Pandamania 10k Training Log

Yes. Lots of ways to fix this.

But just consider, more carbs = more fuel. And before a run, that is always a good thing! :+1:

So yes, less IOB is good. But remember - carbs are your friend on runs!

And BTW, when you are in the ditch, nothing will work faster than the Transcend glucose gels. That is always a good parachute for you on the free-falls. :man_shrugging:

EDIT:
Don’t want to be accused of mansplaining. But IOB means insulin on board. I hate acronyms, but I end up using them because they are a mainstay in diabetes chatter.

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No apologies! I appreciate folks helping me decode the alphabet soup :+1: and the main culprit is, quite likely, my habit of skimping on or skipping breakfast. I came up as a teen girl in the early aughts, and my default habits were set around myths of empty stomach cardio, bare minimum carb intake, and so on. These habits are both unsupported by exercise science, and also really do not work so well with a stick shift pancreas.

It’s a slow process to change habits that have carried for decades, but I am working on it. It feels weird for me to eat before I run and it’s a corner I cut frequently, so probably just doing a more legit breakfast (I tend to eat lightly or nothing) is probably the best fix. Especially since that just reinforces and routinizes race day protocols!

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It’s much easier to skip meals when you have a pump and can turn off your basal! I do that all the time on easy runs. (Never on hard runs though.)

All good, though. Learning and stuff.

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Oh BTW, that’s fine if you are sparse on some of these. Just make sure I get the RPE, time, and distance for each of them at some point.

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04/02/2024
Distance: 3.02
Time: 31:24
RPE: 5/10
Location/Surface: Trails/Packed Dirt
Conditions: 50s, sunny, calm winds

04/03/2024
Distance: 3.25
Time: 30:00
RPE: 6/10
Location/Surface: Gym/Treadmill
Conditions: n/a

And today’s big news: it took literally hours of phone calls and extended hold times, but I FINALLY PUSHED THROUGH INSURANCE APPROVAL FOR THE OMNIPOD DASH!!! Paid for and preparing to ship as we speak. So the insulin game is about to change! :+1:

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Fantastic! I use Dash with DIY Loop and would hate to go back to MDI!

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I know so many people have dealt with so much worse treatments- and dealt with those frankly scary barbaric options for much longer than I have even been diabetic at all!

…but I am really looking forward to the pump. :sweat_smile::+1:

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@panda
Here is next week.

Day: Date: Workout:
Monday Apr 8 4 mile run, easy pace
Tuesday Apr 9 *Stryd baseline
(see comments below!)
3 miles total
Wednesday Apr 10 8 repeats:
1/4 mile @ 9:00 pace (~6.6 mph) with 1/4 mile recovery jog after each rep
Thursday Apr 11 3 mile run, easy pace
Friday Apr 12 Rest
Saturday Apr 13 5 mile run
(2 mile warmup, last 3 miles at sub 9:40 pace)
Sunday Apr 14 Rest

*For the Stryd baseline, you need to keep a constant pace on a flat surface, so doing this on a treadmill will probably be the best way to do it. The power rating from treadmill to outdoors should match up pretty well.

Set your treadmill at 6.2 mph and run for 1 mile, to let it get warmed up. Do not start your watch during the warmup!

Once you get to 1 mile, start your watch and record the next 2 miles at 6.2 mph. Leave the speed alone.

After your watch has recorded the 2 miles, stop the watch first, and then stop the treadmill.

You should have a power rating that is fairly consistent for the 2 miles (some slight variation is normal, but the power numbers should all be pretty close for the entire run).

This is your power baseline.

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Ok! Time for an update.

I FINALLY got the OmniPod dash. Today 4/9/2024 is my first day pumping. IT’S A BRAVE NEW WORLD FOLKS! I also added Stryd pods on my feet :woman_shrugging:t2: what can I say. What I lack in natural talent (so, everything), I make up for and then some in gadgets! :tada::+1:

4/8/2024: Easy Run: Treadmill (poor weather)
Duration: 48:00
Distance: 3.99 miles
RPE: ~5/10
Cadence: 158spm
Power: 137w
Pace: 12:00/mile

4/9/2024: Stryd Baseline: Treadmill (pace control)
Total Duration: 28:19
Total Distance: 3.21
Stryd Duration: 18:47
Stryd Distance: 2.00
RPE: ~6+/10
Cadence: 160spm
Power: 170w
Pace: 9:23/mile

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170 is your magic number. Let’s get to where we can hold that for one hour.

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Running with a pump is so much better than running without. I don’t understand why this isn’t a first line recommended therapy.

