Frustrating

Sometimes planning just doesn’t work out. After finishing the Ruka Triple World Cup in Kuusamo Finland on Sunday, I spent all of Monday in Rovaenemi to let myself recover and make sure that my blood sugar stabilized before flying today. I woke up with my glucose at a perfect 110 and ate breakfast. It stayed constant at 120 through check-in, security, takeoff and landing in Helsinki. Then it plummeted as I walked to my connecting flight to Norway. I was left sweating and jittery for about 10 minutes before I could get enough glucose into myself to climb out of the hole.

I know from experience and from medical texts that low blood sugar episodes are extremely stressful to the body and it was the last thing I wanted to happen. I traveled separately from the US Ski Team today specifically to avoid this occurrence. It is another blow to my confidence coming off of a lackluster weekend. With the 15k classic being held on the World Cup in Lillehammer this Saturday, I have been striving to attain the world class form that has eluded me thus far this season. At gate B23 of the Helsinki airport, I sat with my head in my hands, shivering from my clinging sweat soaked T-shirt. I couldn’t help but wonder what I am doing. Is striving to win a World Cup race a realistic endeavor for me? My diabetes opens up so many pathways for my fitness to be buried under fatigue and frustration. It would be so easy for me to say that I have had enough and that my body and mind is tired of calculating the short term consequences of diabetic episodes with training and racing stress loads. But then I think of my work at summer camps for kids with diabetes. How can I tell a child suffering from diabetes not to give up on themselves and their dreams if I compromise my own goals?  I will not give up because of this disease. I preach that you should never give up what you love to do because of adversity. And mark my words, I love ski racing.

My New Webpage

I have started a new webpage and I promise to update it at least once a week. I had a slow start to the season this past weekend. This coming week I will be consulting with my doctor and coaches about how to adjust for the rest of the season. I am leaning towards a very different insulin dosing strategy for 15k races. I will write more on the new protocol as it develops.
For now, a huge congratulations to my training parter Noah Hoffman on winning the pursuit split in today’s World Cup!

Noah and I training on our own in New Zealand, August 2012

Noah and I training on our own in New Zealand, August 2012

Ride Aroostook

This Weekend I drove back up to Presque Isle Maine to take part in the Ride Aroostook bike tour which benefits the children’s diabetes program “Camp Adventure.” I have worked with this camp on two occasions, going for a downriver canoe and participating in a run and shoot biathlon relay race. I was impressed with the organization and ambition of the camp.

Ride Aroostook is a two day bike tour that is advertised as being 150 miles total (by my measurement it was 62 miles the first day and 70 the second). I decided that it would be fitting for me as an Olympic skier and type 1 diabetic to roller-ski the event in order to drum up more donations and draw more attention to Camp Adventure.

I skated the first day and really enjoyed the well marked course that hugged river beds and meandered through rolling potato fields. The weather was nearly perfect at 68 degrees and blue sky. However a strong wind made some of the open sections a little slower than I would have preferred. There were three aid stations spread out evenly which meant I could ski with just a water-bottle belt and restock at each stop. Using Swenor skate skis with “2″ wheels it took me five hours and four minutes to complete the 62 miles. That evening the event organizers provided an Italian buffet for the riders. I was the keynote speaker and gave a short speech at the dinner.

Day two saw even better weather. A full sun and 70 degrees was complimented by a light breeze. The course consisted of two loops. The first was 33 miles long and the second was 37 around. I double poled the first loop on Swenor classic skis with “3″ wheels in 2:45 and realized that I would be out for six hours if I completed the whole course on my slow skis. So I switched to my Swenor “2′s” and continued onto the last loop which I double poled in 2:50 for a total time of 5:36.

Thanks to some generous donations I was able to raise nearly $1800 and I got two well supported over distance workouts in the process. I would say I had a successful weekend. Now I am going to take a nap.

 

Top Notch Triathlon

I raced the Top Notch Triathlon in Franconia NH this morning. The unique race starts with a six mile uphill Mt Bike. This is followed with a half mile swim across Echo lake to the base of Cannon Mt. The last leg is a run/scramble up the alpine trails to the summit.

