Last night I ran that same run I did a couple weeks ago when I went low while out on the hills and ate all my low food. 

Last night I finished at 303.

What?!

I knew I had a run coming, but what I didn’t know was that I had heard my running buddy say 5:00 and my running buddy had thought 5:30… so I planned for a 5:00 departure, not a 5:45 departure.

This matters when adjusting basal rates before exercise.

I try to time my temporarily lowered basal rate precisely for the moment my body has different requirements—when I run, my insulin responsiveness is much higher and essentially the insulin in my system becomes more “powerful”.  As a result, any insulin I have on board at the base of that hill can work against my efforts as it did the other day.

So yesterday, I tried to outsmart the system.  I lowered the amount of insulin about an hour before I expected to go for the run.  It should have been as beautiful as a symphony.

Except for that extra 45 minutes I hadn’t factored in.

As I drove to the run, I also ate a dried fruit bar, 10 grams CHO.  Should have all worked wonderfully to sustain my blood glucose levels.

Except for that extra 45 minutes.

So what ended up happening was that I was already heading high from not having enough basal insulin in my system without any exercise and I added more glucose to my system, in the form of that bar.  So I overloaded my body with glucose and had insufficient insulin to use the glucose.  Result?  38 minutes of running as my glucose levels climbed steadily.  (Insulin can’t be powerful if it isn’t in my system!)

I’m not sure if I run as well when I’m at 300+ as I do when I’m at 150; it doesn’t seem like I should.  Although, I ran my fastest half marathon last fall at 250-320 (same reason- basal rate and my start time). 

I will say, that run last night was no personal record.  And I know I struggle with my timing on temporary basal rates all the time. 

It bugs me.

But the insulin I took after I checked at my car worked well, and I still did a good thing out there last night. 

Next time I’ll make sure me and my running buddy synchronize our watches.  Maybe that’ll help.

I signed up for a road race today.  I haven’t run many this year since I was a bit over the concept after I finished my January marathon, but this one is kind of fun and my friend invited me (I need little more reason to run!).

So during the registration, there was a yes or no question:

Are you an athlete with special needs?

Well, yes.  Of course.  But do I need the race organizers to be involved in my running with diabetes?  (How would they even do that, with 35,000 runners?  Make me start first?  Run alongside someone with glucose?  How weird would that feel??)   

I honestly don’t think I am an athlete with special needs.  I always run with glucose, have a Road ID on my shoe and my Medic-Alert card in my pocket and always mark my bib number with my diabetes and pump information when I do an organized event like the one I registered for today. 

But none of that seems like a special need.  Just like tying my shoelaces, it seems like how I run.  I think each of those 35,000 runners all run with our own certain ticks and tricks and strategies for success and plans for potential failure.  It’s part of life!

I think I simply assume these questions about special needs don’t apply to me.  I’m not sure if that is some kind of denial, but I never think about special treatment first.  I think about how to reach my goal, and then factor in my diabetes along the way. 

It’s just like saying I am a person with diabetes instead of a diabetic person.  Some would say it’s just semantics, but others know how important it is for me to define myself on an individual level and separate from my disease in a basic and elemental way.

Because really, I am separate from my diabetes.  My identity isn’t tied into what I look like, either, or how tall I am or what clothes I wear.  It’s tied to what I think and what I do and how I treat others and how I treat myself—not my insulin pump or my blood glucose meter or the holes in my fingers or the numbers streaming through my head. 

So I will line up at that start line in July with 34,999 others beside me, and I will know we are all athletes with special needs.  I’ll just be the special one with extra sugar in my pocket and a great friend next to me.

I went to a talk last night given by a type 1 psychologist (you may have read my earlier post stealing from an article about her).  She gave me some things to think about in an interesting new light.

