Diabetes in the Workplace and School

Let's face facts: We do not introduce ourselves to others as we should. It's normal to hide diabetes. It's a little embarrassing and a lot weird. I hid my diabetes for years, until it was too late and I ended up in the emergency room. Don't make the same mistakes.

In 1981, I had the worst insulin reaction ever. I was working as a summer employee at Kodak in Rochester, NY, and I made a few cardinal mistakes that fateful day. I woke up late, gave myself a rushed injection of insulin, and headed out the door with no breakfast or food. I was so rattled I did not realize what was about to happen. Later that morning, I was sitting down, shaking and barely able to speak. I vaguely remember a few co-workers asking me if I was okay, and I think I mumbled yes. Somehow, I was able to walk to the cafeteria, get in line for food, and by the time I was at the register I collapsed on the floor and rushed to the emergency room. A few days later, my mother had to intervene because my supervisor was concerned about my driving the mail route at work. I was transferred to a walking route. I was not fired. I was okay. But it could have been avoided. I was dumb. I was 20 years old, and I did not take seriously my responsibilities as someone with diabetes.

A few key take-aways: 1) TELL your supervisor, co-workers and everyone close to you that you have type-1 diabetes. Don't be shy. They will not judge you, and they will understand; they will not feel sorry for you, and they could help save your life. 2) ALWAYS CARRY some fast-acting GLUCOSE with you. Since that fateful day, I always have both glucose tablets in my pocket and a gel-pack in my backpack. If you are unable to check your blood-sugar and feel weird (sweating, unable to think straight, heart palpitations, etc.), eat the glucose with some water right away. Better to have your blood sugar run temporarily high, if you're unsure, than to crash low. 3) Keep glucose or carb-rich snacks in plain site for others. My wife is a master at spotting lows in me. She tells me to sit down (which, in my stuporous-state, often leads to arguing or even yelling from me! Who am I when my blood -sugar runs low?) and she faithfully gets me some fruit juice. Minutes later, I am usually back to my "normal" self.

Remember, YOU ARE A PERSON WITH DIABETES, not a diabetic. Stay strong, stay healthy, and check your blood sugar regularly.

The Devolving Human

For me, running is one of the best ways to stave off the inevitable: We are, as a species, devolving quickly into globular blobs. We spent way too much time in front of TV or computer screens, or behind the steering wheel of an automobile.

Today's Wall Street Journal article, titled "Why Evolution Is Making Us Fatter" explains it all. The science suggests that despite the recent increases in humans spending time sitting, the body is going through a separate evolutionary process that makes us less mobile. That is a terrifying idea.

I am convinced that if we rise up off "the couch of doom" (thank you Steve Runner!), we can live a better and healthier life. Evolution may have other plans for us, but we do not need to look like the adults in the movie "Wall-E" in the process.

My 4-mile run this morning was terrific. Blood sugar pre-run was 137; post was 72. One hour after breakfast 128. Stay safe out there, run long, and check your blood sugars.

The Return Of Uncle Chubby

Okay, so I am not overweight. And I do not want to get obsessive about a few pounds. But what the heck? I'm running 20-25 miles a week, with 10 mile long-runs, and my weight is going the wrong way! I cannot figure it out. Ultimately, I would like drop five pounds by race day (April 3), to increase speed and lower the strain on my hips and knees. Will Girl Scout cookies ever go away? Will I be able to resist the large scoop of peanut butter? And can I actual "just say no" to the nightly work-week glass of wine (not unless work gets a lot less stressful . . . hello, large bequest needed!). These are my challenges. I will strive to drink more water to quell the hunger and get the double benefit of staying hydrated. I will eat more fruits and vegetables. I will get more sleep. And, I will reveal my results within. Wish me luck. Run long, and check your blood sugars. [You can see my running stats at www.buckeyeoutdoors.com and look for the username runrobrun]

Work stress and running

This was a fractured week. I got my 4 miles in on Monday, but then my left knee felt weird. Then I traveled to Arlington, where the snow is still high and the trails covered in ice and snow and, hence, unsafe for running. I could have brought my Yak-Traks, but given the uncertainty surrounding my knee, I took two days off hoping to get back on-track later in the work week. Thursday and Friday I got my 6 and 3 milers in, with no apparent discomfort to the knee (knock on wood).

Work has been insane, and running had been my salvation. The time I spend running provides me with a great sense of accomplishment, peacefulness and comfort. I am really looking forward to this weekend's long run, as the temperatures look to be back to normal for this time of year in Virginia (maybe nearing 50!). Blood sugars have been running fine, and I am glad that most of the Valentine's Day cookies and candies are nearly gone.

This is a great time of year to get outdoors and get to your running. The promise of Spring will be with you in each passing mile, and the early birds will greet you with their warbles and whistles. Enjoy the trails and stay safe.

