Type 1 Cycling

Type 1 Cycling

Friday, December 7, 2012

Cycling at the olympics

Its been months since I was in London.  But I have fond memories and a nice teeshirt from the week I spent at the Olympics.  I attended 6 events in total but the highlights were the first and last events that I attended the Cycling Time Trial at Hampton Court Palace, and the very last night at the velodrome.  The atmosphere at all the events was amazing, but somehow got turned up to 11 when a British contender was doing well or even winning the gold medal.  And I got to see some of my cycling heroes win medals.  So here are some pictures, the highlights of these events.

Enjoy the whole album here

Here are some of my favourites.

Wearing my home made Go Wiggo teeshirt

My view of the screen showing Hampton Court Palace

Lizzie Armistead coming home

Lizzie Armistead coming past me

Everyone out having a great time, and sporting some gold too

Fumiyuki Beppu

Michael Albasisni

Banter with the guys across the street

Ryder Hesjedal





Spartacus in pain

poorly dressed but awesome

state of the art velodrome

warming up

Vicky P in the semi final

wins it be a mile

Laura Trott in the scratch race - ominium

More of the scratch race

Victorious Trotty after winning the 500m TT and the ominium

Vicky P in the sprint final

Start of the Keirin final

Chris Hoy coming round the final bend to take the win


Chris Hoy becoming the most successful British olympian

Wednesday, November 14, 2012

Diabetic Online Community - Israel #ILDOC

ההודעה בעברית בהמשך

I have been on twitter with my handle @type1cycling for no more than a fortnight.  I have met many diabetics who share other interests of mine, endurance training, cycling or generally being a geek.  I have been constantly amazed at the friendliness and how some many people want to get involved to make things a little better for the Diabetic community.  On twitter there is a hashtag for general diabetic stuff #doc - for Diabetic Online Community.  A while back someone in the UK decided that he wanted to get more involved and focus some of that energy.  He decided that though it is a global problem there are many local issues involved with a diabetic life.  These things can range from where to get treatment or diabetic supplies to the amount of sugar in certain foods.  Foods that may not be common in one country but literally grown on trees in another.  There is a need for a local and local language discussion.

My new friend started a hashtag #GBDOC.  He used it to host a tweet chat, that tweet chat now reaches 8 millions people.  They have up to 600 contributors.  There is no doubt in my mind that it is doing some good.  He has launched a website to post the latest transcripts from the weekly online get together and other helpful information about diabetes.  His goal is to find people to run these simple things in every country.  Specifically focused around the local language as well as the local themes.  He has invited me to get involved and set up #ILDOC.  I am happy to do so.  I intend to have the first chat on 21st November at 2100 IDT.

My experience over the past few weeks has told me that not everyone how suffers from Diabetes has a good network of people they can rely upon, not just for medical advice but support and attention.  I am lucky I have diabetic brother and some friends too.  I work hard at my diabetes care and pay attention to what my health care professionals tell me.

Anyone can come to the tweet chat, it will be in a mixture of Hebrew and English. You do not have to be in Israel to join in, though I hope many people in Israel will be in attendance.  You do not have to be diabetic to join in either, I hope families and friends of diabetics can come join and share their experiences too.  Maybe some healthcare professionals could also join to give some medical advice.

If you want to help, get involved or have any ideas, let me know.

למרות שאני פעיל בטויטר בשם @type1cycling רק כמה ימים, אני כבר פגשתי הרבה חולי סכרת אשר חולקים איתי אינטרסים כגון אימון סיבולת, רכיבה על אופניים או בעצם העובדה שאני קצת חנון.  אני מתפעל בנחמדות ובכמות האנשים אשר מעוניינים להיות מעורבים בשיפור חייהם של קהילת חולי הסוכרת.  בטוויטר יש hashtagלעניינים כללים של חול סכרת – #doc – Diabetic Online Community, אך בן אדם באנגליה, שהכרתי לא מזמן, החליט שהוא רצה להיות מעורב ולמקד את הנושא. למרות שמדובר בבעיה   גלובאלית, ישנם הרבה נושאים מקומיים הקשורים לחיים עם סכרת – איפה ניתן לקבל טיפול הולם, למצוא ציוד מתאים ואף כמה סוכר יש במצור מסוים שייתכן ולא קיים במקום אחד אך נפוץ מאוד במקום אחר.   נדרש שיח ושפה מקומית.
חברי החדש התחיל  את ה- hashtag #GBDOC ושם אירח צ'אט בטוויטר. כיום, אותו צ'אט מגיע  8 מיליון אנשים ויש לו כ – 600 משתתפים. את התמלילים הוא מעלה לאתר אינטרנט בתקווה שהמידע שנאסף יספק מידע שימושי על סכרת.  אחת ממטרותיו הינו למצוא אנשים לנהל דברים דומים במדינות שונות בעולם – שיתמקדו בנושאים מקומיים ובשפה המקומית.  הוא ביקש ממני להיות מעורב ולהשיק את #ILDOC ואני שמח לעשות זאת.  הצ'אט הראשון יתקיים ב – 21 בנובמבר 2012 בשעה 21:00 שעון ישראל.
בשבועות האחרונות הבנתי שלא לכל חולי הסוכרת יש רשת טובה של אנשים עליהם ניתן לסמוך, לא רק לייעוץ רפואי אך גם לתמיכה ותשומת לב – דבר חשוב וחיוני.  מטרתנו היא לספק את אותה רשת מקשרת בו ניתן יהיה לשתף מידע וחוויות בין חולי סכרת וקרוביהם.
כל אחד יכול להשתתף בצ'אט בטוויטר, היא תתנהל באנגלית ועברית.  אני מקווה שיהיו הרבה משתתפים שגרים בישראל, אך אין זה תנאי להשתתף בצ'אט. אני מקווה שישתתפו לא רק חולי סכרת, אלה גם המשפחות והחברים שלהם שיוכלו לבוא ולחלוק את חוויותיהם. בנוסף, נשמח אם ישתתפו אנשי מערכת הבריאות אשר יוכלו לתרום מהידע הרפואי שלהם בנושא.
אם יש לכם רעיונות מעניינים או שאתם רוצים להיות מעורבים או לעזור, אנא צרו איתי קשר.

