Diversifying Exercise (and a Larry Bird)

I’ve been clawing my way out of an exercise funk that started around the first of the year. It’s been a terrible fight so far, and full of speed bumps.

About eight weeks ago I started getting back to the YMCA for basketball. About six weeks ago I twisted my ankle while playing. The worst sprain in a long time. For the record, these injuries usually need a minimum of six weeks to heal, but like an idiot I started playing ball again in just a week and a half.

All was well though a little sore and tender, until about three weeks ago when I twisted the same ankle again.

I was SO frustrated. Partially at myself for rushing my injury, and partially at another disruption in my exercise — just as I was starting to get my wind back.

Cringing in pain and laying on the gym floor I started thinking about diversifying my exercise. I decided that I needed to find some backup exercises to mix in with the basketball, and to lean on when I couldn’t play ball.

I did the cycling thing last spring, and it went very well. I never felt better than when I was doing my bike training and playing basketball. But there were some challenges here. Spring hasn’t sprung here yet, so no outside cycling (I’m not that hardcore), and I sold the trainer that I used last year when we moved recently (I very recently found myself another dirt cheap spin bike I can use indoors).

photoI’ve also been inspired by a bunch of people to try running. With a lot of travel on my schedule this year, I figured it would be a good option. So I ordered some crazy colored shoes (hat-tip to Brian). They arrived on April 10th. April 11th it snowed. A lot.

It started to warm up, the snow melted, then BAM! Another snowstorm the following week, then another tease of warm weather, and yet another dump of snow. It has been the craziest “spring” I can remember.

All of this means that I’ve been too chicken to brave the elements and go outside to start running.

I made it back to the gym for basketball this week, again probably rushing my ankle injury, but I’m armed with some better shoes and an ankle brace. I feel like I’m starting to get my wind back again, and my legs aren’t complete jelly on the court anymore.

I couldn’t play ball today, but as fate would have it I picked up an awesome treadmill that was being orphaned by a relative. I managed to move it out, load it up AND move it into my place all by myself (“Hercules! Hercules!“).

After my entire family played on it broke it in, I strapped on my new kicks and jumped on for my first run of the decade.

I did really well in my opinion. I had the timer on the treadmill counting down from 40-minutes. I was shooting for a 10-minute warmup walk followed by 15-minutes of running, 5-minutes of walking, then an attempt at another 10-minutes of running.

Everything went great until I had 8-minutes left. I didn’t feel like I could push through. I thought I might be low, but couldn’t tell. I did the smart thing. I stopped and tested my blood sugar.

33 mg/dl.

After thinking of Kerri and her love for all things 33, I got scared. I wolfed down pretty much anything and everything I could find. I was a bit freaked out.

Yep, spooning it right out of the jar.

Yep, spooning it right out of the jar.

Once I had my wits about me I wondered what my Dexcom had to say.

My Dexcom is anti-exercise

My Dexcom is anti-exercise

I have never been able to rely on my CGM (any brand, any model) during exercise. Doesn’t matter if I’m cycling, playing basketball, or apparently running, it’s woefully late to the party and often times wildly inaccurate (trends and numbers).

In fact, most days it takes a couple of hours after I’m done playing basketball for it to sync up with my actual blood sugars.

Why is that? I don’t understand?

I sure could have used a “heads-up” tonight. 33 mg/dl while exercising doesn’t leave much room between being fine and being dead…

I Passed Out

December 24, 2012. Christmas Eve day.

I felt blessed to get in a couple hours of basketball, even on a holiday.  We played hard. I had a lot of fun and wore myself out quickly. Blood sugars were pretty normal for most of the session, with a slight spike as I was finishing.

We got cleaned up and headed out to lunch — a normal routine I have with a few buddies at the gym. Before leaving I tested my blood sugar again and was surprised by a very high reading. So high that it didn’t fit the pattern, but I didn’t think twice about it.  I took a correction bolus and my lunch bolus, wanting to give my insulin a head start on my meal. Especially since I was so high.

About forty minutes later I had my food in front of me and started eating.  I got halfway through my sandwich (a grilled cheese, of course) and a wave of nausea hit me hard. I got up and headed to the bathroom, convinced I was going to lose my lunch.

