Wednesday, May 30, 2012

Historically, Gunnison CO holds one of the largest mountain bike races in the state over Memorial Day weekend. For the past two years, they have added a Gran Fondo road race due, in large part, to their location as a host city to CO’s USA Pro Cycling Challenge. This year, the event promoters and the USA Pro Cycling Challenge teamed up create the KOM Challenge.

So, since my husband had the day off and the kids were itching for something to do, I figured we'd head up to the mountains for a little racing and relaxation....

Traveling with kids is always an event, and more so when the travel involves a four hour drive over a bunch of mountain passes. Midori somehow managed to wrap baby doll in about eight feet of gauze and tape before turning her sights on Henry, all the while chattering non-stop. About every six miles, she inquired if we had arrived in Gunnison.

I remarked that Henry had been traveling quite well, as we'd not heard a peep from him in some time...until we realized that his silence was an indication of motion sickness. Somewhere over Monarch Pass, he began vomiting profusely. Midori took the opportunity to sock him in the gut as he reached gingerly for a vomit receptacle, grasping for her play medical bag. We pulled over at a gas station, hosed off the kids and car, and moved on down the road.

It was about 6:00 on Saturday night when we checked in to a tiny cabin on the outskirts of Gunnison. We made our way to the only veg-friendly establishment in town for a little tofu pho and edamame.

It was seated there, at the Twisted Fork, that I first thought to re-check the forecast. I'd seen it earlier in the week, and they were anticipating a cool morning in the 40s with some light winds. Now, however, it was bitter cold in Gunnison...and I couldn't imagine it would warm up significantly before morning. I was right. The high on Sunday was predicted to be a  mere 52 degrees, and the temperature at the start line was 26 degrees. They were anticipating 30mph cross-winds. I'd brought a base layer for my upper body, but nothing else in terms of cold weather gear. Everything in town was closed, and I had no idea how I was going to ride in freezing temps with what I had on-hand.

I was beginning to get psyched out.

The course itself is rather difficult, and follows the second stage of the USA Pro Cycling Challenge - a steady uphill grade for the first 30 miles, and then the final five miles as the KOM, in what is described as a “grueling finish at the top of Mt. Crested Butte.”  Part of the challenge, however, is simply due to elevation. The ride begins just under about 8000ft., and ends at around 10,000ft.

Added to my concern was the fact that I’d been pretty sick all week long, and my blood sugar was running really high. I was giving myself a lot more insulin, obviously, and I was really nervous about how that would translate to the bike in this kind of tough race. I wasn't sure I was physically well enough to be riding, and certainly not sold on a hard course with tons of wind in freezing temps. I almost bailed…but you know, my $80 check was cashed and I felt like I should get something for it. We'd made it this far...

I didn't sleep at all well that night. Sometime around 3:00 in the morning, I googled the Gunnison Wal-Mart to see what time they opened, figuring I could grab some cold weather essentials before the ride. At 6:00 in the morning, I was the first person in the store, searching for anything to keep me warm enough to ride the 64 mile course. It was slim pickin's. This was the end result:

Super sexy long underpants and tube socks. Note the growl...

I checked my blood sugar at the start, and was 190, which was maybe a bit high but a number with which I was comfortable. We were lead down HWY 135 by police escort after a shotgun start. (Yes, here in the Western half of the state, everything begins with a gunshot.)

All I could think about was the cold for the first few miles. My fingers literally felt like they were going to break. It was awful. Everyone was freezing. Then, after about eight miles, we settled in, and the views were amazing. I felt pretty good, to my surprise, and kept pushing myself harder. That might have been a bit of a miscalculation on my end, since the KOM was just after mile 29. I know a lot of people were really saving their efforts for that stretch…but I didn’t want to have to play catch-up on the ascent, either.