My diagnosis

As it is World Diabetes Day today I though I would post about my diagnosis inspired by the story of @ninjabetic1 which is found on The Independent's website.  Let me start off by saying I was one of the lucky ones.  Like ninjabetic my brother also ended up in hospital with DKA (diabetic ketoacidosis).  DKA is pretty horrible, when you become diabetic your body thinks you are starving because without insulin your cells do not get enough sugar.  So the body compensates, fat and protein are broken down, this is significant people lose a huge amount of weight.  This makes the problem even worse.  Your cells still aren't getting enough sugar but the body is dumping more sugar into the blood.  So your sugar rises and rises.  The fats that get broken down release ketones into the blood stream.  These ketones cause the blood to become acidic.  It goes with out saying that this is bad.  This is usually the point where people find out they are diabetic.  Your body does not like having and acidic blood stream and it rejects it by telling you in no uncertain terms, pain, lots of it, and vomiting are the main ways.

How do people get to this point?  Well they don't know, their parents/teachers or guardians don't and sometimes their doctors don't know either.  What don't they know? They don't know how to recognise the symptoms of diabetes.  DiabetesUK has a campaign on coinciding with World Diabetes Day to educate people about the 4 Ts. They are:

  • Toilet - you need to pee all the time, I mean ALL the time
  • Thirsty - nothing will quench your thirst
  • Tired - you literally have no energy
  • Thinner - because your body thinks it is starving it breaks down all the fat and protein
Educating people about this will help people realise when they have the symptoms of Diabetes before it gets too serious.  Unfortunately I am talking about Type1 diabetes.  There is no way to prevent it or delay it.  Once you have the symptoms it's not going away.  But you can avoid ending up in hospital like my brother and ninjabetic.

I was lucky, my brother had been diagnosed with Type1 Diabetes 12 years earlier.  At that point, being the budding scientist that I was I learned all about it.  In short when it happened to me I knew early, I knew so early that there was no rushing to get me an appointment with the specialist just a casual blood test and confirmation.

My Story:
October 2004, I had wrapped up my yearly Succot party.  Since I was a student we had been having a get together once a year at my mum's house.  Many (up to 10 in the house at once) of my friends would come over.  We would build a Succah, cook up a storm.  And have a great time.  We had friends come for meals in the freezing cold and rain of Manchester.  Plenty was eaten even more was drunk, and everyone had a good time.  After a couple of days of this I woke up on the Monday morning to get ready to go back to work.  I felt terrible, I was thirsty I had a headache, I was tired.  Of course, I thought to myself.  I am hungover.  Too much partying.  Tuesday morning was the same, and this time I knew I wasn't hung over and my thoughts went back to 12 year previous.  I remembered how thirsty my brother was, he would drink coke because no one had any idea that it was making him worse.  I remembered how tired he was, and ill all the time.  And why did I need to pee all the time, this added up to one thing in my mind.

The thirst, tiredness and needing the toilet all the time got worse all week.  That weekend I was staying with a friend.  A friend I have known most of my life.  He is also a doctor.  I told him what was up, and what I thought it was and like a good friend told me to go see a doctor.  Thanks for that!  He checked some things in a textbook and we read up on it together.  He told me that I needed a fasting blood glucose.  A few days later I went to the doctor.  I got my blood test and I got referred the the Manchester Diabetic Center.  A place were 10 years earlier I had done work experience shadowing Prof Boulton who was head of the center and an expert in Diabetic complications. (At one point I wanted to be a Doctor, a medical one)
My first appointment was mainly with a nurse.  She was wonderful.  I explained I knew something about my disease so she suggested I tell her what I knew and she fill in the gaps.  I did, she didn't have much to add.  But she tried to prepare me for the reality.  As I found out knowing all the theory just does not prepare you.

