Virtual Races and Diabetes: Have I Mentioned that T1D is a Pain?

Way back in April, in a moment of... something... I succumbed to peer pressure (shocking, I know, and very out of character) and signed up for a virtual race with a couple friends. The Social Distance Run promised to be goofy enough to appeal to my tongue-in-cheek sensibilities and historic loathing of organised events. With the lure of dad jokes, a cool shirt, a medal, and the slightly terrifying prospect of an actual training plan, I agreed to run a half marathon.

At first glance of the training plan, I went "oh god, training plans. Barf." But since I'm not a quitter (most of the time), I sucked it up and mostly followed it. Two shorter runs, an intervals day (hills or track, but I hate tracks so only did hills), and a long run on the weekend. There was a strength and stability day in there, too, but after doing it twice and limping around like a cripple for a few days after, I decided to stick to the running and leave the "getting stronger" thing for other people.

Gotta say, I've fallen back in love with running. Daniel (of aforementioned peer pressure) did most of the long runs with me (at a socially appropriate distance, of course), which made for an awesome weekend tradition that I'm hoping to keep up after race day.

 

-------------------------------------------------------------------------------------------

I've been running for 10 years ish and was so goddamn sure that I had a handle on the diabetes and endurance running. I've talked in the past about my learning curve when I started running and how I'd managed to get things figured out. Welp, it turns out that when you haven't been doing long runs or high milage for a few years and are also, ya know, ageing, your body behaves differently. My diabetes didn't get the memo about behaving the way it did 6 years ago.

This virtual race thing coincided with my relatively new use of Tandem's Control IQ system. Initially, I was super pleased with Activity Mode. It impressed on shorter runs (2-3 miles) and hikes, and as long as I had minimal insulin on board and ate 15g of carbs before starting, it seemed promising and sustainable. When I wrote my review of Control IQ, I raved about it, noting that it was great for physical labor, hiking, and the runs I was doing at the time. 

Welp, fast forward two months and 150 miles and I need to amend my original review. It turns out, my 30-year-old body doesn't like to process sugars or carbs while exercising. Also, I get ultra-sensitive to insulin while running / doing aerobic exercise. Looking back, I always addressed this by carbo-loading and setting temporary basel rates, going into long runs with a high blood sugar, and no insulin corrections. Unfortunately, the Control IQ algorithm doesn't allow you to do this effectively, what with the auto-corrections to keep you in the target range and the inability to set temporary basal rates. 

As I followed my training plan (complete with the promised dad jokes) and upped my milage to 20-ish miles a week, I found myself constantly fighting hypos. I started messing around with my diet in an attempt to stave off the inevitable crash during long runs, joined a couple Facebook and reddit type 1 diabetic running groups, and trying different supplements and gels on the recommendations of other T1D runners. I even tried making my own gummies using UCAN powder (surprisingly easy), which seem to be pretty effective at postponing the BGL crash if I take them 45 minutes before a long run. Supplement with regular gummies and Huma gels, and I think I have the diet thing mostly sorted out. After much struggling and many hypos, I also stopped trying to make Control IQ work for runs farther than 3 miles and started turning it off so I could set a temporary basal rate. I'm definitely on a stats kick right now, tracking my BGL and carb intake throughout my runs.

A major problem for me is that, for some unknown reason (probably because it likes being contrary), my body does not seem to absorb sugars when I'm exercising. What this means in practice is that I start a run, begin trending low, treat with some fast-acting sugar, and nothing happens. I can take on 60g of sugar during a run and still maintain a gradual (or fast) downward trend until an hour or so after the run is over, at which point it all seems to absorb at once and I skyrocket back into normal range (sometimes I get high, but as long as I don't keep treating the low, I don't seem to rebound in an extreme fashion). Basically, my best outcome for a long run is to slow the decline enough that I'm finished before it gets dangerously low.

Have I mentioned how annoyed I am that my old method of "carb up, wait 30 min, then run" no longer works?