I felt off as I walked to the bathroom. By the time I got to the front hallway I lost all logic and couldn’t read the signs to figure out which bathroom was which.  Stumbling through the hall and bouncing off of the walls, I pushed through the front door of the restaurant and reached for an outside wall.

That’s all I remember.

I woke to the sound of approaching sirens and my friends calling my name. I was sitting against the outside wall. There was a glass of orange juice. I drank it and asked for another. Coming back now. Help was on the way.

I was embarrassed and confused but knew it was low blood sugar. I was back enough to test myself; 69 mg/dl.

View from inside an ambulance

Ever seen an ambulance from the inside?

A fire truck and a police car pulled in, sirens blaring.  They asked about my blood sugar reading and gave me a tube of glucose gel.  The ambulance pulled up and I was able to get up and climb aboard.

They tested me a couple more times and I was coming back up.  I was fully back now and able to answer all of the questions (name, (new) address, doctor, etc).

I had another glass of juice and some glucose tabs while I sat with them.

A bit later my friends drove me home and I tried to understand what happened.  Was that high reading inaccurate? Possible, I guess. I also think my insulin was accelerated by the recent exercise and started working much faster than normal. Maybe it was a combination of both? Who knows.

What really rattles me is that I didn’t have any warning. By the time the nausea hit me, it was already too late. This low ran me over before I had a chance to see it coming. The CGM had no chance either, and it’s usually a little bit wonky right after exercise anyway.

Until this event, I’ve had no trouble with hypoglycemia unawareness. Time (and frequent testing) will tell if it’s something I need to watch out for.  Heck, we all need to watch out for it, right?

This is the first time I’ve needed help with a low while awake since Jr. high school (1987?).

I thought I was doing everything right. Only the benefit of hindsight shows what I did wrong. I should have double-checked that high reading, and I should have waited on my insulin. The speed and ferocity the price of my mistake exacted on me is terrifying.

After a week of sitting on this experience, I’m feeling a bit better.  But I’d by lying if I said I wasn’t psychologically shaken by this event. I’m a mess, mentally, and my wife won’t let me out of her sight if she can help it.

I need to share that this can happen. Diabetes is dangerous. If this can happen to me it can happen to any of us. If you think you’re exempt from the dangers of low blood sugars, if you think you’re so on top of everything that it will never happen, I have news for you…

Please be careful out there. The tiger is always on the prowl, sometimes just because he’s in the mood for a snack.

Can you have a pet tiger? Sure. So long as you feed it well, groom it, and never turn your back on it, you can co-exist with a tiger in your living room. But if you neglect the tiger, starve it, turn your back on it, the tiger will pounce on you and tear you to shreds. Diabetes is the tiger. Feed it right. Take care of it right. And the two of you will live just fine together.” — Wil Dubois, Taming the Tiger


Baggies & Sugar Cubes

Anyone else remember when treating a low involved sugar cubes or tubes of cake frosting?

Options, gotta love options

Good old sugar cubes, and other, more up-to-date, choices for treating lows.

Have you ever had a tube of cake frosting break open in your pocket?  Or tried to carry around a baggie full of white powder that started off as a bunch of sugar cubes?

I’m thankful that today’s options travel well and are easier to carry.

Confessions: Late Night Low

Sweet Dreams

It was not about the safest, smartest, most precise way to treat this low. This was all about what would be more fun to eat.

One of my greatest struggles is low blood sugars and the strong urges that come with them. The lows at night are the hardest. Low blood sugars are medical events that should be treated as such with medicine (glucose tabs, etc). Not Reese’s Puffs cereal.

But I can’t often separate the medical event I’m in from the primal urge to eat food. Especially when I’ve been avoiding treats and the like.

During this low I observed my brain evaluating options and settling stubbornly on which option would bring my taste buds the most pleasure. I felt powerless to assert my will on the situation.

Maybe that is because it’s 12:54 AM.

Sloppy Evenings, Low Blood Sugars, Guilt, and Fear

This has been an active week for me. It feels good. My body feels good.

Four days of basketball, with one seriously kick ass weight session afterward. Four days of tossing a football around with my son and shooting baskets with my daughter. One short bike ride back home after taking my old pickup truck to the repair shop.

As far as exercise, I’m doing it. And it feels good.