I was lucky.  I had the knowledge then that they are only just trying to get across to people now.  If I hadn't known a couple of months down the line I would have been in big trouble.  8 years on I am not only healthy but training for endurance cycling.  I have an amazing care team and my friends and family are amazingly supportive. Being Diabetic is a pain in the ass, but I am not letting it get in the way of anything, in fact it gives me more determination to reach my own physical goals. TeamType1 say it best.

"Diabetes doesn't stop us. It fuels us"

Tuesday, November 13, 2012

Do not get frustrated

Having diabetes is frustrating. It just is. While other people are tucking into their food I am sat fiddling with testing equipment, needles and pens. Even worse when I am keeping my logs, I have to type into my phone what I am eating.  Worse still when out with friends it looks rude to be sat there typing on my phone while at dinner, I am not on twitter this is a medical necessity ... mostly.  When we go out to restaurants for dinner I have to ask the waiter what carbohydrates come on the plate.  When we go to friends I look impatient because 5 minutes before the meal starts I am asking them whats for dinner, so that I can get my calculation correct.  And that's just the day to day management.

Then there are the highs the lows and the swings between the two. They are both horrible in different ways. Highs make me feel terrible in a lethargic and fuzzy headed way.  They are not so scary in themselves but I know what long term bad control does to people.  I have seen a lot of complications of diabetes and it is not pretty.  Blindness, kidney dysfunction and worst of all loss of limbs is a horrible prospect.  Especially when I wake up high and I know I have been high all night, that is when I start to remember what I have seen.  It is scary.  The hypos are more scary at the time, they can also have a prolonged effect even after I have recovered my blood glucose levels I am still affected by it later.  The worst is early morning or in the middle of the night.  I wake up, a neat reaction to low blood sugar, so I can deal with it before it gets too bad.  But the interrupted sleep usually messes up my next day.  The additional problem with hypos is other people, some know what to do, some don't, some panic some don't.  My wife knows what to do, she will get up in the middle of the night and get something from the kitchen if need be.  She will also stop me from doing something stupid.  I had a hypo while were out the other day and she stopped me from carrying on and made me sit down and drink a coke.  It must be frustrating for her too.

This reminds me of something that happened to me a few months ago. We were returning from London on a British Airways flight. It was towards the end of the flight and people were being told to return to their seats to prepare for landing.  I started to get that feeling.  Slightly fuzzy head, and tingling in my lips and tongue.  "Uh oh" I said to my wife as I started fiddling around with my BG monitor.  The reading was in the 40s (mg/dl - thats around 2.5mmol/L).  I stumbled my way to the back of the plane.  I said apologetically that I was diabetic and I needed to sort myself out. They were really quick on their feet, water, coke, something to nibble on.  I waited while I recovered and chatted to these two wonderful women.  They said they had had training in how to handle this situation and one of them had been a nurse earlier in her career so was familiar with my condition.  They handed me some more water and coke to take back to my seat just in case.  I was stunned, I mean it was so well handled, no panic, no calling doctors.  Just understanding the situation and handling it perfectly.

So I do what I can to get it right, I am frustrated by what I have to do, and more frustrated when I get it wrong.  I am sure I calculate my insulin correctly then I check a few hours later and find I am really high, or low.  Then I have my recent Hba1c result 7.4%, not terrible but after the training that I had been doing and the loss of weight I thought maybe it would be and improvement.  This is the biggest frustration.  With all the other frustrations one would hope that it would lead to better results.  But when it doesn't it gets super frustrating.  The natural reaction is to say to yourself, its not worth it.  Why bother trying so hard when it makes no difference.  Why test? why exercise so much? why bother trying to calculate how much insulin, take less and just avoid the hypos.  Why not? because its worth it in the long run.  This disease takes practice and a lot of work.  You cannot expect to get it right every time, but you can learn to listen to your body, you can work at every aspect of what you do, and you can get better results.  Getting frustrated and giving up is the worst thing you can do.  If you want to scare yourself into getting it right ask your doctor to tell you about diabetic complications.

It may seem like it isn't but this is a simple problem.  It is.  It is a closed loop, you are closed loop.  Your results can be calculated, what goes in will come out in the result.  It is not as simple as the equation of insulin exercise and food.  That's the starting point, know how your body reacts to these 3 main components.  What changes that reaction; time of day; illness; stress.  You can understand how you end up with the results you do by keeping a log, keep as many details as you can, test often.  Get in tune with your body, accept that you will have bad days and bad results, but don't let it get you down.  Keep going, keep striving to get it right.  Live a long and healthy life.

