Race Report: Shamrock Marathon 2015

Last Sunday the 22nd, I ran my eighth marathon! shuffled my way through my eighth and WORST marathon yet! Thus follows a race report.

tl;dr I did a marathon, it sucked for me. I don’t know why it sucked, but I can make some guesses and learn from them. And I have cool teammates and friends.

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Okay, here’s the full version.

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IRONMAN.

This is happening.

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In exactly six months I plan on crossing the starting line– and, dammit, the finish line too!– of IRONMAN WISCONSIN with a lot of other diabetic athletes.

Why?

This can be explained in multiple parts.

A few significant anniversaries

A while ago I was on a run and letting my mind wander. My diaversary is coming up……hey, next year it’ll be on a weekend…..maybe I should do a race or something…..or maybe I should GO BIG OR GO HOME?

Which began a longer mental conversation about doing some sort of physical challenge that related to diabetes, that honored diabetes in some way. Because as much as I keep it tucked away sometimes, it is a significant challenge in my athletic (and hell, everyday) life. And it’s good for my mental health to periodically take some time and acknowledge, “This stuff can really suck! Might as well show it up and kick its ass as much as I can.”

Then I got to thinking about how I would be coming up on 10 years of Being a Runner, which is to say, a whole decade of maintaining a fitness habit. And that corresponded with the thirteenth year of managing diabetes. And for the past several years, I had been trucking along, running 1-2 marathons per year, always at a fairly average (or slower than average) time, and not REALLY pushing my boundaries.

Maybe this is the perfect time to GO BIG OR GO HOME….

Enter Jeff Mather

As I was kicking around ideas, I was emailing with my buddy Jeff about various and sundry. Or were we blog commenting about various and sundry? In any case, his devilish temptation to join an Ironteam of diabetics with team Riding on Insulin came in many forms. (I just did a quick Gmail search, and lo and behold, we’ve been talking about Ironman since 2013. Go figure!) Anyways, he threw it out there on the blog, we talked about it via email, I’m sure we tweeted and facebooked (but not snapchatted) about it too….and the idea began to take shape. How cool to participate with a team of T1s and the people who love them! Plus, Riding on Insulin is a charity headed by Michelle Page Alswager, a woman whose activism and spirit I had admired from afar for many years.

I talked it out with my darling boyfriend, who agreed that he wouldn’t mind me being a slave to weekend bricks for months on end in preparation.

Ta-da!

So that was it. I signed up for Ironman Wisconsin (WI, because it’s home base for ROI). Across the US and Canada we have a team of 70ish triathletes, about 40 of whom also have Type 1 diabetes. There is a mix of experienced Ironpeople and noobs like me. We have a FB group where people ask about CGMs in bento boxes and talk smack about Strava stats.

In the midst of this, we are all raising money to send kids to ROI camps. I’ll talk more about why I believe in Michelle and this group in another post. For now, if you’re interested in good karma, the link to donate is here.

Fear and excitement in 3…2….1….GO!

Does Emotional Stress Spike Your Blood Sugar?

A few days ago, Kerri posed this question on Twitter:

I was struck by Jess’ response:

I was always under the impression that it could– stress increases hormones like cortisol and epinephrine, which raises blood glucose– so why would a licensed physician say no?

Well, perhaps he is devoted to evidence-based medicine, I thought, and the data are not strong enough to support that hypothesis.

So I enlisted the help of my friends– Dr. Google, MD and Dr. Google, PhD– to investigate what the experimental data say.

Like much of science, the evidence is….tricky!

Some studies indicate yes:

  • An active stressor (e.g. a timed arithmetic test) led to a significant BG response in insulin-dependent subjects, but passive stressors (like watching a tense film clip) did not. (Gonder-Frederick et al.)
  • One T1 girl prone to frequent and debilitating DKA experienced a rise in glucose and fatty chain acid levels after a stress interview. (The experiment was in regard to beta adrenergic blockade, which blocked these physiological responses after a subsequent stress interview.) (Baker, et al.)
  • Rats with lab-induced diabetes showed a rise in BG when exposed to a cat, with different patterns of spike and drop between Type 1 and Type 2 diabetes. (Chang, et al.)

More studies seem to indicate nope:

The data showing hyperglycemia in physical stress (like stroke or heart attack) is more robust (McCowan, Malhotra, and Bisitrian). So, too, is the link between chronic stress and diabetes. High A1Cs are associated with both life hassles (Cox, et al.) and psychiatric illness. (Lustman, et al.)

But I’m just not convinced by the data regarding acute emotional stress and high blood sugars. One study involved rats. One involved two subjects. The only one that involved a decent sample concluded that “Subjects’ BG response to the active stressor was idiosyncratic,” even if it was statistically significant over time.

