People like to talk about themselves, and I like a good story. It's easy to relate when you are also in the club. So, with our common ground established, I chatter away. (I try not to do this on ascents, because people do get a tad bent out of shape puffing uphill as I am asking them to explain their glucose management strategy. Not cool.)
I showed up for the Tour de Cure Spring Cycle event last Saturday, all set for a nice, mellow day on the bike among good friends - including those participants not yet aware they were about to become my buddy along the way. I got my business card with my route assignments (thanks, Tami, for the organizational prowess that is the envy of every Franklin Covey seminar attendee), and made my way to go find some water.
As I was walking past the registration table, I caught a woman in a Red Rider jersey telling a group that she tried to ride the 30 mile route at the Tour two years prior, and her blood sugar had dropped so low that it had scared her. She went on to explain that she had asked other people how to manage the BGs on a ride, but no one really knew, and no matter what she tried, it didn't seem to work as planned. Frustrated, she had decided to never again do another Tour de Cure event...but she liked the idea of the ride, so she had chosen instead to volunteer at her work and organize a corporate team, and to work on a Tour committee to help produce the event.
This woman is so dedicated to the idea of using cycling as a conduit to controlling diabetes and remaining healthy and active that she has organized her co-workers to do the ride and dedicated countless hours of her personal time to make sure the Tour happens as planned...but she is not actually going to cycle the event because she is not sure how to manage her blood sugar?
So, you see, I have no choice but to rudely invite myself into her discussion, and give her the tools to do this thing that she wants to do, but has decided she cannot do...but I know otherwise. (I know, I know. Run-on sentence. Focus on content, kids.)
Of course, I have no idea what she needs to do to keep from going low because, as every diabetic knows, there is no "one-size fits all" answer. What I do know is that there are some generalities: turn down your basal insulin or reduce your long-acting, bolus less or not at all within a few hours of getting on the bike, ingest about 20g of carbs every half hour or so...
But that is not what she needs, anyway. She doesn't need a tutorial in diabetes management over 30 miles on a bike. She needs someone to tell her not to be afraid. She needs to know that she can be the Chief Executive Officer of her body and her diabetes - that, with a good strategy in place, she can control what happens on the bike. She needs someone to tell her it's not only possible, but possible for her. And I am all over possibility.
We talked at some length. It turns out, she was suspending her basal insulin on the pump right before hopping on her bike. The insulin she is using has a four hour tail on it, so hitting 'suspend' right before riding isn't really helping her over those 30 miles because all that insulin is still going to be in her body, doing its job. She needs to start turning down her pump hours earlier. (This, by the way, is why I don't pump. I workout at four in the morning, so I'd be up in the middle of the night, turning down my freaking D technology...but that is a topic for another blog post.) Moreover, though, she was really fearful. She was afraid of dehydration, so she was drinking copious amounts of electrolyte solutions...afraid of going low so she was eating constantly until she was too high to get on the bike...afraid of going too high so she wasn't reducing her insulin enough to prevent her from dropping... She was just scared.
I remember hearing about fear right after I was diagnosed. I was at another Tour cycling event, but as a participant. Seated next to me on a bike was a woman wearing an insulin pump, who told me that she was not very active as a child because she was afraid, always, of exercising with diabetes. That has stayed with me all these years because it seemed strange to me, the newly diagnosed adult, who did not fully grasp the severity of this disease. Unlike most people when diagnosed, I had a kind of blissful ignorance about the illness. I knew and understood it in a clinical context...but my own experience with diabetes was rooted in observations of my healthy, active and fearless grandmother who managed diabetes in a manner almost nonchalant. I now know that she did worry about the repercussions to her health but, as a young child, managing her blood sugar seemed a natural part of her daily routine. Uneventful. Almost unimportant.
It's hard for me to imagine that kind of fear. It's tough for me to envision being held back because you doubt your own sense of control. I didn't just want this woman to get on her bike, I wanted her to do it in a spirit of agency: I am in charge of this. I have the knowledge and the power and the strength to do those things important to me...not in spite of having diabetes, but with diabetes as a part of my process.
I am short on inspiration, but I am long on talking. I gave her ideas, and I reassured her that we are all in this together. There was a room full of Red jerseys, all of whom were going to do the very thing she decided was unattainable. We'll do it together...pedaling up the same hills, with me talking on the right hand side of some unsuspecting 'betic.
I departed for my ride. When I got back, I gave her the business card Tami had provided me for my route duties, with my cell number scrawled on the lower left corner.
Call me. We'll do it. We'll figure it out, get a strategy in place so you can feel confident, and you can ride with the team you created. Because that is how it should be. And I swear, I will not ask you any questions while we are going uphill.