Monday, November 12, 2012

Some more on Stack Exchange

Update:  I am sad to say that due to lack of support for the project it has automatically been deleted.  If you think that this is something that I should attempt to resurrect and are will to support and publicize it, please let me know.

StackExchange started life as a programming ( stackoverflow.com ) related question and answer site.  Set up with certain guiding principles to "do it right" where so many similar sites got it wrong.  On the whole they did a really good job.  The creators took the model and created a network of sister sites all under the umbrella of StackExchange.com . The topics range from the English language to photography, from bicycles to religion, and many many tech related niches.  They also offer the opportunity to propose any site you wish to be housed in their network at http://area51.stackexchange.com.  I have proposed diabetes as a new site but I am having trouble gaining traction.  The problem is at the moment 3 fold. 
1) I am not doing a very good job of publicising it.
2) I am not sure that enough diabetics are interested in a site like this
3) I think there are a lot of websites out there that may already offer some of what I want to offer here, mostly in a different format, but at the same time making it redundant at least in some people's eyes.

The best thing to do is to have a look and see what you think. my proposal link is below

A bit more info:
The site relies on the good will of people and the desire to get involved and help people out.  This is all done for free.  There are no prizes only reputation (it is amazing how much a number on a profile can motivate you).  The more reputation the more reliable you are deemed to be, and the more privileges you receive.  Reputation is gained by both giving good answers and asking good questions.  The end result is a repository of useful information, created and moderated by its users, who are motivated people that share an interest.  The sites are clean, and easy to use.  You do not have to pay to be a member and you don't even need to create a new ID to join (you can use facebook, twitter or google logins).

What  we need.  In order to get a site off the ground, that is out of the proposal phase and into the testing phase I need people to sign up, if they are not already and click on follow.  we need 60 people following the proposal.  I also need people to propose questions that they think are suitable for the site, you can only post 5 questions each so make them count.  Some will be some won't be.  There will be some discussion about the relative merits of each question.  Finally if you like questions that other people have posted you can upvote them.  Once we have 60 followers and 40 questions with at least 10 upvotes each, then we move on to the next phase.

This is the starting point.  What we really need is for people to commit to being on the site regularly.  Help writing the FAQ, moderating and answering questions.  The more use it gets the more useful it will become and the more users will be attracted to it.  Its easy to get started. Trust me I started with stackoverflow because I was looking for an answer now I check every day to see if I can help other people with their problems.

Final thought.  I have noticed over the past week that I have got stuck into the online diabetic world that there are people, like yourself, out there who wish to selflessly get involved and provide resources for other diabetics.  There are also people out there who need answers.  There are also people out there that are alone and looking to meet other diabetics.  These are all things that I am targeting and I have seen that they exist.  Converting that energy is proving difficult.

Let me know what you think and if you have any ideas, but most of all come join in.

Sunday, November 11, 2012

Rainy weekend on the trainer

I had plans to do some big hills this weekend.  With my new regime (eating regularly and maintaining my evening insulin) I was interested to see how that effected my hill climbing.  That and the fact the temperature was due to finally drop out of the high 20s for the first time since before the summer.  I was going to attempt two second category climbs.  The weather though took a turn for the worst.  I just didn't want to risk going out after the first big rain.  The roads here are so dangerous, no one has the faintest idea how to drive in the wet.  After 8 months of sunshine the oil and crud on the roads can make them like ice rinks, descending was not going to be fun.

So I took it easy, just an hour and a half on the trainer.  This is actually the first time I have used my new bike on the trainer.  It was a little strange getting used to, and I really missed the enjoyment of cycling on the road.  I have the cycleops magneto trainer.  Its pretty easy to setup and has a progressive resistance.  That means the faster I go the harder it gets.  Up until now I had thought this was a good thing, but I was wondering whether it might be better to fix the resistance or at least control it making it harder and easier for different intervals.  The only way to control it is to find a gear that you can go at a decent cadence and stick with that.

I settled in to a rhythm, found the right gear, put something to watch on my laptop and off I went.  I have a good space to do it on my balcony.  Its a closed balcony with big windows which I opened all the way.  I still needed a fan on me to keep me cool though.  I had a little bit to eat before starting my ride and the advantage of riding in one spot is that its easy to check my blood sugar while I am riding.  Generally I was fine.  I was not going too hard so didn't feel the need to eat anything during the training period.

My sugars were a little elevated after the exercise but were all brought back in to line later on.  I woke up the following morning with great numbers, really glad there were no swings at all this week.