8 Mile

The goal between now and April 3 is to run eight miles every other Saturday, and on the other weekends build up my long-runs to 12. Saturday morning. All started well, until I checked my blood sugar upon wakening: 61. Rats. I treated it with a full pack of Sport Beans and fifteen minutes later added eight oz. of apple juice (with ground chia seeds). The goal today was to run eight slow miles (aerobic heart rate of 136). I really look forward to these long run days. They are not as difficult as they were a year ago, and running them slower helps me from fatiguing and getting injured. It was a great run; cold, but great. I dropped my basal rate to 30% for 90 minutes. Post-run, blood sugar was 121! Average pace: 10:05 per mile. Average heart rate: 144 bpm. Looking forward to snow melting (it will take awhile) and to keeping strong and injury-free. I should add in some core work and push-ups on my non-running days (have not done it consistently).

Using a log book

This morning, as planned, I got in 3 easy miles (9:00 ppm). Thank goodness the wind was not a factor; the forecasters originally had predicted wind chill levels in the single digits. Instead, I was able to run virtually wind-free in 29 degree temps. Blood sugar was low upon waking: 51. I treated it with 5 Dex-4 tablets, water, a small glass of OJ, and waited 30 minutes before running. I dropped my basal rate to 50% for 30 minutes, and my blood sugar was 107 post-run.

One of the most effective tools I have found for running progress, injury and diabetes management is recording ALL of your runs in a log book. I use two sources. The company Nathan makes a great, compact spiral-bound log book which is undated and lasts 365 days. I have used these in each of the past 3 years and it really helps motivate me to get in all of my runs and monitor my progress. It reads like a runner's diary, and it is a big help when I need to learn from past experience about what works and what does not in making sense of my running and its impact on my diabetes management.

Another useful tool is an on-line log book. I use a free website at http://www.buckeyeoutdoors.com/cgi-bin/training/traininglog?guest=runrobrun
Feel free to see my progress at this website. I am also a lucky member of the "Running from the Reaper" online team. We are admirably lead by Nigel from Staffordshire in the United Kingdom. Nigel also produces a great podcast, "Running From The Reaper", available at iTunes (also for free!). Enjoy.

Half-Marathon Training 101

• You need at least 18 weeks to train properly and reduce the risks of injury.
  
• If you are currently running only 1-2 days a week, I suggest increasing your days gradually and get to four days a week, always running on Sat. for the longer runs.
• The Saturday long-run is the most daunting. Don't worry about it. You'll be amazed at how long you can run. Remember, run these days at a slow, conversational pace. The other days you can step it up a bit, if you wish.
• Your total weekly mileage should never increase more than 10-15% from the previous week's total; your long run should never be more than 50% of your weekly total.
• Yoga is good, so is post-run stretching and rolling (use a 36" hard foam roller). I now never stretch before a run.
• Your first mile should be your slowest of any part of your run--get warmed up properly. Don't worry about speed.
• Try to practice the "30/20" rule. Count how many times one foot lands on the pavement during a twenty second period. If it is less than 30, your stride is too long. Practice shortening your stride, so you look like you're running a quick march. Try to have your feet land underneath you, landing on the middle of your foot. Try not to land on your heel or forefoot. Your knees and joints will thank you later.
• Try to get as many of your runs in during the morning, since most races start early in the morning--you'll want your body to be used to running at that time of day.
• Go to a really good running store and get fitted for new running shoes, if you haven't already. Your knees and joints will thank you later.
• Hydrate, hydrate, hydrate. Try to drink at least 60 oz. of water every day. Real fruit juice and milk count; coffee and soda do not.
• Try to eat 60 oz. of protein every day. Oikos organic Greek yogurt is excellent; so are local eggs, grass-fed beef, pork, turkey, chicken and local fish. Try making sandwiches with protein-packed potato bread (made by Martin's). Eat a lot of fruits and vegetables and whole grains. You will be burning a lot of calories, so keep it balanced, eating five small meals a day, if possible. Otherwise, three medium, and 2 healthy snacks should work.
• When your runs start getting to be 60 minutes or longer, you should start experimenting with gu's or gel's, needed usually every hour of running--with water I don't like most of them, so I use Sport Beans at mile 8 by Jelly Belly, with water. These will help give you a boost for the final push.
• The last 2 weeks are "taper" weeks, after you have done at least 12 mile long run.
• Don't worry too much if you feel tired during your long runs. Occasional walking breaks are okay, It is better to take a break before you feel exhausted, then you can resume running and feel fresher at the end. (My first 12 miles I conked out at mile 11, huge hills, bad night's sleep, etc.) But two weeks later, I finished my first half-marathon race!
• I found the Shamrock Half-Marathon beginner's training schedule to be excellent. Check it out at: http://www.shamrockmarathon.com/Primary_Navigation/Race_Info/training.htm
  

Getting "it" done

In anticipation of another supposed snowstorm, I awoke this morning to the smell of coffee and prepared for five miles (no hill or tempo components). Looping the Western Albemarle High School parking lot has gotten really boring, so I drove to Old Trail to find some clear pavement and a change of scenery. My pre-run blood sugar was 129. I dropped my basal rate to 50% for one hour and headed out for my run in 22 degree cloudy and still skies (no snow yet). It felt great after a slow first mile trying to get warm. I kept the pace up a bit without looking at my watch to see how I was doing--just tried to feel good and strong and not worry about pacing. It was one of my better mid-week runs, a bit slower than I expected (average pace per mile of 9:02). Post-run blood sugar was 82! I drank half a Myoplex protein shake, and bolused 3.3 units for my breakfast. Overall, a great start to the day. I am glad to be keeping up my miles, despite the rough Virginia winter. No running tomorrow, and only three miles called for on Thursday.