Further complicating matters is the fact that I've been having some pretty gnarly reactions to the Dexcom adhesive, making my CGM use a bit sporadic. I've been on the phone with Dexcom about this repeatedly, and they insist that nothing has changed in their adhesive or manufacturing. I call BS. The T1D running forums are full of people complaining about abruptly developing allergic reactions to the Dex adhesive and seeking ways to mitigate it. So far, I've tried Flonase and IV Prep to create a barrier (to no avail). This week I tried some Skin Tac barrier, but it's definitely not going to last the full 10 days; at this point, I'm hoping it stays on through my half marathon before the reaction bubbling under the adhesive rejects the CGM completely. The next attempt will be an actual adhesive barrier like Tegaderm, which I've been trying not to do because I have a history of reacting to similar products. I have photos of the reaction progression. They're not pretty. If you want to see them, I can show you, but let's spare unsuspecting eyes the trauma.

-------------------------------------------------------------------------------------------

Tomorrow is race day. I have a plan. The plan involves lots of complex carbs in the morning, a bunch of slow-release carbs during the run, and a beer at the end. Ev and I are aiming to meet Daniel around his halfway point (crazy guy's doing a marathon) and finish the run together at a brewery.

Let's be honest.... I'm really just in it for the beer.

-------------------------------------------------------------------------------------------

Update:

Half marathon on the books. And apparently, I finally got the diabetes part right (shocking, I know). Also, selfies while running (and dying) are super flattering.

The Quarantine Diaries

Day 45

0530 My internal clock is telling me I should get up. You’re late for the climbing gym. You want to skip traffic. You have a ton of work to do and it’s easier to get it done before everyone else shows up at the office. I shut that shit down, steal the blanket back from my husband, and fall back asleep.

0655 The first alarm goes. I just fell all the way back asleep. Hard pass.

0710 The second alarm goes off. This time I roll out of bed and limp my way to the kitchen. This is why I prep coffee the night before. Hit the “go” button and then the bathroom. Cold face wash gets my eyes open, and working the ankles gets them actually mobilizing for the day.

0715 Coffee time. Also a yogurt. But mostly coffee. A decade of exposure to my cheerful morning ways keeps the husband from talking to me and it’s fantastic. 10/10 would recommend.

0745 Actually awake and approaching functional. I consider putting on real pants, and opt for yoga pants (again). Jeans are a relic of the past, but I try not to wear actual pajama pants during the day. Relocate from the kitchen island to the dining room table, aka my work station. If I think about it at all, I get annoyed that I’ve given up my dining room table to work from home. We’ve been eating in the kitchen, standing up, and on the floor or couch the last two months. 3/10 would not recommend.

0750 Log in, check emails and missed Teams messages. Grumble about how stupid this is. Start working on whatever nonsense I had going the day before.

0830 The daily department check-in meeting is such an adventure. We’re all keeping busy, and while this call always starts on-topic, we wind up discussing home buying, yard work, and how reports from people who have “recovered” from Covid are incredibly terrifying. I compare Covid to polio insofar as just because you survive doesn’t mean it doesn’t fuck up your life long-term. Surprisingly, nobody disagrees with me. We all agree that discussing it in terms of mortality and recovery rates alone doesn’t capture the actual magnitude of the pandemic. We’ve been in this meeting for 45 minutes and off topic for 20. We should probably go do the things we actually get paid for.

1000 The husband wanders out of his “office” (aka the gear room, home of the climbing gear, camping equipment, and general happiness. I think he got the better office space in our arrangement. I wonder if I can convince him to trade work stations?). We go on a walk to the coffee stand down the street. It’s a nice excuse to stand up and move around for 5 minutes. Also coffee. I should really build a shrine to it.

1010 Triple shot americano in hand, it’s back to work. Time to zone in and do… oh god, why is the model acting like this? These numbers don’t make sense… the math isn’t that complicated… maybe I’ll do a hand calc just to compare. Wait, I’ve already done hand calcs. Okay, I guess I’ll update it to the specific modeling method. I swear I’ve been stuck in this loop for a week.