Friday night:
09/11/2012,20:37,342 mg/dl
09/11/2012,22:10,310 mg/dl
09/11/2012,22:54,309 mg/dl, Latte15g carbs 4u Novorapid
09/11/2012,23:58,272 mg/dl
10/11/2012,00:48,233 mg/dl
10/11/2012,01:46,222 mg/dl
10/11/2012,02:51,193 mg/dl

Sunday morning:
10/11/2012,09:50,114 mg/dl, 4u novorapid, 30g carbs - Coffee with milk, Bread roll with peanut butter
10/11/2012,10:17,150 mg/dl,
10/11/2012,10:38,193 mg/dl,
10/11/2012,11:21,201 mg/dl,
10/11/2012,11:52,176 mg/dl,
10/11/2012,12:30,186 mg/dl,
10/11/2012,13:05,194 mg/dl,
10/11/2012,13:49,180 mg/dl, 9u Novorapid ,Soup with bread
10/11/2012,16:07,176 mg/dl
10/11/2012,18:29,209 mg/dl, 45g carbs - Meat sandwich, 9u Novorapid 30 u Levermir,
10/11/2012,22:47,145 mg/dl
10/11/2012,23:40,126 mg/dl,250g chilli
11/11/2012,00:52,131 mg/dl,Cookie

Sunday morning:
11/11/2012,07:53,124 mg/dl,
11/11/2012,09:17,146 mg/dl,

Thursday, November 8, 2012

Nearly 100KM

I set out to do a 100KM ride.  I planned the route, set my self a target, and almost made it.  I got to 97.5KM and got a puncture.  At this point I decided enough was enough and called my wife to come and get me.  I had no energy to change the inner tube at this point and I wasn't too far from home.  So that was a little disappointing.  From a diabetic point of view I did things differently and I found that it resulted in a much better outcome.

The big difference was that I probably used a lot more insulin than I normally would have.  I retained my 30 unit dose.  I took a little less at dinner the night before, and only 4 units with my sandwich and coffee in the morning.  This meant I had to be super careful and eat enough.  I checked regularly on the ride and ate too.  I had about 4 gels and a couple of granola bars during the ride.  I was told I needed about 15g per hour but that sounded too little I trusted my gut and I was right.  I had 4 energy gels and a granola bar while out on the ride which is more than double what I was recommended.  As you can see from my sugars below, this worked well for me.  If anything I could have eaten more.  I think next time I plan to ride for as long as this I need to do better carb loading.  Perhaps eating a little more bread before the ride would have been helpful but no extra insulin.  When I finished my ride I was heading for a low, fortunately I tested and had some food immediately.  I think I should have eaten soon after I finished the ride instead of waiting until after my shower and nap.

That evening I allowed my blood sugar to rise so that I would not have a low over night.  I thought it might be a little high and having eaten something unexpected in the evening I decided that I should add a correction.  This was a mistake as I ended up waking up very low.  I know better for next time that after a long ride I need to leave my blood sugar on the high side in order not to have hypo over night.

Friday evening
20:03 - 167mg/dL,Friday night dinner,11units short term,30units long term,
22:59 - 312mg/dL,
01:00 - 254mg/dL,
01:28 - 234mg/dL,

Saturday morning
06:13 - 152mg/dL, Bread Roll with peanut butter, Coffee with milk 4units short term
06:55 - 188mg/dL, - leaving the house
07:29 - 196mg/dL, - warm up done, 1 41g energy gel
08:27 - 159mg/dL, - 1 41g energy gel
09:04 - 132mg/dL, - half way point  (50k)1 41g  energy gel and half granola bar
09:50 - energy Gel
10:21 - 141mg/dL, - 80KM, half granola bar
11:30 - 90mg/dL, - back in the car, 2 cookies
11:53 - 108mg/dL,
12:14 - 119mg/dL,
13:18 - 144mg/dL,
13:55 - 139mg/dL,
15:10 - 163mg/dL,Noodles with chicken, 4units short term
16:14 - 183mg/dL,
17:17 - 146mg/dL,2 Bread rolls with cold meat and humous,9units short term.
20:04 - 238mg/dL,
20:47 - 30units long term
21:15 - Some fish and chips I was eating off a friends plate
22:15 - 268mg/dL,
22:15 - 3units short term as a correction for the fish and chips
22:58 - 225mg/dL,

Sunday morning
06:24 - 43mg/dL,3 cookies
07:03 - 106mg/dL,

Tuesday, November 6, 2012

Some pics from the western Galil bike ride

For a full set of the pics go here.

The flat, calm before the storm

Top of the 2nd category climb only a 3rd and two 4ths to go
I just made it in to this pic at the top of the hill after the rest stop

Monday, November 5, 2012

Meeting my medical professionals

Today I had my meeting with a nurse, dietitian and a Doctor, all of whom specialize in diabetic treatment.  Because of my change in regime due to my training I came armed with a bunch of questions as well as the past week and a half of documented sugars levels, insulin and food intake.  I see the same people every 3-6 months and have a blood test a couple of weeks before I go.  The blood test is Hba1c and once a year I have a full panel to check my kidney function, cholesterol and a few other things.  The most recent Hba1c result was 7.4% up from 7.0% the previous test 6 months earlier.  I was a little disappointed.  With my change in regime I was really hoping for an improvement in my result.  Sadly no, I have got my weight down from 91Kg to 87Kg (fully clothed).  I am happy about that but I really want to get down towards 80Kg.  I am sure that will come with time.

