Picking up the Pieces
Tuesday, March 9th, 2010Over the last four years I have done everyting I could think of to prepare for Vancouver. The Olympics were obviously a complete disaster for me. I was so emotionally and physically exhausted after the 50k that my coaches strongly reccommended that I go home and recover, not go onto the world cup. I protested initially but soon realized they were advocating a good decision. Whenever I have had poor performances, trying to push through to the other side has lead me to illness.
Given the promising way the season started and the dismal way it developed I am a serious contender for the most volatile and inconsistent skier on the world cup. Recognizing this I am going back to the drawing board on my diabetes care regimen. I have already been fitted with the latest Dexcom continuous glucose monitor and thus far it seems very promising. I am also interviewing with new endocrinologists to get any more data and suggestions that I may have overlooked. Over the past two years I had such tunnel vision towards the Olympics that I stopped integrating new developments in diabetes treatment into my glucose management. I was more focused on training. Clearly this was a mistake. I cannot fully utilize my training when I have glucose issues.
I have been asked why I have had difficulty with 30k and 50k races over the last several seasons but not in the years directly following my diagnosis. Type 1 diabetes occurs in people when the immune system mistakenly attacks the islet cells on the pancreas. No one knows why the mistake happens which is a big reason there is no cure. It can take a long time for the attack on the islet cells to be complete. In my case it took about seven years after my diagnosis to have no insulin production. Over those years I had to change my insulin regime every season to accomodate the constant decrease. In 2002 I only managed my bloodsugar at night and at meal times. I did not need to take a basal insulin during the day or when I was racing (basal insulin is a long-lasting insulin that is injected in order to manage the sugar the body releases between meals). By the 2003 season I needed to use basal insulin during the day and for races. The amount of basal needed increased steadily during the gradual erosion of my pancreatic function.
By 2006 I was having problems managing sugar on the road when I got sick or tired. Activity makes the body more insulin sensitive which makes glucose management less difficult. When I got sick I could not train and I would begin to lose control of my sugars. So I would continue to train when it was not prodcutive for blood sugar management. This was a recipe for long lasting fatigue.
At a 30k in Rybink Russia in 2007 I was taking more basal insulin than I ever had and my bloodsugars were climbing rapidly anyway. I suffered from Hyperglycemia during the race. At this point I knew I would need to change my insulin management strategy. I began to use an OmniPod insulin pump which allowed me to change my basal rate at anytime. Before using the pump I would have to decide on one basal dose that I would be locked into for 24 hours. The OmniPod gave me the flexibility to change basal rates for varying race distances and has given me the freedom to rest when needed.
My switch to the OmniPod took place shortly after my pancreas finally tapped out. The good news there is that I no longer have to deal with ever decreasing natural insulin. The bad news is I have no natural insulin to bail me out when I miscalculate. I have developed a very effective insulin regimen for 10 and 15k races. My 30 and 50k strategy still needs a lot of work.
I am hoping the continuous glucose monitor will help me map out exactly what is happening in my body during longer races. The device gives a reading every five minutes that I would like to use to chart my glucose fluctuations throughout a race. If this technology works the way I hope it does I should be able to tailor a reliable insulin strategy for longer races.
In the meantime I have been skiing at home at Waterville Valley. Skiing is therapeutic for me and was the only thing that could get me out of the house once I got home. I probably skied too much last week but I needed to be out on the snow to stay sane. This week I will structure my training to prepare for the supertour finals in Maine at the end of the month.













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