Wildflower Here We Come

After a five year hiatus from tri due to hyperthyroidism, I am back and ready to race. Tonight was bike maintenance.

The Wildflower triathlon is a mountain bike sprint so I have dragged out the fifteen year old mountain bike that I bought for Tony before we got married.

I love that in our house it is perfectly acceptable to do bike maintenance in the kitchen. In fact our eat in kitchen nook has become the permanent home of Tony's new Franco bike.

The tops to the PowerGel's I used to keep my blood sugars stable on my last Wildflower Triathlon. I didn't know it at the time, but I was already sick then. I am going to keep them on there as a reminder of how far I have come in getting healthy again.

I think I used about the whole can of lube to get this bike back in shape.

And of course, after a day battling highs, the second I start this project I go low and have to stop to correct. Can you see this morning where I took the steroids to help my asthma? Steroids and insulin don't play nicely together.

Marks left over from the tape I used to secure my glucose meter, lancet, and test strips to my handle bars so I could test on the bike. Now I throw my Dexcom in my back pocket and ride. Got to love technological advances, they are definitely cutting down on my transition times. (No more waiting 45 seconds to get a meter result.)

Correcting with some apple juice while I continue to work.

The finished product. Forgive the colors, I had to get some spare parts from the bike shop that has taken up residence in our garage. It is not color coordinated, yet.

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14 Tips for Bringing Diabetes on the Trail

The date has been set. The packing list has begun. The companions have been chosen. I am off into the planning stages of my next adventure. Tony, Michelle, Brian and I will be hiking from one end of Catalina to the other over two-ish days. In addition to the usual hiking/backpacking preparations, I also need to make the diabetes preparations. And there are quite a few.

I recently came into contact with another diabetic hiker, Dylan, looking for tips. He is a ten year old who is hiking the Appalachian Trail this summer (a much bigger adventure than I can imagine) to raise money to purchase three Diabetic Service dogs, one for himself and two for fellow diabetic kids in his town. You can check him out at www.dcubed.org.

I'm always looking for cool new ways to solve diabetic problems on the trail and thought I'd share some that I have found along the way. I have a feeling there are thousands more tips out there just waiting to be shared. So your job is to add them at the bottom of this post, for Dylan and for Michelle and I.

So here are my tips, in complete random order, and probably useful only to some... (and they are just things that work for me, not in any way to be confused with medical advice or something I would advise you to do.)

FOOD, BASALS, and BOLUSES

1. I like my pump to be turned down to 45-55% for long hikes. I start it usually about an hour before the hike.

2. I cut back on boluses for food to the same percent.

3. I bring two bladders for fluids. One with just water for when I am higher than I would like, and one with what I call GatorPel. It's half Gatorade and half Propel. It gives me enough sugar to keep hiking and extra electrolytes (super important on a hike) from the Propel. When it runs out, I refill the bladder with water from the trail and pour in a pre-measured Ziploc with another dose of the GatorPel powder.

4. I never under-eat on a hike, even when I am higher than I'd like to be. I have found I burn at least 100 calories an hour on top of my usual daily calorie burn. Food early and often is very important.

5. I love to bring pre-measured trailmix in Ziplocs in an outside pouch so I can grab them easily without having to stop to get them out and slow everyone down. I make them with 240 calories of raisins, chocolate chips and Annie's cheddar bunnies (an organic version of Goldfish). For me that's a 2.0 unit bolus, or on the trail a 1.0 unit bolus.

6. Watch out for the overnight lows after a big hike. I have had to go to a 15% bolus at times. Other times if the day's hike was too strenuous my sugars would spike and become very obstinate. It really depends on the nature of the hike. After a few days on the trail, those results may also change.

GENERAL HIKING TIPS

7. Fresh socks, halfway through the day are AMAZING!!!!!

8. Dehydration is a really big concern on a hike, especially with diabetes. On my last hike, I ran out of water between stops in the hottest part of the canyon and could't take in calories because my stomach got so out of whack. And that's not a place I want to get again.

PACKING

9. Bring enough food, quick acting sugars, and insulin supplies to last more days than you expect to be out there in case you get lost or stuck.

10. Find a way to refrigerate your insulin if it gets hot, or warm it if it gets cold. No one wants frozen insulin. Consider the moisture of the air also can ruin test strips.

11. Having a favorite food for a mid-day meal will do wonders for morale. Even if it seems like it's a pain to pack. Last hike it was a soda and a chocolate candy. So worth it!! It gave me something to look forward to before and something to revel in afterwards.

CGM's

12. I have hiked the Grand Canyon with a glucose meter, and I have hiked it with a CGM. Let me just say, CGM's RULE!! If you don't have one, find a way to get one, even if it is just for the duration of the trip. With only a meter, I had to stop my group sometimes every 30 minutes to test. They hated it and we never got into a groove.