Both the appointments with the Dietitian and Doctor were productive.  I have an additional appointment with the dietitian and someone who can advise me on sport in a couple of weeks.  I hope that will be useful too.  I had a number of questions that I needed answering plus we talked about how my training was affecting my blood sugar.  The most interesting thing was that I have been making a mistake with my long term insulin.  I have been told to keep that constant and only vary the amount I eat and the amount of short term insulin that I take before and after exercise.  Additionally we calculated that I should be eating about half what I eat every hour.  I eat about 30g of carbs in energy gels and bars, I need to try to eat 15g on every hour.  I should also eat some slow burn carbs before I ride and take a small amount of short term insulin.

Hopefully my next meeting I will learn more about the food and insulin intake that I need to do long rides without hitting the wall and without having hypos during and then having huge swings after.

I had some questions prepared for the appointments, I have listed the ones that I have already discussed above with the answers I was given:

I have hard bumps around my injection sites, they are more noticeable to the touch not that I have lost some weight.  Is it hard insulin, and can it be released slowly into my system.  Will they ever go away?

A: It is not hard insulin.  I didn't fully understand (a consequence of us both speaking to each other in our second language) but I believe what she told me was that it is fibrous tissue that forms at the injection site as a reaction to too many injections in the same place over too short period.  They do not go away. (sadly as I am losing weight they are becoming more noticeable)

Can I get a Continuous Blood Glucose monitor?

A: No currently I am not eligible on my current Kupat Cholim (health plan) - Maccabi Gold.  I am not at risk enough and they are very expensive.  I am free to buy them at my own cost but they are very expensive.  Dexcom Medtronic Abbot.

Should I eat late in the ride to stop excessive glycogen breakdown?

A: I should eat throughout the ride to try to keep constant levels of blood glucose and avoid large swings in either direction.

Where can I get a medic alert bracelet?

A: The Israel association of diabetes has information about them on their website.

If I have a chocolate chip cookie that weights 45g total (it is home made so I know its flour, sugar, butter and chocolate) how much insulin do I need to take for it?

A: About 50% carbohydrate to 20 to 22.5g when estimating how much sugar to take.  Bear in mind that the chocolate and butter are fats which slows the uptake of sugar.  This makes such a food item less suitable for recovering from hypos

Why is my Hba1c so high?

A: Not sure, possibly from the high swings after riding. 

Thursday, November 1, 2012

Weighing in on Lance Armstrong

I honestly don't want to get too involved in the debate about his apparent guilt. This is partially a cycling blog and it is something any fans of cycling as a professional sport will have and opinion on.  What I have been saying from the start is that targeting Armstrong is a little unfair.  I could even go so far as to say that it has been sounding more and more like the main protagonists are just bitter people with an axe to grind.  I am not saying that Armstrong is innocent of wrong doing, but the reality is not quite the picture they are painting.

What I am saying is that Armstrong was probably competing on a level playing field because most of his competitors were also on performance enhancing drugs.  He had the team that was best at utilizing the drugs and not getting caught.  No different from a football team that does its best to dive when they get the chance to get penalties and free kicks.  I could go on but I think it best left to this article.  Reasonable evidence that the problem of performance enhancing drugs was not limited to Armstrong, it did not start with him either, in fact it is something evident in the peloton for more than 20 years perhaps considerably more.

Tuesday, October 30, 2012

New Stack Exchange Q and A site for Diabetes

I proposed a new Q and A site on Stack Exchange about Diabetes.  Come show your support.  I need people to follow its progress and propose and vote for questions that are suitable for the site in order to get it off the ground.

Joining is easy if you are not a member and if this is something that you could get more involved in let me know.  If you don't know about Stack Exchange check it out. stackexchange.com is a network of Q and A sites that allow people to ask questions and get answers from other people who are either experts or have been in a similar situation.  Their biggest sites are centred around technology but there are site for many other topics.  I am involved in stackoverflow (the original site for programmers) and bicycles.  Now I want to create a new site for diabetics to get help too.

The goal is to bring together a community of people who have diabetes, are related to someone with diabetes or are a medical professional with who works in the field of diabetic care.  It will become an important resource for anyone wanting information on this disease.  It is my hope that it will provide invaluable information for people who have this condition and lead to better control and management so that everyone can learn to live life as normal.

Monday, October 29, 2012

Hill climbing repeats

Today I did some hill climbing repeats as suggested by this answer on Stack Exchange.  I did not have much time so I thought this would be a good exercise for training.  My hill climbing is terrible.  Looking at previous climbs I can go hard on the flat and descend with the best of them.  My hill climbing however is slow compared to other riders who I can keep up with on the flat.

My max speed from last weeks ride.  I am a bit of a demon descender!