I set the course record for this race with a 1:06:05 in 2006. That year the course was dry as a bone and the Mt bike was ripping fast. This summer has seen more rainfall than I can ever remember in New England. For good measure there was a long thunder shower last night that completely saturated the trail. Setting a new record in the muddy conditions was going to be a tall order.

Fortunately another very talented competitor, Ryan Kelly, raced today and we pushed each other hard. Ryan is a more practiced and technically better rider than me. I was killing myself to stay with Ryan’s strong accelerations and smooth lines on the more technical sections of trail. I looked forward to the hard sustained climbs where technical proficiency wasn’t as important as overall engine size.

I made one stupid mistake that resulted in a crash. When I previewed the course I noted that the two most technical sections were in rapid succession and that my preferred line went from left to right. What I failed to take into account was that there was a wooden bridge in between the two lines where I needed to cross the trail. Wet wood and rubber is not a good combo. I came down on my hip hard, lost about 20 seconds to Ryan and had to cash some chips to catch back up. On a 1-10 stupidity scale I give myself a 5 on this one.

Ryan and I went through the swim exchange at exactly the same time and I followed his slip stream all the way across the lake. I have been swimming a lot this summer to gain shoulder flexibility but I have not received any formal technical instruction since I was 12 years old. Amy Caldwell offered to coach me a bit this summer but it never happened. I was able to stop choking on water cease thrashing about half way through the water, when I started timing my stroke with a mental chant “should have” (left arm) “learned to swim” (right arm). Anyway, with the advantage of the slipstream I came out of the water only five seconds down.

Then I made my second mistake. I have done this race multiple times and always set up my running exchange 100 meters further up the mountain than anyone else. This year a dozen people had placed their things near mine and I got confused and ran right by my shoes before having to turn around. Ryan ended up with a 20 second lead. I have to give myself a 10 out of 10 on the stupid index here.

Every time I have raced the Top Notch I have had the fastest run time so I was confident that I could still make up the gap and win. Ryan was hauling ass though and I had to dig to catch him by the halfway point of the mountain. We climbed together until what I figured was about two minutes to the top. Then I made my move. Hiking on ridiculously steep grass and mud we had a ski walking battle. My advantage here is obvious and I was able to put 16 seconds on him by the finish.

The back and forth in the race resulted in a couple of fast times. Despite the sloppy conditions I posted a new course record of 1:05:30 and Ryan bested my old record finishing in 1:05:46. He gave me a great race.

On the diabetes side of things, racing a point to point triathlon without a support crew is not ideal. It is an especially big pain when there is no clothing transport from start to finish. I had to pack two med kits with extra OmniPod insulin pumps, glucose monitors, and Humalog insulin. The OmniPod is programmed by a separate remote that is not waterproof and bigger than I would want to carry in a race. Each Pod is synced to one remote at a time in order to avoid cross talk between OmniPod users. I needed to have my remote at the start of the race in order to make last minute adjustments to my programming. So I left a second remote as well as new insulin pods and a glucose monitor as close to the finish line as I could. This way I could attach a new pump synced to the second remote after the race. The closest I could get this med bag to the finish was the base of Cannon Mt. So I had to finish the race and jump on the Tram to the bottom of the Mt as quickly as I could. It took twenty-two minutes to get from the finish to the bag.

I have been running a very basic basal insulin rate of .5 units per hour 24/7 due to my high training load. For the race I turned my basal up to .7 two hours prior to race start. The extra insulin is to keep my glucose from rising too high from anaerobic effort. Five minutes before the start my glucose was 163 and according to my Dexcom continuous glucose monitor, rising slightly. I took a micro-bolus of .15 units to curb the rise and started.

When I arrived at my bag one hour and twenty-seven minutes later, my glucose was 127 which indicated very good glucose control on the day. I did not need to make any adjustments so I left the Pod I was wearing on. Next I walked around the lake that I had swum across earlier, found my bike in the exchange rack, and had a great time ripping down the soaked trail I just raced up. Once back at my car, I grabbed my synched remote, made some small adjustments and headed out for another forty minutes of wet trail riding.