I checked my BGs at the base of the KOM, and was at about 226. I knew the next five and a half miles were going to be an all-out effort, and that my sugars were likely to climb so, in what was a really scary decision, I actually gave myself a small correction. I wasn’t at all convinced it was a smart choice, but I was really afraid of bonking on that ascent. It turned out well. The KOM was insane. I was only 1.8 miles in when I seriously wondered if I would be able to make it to the summit. It was the hardest climb I’ve done in a long, long time. The altitude made it worse, and there were sections where I was literally gasping for air. When I made it to the summit, I was the second woman and the fifth cyclist across the line…but since it’s just that section that matters, I couldn’t decide if that was a good thing. I knew it put me in good position for the finish of the race, but I thought I had my best chance at the KOM, and I knew those behind me had really held back to get a fast time on the ascent. Good news was that my BGs were 119 at the top...and I still had a pocket full of carbs.

The ride back to Gunnison was a super fast downhill sprint with some rollers. It was there that the cold was most miserable. The wind was pretty rough, too. I was tired and ready to be done. I got back with four other male racers nearly an hour ahead of what the promoters had expected for the “first finishers.”  I was really pleased with my performance, and glad I had not changed my mind about doing the race. I was fifth overall and forth for the KOM. In hindsight, if I would have been a bit more strategic and a little less psyched out, I think I could have made the top three. Still, I was glad with the results, especially since there are no categories, and I was racing some people who were a lot more experienced and racing in higher CATs.

I waited around for another two hours for awards. I was sweaty and cold, and now really starting to feel lousy. I made my way to a cafe for a cup of coffee and grabbed the kids some cider. Dennis also took to peeling the gum out of Henry's hair, stuck there by Midori who commanded that he "keep it safe for her until ready to chew again."

I got back to the podium area just in time to hear my name being called, and to claim a sweet Mavic cold weather jacket that would have been useful about four hours earlier.

From there, we walked around Gunnison for a bit longer before deciding that it was pretty much the sixth layer of Dante's Inferno, and electing to bail back to the warmer Front Range, armed with coffee and Dramamine.

Wednesday, May 16, 2012

When you have Diabetes, you get to spend a lot of time visiting your doctor. Every three months, I get to visit the office of my endocrinologist - a woman with a bedside manner so dry it is almost painful for the both of us - and have a blood draw to check my HbA1c (or A1c), which is a measure of my average blood glucose over the prior three months. A typical A1c for a person without diabetes is about 5%. The target is a bit higher for a person with diabetes...though the matter is up for a bit of debate. The American Diabetes Association recommends an A1c target of less than or equal to 7%. The American Association of Clinical Endocrinologists recommends a level of 6.5% or below. I'm pretty conservative when it comes to my diabetes management, so I aim for around 6%.

With all that in mind, I went in last week for yet another visit with Dr. Bland. On the appointed day, I made my way to the check-in desk, where a semi-medical professional conducted a thorough examination of my health insurance ID card, and made me sign a form stating that I have a right to privacy, and they have the right to abduct my first born in the dead of night should I fail to remit payment in a timely manner. I was then left to mill about the waiting room with three or four dozen other patients (several clearly deceased) and old Woman's Day magazines for a period ranging from one to four hours.
Luckily, I managed to find a stack of these to occupy some time.  >>> 

After a really long time (how long, I cannot say), dehydrated and sufficiently demoralized, I was placed in a stark examination room furnished with a plastic chair, a paper-covered examination table and a large, detailed color diagram of the human endocrine system. The semi-medical professional took my blood pressure and checked my pulse, no doubt to ensure I had not gone the way of the patrons in the waiting room. I was then left alone to stare at the diagram and thumb through old issues of TIME. The minutes tick by. Fifteen minutes. Thirty minutes. I begin to wonder if I have been forgotten...

At last, Dr. Bland appeared, obviously in a hurry to ensure other patients were not...uh...kept waiting? The good doctor moved at the speed of a ninja. I got a .016-second pleasantry before she started madly penning things in my chart. I can only imagine what might be contained in that manila folder, but no doubt it has nothing to do with my general awesomeness. Then, with the speed of a kamikaze pilot, she disappeared.