But I get sloppy in the evenings. High carb foods combined with estimated carb counts and ballpark boluses PLUS a lot of exercise and activity equals an evening full of lows that leave me feeling fat, guilty, foolish, frustrated, helpless, stupid, and scared.

The first low blood sugar I treat with glucose tabs. But because I’ve been so sloppy with my insulin dose, they are not enough to do the trick. So I have food.

But then I worry about having over-treated, and I’m sure I’ll be sky high later. So I toss a little more insulin into the mix. You know, to balance it all out.

My blood sugar never crawls above 96 mg/dl (5.3 mmol/L), but because I’ve got all of that insulin working, it’s not long before I’m low again. I’m full, and the last thing I want to do is eat more. But I’m low (again) too, so I eat. Glucose tabs, wait, regular soda, wait. Doritos then ice cream. That should do it. That is enough to fix all of the low blood sugars of the DOC combined!

As I come to my senses, I start thinking about the doritos and ice cream. Slow food. Fatty food. So I program some insulin to be slowly delivered over the next 4-5 hours to help curb the rebound high that is sure to happen. My CGM is all confused, reading just enough lower than my blood sugar to trigger the unchangeable 55 mg/dl (3.0 mmol/L) alert over and over again. Not wanting to be pestered by false low BG alerts as I try to fall asleep, I turn it off.

But I can’t sleep. I start thinking about my daughter lying next to me, and those that we’ve lost overnight, and start praying that tonight is not my night. That I wouldn’t want her to be the one to find me, cold and grey and gone.

What the fuck. Am I losing it? Something not right. Something nagging at me. God told me to check my blood sugar.

No rebound high. More low. Ironically, it is 55 mg/dl (3.0 mmol/L). Right where my CGM had me pegged before I shut if off.

I’m still full. I’m sleepy, but with a weird adrenaline edge to it. I’m jittery and exhausted.

I’ve packed in a fourth dinner and really don’t care how high my blood sugar will be when I wake up. My stomach is bloated enough to push doors open before I walk through them. I feel miserable.

My activity level and sloppy insulin dosing led to a world of trouble tonight, and I know better. There is a lot of guilt and frustration I’m dealing with, because I know better. But I need to let it go. It is not my fault. My pancreas is broken, and our very best attempt is still not as good as the real thing.

I need to try and remember that my activity level does not grant me a free pass to eat less responsibly. In fact, with diabetes, it probably requires MORE attention and precision, more thought and planning for the rest of the day and night.

If I would have simply done a better job of counting carbs for dinner, this spiral of crap would have been much less crappy.

Even though I’ve had all of this trouble tonight, I have every intention of exercising again tomorrow. I’m also going to try my best to be smarter about my actions after exercising. That’s where it all comes together. Even if I can’t get it perfect, it will surely be closer than I got tonight.

Cops and Low Blood Sugars

Last week I was at one of the local type 1 meet-ups.  We were at a Caribou Coffee, and I noticed a couple of cops there having coffee.  I say “cops” in a general way.  Technically, I think they were Ramsey County Sheriffs.  But you know, uniform, badge, gun, bullet-proof vest bulging underneath the shirt. The term “cop” works for me.  No, they were not having donuts.

I approached them, apologized for interrupting, and asked if they had ever dealt with traffic stops involving diabetes and low blood sugars.  They had.  I asked what helps them determine it is a low blood sugar (or other medical event) rather than intoxication?

The male officer started to reply, but had a lot of trouble trying to assign words and language to the complicated “decision tree” process they instinctively fly through during an encounter.  He said that there are usually other signs or clues present when dealing with someone who is high on something.  The smell of booze, bloodshot eyes, stuff like that.  But it was clear to me that there is a lot that goes into that on-the-spot decision making, and not all of it can be clearly verbalized without careful thought.

The female officer said that one of their routine questions, when someone is acting unusual, is about medical conditions and needing help. All of the PWD’s that she has encountered have been able to respond positively to this sort of question, which then helps the officers start down a different troubleshooting angle (rather than trying to determine “friend or foe”).

I asked them if they encounter lows on the road often?  They said maybe 2-3 times each year.

This was no statistical measure of course, just casual conversation in a coffee shop.  But I left thinking that 2-3 times each year is not that much.

A couple of days later I was talking to my dad about it, and his reaction was different (and much more logical than mine).  He figured that if these two officers encountered a few low blood sugar related driving incidents per year, that it must happen pretty often! How many lows did their department as a whole encounter?  2-3 events per officer times how many officers in the department?