 

Busy July

In late June I wrapped up my first training camp in Maine with a 5k running race. I broke 16:00 for the first time since the year 2004 with a 15:53. Not blazing fast but still a good indication that things are going well.

Finish Line

Since then my summer has gotten very busy. Over the past eight years I have been visiting summer camps for kids with diabetes all around the country. I share the story of my diagnosis and career with them in the hopes that they will not let the disease deter them from their dreams and goals in life. I find the advocacy work very rewarding so I planned to visit 10 camps over course of five weeks. I planned the disruption into my training in the Spring so I have only scheduled 75 training hours for July.

I am not allowed to post pictures of the campers so the two pictures below are of me at Camp Jack in Road Island and playing dodgeball in New Mexico.

Camp-Jack

DodgeBall

It has been very hot and humid in New Hampshire but I love training here. The beauty of the landscape here never gets old. My last three days of training have been as follows.

2 hour run/2 hour double pole
1.5 hour no pole skate/2.5 run on Welch and Dickey Mountains
6 hour road bike for 120 miles

The over distance road bike will be my second to last ride of this length. I am transitioning to more specific training. Below is a picture of Wyatt taking advantage of a stream on the Welch and Dickey trail.

Its-Hot-Out

Toughman Workout

Every summer I like to come up with at least one “Toughman workout.” My definition of of a “Toughman” is a workout that is so extremely hard and difficult that it is of questionable training value. However these workouts do have the clear benefit of making nearly all other workouts seem easy in comparison.

In the past I have done double century rides on my road bike or set out on a 42 mile run that summited four mountains. This year I decided to do a shorter workout with an increase in intensity. I started at the Franconia Falls trailhead and ran the Franconia Trail to the Garlfield Ridge trail. This was about 12 miles of gradual uphill on increasingly rough terrain. When I turned left on the Garlfield trail I increased my intensity to Level 3 and ran, bounded and ski walked to the Summit. The effort took 20 minutes. From Garfield I descended towards Mt Lafayette and once again increased my intensity when the Ridge started to gain elevation. I followed this routine over Mts Lincoln, Haystack, Liberty and the flume before descending back to my starting point.

View Of The Ridge From Mt Lafayette

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Half Way Through

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The loop took me 4:58 to complete with 1:20 minutes of level 3 exertion. Following the workout I went to Cape Cod for two days on the beach to ensure full recovery

 

Off Day?

Today was supposed to be an easy off day for Hoff and I. However there is a severe lack of stimuli in our isolated lodge, so we convinced each other that going for a crust cruise was a good idea. We headed out to climb the mountain that dominates our view every morning at breakfast.

starting the ascent
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continuing the climb
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still going up
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Hoff on top
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Sketchy traverse
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The roundtrip crust cruise took a little over two hours. It was the most scenic ski I have been on in years and we only got lost once.

PPP Coverage

The Pole Peddle Paddle is definitely a big deal in Bend. The race took up the first page of the sports section for three days in a row and claimed space on the Front Page the day after the race. There were also two news broadcasts in the evening.

http://www.ktvz.com/sports/31087040/detail.html

http://www.ktvz.com/news/31088492/detail.html

I enjoyed competing in the event. It took a lot of energy though, as preparation took three afternoons in a row. Andy Fectaue from Rebound physical therapy helped me practice using the equipment that he put together for me. He also shared the techniques he developed for fast transitions from his own racing days. I have recovered well and enjoyed mixing it up with my teammates in a skate sprint relay yesterday.

 

Cyborg

Racing with diabetes presents many challenges but simply living on the road can be difficult as well. It is well documented that I had some severe low blood sugar while I was racing last year but to compound that I was also having low sugar while at rest. It was not uncommon for me to have sugars falling into the 50′s during travel or while sleeping. Having low blood sugar wastes adrenaline and leads to long term fatigue.