With the Dexcom, I kept it in my pocket and pulled it out about every 30 minutes to check. It also alerted me if I was dropping fast BEFORE I got low and had to stop hiking to correct and then wait for the sugar to hit before continuing on. But always keep a backup. On my last hike, my fellow Type per Michelle had her Dexcom go out within the first 30 minutes.

13. I've had a sensor pull out on other trips as well. You may want to consider additional measures to keep the CGM sensor on. I use SkinTac and have had excellent success (Just an FYI. This is not FDA approved or Dexcom approved) but those sensors stay on like no other.

14. Start your CGM an few days before your trip. I've found the first two days on a new sensor can be a little more off than later int he sensor's lifetime.

So what are your tried and true tips for taking diabetes on the trail?

An Excerpt from Islands and Insulin in Three Installments

6 April 1996

La Jolla, CA

I close my eyes and I can still see that moment years before, when it all changed. It’s as clear as yesterday, and yet it seems a lifetime away. The symptoms were there, but they weren't anything I really paid any attention to. Being only nineteen, I was not tuned in to what my body was trying to tell me. My time was spent ditching college classes and surfing and hanging out with friends.

I was never one to drink water, never really liked the taste. Apple juice, chocolate milk, Dr Pepper, now those were worthy of drinking. Water just seemed like a waste of time. But I started drinking it by the boat load, craving it really. I couldn’t sit through a Physics lecture without getting up at least three times to drink from the fountain (this was in the days before carrying a PBA-free water bottle everywhere was in fashion).

With all the extra water came all the extra bathroom trips. At least, that’s what I thought was causing my nocturnal wanderings towards the toilet. I tried to explain it away. It’s just the heat. It was spring and the weather was heating up.

As I got up for the third time to miss yet another section of the lecture, and was forced to drink out of that overused, under-cleaned shiny metal box of cooled tap water, I told myself the lecture was just really boring and I was looking for a way to stay awake. Physics was my favorite subject though, so I don’t know how I convinced myself of that one. Maybe it was just the best explanation I could come up with at the time.

To make matters worse, I was studying for finals in the thick of it all. I spent one evening with my roommate, Martha, at the food court on campus so that we would have easy access to the soda machine while we studied. I never developed a taste for coffee, so my study drink of choice was Dr Pepper. I must have had about eight, twenty-ounce drinks that night. And that wasn’t Diet. Diet was for fools. It was all real for me.

After studying that night, I couldn’t find a way to slow down to get some rest. I lay in that state between awake and asleep when thoughts run amok and you can’t control them and you can only sit and watch them run all over the place and make no sense at all.

My dreams that night were filled with Organic Chemistry equations. The kind where two types of molecules in their 3-D structure are blended into an entirely new molecule. They were converting over and over again in front of me, taunting me with every conversion.

I assumed the insomnia was due to stress and finals. The minor symptoms I was feeling didn’t register as the beginnings of anything serious until I was riding my bike home from school the next week and came to Hell Hill. Most of my runs and bike rides ended on this shady, tree-lined hill. It was only about a quarter mile long, but the incline made it a challenge. My goal each day was to ride to the top without being forced to stand up on the pedals. At the time I was in good shape and was making it to the top fairly consistently.

But not that day.

Half-way up the hill I was so weak and light-headed that I was forced to get off my bike and sit down for a few minutes. Normally it would have taken me less than two minutes to get home from that point. Thirty-five minutes later I was still trying to get there. I had to lean all of my weight on the bike to wheel my failing body home, stopping every few hundred feet to gather more strength. When I got home I sat on the couch dazed while my roommates tried to help. Martha came in first.

“Erin, you feeling alright?”

In the spring of 1996, La Jolla was the perfect backdrop for a wonderfully easy life. My parents were still footing the bill while I made my way through school. Classes were easy and the beach was close by. My last three years at the University of California, at San Diego I shared a three-story condo with six girls. Each year we had a different group of girls paying the rent. Every summer some of the girls would move out and new ones would move in, which made it the perfect place for me.

With that many people coming and going I could stay unnoticed, well-hidden. Martha was the only girl to live with me for all three years and one of the only ones who didn't let me fade entirely into the background. She was consistent and reliable, not one to add drama to any situation.

“I don't know,” I tried to answer. She sat down beside me trying to assess the situation.

“What happened?”

I did my best to relay the story in my confused state.

“Maybe you were just working out too hard. Here have some licorice; maybe you just need some sugar.”

If she only knew that sugar was exactly what was killing me. I recovered after about an hour and moved on. I spent the next few days trying to explain away what happened. I was sick a week before. I wasn’t a hundred percent yet. I went too hard too soon.

I had no idea it was really the diabetes starting to show itself.