Since I began using Apidra as part of my diabetes treatment and training regimen I have seen seemingly remarkable improvements in my performance on the bike. I now have a tool to actively manage my blood glucose levels, rather than the passive management most type 2s have. Before beginning Apidra, I managed my blood glucose levels passively with radical carbohydrate restrictions and aerobic endurance cycling. 

 What a difference a day can make here on the front range of the Rockies. 

Yesterday I went out for a short intense 16 mile training ride with about 1000 vertical in gale force winds. These were the kind of winds that make you want to drop into your small chain ring on the flats. We're talking wind here. My legs and breathing were all out of whack. I found myself out of breath at 145bpm a couple of times. Just didn't make sense. 

This morning we woke to several inches of heavy wet snow and it was still dumping. I tried to ride, but the snow was to deep on the bike path. It was compacting under my wheels making it quite tricky to keep upright. So I returned home and took the train to work. Figured better that then to risk injury so close to RAAM. 

Here is a photo I took with my cell phone of Sugar Rush yesterday with the new setup. I lowered her stem all the way down, and added the aero-bars the team sent me. She seems quite a bit faster now that I am riding in a more aerodynamic position. 

 Here is what it looked like out our patio door this morning:

I knew I was going to run hard on my personal ITT route after work today. The 15 mile route runs mostly flat for 9 miles, then turns west and climbs for the next 6 miles. Total elevation gain is ~500 feet. Very flat for around here.

Knowing the hard effort ahead of me, I ate around 100g of carbs before the ride and bolused 5u of Apidra. Pre-ride bg was 276mg/dl! YIKES! I am still trying to get the timing dialed in with the Apidra, but normally do a better job than this! 

I headed out, temp was much cooler than expected. I cruised out of downtown Denver onto the route and proceed to pick up the pace. Spent most of the time in the aero-bars.  Averaged 18.7MPH for the first 9 miles which is great for this route as there are several sharp turns which you must slow for. 

The climbing of the last 6 miles combined with the very curvy and corners dropped my overall average speed down to 16.7MPH for the entire ride.

I spend much of the ride with my hr running over 155bpm, and quite a bit over 160bpm. All in all I feel good about the effort, and am pleased with the  results for this route. 

Post ride bg was 122mg/dl. The Apidra had kicked in and opened the pathways for all that glucose to get into my muscles so I could keep the pace up. Good stuff! Post ride meal was 6 scrambled eggs with shredded cheese and taco sauce. Yum. 

It will be interesting to see my 1 and 2 hour post meal bg. All of my bg results are posted to my twitter feed on the right side of this site. 

What a beautiful day in Denver! The weather was just cool enough to require arm/leg warmers & wind breaker. 

Today was the first ride on Sugar Rush with the new aero-bars and the lowered bars. The new position felt much better than when the bars were 2" higher. Felt better and she rode much faster! Set a new personal record for the route at 52 minutes with average speed of 17.7MPH.

My waking bg was better than it has been lately. I wasn't hungry, so didn't eat. Just had my normal coffee with half-n-half. Started the ride at 143mg/dl which I figured was pretty good. I pushed pretty hard and ended the ride with bg of 177mg/dl. Normally I will see a 50 point drop during the first hour of a ride. However, since I didn't eat and didn't have supplemental insulin onboard, my bg when up. This phenomena is explained here. I bolused 1u of Apidra to correct for the high, and went about my day. Lesson learned. 

I'll have to see about posting a new photo of Sugar with her new fast setup. 

Here she is before I changed things up:

 Waking blood glucose this morning was 117mg/dl. Ate a 4 egg ham and cheese omelet. I have been strick low carbing since the weekend. Have dropped 4lbs. I am beginning to feel the effects of eating less than 25-30g of carbs per day now. 

This morning I felt sluggish. Unmotivated. Was just happy to sit on the couch with Elvis watching the morning news.

I pushed myself out the door on the bike. Glad I did as I always feel better when I ride. The ride was slow. My body didn't want to move. Legs felt good. Cardio was amiss. 130bpm for 12-13MPH is way off of my norm. I'm thinking that this may be an indicator of my body's switch from burning carbs as fuel to burning fat. (ketosis) I have experienced this before when going back into ketosis so am not overly concerned. 

My one concern is maintaining 100+ miles per week on the bike while consuming less than 25-30g of carbs daily. Add in the cold and windy weather conditions this time of year, and it makes for a bit of a dance to balance it all out. The one big positive is that by low carbing and exercising will certainly improve my blood glucose control until I get to see the Endocrinologist next week.