Of course it wasn’t a hard and fast record, and of course not every officer would encounter as many, but some might encounter more.  Any way you count it, ANY low blood sugar related incident is one too many.

It would sure be interesting to collect some figures around diabetes related law enforcement events for different areas.  I wonder what it would take to do something like that?

It’s Amazing Really…

I had a low blood sugar.  I’m recovering and am starting to feel better.  I exercised incredible restraint in how I treated it, but still managed to eat at least two full meals worth of stuff.

While vacuuming down all of this food, I kept saying “Hang tight Scott, you don’t need much”.  That kept me from going ape shit and eating everything I wanted to, but it was a LOT of work.

How can a person feel so… hungry?  But “hungry” isn’t really the right word for it, is it?  Because it is not a hunger that comes from your stomach.  It is coming from somewhere else, and it is powerful.


As I sit here typing this, my stomach is all bloated, and I feel pretty miserable.  Not to mention wiped out from the low (thankfully sleep is right around the corner).  I have a gross taste in my mouth from all of the mish-mash stuff I ate (none of the things “go together”), and I’m a bit sick thinking about all that varied stuff in my stomach.  Like, handfuls of dry breakfast cereal do NOT go well with Velveeta cheese sandwiches dipped in ketchup.

It is absolutely mind blowing to me just how strong the urges to eat are when I’m dealing with a low.  It is like there is no stopping them.  I am in AWE of folks who can treat smartly and wait to feel better.

I’ve talked about this so many times before. Why is it such an issue for me?  Is it just me?  Logically I know that I will be fine with just a little bit of stuff (glucose tablets, juice, food, whatever).  Physically I think I am going to die in the next 3 minutes if I don’t cram more food in my mouth.  Even when my brain is screaming “NO, NO, NO!!”, it is damn near impossible to slow it down.

How many of you out there can treat smart and wait?  How many of you might be more like me, and can’t stop the urges to eat?  Please let us know, and if you are in the “treat smart & wait” crowd, what’s your secret?

Medic Alert Feedback and What Can We Do?

Since my dLife article hit the page I have been getting e-mail after e-mail about people who have had their medic alert jewelry completely ignored, or reports of their loved ones being put in harms way due to their information being ignored, even when very clearly displayed.

It scares the crap out of me.

How can we protect ourselves?  How can we be sure that we won’t be put in harms way by the very people we are depending on to save us?

We have a lot of scenarios to think about.

1) We are unconscious – in this case I don’t know what more we can do besides wear our medic alert type jewelry or tattoo, and pray that we’ll be able to communicate when we wake up.

2) We are pulled over while driving – This is what happened to the poor chap I wrote about (video from CNN).  In his case his medic alert jewelry was not visible, which is a very likely situation for many of us (I wear my own necklace under my shirt, just like he did).  To help this I ordered some stickers (from D.A.D. Innovations (site/link currently not working properly)) and applied them to a couple strategic places on my car (remember that your driver side front window may very well be rolled down to speak with the officer right?).

Picture of my car with two "Diabetic Driver" stickers on it


3) But what if I’m not in my car.  This is perhaps the most troubling scenario — where you are just acting downright nuts, unable to communicate that you need help.  Amy Tenderich at DiabetesMine.com covered a lot of ground with her posts about Doug Burns back in April of 2007.  She even started a huge dialogue about coming up with some “code word” that would be universally recognized and inform responders that we need help!

We have a tough problem to solve here.  There is a real conflict between our right to privacy and our possible need to let the world know we are diabetic when we’re unable to communicate for ourselves.

I’m sure there are many of you reading that would be quite uncomfortable putting stickers on your car, or wearing medic alert jewelry, broadcasting to anyone who can read that you are diabetic.  It is a very valid concern for those that don’t wish to be identified!

I guess I’d rather be identified at a glance than be blasted with a taser gun (or worse…).  But that’s just me, and I’m pretty “out there” with my diabetes anyway.

How can we protect ourselves?

This is a real problem that could make anyone who solves it both a hero and an instant millionaire.

Do you procrastinate too?

I had a really mild (which I define as a very slow moving, just barely below normal BG’s) low blood sugar tonight as I was juggling dinner items in and out of the microwave for dinner.

