrees F. Notice the steam pouring off me with the wind. Notice also that I don't exactly have the Atlas body and never will - sorry.

I skipped the 8.5 mile run today because I am fighting off a recurrence of plantar faciitis after the 15 mile run on Sunday. Therein lies the rub. I will fight to make it to the starting line of the Ironman and the biggest part will probably be to keep walking by managing my runs. The orthodics and Newtons have really saved me but anything over a half marathon seems to injure me.

I swam yesterday for 3600 yds and it felt great after running the day before. I warmed up with a 2000 yd swim which is my minimum now to try to get mentally used to swimming distances. I had a high school boy in the lane next to me who was getting prepared for the upcoming high school season. I enjoyed the company BUT I had a really hard time letting him go by me during the 2000 yds. Therein lies the rub. He appeared to be doing sets of 200's or 300's. He would initially get in front of me and then I got by him by the end of his swim. The problem was that I had to keep going so that wasn't too smart but I couldn't help myself.

I am a type A personality and I like to win when I have decided to compete. The trick for me, mentally, is choosing to compete in as little as possible. Therein lies the rub. When I ran the 1/2 marathon in Carlsbad my sugars spiked at the start line and it took 20 minutes for my heart rate to come down from 190 to 135. This is what I have been trained to do in sprint events. I have to be okay with finishing Ironman - end of story. I have to be calm at the start of the swim, I can't try to sprint the swim portion. I have to let people pass me in the swim. I can't push the bike climbs and I have to stay on the road and not push the descents to 50 mph . Finally, I HAVE TO KEEP RUNNING/WALKING during the marathon portion as people continue to pass me in droves. I am expecting to be in a good position after the bike but will probably lose a couple of hours on the run. I have actually had a recurring dream where the starting temp for Ironman is 28 degrees with a 50 mph wind causing huge whitecaps on the lake and making the bike miserable, not for me, though, because I am wearing my ice fishing gear. The advantage is that it takes out all of the really good runners (except my teammates who are fine in my dream). I know that I am disturbed but that is what my sub-conscience is coming up with for race day. In summary, I have to finish this Ironman because Zyler, my family and a bunch of other diabetics will be at the finish line expecting nothing less from me.

Thanks and stay warm (-8 here now before 7pm and dropping fast)

Brian Phelps