Even the slightest incline can see me dropping off the pace.  So my goals were to do this hill (a category 4, 2KM climb) in under 6 mins and to see if I can manage my sugar better to avoid the huge swings I am getting after intensive training.  In case you don't want to read on I did not achieve either goal.  I did cut my best time for the hill down to 6:12, 24 seconds better than my previous best, and I climbed the hill 7 times in total in under and hour and a half.  So that being said it wasn't a total bust of a day.

The past two weeks have been a similar pattern.  Fine during the ride, and blood sugar rising fast after the ride.  I make the same mistake both times, over compensating for the hyper by taking too much insulin and have a low blood sugar episode sometime later that day.  From the previous ride until this one my blood sugar control has been really good.  The raise in metabolic rate as a result of my exercise seems to be keeping everything else in check.

In More Detail

The night before the the ride we went out for dinner.   I always find this a little tricky.  I have learned not to take my short term insulin before I get my main course or at least until the first course arrives if it is accompanied by bread.  The reason being if I take my bolus when I sit down and there is a delay in getting the food then I will have a hypo before I get to eat anything and that will be dinner ruined.  Inevitably service was very slow, the staff were great, and we were given a number of complimentary dishes.  They were mainly deserts so I missed out on that somewhat, but thankful as every that I waited to take my insulin.  The other tricky part is I never know how much food I am going to get (unless I have been to the restaurant and ordered the exact same dish before).  So I wait until I can see my food to do a better estimate of how much insulin I need.

I took 2/3 my normal dose of long term insulin (20units) and lowered my bolus a few units as well.  I probably should have skipped the alcohol, but it was only a glass and a half of wine, not like a serious binge. After dinner I was out playing poker with some friends until 2am.  Whilst I have done this before I am pretty sure I would have a better performance if I had 2 or 3 extra hours sleep the night before.  I do not believe however that it makes much difference to my diabetic control.  I woke up with higher than normal blood sugar as expected.  I decided this time not to eat substantially before riding.  So I had a cup of coffee and a granola bar on the drive to the area where I was riding.

After a little warm up I started the repetitions.  I checked my blood sugar after a few repetitions and ate an energy gel and a granola bar during the training period.  As usual after the training my blood sugar started to rise.  After I returned home I ate and had some insulin to try to bring my blood sugar down.  This was fine, but I found myself a little later at a picnic and eating again.  I only ate a small amount and the additional bolus was unnecessary less than 3 hours after my previous one.  As a result later that afternoon I had a serious hypo, which while resolved was unpleasant.  I made sure to go to bed with high blood sugar and the following morning I was fine.

Friday evening
23:39 - 254mg/dL
02:02 - 228mg/dL

Saturday morning
06:48 - 157mg/dL, - leaving the house
07:39 - 196mg/dL,Granola bar - before exercise
08:49 - 166mg/dL, Energy gel, Granola bar - during exercise
09:36 - 249mg/dL, after exercise
10:21 - 279mg/dL, back at home
11:25 - 313mg/dL,Hafouch. Tuna toast, Insulin 14units
12:48 - 256mg/dL,Some pita and humous, Insulin 6units
17:08 - 41mg/dL,Cookies, 1 piece of toast.
17:36 - 99mg/dL
20:03 - 234mg/dL
20:32 - 253mg/dL,Beet tart (pastry) with goats cheese, Insulin 10units
22:46 - 306mg/dL

Sunday morning
07:19 - 136mg/dL
08:13 - 126mg/dL

Monday, October 22, 2012

Hard day in the saddle (cont.)

We arrived at the zimmer around sun down, having checked the location of start.  It was just a few flat kilometers from where we were staying.  A nice little warm up.  The zimmer was comfortable and spacious.  It had a nice size hottub and a little kitchenette.  We relaxed, made dinner and had a quite evening while I prepared for the bike ride the following day.

In preparation for my ride I put some tape on my bike with a message saying that I have Type 1 diabetes and if there are any problems / emergencies call my wife.  I tried to stick the same message to my jersey but without success so that went on the back of my phone instead.

I am going to try the following format for these blogs where by I list my sugars what I ate and how I felt in the run up to, during and after a big bike ride.  It maybe dull, but this is how I manage my life on a daily basis.  Other diabetics maybe able to learn something, or possibly help me out by commenting on my results.

Bare in mind my usual dose of long term is 30 units and short term is 4 units per 15g of carbohydrate at breakfast or lunch, plus 1 unit for every 25 I am over 100mg/dL and in the evening 3 units per 15g carbohydrate and 1 unit for every 30 I am over 150mg/dL.  Usually I reduce my long term before and after a ride to 20 - 24.  I also reduce my short term insulin for the evening and morning meals before a ride and the meal immediate after too.