The model I’m working on looks like a penis. Has anyone else noticed this? How has nobody commented on how bloody phallic this geometry is. *snicker*

I think I know why the program is outputting different values. But I want someone to confirm. Tech support is lost and just sent me to an actual programmer. He’s lovely and looking in the back-end at equations and dependencies for me. I’m pretty sure I found a fairly important limitation (from a user-perspective) when constructing models, but I really want it confirmed. Have I mentioned I want confirmation of my hunch?

1300 How is it already afternoon? I should grab some food. Looks like leftovers. I’m down with that. Oh! Cookies! I like cookies.

1305 Back to the models. Maybe I’ll stop trying to figure out what’s going on and just use a simplified method. Less exact, more conservative, but at least I understand why it’s calculating things the way it is.

1400 The phone rings. Who even uses phones anymore? Isn’t that why we have Teams and email? There’s a metaphorical dumpster fire and they need me to design a retaining wall. “Do you have a couple hours to get on this?” Not really, but I suppose there isn’t anyone else, sooooooo…. “They need it designed by Wednesday. Have to get it submitted for permitting.” Alrighty then. I am a retaining wall ninja. I shall design this retaining wall using my extra-special Mathcad sheet. I went through it and updated it to highlight the user inputs, manual table updates, and check values a couple weeks ago. This will be a good test to see if I missed anything.

Ooooooh! How do other states have such well laid out design guides and standard drawings? This is making my life so much easier! I should get a Washington license and only work on jobs down there.

1600 It’s quitting time. Working through lunch is great. I love not working. I should probably finish this retaining wall design though…. It’s almost done. 5 more minutes.

1630 Time is a construct and I’m bad at managing it. Quitting time for real. Switch from the dining room office back to the kitchen island, open up the laptop, and dink around on the internet for a bit. Mmmmm internet. For some reason, I’m cranky. No reason to be, but I feel my mood deteriorating. I blame work and being stuck in the house.

1700 The husband is done with work. We discuss going for a run, but he needs half an hour to “decompress.” Fine. I can wait. The couch is calling.

1730 Run time. In a fit of stir-crazy, I signed up for a virtual race with a couple friends. It comes with a training plan. Being slightly compulsive, I’ve been trying to stick to it. I hate training plans, but I guess it keeps me motivated. I am now fully on edge and rapidly approaching stabby. According to the plan, it’s a 3 to 5 mile day. Fuck that noise, I want to sit on the couch and not wear pants and wallow in my crankiness.

Mile 1: This is stupid. I hate my job. I want to stab everyone.

Mile 2: I guess things are actually okay. I like being outside.

Mile 3: I suppose I also like my husband. I’m actually in pretty good shape these days… all this running around the neighborhood is good for my mileage.

Mile 4: Goddammit stupid diabetes. Blood sugar is tanking. The day is beautiful and I’m happy again, but also fuck everything cuz I’m low. I seriously need to reconsider my diet.

1900 Finally got the blood sugar level trending up. No idea what we’re doing for dinner. I hope that if I ignore it, the husband or sister will cook. We play a sad game of cooking chicken in this house. I often win.

2000 Consider showering but decide it’s too late and I don’t want to sleep on wet hair. This is a garbage excuse, since nobody sees me in this time of Covid. We turn on White Collar and zone out to the TV instead. Amazon Prime has surprisingly limited commercials. Also, Rachael Ray’s dog food commercial is making me homicidal. Nobody should be that perky. It plays every time there’s a break. Kill me now.

2200 Despite heckling from the couch, I call it a night and relocate to the bed. Not like I’m going to sleep or anything… I start off reading a couple chapters of “Sapiens” and then switch to a free trashy romance novel. Variety is the spice of life. Also, thinking keeps me up at night. I refer to romance novels as a “pallet cleanser”.  

2330 Unfortunately, the pallet cleanser is easy reading and I go through half the book before I feel tired. Did I read this much trash before social distancing? I should really go to sleep…