I grabbed a few handfuls of Cinnamon Toast Crunch cereal.  As I ate the cereal I was thinking that even that was probably a bit more than I needed to treat the low.  It would get me back up to normal (plus some) as I waited for my Pasta Roni to cool off.

Picture of a box of Little Debbie "Cosmic Brownies"But, almost on autopilot, I went to the cupboard and grabbed one of those evil Little Debbie “Cosmic Brownies”.

Did you know that one little package has 43 grams of carbs?!  Zonkers!  That’s about, well, 43 times more than what I needed (remember, I already ate the cereal)!

But, I wasn’t thinking like that.  I was thinking about how panicky I felt, and how satisfying and reassuring it would be to chomp down that brownie.  I knew it would be overkill, and as I was fingering the edge of the wrapper, ready to tear down right where the seams come together, I thought “you don’t need this”, and “put it back, it’s to much”, and “what about working on not panicking?”, and “remember the helicopter“.

“Next time”.  As in “I’ll work on it next time”.

Not this time.  Because I just wanted to feel better.  It wasn’t about that brownie, because I really don’t like them.  It was about the urge to eat until I felt better, because I was, at some  primitive level, scared and fighting to survive.

Except that in many cases it is really not that serious!  I felt the low, I treated the low.  I ignored the opportunity to practice control simply because I didn’t want to deal with doing the work right then.

At that moment, for that decision, it was all about working on self improvement later.  Much later.

Good Intentions

Boxes of Pasta Roni & Rice RoniIt started with a mobile Symlin bolus (a symlin dose delivered via pump while driving) on the way home from work.

I was hungry for dinner and I wanted to eat soon after getting home.  My wife has been graciously helping me with dinner (one of my trouble spots) and was cooking a portioned serving (a.k.a. “box”) of pasta roni fettuccine alfredo for me.  Yes, far from gourmet, but the carb count is clearly labeled.  That counts for a lot in my book.

Similar to traditional insulin dosing, Symlin is best delivered a bit before the meal.  I’ve been aiming for 15-20 minutes pre-meal when I can.  Since my I had about 10-15 minutes left in my commute, I figured the timing would be perfect.

But as I got home and made my way to the dining room table I was feeling the tell-tale symptoms of a low blood sugar.  56 mg/dl.  Damn.  I must have had some phantom insulin on board from a late lunch bolus.  Symlin and insulin on board do not mix well (nod to Bernard for this info).

I had to treat the low with something much faster than fettuccine alfredo, so I had a couple rolls of smarties and reeling from low starvation I nabbed a couple small squares of luke warm pizza that the kids had.

I sat down and started eating my pasta.  Not more than three or four bites into it and I was hit with the post-low exhaustion that sometimes happens.  I was wrecked.  That low really took it out of me.  I was very much not interested in finishing my plate.  I think this was a combination of feeling run over by the low and the Symlin doing its thing with my appetite.

I was suddenly quite frustrated and emotional.  I didn’t have any simple way to figure out how many carbs I had eaten between the partial pasta dish and the pizza.  I think the pizza was nominal – less than half of a typical thin crust slice.  The main goal of eating some crappy boxed pasta dish was to have a (fairly) accurate carb count, and now I didn’t even have that anymore.  I had to guess, and I got it wrong.

I woke up the next morning with a 200 mg/dl blood sugar, and felt a bit upset that I had probably been sitting at 200 mg/dl all night long.  Highs overnight are a sure way to ratchet up that A1C.

As I reflected about the night before it struck me that I had nothing but good intentions with that Symlin bolus.  But rather than help things, it set off a slight chain reaction that worked its way to a 200 mg/dl blood sugar for a solid eight hours overnight.   I just wanted good blood sugars.

That thought ran a bit and I thought about how each and every one of us has good intentions in regards to our diabetes management efforts.  I don’t know a single one of us that willingly runs out of control.  We all try very hard, but maybe run into challenging scenarios that we haven’t figured out yet.  Sometimes it seems hard to muster up the energy necessary to figure out those challenges.  Sometimes despite our good intentions we can’t seem to get that A1C where we want it, or successfully manage an intense work out without a low blood sugar, or whatever.

Our good intentions do count for something, and our resolve to keep working towards the good is critically important.