I liked hearing from her “therapist” point of view, as opposed to my “attorney” point of view.  We very much agreed, but my spin is a bit different than hers.  We agree that there are too many factors outside of anyone’s control that affect blood glucose levels to give patients the blanket instruction of “control your diabetes.”  (Dr. Bernstein calls the various factors and how they can affect blood glucose “inevitable imbalances”.  I’m planning to use that term; I like it!)

Given these inevitable imbalances of factors affecting blood glucose, Dr. Bernstein wants doctors to assure their patients they are not at fault when their blood glucose levels do not fit in range all the time. 

Knowing that “success” in this endeavor must be re-defined as something much much looser than 100% of my time in range, I want doctors to help me figure out what factors do what, when, so that I can plan accordingly and try, essentially, to outsmart the factors as often as possible. 

For her, a visit to a doctor is a chance for a virtual hug.  For me, it’s a chance to learn more about the game and to modify my strategy.

Interestingly, Dr. Bernstein asserted that people in Western culture fundamentally do not deal with mortality or suffering, and western medicine is designed to fix physical ailments and eliminate suffering.   

Living with diabetes involves recognition of our own mortality and daily dealings with our body means tricking it into staying alive with insulin injections.  This leads a person living with diabetes to a different psychological place than where a doctor usually meets her patient.

A doctor went to medical school I expect because they wanted to heal or fix patients with physical ailments.  But you can’t heal or fix diabetes.  You can’t even control blood glucose levels!  So in order for a doctor to approach a patient with diabetes with compassion, she must first acknowledge that diabetes can never be about achieving control or fixing or alleviating suffering.  Type 1 diabetes is most basically about an effort to stay alive with the use of insulin, precisely timed and precisely planned in an incredibly imprecise environment.

Whatever support a patient needs as they struggle with the inevitable imbalances and imprecision, I believe a doctor thinking that success with diabetes just takes the patient doing something differently will always fail. 

Diabetes is about doing your best, knowing as much as you can, thinking as much as you can about what you do, doing it intelligently, letting the rest happen, and always making sure the person with diabetes knows that they are not alone with their struggles and that there is no blame involved in a glucose reading.  We have enough going on to inflict any blame on ourselves–we have a body to take care of!

Here’s to the work you do every moment of every day.  Here’s to you.

We all know that living with diabetes is a load of work for each of us.  And how we handle that load affects how much work we will have to endure later with any complications of our disease. 

I, for one, I spent the first 10 years of my life with diabetes with an A1c between 10 and 13.   Not great, and my body felt the effects of my constant attempt to avoid dealing with my disease.  When I first found an environment that allowed me to face my fears of living with diabetes and showed me ways to live with the disease and stay myself, I came home with an A1c of 6.9, and have stayed between 7.0 and 7.5 since (with a brief stay at 7.8 while taking the California bar exam… can anyone say “stress”?!).  While training for my marathon last January I had my lowest result of 6.7 (not sure if that was the training or a switch to Apidra; time will tell).

I am of course afraid of potential complications of diabetes.  But for me, a vague term like “complications” is scary just on its own. 

So what complication in particular scares me the most?  I’m not sure.  I think a heart attack scares me the most; I am afraid of realizing I am having a heart attack and what that may do to the people I love.  Going blind doesn’t scare me; I don’t really think that’s a likely complication given my overall lifetime treatment of my diabetes.  Losing a limb is hard for me to comprehend for the same reason.  (I always have to laugh when a doctor asks if I can feel a sensation as they check my feet; I am too busy giggling to answer because they are tickling me!!) 

It’s all so vague, all this talk of “complications” when I was diagnosed at ten and am thirty two years old and fitter and stronger than ever.  It is simply too hard for me to comprehend.

And yet, I’m still afraid of “complications”.  They just sound scary, even when they aren’t guaranteed and aren’t even identified as they potentially apply to me.

So I do what I can to address the complications I am afraid of.  I don’t waste my time denying they are possible.  I look at them, head on, and ask myself: (1) how realistic is it that this complication in particular will affect me (2) what do I need to do now to lessen the likelihood that the complication will affect me.  Then, once I’ve figured that out, I put my fears away on a shelf.  They’re there, but as long as I am doing what I can, in a way I can manage right now today, I rest assured that I will not passively meet any complication ahead of me.