So here comes the emo bus: my apologies in advance. I generally try to keep a bright face on things for the most part but I have had a sort of psychologically rocky couple weeks. Unfortunately my doctor continues to rip me around by trying to micro-manage my insulin and, by extension, my diet, exercise, and all aspects of my life. I called the endo where my referral was sent and got told NO: I wasn’t yet approved to even schedule an appointment. I am struggling to convince anyone to give me vials of Novolog: NO, you don’t need vials. I have a hand-me-down glucagon kit because my doctor (who is so scared of me being low) refused to prescribe me the anti-low oh-sh*t handle despite her lip service to concerns about hypos: NO, what would you need that for? And I am being blocked on pen refills being told NO, and that if I was “being responsible then I shouldn’t need more than 12u a day and 15ml should last you 90 days, we won’t give you more unless you pay $$$ for an appointment and explain yourself and convince us”.

I… well, this is about running, and this is also very much not about running, in the sense of progress, setbacks, belief in self, and mental fortitude. I spent yesterday morning getting told NO endlessly for literally no good reason at all. I ended up collapsed on my kitchen floor clutching my phone and sobbing. It was hours of sincere effort and just NO NO NO. I felt so low, like maybe I didn’t deserve treatment after all. I just sat there and rocked and cried and freaked out my dog because she didn’t know what was wrong with me. I don’t know how to respond when telling the truth to doctors and doing my legit best to manage this condition earns me nothing but what amounts to punishment: restrictions on my life, criticism of my lifestyle, denial of better treatment options. I’m not a good liar and I don’t feel good about myself when I’m even “selective” about truth-telling, but it seems like lying to professionals is a requirement with diabetes. I was raised to be honest and do my best and that was the way, and now it turns out that being honest and doing my best is, if anything, literally detrimental to my health.

I find this a super stressful spot to be in, and I feel hamstrung, criticized, judged, cornered, bullied, and denied by the professionals I should be able to trust. I end up wondering if it’s my fault, I feel stupid and I feel like maybe I don’t deserve the care I’m asking for. That obviously also makes appointments something I dread, and is a horrific description of a care relationship. I am having a hard time with this, and I felt totally at a loss for what to do. So I just dropped on the kitchen floor and cried and cried and felt very sorry for myself.

…and then I remembered there are people in my corner and I messaged my coach, @eric. I don’t have words for the difference it made that someone - not just anyone, but Gandalf himself basically - made time in his day for me, and was there to talk me through it. That conversation helped set to rest some of the feelings of shame and failure (and yes I felt like a failure) that sprang from being basically criticized and guilted by my doctors, who constantly behave as if this is something I am doing wrong and seem to hold a deluded belief that they know more about this than I do. Coach reminded me that this is a marathon not a sprint, that I do deserve treatment and that I deserve to live the life I want, that doctors don’t get to dictate that to me, and that like any game there are strategies and tactics that will advance my goals. That there are indeed ways around the system. It won’t fix everything, but i think we now have a plan to get around a few of these roadblocks. Right @eric?

And after we talked I took a deep breath, had a snack, turned off my basal (which is proof I’m making headway in the system even when it doesn’t feel that way points to new Pod on belly), and then I did my run. And I rocked it.

It shouldn’t be this hard to just be granted the freedom to live my life, not when all the tools are right there. I feel so bullied by the medical system, it feels like they purposely want to hem me in and prevent me from accessing things that would set me free. I literally don’t know where I would be without all of you - but suffice to say it would be somewhere infinitely darker than where I am. “Thank you” is wildly insufficient, but it’s about the best the English language offers. So thank you all for being the people and community you are: I am only one person, but my experience tells me that this community changes lives. You are the lighthouses steering me through these reefs and reminding me that, even if it’s not a straight shot, there does exist a route to shore. Thank you all.

And here’s the run deets since this is a training thread not a therapist’s office.

4/10/2024: Crazy Eights
Location: Treadmill (interval control)
Duration: 45:05
Distance: 4.0
Cadence: 161spm (min 156, max 182)
Power: 143w (min 114, max 193)
RPE: 6+/10
BG Events: None (range 93-115)

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Sorry about your tough day. :frowning_face:

We can get you setup eventually. It takes time to get all the stuff sorted out.
In the meantime, you will have what you need. And then down the road, you will have backups, and backups of backups and everything else.

Lots of ways to learn how to work the system. For example, you need vials to fill the pod, of course. :wink: You can’t fill them with a pen! The trainer told you that “you must use vials and the pod syringe” to fill the pods! :wink: So you get vials.

But you also need pens, right?!?! You’ve had issue with your pump PDM dying, and you need pen backups, because you don’t know how to use syringes very well to inject, right? :wink:

So you get a vial script, and a pen script. And maybe you just go to two different doctors to get this handled. But whatever, you get it done. And something like that gives you double the insulin supply, plus backups.