On the other hand….the relationships between blood glucose, stress hormones, and emotions are really complicated. Anxiety increases oxidative stress in mice, linked to cardiovascular disease and cancer (Bouayed, et al.) But in people without diabetes, epinephrine can increase blood glucose, which thereby may feed the brain and enhance memory of emotionally strong events (Blake, Varnhagen, and Parent). Oh, and watch out if you’re depressed, because you have a 37% higher risk of developing Type 2 diabetes than adults without depression. (Knol, et al.)

As the scientists conclude in one baller study that measured endocrine response while subjects went skydiving, “Even in a very homogenous group of subjects and under well-controlled conditions, endocrine responses to acute psychological stress show considerable variations.”

And that’s without diabetes in the picture!

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Sometimes my blood sugar drops like this!

Medicine is a science. I can understand why Jess’ endo would take the evidence-based route and say that stress does not affect BGs. However….medicine is also art. What if this guy listened patiently? What if he took a moment to stop charting “pt is non-compliant, warned of complications of uncontrolled glucose” and took 2 minutes for open-ended questions?

How does stress affect your diabetes management? What can we do today to make it better?

Until more experiments can enter the annals of medicine, let’s see what happens when n=1.

Behold, Some Bold Blog Posts

Here’s what I’ve been reading lately on the internet that I would recommend to friends and strangers alike.

Happy weekend, and I would love to hear your own thoughts on any of these articles and blog posts!

Tuesday Tunes: First Aid Kit, “My Silver Lining”

Heard this song on the radio while driving with a friend to church, and fell in love. The melancholic chords combined with the hopeful lyrics are fitting for these last weeks of winter’s dregs.

Something good comes with the bad
A song’s never just sad
There’s hope, there’s a silver lining
Show me my silver lining

With the maturity of their music, it’s hard to believe this group is two Swedish girls who are under 25 years old! If you like it, check out First Aid Kit online. And at a folk festival near you….if you live in Norway, anyways.

Diabetes (Or Not) In the City

Within a few days, I had the exact same conversation with a coworker and a running teammate, both of whom I have known and seen regularly for several months:

Me: blah blah blah low blood sugar blah blah blah continuous glucose monitor blah blah–
Him: Wait, you have diabetes?
Me: Yeah…
Him: Oh, I had no idea.
Me: ??

I had a few reactions to this:

  1. Confusion: Haven’t they seen me check my beeg, take a shot, or talk about lows and highs before? Guess not. Or they did and didn’t put two and two together.
  2. Relief: Things have been great with my diabetes lately– I’ve had no crisis or even difficult events that puts diabetes Out There in view. Phew!
  3. Amusement: LOLlerskates, me being so self-absorbed that I assume this thing that is so obvious to me is also obvious to them! Reality check, self, no one’s watching you that closely! Spotlight effect!
  4. Despair: Oh God, the running buddy didn’t notice because I never bring my meter and insulin on long runs. BECAUSE THEY’LL FREEZE AND STOP WORKING NOOOO WHEN WILL WINTER END.

Contrast this with a meetup last Thursday with Manny and Melissa of the Diabetes Hands Foundation, along with many other diabetics (and a few non-Ds to boot). Manny is stepping down as the Executive Director of DHF, and Melissa is the new Interim Executive Director. They were in NYC for various stakeholder meetings and (wisely) planned a social get-together. We hung out at a cafe in the East Village and ate and drank and talked for hours. A lot of the conversation I was involved in was about DHF now, DHF in the future, my work in healthcare, and running in this godforsaken winter. There was a lot of talk about advocacy and where our efforts are, and should be, channeled. And, of course, the usual conversational fodder like TV shows and daydreaming of winter vacations.

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Melissa had someone take this happy, happy photo

 

The thread between these encounters is that there was very little talk of ME and MY diabetes. Which is nice. (Realization of point #3 and all that.) Not everyone needs to know. And time with my diabetes friends is better spent plotting about how to support the people who most need it.

(I realize it’s somewhat ironic to be saying this…..in a diabetes post…..on my personal blog…..”OH IT’S GREAT NOT TO TALK ABOUT ME! LET’S JUST DO IT SOME MORE.”)

In any case, I was delighted to see friends like Manny, Melissa, Maria Q, and others for the first time in years. I also met terrific people like Riva Greenberg & her husband Bou, and Marina of The Betes Org. I’m excited for the future of DHF and their ability to continue connecting and helping others, and I trust in them to be a voice for everyone with diabetes who wants to be part of the conversation.

I hope it’s less than a few years until I see all of them again! In the meantime, I’ll just continue plugging away until the next person asks, “Hey, what’s that beeping noise?”

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