A phlebotomist came in to do the blood draw.  As I sat down in the chair and rolled up my sleeves, the person taking the blood politely inquired, “Which arm would you like me to use?”

Someone else's?

Truthfully, I have never had issues with needles. Even as a kid, I was pretty low-key about the whole business, and having been diabetic for five years now, I'm better still with sharp things and skin. The crappy parts of having diabetes have nothing to do with shots and needles, and everything to do with trying to manage numbers...the numbers we are about to check. It's not about getting stabbed a bazillion times. It's about making sure I can live long and well. Before every check of my A1c, I reflect on the morning I got up and found my blood sugar was sky-high, or all the times on airplanes when I was running over 300, or the time I forgot to correct for a cookie.

With the blood draw done, I checked out and set up another appointment in another 90 days. And then I wait...

Yesterday, my results came in the mail:

Tiny font, you say?

My HbA1c was 5.4%.

That, I might add, trumps my non-'betic better half, who had an HbA1c of 5.6% at his annual physical. In short, my blood sugar is the same as a person without diabetes.

I should point out here that this kind of number may or may not be ideal for all persons with Diabetes. Two studies published in the New England Journal of Medicine looked at the benefits and risk of intensive blood glucose control in persons with Type 2. The results of both studies suggest it may be more harmful than beneficial to target the A1c less than 6.5%, especially if the person with Type 2 has elevated cardiac risk factors (which many do) as attributable to excess weight, hypertension or hypercholesterol. These same studies did not examine persons with Type 1, and it is only intuitive to me that my risk factors for things like heart disease (CVD), peripheral neuropathy, amputations, retinopathy, and kidney disease would be the same as the non-diabetic population with a similar HbA1c.

Really, though, the point of all this is control. No one knows "the magic number," and no one can say when you cross the threshold of "safe."  What I can tell you is that I work really hard to keep my blood sugar as normal as possible. I test often. I eat well. I exercise every damn day, whether I feel like it or not. And the natural result, for me, is normal. I feel good. Plenty of Type 1's strive to lower their A1c, only to swing from high to low...correct...end up high again...send their blood sugar to the basement to try and keep that percentage under a certain predetermined goal... That's not control, either. Control is when you have managed down your risks insofar as practical, and you still feel healthy and fit and empowered and unafraid. It's the place where you are comfortable with your physical being, where you wake most days feeling pretty good, where you are best able to do the things you wish to do with minimal interference from diabetes. It's not about a's about balancing the demands of your life with the demands of staying healthy. I'm there, and it rocks.

Monday, May 14, 2012

It does not matter how slowly you go, as long as you do not stop.Confucius

So, in my mind, Mother's Day would go a bit like this: Wake up around seven or eight, saunter off to Cafe Luna for a vegan brioche and cappuccino, read the paper with my little darlings, and then troll about on the bike (not training, mind you, but playing).

Dennis's version went something like this: Wake wife at the crack of dawn, and pile her and the kids in to the car to go run the Title 9.9k race first thing on a cold, wet morning. Fight our way through scores of women and children to get back in the car and drive home, shower, and then fight our way through crowds at Petra for some homemade tabbouleh and hummus with extra tahini.

Dennis won.

It's not that I didn't want to's just that...well...I didn't want to race. I race every week, and I have traveled every other weekend for the last 90-some days. Add to that six days each week of training and, well, I was thinking I might be due for a little respite. My husband was quick to remind me that I could just run the race without trying to beat times or score some personal best...

But yeah, if you know me or read this blog, you know that's not really how I roll. Everything is a competition - from cleaning the house to making birthday cupcakes for the kids to, yes, getting out of bed and running a race I couldn't care less about doing. So, with that in mind, I was up at 5:00 on Mother's Day, trying to convince myself that I was about to have fun.