Just things like that.

And most of this goes away once you get an appointment with a single competent doctor, which is what I want you to focus on.

In the meantime, the easiest way to get Novolog until you get everything sorted out is to just go to your mailbox in a few days. :stuck_out_tongue_winking_eye:

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Now I’m crying for different (happy, supported) reasons :sweat_smile::pleading_face::heart::pray:

No words. Absolutely no words. :heart::pray:

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Panda, I’m sorry to hear that you are still stuck with a bad doctor. I truly believe that, unlike your current one, most physicians don’t specialize in the prevention of adequate healthcare. In time I trust you will find medical care from someone who supports the strong efforts you are making to take good care of yourself, applauds your success, stays out of your way when you are doing reasonable things and getting reasonable results, and does watch out for issues that they can see but you don’t.

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I am a firm believer in the motto,
IMG_0153
It was emphasized strongly when i received my 1st diabetes education 34 years ago. The clinic used the analogy of a game with teams, support and rules- the most important thing was, “You are the Captain of the team.

I was extremely lucky at diagnosis to have my medical care in the hands of a clinic that had all the doctors necessary to monitor any health problems, including those with complications from diabetes. I don’t know if the interaction of primary care and specialists is still happening today as that institution decided to not take our insurance anymore. For the last 10 years, my wife and I have doctors scattered all over town who have trouble communicating with one another.

But fortunately I was able to build on the great foundation laid by that clinic with books and sites like this one.

I posted about the possible contraindication of a drug prescribed by my endo causing unstable BG since I had surgery. I left a note at his front desk asking to prescribe another kidney protective drug, Kerendia, which does not increase glucose in the urine. What I think is happening is the glucose rich urine passes to the ileum conduit, which is repurposed small intestine.

Glucose can pass right through the conduit in the bloodstream. Thus causes a rise in BG, my pump or me does a correction which lowers BG, causing it to drop. Glucose is still passing glucose to the blood, leading to a roller coaster.

Well, I stopped the SGLT2 Inhibitor 2-3 days ago without doctor permission. I just got through doing a 1hour plus workout with my personal trainer. I am almost back to pre surgery form. She was impressed, me too. BG did what it is supposed to do with a strength workout, it rose about 12mg/dl.

I still have that educational material from 34 years ago. Here’s a picture of page one of “The Game of Life With Diabetes.” Never forget that you are the Captain of the team, the doctors are team players.

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Thank you all! I have rebooted and am back on track: my outlook is sunnier today.

@bkh I certainly don’t mean to malign any individual doctor - I think most do the best they can, although good intentions can’t rectify subpar care unfortunately… and I do seem to be hitting a real streak of doctors who are out of their depth with T1 and consequently say or do sort of unhelpful stuff. It seems like the system fails doctors, too, in some ways, because the ones I’ve had really seem caught flat-footed when it comes to this Dx. I also get bounced by insurance or stonewalled trying to push referrals forward a lot, and repeated “nos” get in my head and I start to feel like I must be doing something wrong or else why would I get so much pushback. I take it hard when I get lectured or denied by doctors or insurance, and have also gotten a lot of weird refusals and rejections for common-sense things like an emergency glucagon Rx. Still don’t know why anyone would refuse to prescribe that to an insulin-dependent patient! And when my doctors are not that well versed, that can cause rippling errors with insurance if things aren’t quite submitted properly and so on.

Basically consistent “no” gets me feeling like it must be my fault and I’m somehow wrong :woman_shrugging:t2: and that can start to sort of eat away at my mood. Since I live alone, these kinds of phone calls can make up the overwhelming majority of my human interactions in a given week, and that can get… well, that’s honestly pretty depressing sometimes.

But mostly I truly just feel caught in a spiral of systemic bureaucracy that seemingly (at a macro level) has no regard for patients. It’s the feeling that I’m beating my head on a brick wall of red tape and hoop-jumping, for no real reason, and that’s what really gets me down. I doubt it’s even one individual’s fault (though I certainly have had a few fairly appalling individual interactions…). It seems more like the incentives governing the overall system are all wrong, optimized for something other than patient welfare. It feels overwhelming and that’s what sort of got to me this week: a real Red Queen universe vibe, if you will. It felt like I had to keep running just to stay in place and I felt really maxed out and like I was getting nowhere despite my efforts. It was wearing on me and my resolve to stay positive wavered a bit this week. BUT! We now return to our regularly scheduled programming. Onward!

@CarlosLuis I like that analogy! I think part of my struggle here is an internal war between deferring to experts vs advocating for myself. I’m not used to having to do this, and I have a pretty strong tendency to yield to those in positions of authority on things like this in a lot of ways. I need to get better at standing my ground and making the case for my requests even if I get pushback I guess, so the team/captain analogy is helpful! And as always, you are an inspiration as you tackle such enormous challenges!