The night before the ride I had a relaxing evening and an early night.  Dinner was pasta with tomato sauce cheese and tuna, I took a reduced dose of both long and short term insulin.  Woke up before the ride with slightly elevated blood sugar, ate and had a small amount of insulin in order to continue raising my blood sugar.   I filled up two water bottles with water and electrolyte powder, almost 1.7l in total.  I took in my pockets my tester, glucagon hypokit, phone, insulin pen, 5 granola bar and 5 energy gels.  By the time I started the ride I was pretty high.  I ate and drank when I could en route, when ever there was a stop I checked my blood sugar.  I finished with acceptable blood sugar, which then rose to unacceptable levels followed by dropping to hypoglycemic levels.  All leveled out in the evening and the following day my sugars were great all day.  Below is a more detailed diary of my sugars and food intake.

After such a hard ride I was expecting to have worse cramp than I did.  This may have been prevented by drinking water with electrolytes instead of plain water.  I think I need to eat more often on the ride than I did.  I am worried about my huge swings after my rides and I think I would benefit from a continuous glucometer. I am also worried as I have been training reasonably seriously since the end of august and my Hba1c which I did 3 days before this bike ride came back at 7.4%, which is much higher than I was hoping for.

Arriving at the start
What a lovely place to start a bike ride
It's gonna be a warm one
Me and my Merckx EMX-1 before the ride
Some other riders relaxing before the start
lining up on the start line
The start and the Lebanese border
Me getting ready for the off.
Lining up to go

resting at the midway point
joined by hundreds more at the midway point getting ready to start the rest of the ride
starting the second part of the ride

Friday evening
19:54 - 145mg/dL - Before dinner, 9 units of short term term insulin and 20 units of long term.  Dinner was pasta (two large helpings) with tomato sauce, capers and artichokes, cheese , chopped salad, and a tin of tune for some extra protein.

21:26 - 111mg/dL, I was surprised at how low I was here

22:10 - 144mg/dL, as my sugar was head in the right direction I was less worried

22:37 - 172mg/dL, this is about right before bed

Saturday morning
06:35 - 158mg/dL - Coffee with milk, bread roll with peanut butter, 400ml of orange juice. 4 units of short term insulin.  I was expecting to be higher after taking less insulin and eating a lot.  I would not start a bike ride without eating something.  My usual calculation is 180-200mg/dL before heavy exercise for 45-75 mins, where I would not expect to eat during.

06:57 - 161mg/dL, last check before leaving for the start line.

07:29 - 238mg/dL - granola bar

energy gel during the ride, not sure when exactly I took this, I think I should have had another one, I felt extreme tired going up hill and it felt like I was pedaling squares it is possible that I bonked (hit the wall).

09:45 first stopping point - 175mb/dL - granola bar, 2 minute break at the top of the big climb, blood sugar ok, supplemented food to keep me going for the next bit of descents and climbs.

10:31 second stopping point - 149mg/dL - energy gel and granola bar.  I had pretty much finished my water by this point so it was a good chance to drink and fill up my bottles.  I felt that considering my earlier test and that I had eaten 45 mins earlier that my blood sugar was coming down hard.  I wanted to avoid dropping any lower.

10:47 just before leaving stopping point - 252mg/dL, mission accomplished, sugar on the way up, enough to last me to the end of the ride (30km more predominantly down hill)

12:10 at end of ride after 70KM - 184mg/dL, I was happy with this blood sugar, high enough that I would not be dropping low any time soon, but no too high either.  My worry was that it was going to go up from here as it often does after exercise.

couple of small protein snacks when I got back to the zimmer

12:57 - 281mg/dL, this rise could not solely be due to the snacks.  This is my body breaking down glycogen and fat (hopefully).  The result very high blood sugar.

13:12 - 298mg/dL, that takes a while to go down

shower and a lie down

15:04 - 265mg/dL - 10units of short term insulin, cheese sandwich, salad, pickled herring.  This is the point where I must be most careful.  Too much insulin and when my body stops breaking things down my blood sugar will drop fast.

16:04 - 301mg/dL - apple 6 units of short term insulin.  I felt that I had misjudged how much insulin to take to bring my high sugar down gently.  I may have taken too much here.

16:44 - 260mg/dL - cafe latte, trying to stay awake for the drive home.  Normally I estimate this as 15g of sugar or 3/4 units of short term insulin but as I had just taken 16 units in the previous 2 hours I did not think it was necessary to add more

back home
18:28 - 120mg/dL, though normally I would be happy with this I felt that my blood sugar may be dropping too fast, as I found out later I was correct.

19:35 -  53mg/dL - 3 cookies, this is usually about right to sort me out when I am low.  I know it wont make me too high afterwards.

21:01 - 159mg/dL - dinner, roast beef sandwich, mashed potato, 1 pint of beer. 9 units short term, 24 units long term.

23:11 191mg/dL - On my way up after dinner.

00:13 - 238mg/dL - just before bed. A little higher that I would like on a normal day but probably the right amount to avoid over night lows.

07:30 - 120mg/dL - just after wake up. Perfect!