Truly, I run about 14-16 miles each week for the purposes of diversifying my training, so a 10k is really no big deal. I do that just about every Monday morning, in fact. It's a little less than an hour of my day...and generally, it's a pretty painless hour. But this particular race on this particular morning was a whole other ball of wax. For starters, it was cold. I mean, really, really cold. And damp. The forecast high for the day was 50, and it was in the lower 40s at the start of the race. Moreover, the course is pretty miserable. It's loose-packed dirt and gravel, with the first 7k all uphill, and then 2k of rollers until a final ascent, followed by about 100 meters of downhill. In the days prior, the rain had turned the whole of the course into mud, save a section of slick rock that was, as implied by the name, slick.

Normally, I take pains to prepare for any race or event....but, you know, this was supposed to be fun. I was not supposed to be taking it seriously. I literally just got up, grabbed a Clif Bar and a cup of coffee and threw on my running clothes. My kids were racing first, so I spent most of the morning readying Henry and Midori.

At 7:15, Midori's race commenced. Five minutes later, Henry was off and running, too. Both kids had good races. Henry had a solid lead through most of his, only to give it up at the end and cross the finish in fourth place. Midori kept a nice even pace, and had a great time. Mostly, she was pleased to receive her Clif Bar prize pack at the finish line, along with a scoop of chocolate ice cream.

About ready to line up for my run, I did one last check of my blood sugar. I had given my meter, strips and lancing device to my husband (he is my race-day sherpa)...which might have been a mistake. Dennis was so busy crowding his pockets with free samples from vendors that he had dropped my poker. I borrowed a pin from Midori's jersey out of necessity.

I like to start a race with a blood glucose around 160-175. I prefer to begin a bit high so that I don't drop too low. Generally, I will reduce my long-acting insulin, and then cut the amount of short-acting insulin I deliver after I eat. In this case, though, I was doing a casual run. I gave myself the full amount of long-acting insulin the night prior, and only slightly reduced my short-acting to cover the Clif Bar. My starting blood glucose was 103. I saw the number, and was instantly worried. I grabbed a handful of Sport Bean packages, and stuffed them in my pockets.

For the first kilometers, I felt pretty good, and pretty competitive. That's right. "Casual run with no personal goal" had morphed into "run as fast and hard as possible because there is no way I am not doing well today." The runners were tightly bunched at the start, but there is a hill series about 2k into the race that separates out the different abilities. This was even more true on the soft, wet dirt. It was like running in sand at times, with mud sticking to my shoes. My calves were tight, but I had a nice, even pace and was settling into the run at a comfortable speed.

Around the fourth kilometer mark, I realized I was low. I have generally poor hypoglycemia awareness when I exercise because activity, in my case, masks the symptoms of low blood sugar. Usually, by the time I feel low, I am really, really low. I reached for my meter....and then realized I had left it with my husband. I sent him a text: "Low." Then I realized he would worry, so I quickly followed it up with, "But ok." In truth, however, I had no idea if I was ok.

There are few things more frightening than being in a situation where you know you are perhaps dangerously hypo, but you have no manner by which to confirm that fact, and no idea how much food you need to ingest to raise your blood sugar. With nothing to do but guess, I crammed two packages of Sport Beans down my gullet, and took advantage of some Gatorade along the route. I struggled through the next mile, trying to figure out how I felt and trying to decide what action I needed to take.
Really, there was this moment when I knew that my head was never in this...that I had not really wanted to be running this race at all in the first place...and that I was now teetering on the edge of calamity. I thought, seriously, about calling it. But my ego has been known to write checks that my body can't cash...and I decided to plod on, and finish this race.

The next few kilometers were spent alternately feeling good and running well, and then feeling awful and trying to regain my stride. I would grab some carbs, then wonder if I had over-corrected...if I was bonking because I was now high. Still, I refused to slow down excepting those moments when my body refused to comply, or where the terrain demanded a more cautious pace. Really, by the time I had a mile or so left, I was running just to be done. I found myself pushing harder because I wanted to cross the finish sooner rather than later.

By the end, I could see runners stretching both in front of me and behind....and I had no sense of where I was in the pack. I decided that, so long as I finished in the top half, I would make peace with it. I had not run well, and I certainly felt slow.