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Your are an inspiration.
image


When were you properly diagnosed, a year?
You were able to run the 10K without passing out, with the help of friends, but it was all you. A suggestion, wear that jersey to your next doctor appointment and feel it is true, because it is.

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Oh less than a year, I was diagnosed 200 days ago today actually! First diagnosis in the ER, got mis-categorized as T2 for the first several months, and correctly diagnosed and given the right treatment as T1 in early February. So I have been at this way less than a year :sweat_smile::woman_shrugging:t2: total rookie! (Errrmm, have I mentioned that patience is not my strong point?!)

And, I mean, what can I say? I’m lucky enough to be learning from the best here. I always come here when I feel like I am low on steam, and the community energy and just seeing how everyone perseveres and overcomes with their own assortment of challenges is balm for the soul tbh… I feel like maybe this is one of those virtuous cycles where we all lift one another. :+1::heart::heart:

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You have been denied and disrespected, that hurts, and that pain is real. It is not weakness that you feel this pain. But like many pains, it can be dealt with after the initial shock wears off.

I think that medical care in the US largely is a business, far removed from charity or service. With respect to that business, we are not the customers, as we are not the primary payers to the medical businesses for their products and services. As patients, we are the raw material from which the insurance companies and drug manufacturers and medical providers make money. Understanding this can help explain why things happen the way they do. In particular, your physician may be under pressure by the insurance companies to reduce their costs.

That said, there are doctors who still have the old-style ethical beliefs that enable them to push back against the business considerations to try to get the best care for their patients. I hope you can find a doctor like that.

You might be able to press on that. Doctors are always one malpractice conviction away from becoming uninsurable and losing their livelihood. (That must be terrifying.) That can lead to considerable conservatism, but it also gives us as patients a lever. In particular, if the American Diabetes Association Standards of Care document states a recommendation, a physician who chooses to deviate from that recommendation should have a good reason. You may be able to point out to your doctor that the ADA Standards of Care calls for all insulin-using patients to be prescribed glucagon, and ask if the physician really intends to be deviating from the standard of care, and if so, what is the reason.

The 2024 Standards of Care is available as a PDF from a link on the left side of this page: Volume 47 Issue Supplement_1 | Diabetes Care | American Diabetes Association

If you check page S118, recommendation 6.13 states:

6.13. Glucagon should be prescribed for all individuals taking insulin…

This is reiterated on page S158, where recommendation 9.6 states

9.6 Glucagon should be prescribed for all individuals taking insulin…

Page S120 has a section on glucagon where they note that the physicians should routinely make sure their insulin-treated patients have access to glucagon, as appropriate glucagon prescribing is very low in current practice.

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@panda Reading thru the above chain, you’ve been given all the good advice and comments anyone could provide. You’ve hit the wall that many of us have had to deal with, medical people that haven’t kept up with T1 treatment or intentionally play the conservative approach for a multitude of reasons. For all the complaints of hearing “a cure is just around the corner” (it hasn’t appeared in nearly 75 years), there have been leaps of change with CGMs, pumps, various insulins, glucagon treatments, and philosophy on best treatments.

While I completely endorse and often advocate and believe @CarlosLuis’s “You are the captain, take charge” philosophy (love the included sheet above BTW), you may be one of many that live in a “desert of healthcare” where the Endo/PCP you’ve seen are the only ones available or there are limited others. If so, you may be stuck or need to resort to @eric’s “working” the system (which I can only endorse). If not, seek a change (I did and found an Endo that accepted I’m in charge, just seek his advice/counsel, is open to advances, and chose to stay reasonably updated.). It may also be about “how” you present a request/desire to the doc’s you currently. It may be best to demonstrate you’ve done your research, know the answer you’ve “almost” arrived at but respect their position and want their input (after they’ve done “current” research, but you’re the one that lives with it daily, and you’re the decision authority and are willing to go another route (around them or through them, their decision). (Note: I do this with my current Endo, he wouldn’t endorse Loop due to FDA constraints [I’m trying iAPS right now], but he’s open, interested, and respects a bit of a challenge, and literally said he can’t fight the resulting numbers.) While it may be demoralizing, you, as the team lead, may have to find out “how to get to yes!”…realizing some docs won’t get there, sometimes with reason, sometimes out of ignorance.

Keep at it, head butt that wall, realizing you’re making a difference for those that follow….and even when you’ve reached the point of being on the kitchen floor grabbing your phone, don’t give up, come here and let us listen, commisserate, and offer solutions that may help!

Glad you’re feeling better! With @Eric’s advice…

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