Just like monsters under the bed.  Turn on the light, look, and they disappear from your fears.  You have that power.

Boogah boogah.

I debated telling you this story.  It makes me look a little less than smart.  Then I remembered you might learn from my experience—you might learn that you aren’t alone—and that is what I want for you, so here it goes. 

I went for a run on Friday after work.  I had spent the afternoon high, so I knew I still had some insulin still swimming around in my body that would make me go low if I ran without modifying my plan.  So I started a temporary basal about 45 minutes before I thought I was going to start running, and I had a bar with 16 grams of carbohydrate.  The combination of all of this should have meant I had about the right amount of everything (energy, active insulin, carbohydrates) for the run.

Now, this is one of the hardest runs I do.  I run about a mile uphill and then start a four mile loop that has about 6 of the most heinous hills in the area before returning to my car, parked a mile from the loop.  I hate it, but it’s good for me.  (I am running a trail 10k in May and need to prepare myself for those hills!)  I also had plans for a pizza dinner when I got done.  Pizza is a food I always enjoy that much more if I feel I have earned it. 

I should also say that there are a zillion walkers and runners out on the loop.  Knowing that I will not be alone affects how I plan and how I pack for my runs.  On this run, knowing I was high before and knowing I had just eaten, I brought a bag of sport beans (24 grams), my car key and my phone.  (I didn’t even have my Garmin Forerunner with me—this was bare bones running!)

I was about 4.5 miles into the run and I thought about eating my sport beans.  Generally, if I find myself thinking “maybe I should eat”, I know from my years of checking while running that I absolutely should eat.  Where is the down side if I’m wrong?  Not that I am wrong often—running is a big glucose-lowering activity for me.

I should also mention that during the first 30 minutes of the run my CGM stopped working.  Usually, I can’t count on my CGM to be at all accurate for me while I run, but it still makes me feel better to have it.  I later discovered that I had dislodged the transmitter from the sensor when changing into my running shorts, but I didn’t know that while I was running and the little guy was alarming like crazy.

So here I am, out on this crazy hard course, my CGM is out of commission, I’ve worked all day and am just trying to get in a good hard run to round out a not-great work week, and I have the thought that maybe I should eat.

Dang.

I had one more hill after that one, so I ate a few sport beans and kept going.  As I went up the final hill, though, I was still wondering if I had had enough beans.  That’s it; game over.  I’m still wondering, that’s enough.  EAT.

Eat and walk.  Great; that was so not my plan for the run nor was it the workout my psyche needed!!  Sigh.  Oh well, I got in a good 50 minutes of running and I was sweaty.  I guess diabetes wins this round.

There is a little guard hut at the bottom of the loop, and I thought about stopping there and asking the guard if he had any sugar in his hut.  I knew from my experience that my beans would bring me up if I gave them a chance, though, so I skipped the question and kept walking to my car. 

I did call my husband and tell him what was going on and where I was and how I was getting to my car.  (I hate to think how he would feel if someone else called him to let him know his wife had collapsed.  I hate to think how he would feel if I disappeared someday and he would have to look for me.  These are reasons I always let him know where I plan to run.)

He was incredibly sweet and offered to stay on the phone with me as I walked back to my car (taking a shorter route back).  It was a nice chance to chat with him and to see a different route; I ended up walking alongside a creek and you would not have believed the croaking frogs!!  They were so loud my husband asked me if he had just heard frogs through my phone chatter.  When I was at my car, I checked and was 60 so I had some juice. 

I don’t have a moral for this story.  I’m just saying: we do the best we can, we make the best choices we can make, and sometimes we win and sometimes diabetes wins.  I feel lucky and strong to know that I win way more often than my diabetes does.

Although, I’m considering giving the guard hut a pack of glucose tabs to keep in there.