I crossed the finish line to see my husband and kids shouting and waving. My husband noted, clearly, that I was looking rather shabby. "Rough run, honey?" My children seemed not to notice...they just like to see mom run...and were quick to toss their tiny arms about my tired legs. I grabbed my meter, and finally tested. Sure enough, I had over compensated for the low, and ended with a blood sugar at 259. I walked to the finisher tent to check my results, bracing myself for the worst. To my surprise, it was not as bad as I had feared. My average pace was 8:48. I was 498th of 2176, and ended up 46th in my age group. All things considered, I was pleased with the result.

I went home and grabbed a quick shower, and headed out to lunch with friends. We met up with our old real estate agent and her family, and had a delightful meal among good company at a Turkish restaurant near our home. Later that afternoon, I took Midori out on her bike for her first real road ride. I was pleased to see how well she controls her bike. She's got a good wheel.

In all, it was not my idea of a fabulous Mother's Day nor was it a fantastic race. Still, it was a good reminder that, no matter the extent to which I swear diabetes will not impact the things I do, it has it's place at the table.

Wednesday, May 9, 2012

Word to your mother! That's's nearly Mother's Day!

In her day, my mother had many bits of wisdom that she imparted our way. Specifically, 1) if you are going to kill one another, you should do it outside so as to keep the kitchen tidy, and 2) you should never leave the house without first going to the bathroom. There was something in there, too, about running with knives...

I admit that my advice to my own kids might not be a whole lot better, despite my best attempts at this mothering gig. I have a lot of shortcomings. If you came in to my home right now, for example, you'd likely find that the bathroom needs cleaned and that there is a heap of dollies in the bottom of the tub having some kind of orgy near the drain. There are scraps of Band-Aids everywhere because my kids have it in their heads that any injury is Band-Aid worthy. My daughter also likes to play doctor, and plaster her brother with athletic tape. It's just the dynamic here, yo. And recently, my husband purged our home of all the picture books without words, because I kept making up stories like, "Plastic Bag Space Helmet and Other Fun Activities," and "The Day Mr. Fork and Ms. Electrical Outlet Became Friends."

Of course, I take comfort in the fact that I am a better mother than this woman:

Unless you've been in a spider hole somewhere, you've no doubt heard about this lady, who was charged with putting her badly burned 6-year old in a tanning bed. Clearly, she  is innocent. It's totally apparent that she was simply trying to uphold a family resemblance. I mean, if you were this woman's daughter, wouldn't you want to be just like her when you grew up?

...I digress...

Generally, I don't celebrate Mother's Day. In part, it's because I am afraid someone will buy me something like this:

Nothing like infuriating and confounding your birth-giver all at the same time.

But the primary reason is because, yes, I know I am loved and appreciated. I know that, despite my shortcomings, my children are still young enough to think that I know what I am doing, that I am generally right most of the time, and that their mother is pretty cool. (That will all change in time, I expect.) My husband has willingly and without complaint assumed the domestic duties while I travel with my bike, and my kids have been on the sidelines of more than a few races, cheering on their mother no matter where I am in the pack.

So, unlike the scores of moms waiting in line for bad service at family-friendly restaurants, or inundated with flowers requiring some kind of care that will no doubt be neglected among the myriad of more pressing maternal obligations, I will be on my bike with my favorite cycling partners, going for a nice, long ride. In fact, I am glad to just be home with them this weekend. Despite having a good time racing and riding, I've been missing my family.

And I am glad that they are mine, because it could be a whole lot worse...

Monday, May 7, 2012

For whatever reason, I had an extra special weekend of love from the TSA. They not only performed the usual screening when I was in Denver, but I got the extra special GATE screening that delayed my flight for a good 45 minutes. Then, I got the pleasure of having a burly woman with man-hands pat me down in Sacramento because she saw me give myself a shot of insulin. I don't know about you, but I feel safer already! In honor of the good works undertaken by the TSA, I thought I would issue the following sentiment for the commoners out there who might whine about a few pithy infringements on civil liberties and good common sense at the expense of our national security. To wit....