Got here to work in downtown Denver only to see my blood glucose had risen to 119mg/dl. Well within the margin for error on the meter, but still... Normally I see a pretty good drop in my bg level after riding for over an hour. Not sure what is going on there. I'll be watching it closely. 

  Just a quick update today.  I received a call on Tuesday from the UC Hospital Endocrinology Dept. They had received my referral and wanted to schedule an appointment to see me. This is great news! I look forward to looking deeper into my diabetes care than I have been able to in the past.  Stay tuned... 

I think taking responsibility for your health is one of the most important things you can do as someone living with type 2 diabetes. You must be proactive in your health. Educate yourself about available treatments. Educate yourself about the side effects. Educate yourself about what the consequences are if you ignore your diabetes. Become your own advocate in your diabetes treatment. 

As my own diabetes care advocate, I have been pursuing a closer look at my control and remedies. My way of blood glucose control has been very strict carbohydrate intake. Less than 30g per day as a norm. Now that I eat more carbs, my blood glucose numbers have been creeping up. Time to take a closer look at my treatment. 

I have acquired a referral from my internist to see an endocrinologist. Specifically an endocrinologist who is familiar  with treating athletes with diabetes. A medical professional staff who understand the difference between someone who is simply trying to maintain control while living a "normal" everyday life and someone who is pushing to greater physical pursuits. The right medical team for the life being lived. The right medical team to support me in those greater pursuits. 

I often describe type 2 diabetes as a moving target when I am speaking to individuals or groups. What I mean by this is that it is constantly changing as your life changes. You can't just sit back and take that pill twice a day. You need to be proactive in your care. Seeking out a higher level of diabetes care  while I am training for Race Across America is my example to you of doing just that. 

What was your waking blood glucose this morning?

What was your last A1C result? 

When is the last time you quizzed your physician about your diabetes treatment and remedies?

If you can't answer all of the questions above, it is time for action! Check your blood glucose regularly. Call your doctor's office to find out what your latest A1C was. Ask them what it means if you don't know. Study up on the latest remedies and treatment for type 2 diabetes so you can ask your doctor questions to see if there may be a better treatment option for you.

Just as diabetes is a moving target within you, the care and treatment of type 2 diabetes changes as more is learned about the disease. 

I had a good ride with Mike (ZenLC) yesterday. We cut it short at a little over two hours. The temps and wind made for a cold windy brutal ride. We did a little over 30 miles.

[ rant warning ]

I have been trying to get an appointment with an Endocrinologist who is familure with treating diabetic athletes. So far, I have had every door slammed in my face. Seems most Endo's are not interested in seeing a Type 2. Why do I want to see an endo? I have done a ton of research in light of recent studies that indicate early insulin intervention in type 2s can prolong pancreatic function indefinitely. I also feel the addition of a basil insulin, like Lantus, could be a huge help in my athletic endeavors. The normal phycians that we type 2s see are either GPs or Internists. I currently see a Board Certified Internist. Great guy, but doesn't think outside of the box when it comes to a proactive patient who is aspiring to greater control of the diabetes. Aspiring to greater athletic accomplishments. 

Is my thinking off here? I grow weary of what seems to be a battle with the established type 2 dogma of those physicians who see complacent patients who don't take care of themselves day after day. I feel as though I have fallen between the cracks.

[ /rant ]

So, in light of this gap in which I find myself I am turning back to what has worked for me in the past. Read on...

Mike played a huge part in my weight loss when I was still very heavy. Before and after the ride yesterdays we discussed my current nutrition vs. blood glucose vs. ride fule issue that I have been struggling with. In the past I only had to worry about fuel for endurance rides. Speed was of little consideration. My whole plan revolved around weight loss and finishing century (100 miles) or 200k (120 miles) rides. Just finishing. Not finishing quickly. I was very successful in achieving my goals with that plan with 2 Triple Bypass, Copper Triangle, Mount Evans, and countless other Club Hypoxia training rides, which are generally as difficult, if not more so, than any of the rides mentioned. 

I mistakenly thought that I needed to increase my carbohydrate intake for me go long distance while building speed. Eating more carbohydrates, as mentioned in a previous post, has caused my blood glucose numbers to rise. This is unacceptable. So, in my conversations with Mike, we decided to try going back to the plan I used to loose the weight while taking in carbohydrates for specific fueling needs. Otherwise, low carb'ing. This is how I lost the weight. How I was able to get my body to use insulin more efficiently. Efficiently enough to discontinue taking glucose lowering medications. 