More miles, more exercise, better health

After another weekend of shoveling snow, I was able to sneak in a four-miler this morning, and keep "on-track" for my training. I made the mistake of forgetting to drop the basal rate on my insulin pump, so blood sugar levels were an issue post-run. Before my run my level was 70, so I drank 8 oz. of orange juice. Afterwards, my blood sugar level was 56! More juice, less bolus insulin with breakfast, and I rebounded an hour after my meal with 147.

I just finished reading "Born To Run" by Christopher McDougal. A great book that I highly recommend. It is funny, insightful, and controversial. While I am not about to go barefoot or use minimalist runner shoes, I do agree that shortening one's stride length and simply "enjoying" your runs without being a slave to your training schedule is a good idea.

Now comes more research showing that running more miles is better for your health. Check out this article and let me know what you think: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/01/MNFC1BID8F.DTL Obviously staying injury-free is key, and something that I am working to do with each passing day.

Happy running, and stay safe out there on the road and trails.

Running in snow storms, part 2

This morning, I awakened to a slow but steady snow, just as predicted. Last night I had a decision to make. I would either take my chances attempting a long-run Saturday in terrible conditions (and perhaps 2 feet of snow) or scrap the long-run altogether, given the predicted and dire weather conditions. I do not own a treadmill, or belong to a gym, so it was either run outside or not at all. Then, it hit me! What if I move my long-run up a day (usually not recommended) and run it this morning before it gets really bad?

So that is what I did. I ran a surprisingly comfortable 10 miles in mostly good footing, at an average pace of 10 minutes per mile. My blood sugar was 147 upon awakening (slightly elevated, but that's okay given what I was about to do). I ate one pack of sport beans, drank some water, dropped my basal rate to 30% for 90 minutes, and off I went. It was a great run; I really enjoyed it; it felt almost magical in spots. The snowy landscape and relative quite really was peaceful and pleasant. I saw two other runners, and they seemed happy to be out before it got really bad. When I got back home, my blood sugar was 95. Yippee!

Be safe out there on the roads. There are a few boneheads who seem to enjoy driving very close to runners, as if it were some kind of target practice. I look forward to reporting back in a few days, as it seems highly unlikely I will be able to get out on the road again until Monday--my next scheduled run.

Changing infusion set sites

As an insulin pump user, every three days I need to change the location of where the insulin gets into my body--as per my doctor and diabetes specialist. Known as the "infusion site," a small plastic catheter is inserted into my skin and sits there for three days, with the tubing from the pump attached. It's a bit of a pain to deal with, but a heck of a lot better than injecting insulin 3-5 times a day.

Since I've been running, I have lost a lot of subcutaneous fat in my upper thighs and hips. That really only leaves the upper backs of my arms and abdomen as remaining sites for my infusion sets. During winter, I tend to use my arms more because I am more than likely wearing long sleeve shirts, etc., and that way the tubing or infusion set do not show to the public (I'm a master of tubing disguise). In summer, I'm pretty much an abdomen guy--and the literature seems right on this area of your body: You will have better and more consistent insulin absorption.

I have had no issues with infections, and I use a small band-aid with bacitracin after I pull out each infusion set. Remember to check your blood sugar within 2 hours after changing sites so you know that everything is working properly. I've had a few scares where I did not check things out, and ended up with a blood sugar of 400 later in the day! This is usually rare, but it can happen. Good luck with your own pump experience, and stay happy and healthy out there running with diabetes.

Are Girl Scout cookies bad for you?

Every year at this time of the year, the requests for purchasing (and thus consuming) Girl Scout cookies comes upon us like a great wave of sugar and enriched bleached white flour. I will admit two things about this uniquely American phenomenon: 1) My youngest daughter is a girl scout, so I am required as a parent to engage in the selling of the beastly delights, and 2) I like Girl Scout cookies. So as someone with Type 1 diabetes, how do I reconcile these conflicts? This year I am hyper-focused on my training for the Charlottesville 10-miler running race, so I am able to "just say no" to the sweets more easily than usual. But I also understand that with the advent of the insulin pump and a lot of miles run and calories burned, I can have a cookie or two without any real damage done (the A1C's and daily blood sugars do not lie). Yes, I can discipline myself to just 1-2 cookies. They're good, but not THAT good.