Dear TSA-Averse Airplane Travelers:

Admittedly, being patted down on your travels by an uniformed officer - perhaps whilst partially undressed, shoeless, beltless and devoid of personal dignity - in front of several long lines of total strangers might produce a sense of discomfort. Remember, though, that it is an experience far more unpleasant for the poor, dejected TSA officials doing the full-body grope.

Sure, you lament that they confiscate your holiday cupcakes because the frosting is close enough to a "gel like substance" to pose a threat. And yes, that bike box containing a velo worth more than your car - the one you meticulously packed the night before - will need to be cracked open, thoroughly inspected, and then thrown carelessly back into the case by an agent with the spatial reasoning of the average two year old, rendering him unable to close said box and leaving your fork sticking out the back as you, in your wing seat aboard the plane, watch in horror while the baggage handler tosses it in with the rest of the cargo like a sack of flour. And grandma in her wheelchair will have to find the strength to stand so the TSA can make sure there's nothing in those Depends but, well, Grandma. But you, the person doing the complaining,  have one of those cushy jobs, like being a neurosurgeon, or piloting a fighter plane, or fighting fires.  In order to keep their jobs, the agents of the TSA have been forced to cop a feel of your saddlebags, muffin tops, bat wings, and back fat as they graze their fingers through your rolls of pudge. Not just once, either, but hundreds of times a day.

The TSA is not trying to rub anyone the wrong way. It's their job to grab your junk. They are our last line of defense. If the FBI, CIA, Interpol and the entire US military fail us, who is going to be there on the front lines to ensure that your Dr Pepper is really just a Dr Pepper, and not an incendiary device that will take down a whole plane of passengers? That's right. The guys in the blue shirts with a high school education. Armed with their bins and your shoes, they are the last hope in detecting a terrorist plot.

So, when they take you into a little room...all alone...and snap on those blue gloves and tell you how they are going to touch you, you shouldn't feel the least bit uncomfortable. It is far more painful for them than you.


Just yesterday I was in line for the porno-screeners at the Security Check in The Sacramento International Airport. I had literally gotten off my bike a few hours earlier, wolfed down a bagel and a three ounce package of Justin's Nut Butter (because, you know, it could be really super deadly to fly with a four ounce package), and had mere minutes to board my plane. I did a quick blood sugar check and - uh oh - I was high. Too high to enjoy my day-after-Cinco-de-Mayo in flight cerveza and complimentary pretzels. Armed with some rapid-acting insulin, though, I gave myself a couple of units and was ready to enter the phone booth for a quick invasion of my privacy.

What do you know? TSA was "Johnny on the Spot." They saw that insulin pen in the pocket of my sweat-stained jersey and thought, "Here she is...all clad in unflattering spandex...wearing a medical alert bracelet and shooting something in line.... This needs some further investigation." Of course, they can't just take my word that I am a diabetic. They need to confirm that I'm not plotting to bring down a plane using Apidra.

So, they kindly took me to a little holding pen where I was seated next to an elderly woman in a wheelchair. She looked pretty suspicious, too. Kind of like Barbara Bush. I would have given her a thorough once-over myself were I not so confident in the TSA's ability to manage the job at hand. When I asked why I was being detained, I was told that they were looking for a female TSA agent to come help me. Thank goodness! It's hard work carrying all this luggage to the gate... oh, wait.

So, the woman arrives (though you'd have hardly known the difference between she and her male, we're really splitting hairs here). They escort me to a private room, and then get all romantical. She tells me what she is going to do with the back of her hand and the front of her hand... She was pretty thorough, too. I mean, I'd only had a physical a few weeks earlier, and the woman put my doctor to shame. My husband and I are going to have some things we need to work through in marital counseling, too.

But before you start feeling pangs of sympathy for me, imagine the role of the TSA agent. Imagine her using those rubber gloves to grapple my sweat-stained bike shorts, inhaling the scent of my post-ride BO. Really, who had it worse?