So the plan is to only take on carbs when I am going to be on rides over 2 hours, or the planned ride includes a significant elveation gain (1000 feet gain is what I'm thinking at this point.) I'll be playing with this plan to fine tune it. Taking on few carbs while maintaining my activity level should help with both weight loss and blood glucose levels. The big question in my mind is,

"Will I be able to build speed?" Guess we'll see. 

I have pretty much lived a very low carb lifestyle for years in order to control my type 2 diabetes. It has worked well, for the most part. I have managed to keep most of the weight off and keep my A1C below 6.5. I have been able to cycle a lot and ride many endurance events, such as Colorado's Triple Bypass Bicycle Tour and the Copper Triangle Bicycle Tour. 

Now I am extending myself into uncharted waters. Competitive cycling. Yes, this fat old guy is going to throw down with the young fit studs in bicycle races throughout Colorado's front range racing scene. Racing in the local amateur scene is part of my training plan for the BIG DADDY race at the end of June. Race Across America (RAAM) is sure to be challenging and an experience of a lifetime. 

To fuel my body for training and ultimately for racing, I have had to begin eating more carbs. Eating more carbs raises blood glucose levels. Which in normal people would not be excessive. But for someone with diabetes, the level of blood glucose often exceeds healthy norms. 

I have seen my waking blood glucose go from 100-110mg/dl up to 130-160mg/dl since I changed my carb intake. I used to see 2 hour post meal blood glucose levels of 140-150mg/dl with a few complex carbs.

This morning my 2 hour post meal reading was 241mg/dl having eaten 1 cup of oatmeal with a small banana. Post glucose dropped down to 126mg/dl after my 66 minute bike commute to work of 15 miles with an average heart rate of 136bpm. Still high.

My 7 day average blood glucose used to be 110mg/dl. Today that average has increased to 132mg/dl. Not acceptable in my book. But is this trend something to worry about? YES! Since taking my health and specifically my diabetes control seriously, I have prided myself on good blood glucose CONTROL! 

I am having trouble regulating my blood glucose as I have to increase fuel. Plain and simple. I have been revisiting my plan for controlling my blood glucose given this general upturn in my averages. My current Internist is a great doctor. However he, as with many in his specialty, do not seem to listen to his patients. I think this is partly due to generalizations that type 2s are not proactive in their treatment. Nor are they athletic.

At the recommendation of several of my Team Type 1 teammates and friends with type 1, I have placed a call to the University of Colorado Barbara Davis Center to see about getting an appointment with an Endocrinologist who works closely with diabetic athletes. I am hopeful that I will be given the opportunity for an appointment, even though I was told they do not normally see patients with type 2 diabetes. This seems to be yet another gap in the healthcare system in which I seem to fall. These gaps are a topic for another post.

The lesson I want anyone reading this to come away with is simple. YOU are ultimately responsible for YOUR care. YOUR treatment plan. And control of YOUR diabetes. Educate yourself. Your family. If necessary, your doctor as to what IS or IS NOT working in your treatment plan. It is only through an active partnership between YOU and your health care team that you can realize a plan that works for YOU.

Finally, if you make substantial life or behavioral changes, be sure to revisit your treatment plan as I am doing now.

 Today was the first day back to the training regimen that our team trainer, Tim Henry from http://www.totalcyclist.com has set out for us. 

I bike commute about 30 miles round trip on Monday, Wednesday, and Fridays. The weather today was warm for this time of year. No complaints there at all. I even managed to make it home before dark! 

Today's planned workout was an hour on the trainer doing "isolated leg training." This is an exercise were you put you bike in a stationary trainer and pedal with one leg clipped in. Then the other. I did this workout on the bike path on the way home tonight. 20 revolutions on the right leg. Then 20 revolutions on the left leg. The 20 revolutions with both legs. This was a good work out! The object of this exercise is to get both legs equally strong and to even out each legs circular pedal stroke. Sure was more fun to do on the bike outside instead on inside on the trainer! 

As the weather gets warmer. The days get longer. I am again trying to figure out how to make it possible to bike commute to my office on Tuesday and Thursday each week. This is a 25 mile one way commute with considerable climbing when riding to the office in southeast Denver near the Centennial Airport. I must have a car at work on these days. I could leave my car there, but I am not very comfortable leaving my car there all the time. I'll figure something out. If I could add these days to my commute I would have 190 miles per week of just bike commuting! Then add metrics (62 miles) or a century (100 miles) on the weekend, and that would put me up around 250-300 miles per week. That much bike time is sure to get the weight melting off me once again. 

These are the things I ponder as the weather warms...