I started using a new tool called the Dexcom Continuous Glucose Monitor this Spring.

Dexcom1

Dexcom Continuous Glucose Monitor

I insert a small wire into the subcutaneous fat in my abdomen. The wire has a transmitter attached to it that sends data to a hand-held receiver. Every five minutes it sends my glucose level to the device and graphs it. Each dot on the picture above represents a glucose reading. The dotted lines going across the graph represent glucose levels of 180 and 60. If my blood sugar is not between those two data points my receiver will vibrate and beep. This is a very important feature for sleeping.

The device requires frequent calibrations from actual blood samples and displays information that it is about 10 minutes behind what my actual glucose is. This combined with its relatively large size (hopefully a watch will be developed soon) make it impractical for racing. However I may carry it on a triathlon race belt, in an ipod case, for 30k and 50k races.

Using the Dexcom device in conjunction with the Omnipod insulin pump means that I have two medical devices in my skin 24/7. My friends have joked that I am turning into a Cyborg. I embrace this, as I am grateful that the diabetes industry continues to innovate and make my life easier. In the picture below you will see the Omnipod on my chest and the Dexcom transmitter on my Oblique.

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Cyborg Impression

The display on the Omnipod “Personal Diabetes Manager” shows the many program options on the device. The PDM communicates wire-lessly to the pump on my chest.

Omnipod1

Maintaining a relatively normal glucose level is critical to the longevity and consistency of my season.  I look into every innovation that comes out in the diabetes world and decided that this combination was the best for me.  I will use it to tackle every race that comes my way this year.  I considered skipping longer races this season as well as the tour.  But I know I can perform well in those formats.  Living scared is no way to live.  I am going after the 30k.

Moosilauke Time Trial

This summer I have spent a lot of time and effort dialing in the right insulin dose for 30k and 50k events with good success. I also revamped my strategy for 15k length races but have not had the opportunity to test it much. It was necessary to change this strategy because my glucose levels were dropping perilously low directly following my races. These low blood sugar episodes annihilated my immune system last season.

Briefly, the new strategy is to frontload my insulin dose before the race instead of during it. I take a 30 minute extended bolus 30 minutes prior to the start of the competition. An “extended bolus” means that the dose of insulin my pump gives me is spread out over a half hour instead of given all at once. In the past I would give myself this dose directly before the start of the race.

The strategy was changed because the synthetic insulin I use does not reach its full effectiveness or “peak” until 45 minutes after injection.

This is a simple timing change but still requires testing and trial and error to do properly. The first time I employed the new method was at New Zealand Nationals in a 15k classic with the Canadian National Team. I took three units 40 minutes prior to the start of the race. I finished with a blood sugar of 240. (Normal blood-sugar range is 70-120, high blood sugar increases lactate production)
I made a note that my sugar was high with this dose and that I should increase it to four units for my next max effort. I also decided to move the dose timing up by 5 minutes.

My next race effort in the 15k range. was the Whiteface Hill climb roller-ski race. I took 4 units 35 minutes prior to the start. I had a good race but my blood sugar control was terrible and very disconcerting. I was at 350 and had a lactate of 12 to go along with it. Clearly I had way under-dosed again.

Whiteface was supposed to be my last 15k max effort before going to Finland but I decided I needed to test the new dosing strategy one more time. Mt Moosilaukee is only 25 minutes from my house and Ruff Patterson was nice enough to add me to the start list when his team did their annual timetrial on Sunday. This time I upped the dose to 6 units and took it 30 minutes prior to start.

It was cold out and misting. The rocks on the bottom half of the course were slick. About half way up I hit the snowline and the footing actually improved. The trail was a nice firm snowy bootpack. My heartrate was bouncing between 175 and my max 181 the entire way. I finished up in the clouds to find that I had run a new course record 35:16. The previous record was 35:23 set in 1998 by Marc Gilbertson. That wasn’t the best news of the day though. My bloodsugar was 105 at the top. I have found the sweetspot so to say and just in time.