Michael Aviad is co-founder of ASweetLife. He was diagnosed with type 1 diabetes in 2002. Michael was born in Santa Barbara and grew up in Jerusalem. He studied law and after passing his bar exam went on to get an MBA with a major in finance. Michael worked for many years as an economist. He and his wife Jess, also a type 1 diabetic, have three sons. Michael loves to run and is always training for the next marathon. Read full bio

Grateful to be Running Again (if you can call it running)

Running Shoes - Blue

On November 2nd, the day I was supposed to run the New York Marathon, I decided to take my first run after a four-month break.

I stopped running on July 4th, after a MRI showed I had a partially torn hamstring (the tendon attaching the hamstring to the ischium) and a case of severe tendonitis. The doctor explained to me that because I had run on the injury for a long time (including a couple marathons), the healing process would be relatively long.

So, I decided to stop running altogether and let my body heal.

I did some physical therapy and some exercises to strengthen my legs, but mostly I just did nothing.

At first, my blood sugar levels went crazy. I spent days and weeks with high blood sugar. But after a few weeks (like a month-and-a-half) I got myself on a better diet, eating less. My last A1c (6.3%) was actually better than any result since Oct. 2010.

But sleeping late (7:00 a.m.) and getting a grip on my blood sugar, didn’t make me stop wanting (needing) to run.

After three months of rest I scheduled an appointment to get an ultrasound with a doctor, recommended by my doctor, who specializes in these kinds of injuries. The doctor told me he did no see a tear, but that I still had a serious case of high hamstring tendinopathy (this is a very good link if you suffer from this runner’s injury). My doctor, (orthopedic surgeon), told me that I could start running again, but that I should return slowly, very slowly, and that if it hurts I should stop and take it slower.

So, on November 2nd, instead of heading out to run 26.2 miles in NYC, I set out to run a very slow and short run. I ran two kilometers walking half a kilometer before, in-between and after. I was very slow, and my legs felt like they had never run before. But I was happy to be running again.

It has been a month since I started running and I am still only run-walking. I have gotten a little faster, and can run three 2-kilometer intervals with half a kilometer of walking in between.

A year ago I could not have imagined being in such bad shape, but now I can say that I am truly grateful to be out and running.

Don’t worry I have not stopped wanting to run marathons but, I know that it is going to be a very long process, with ups and painful downs.

My hope is that maybe I’ll be able to run the next NYC marathon (if I can get in again).

 

 

After 4 weeks of running I have worked my way up to a weekly total of 23 km of run-walking (that’s about 14 miles).

 

1 comment

Murphy’s Diabetes Law of Insulin Pumps

I don’t know what it is about weekends, holidays and vacations, but it seems like my insulin pumps (I’ve gone through quite a few in the short time I’ve been on the pump) always malfunction and need to be replaced during these times.

Yesterday, on the eve of a holiday in Tel Aviv, when most people were settling down for a long weekend, I was sitting with my son discussing his programming homework.  Suddenly we heard a double beep coming from my pump.

I unclipped the pump, looked at the screen and saw a new and unfamiliar error message flashing at me, MOTOR ERROR. (I have had a few BUTTON ERRORs and Delivery issues in the past.) It was immediately clear that I was heading for another replacement pump, my fourth or fifth, I’ve lost count.

“Oh shit, here we go again,I said as I grabbed my phone. 

With fear of a long rollercoaster weekend in my mind I called Daniela, the Medtronic sales rep who saved me once before (she lives just a few blocks away).

“Hi, Daniela,” I said when she answered her cell. “It’s Mike Aviad, you helped me once with my pump…”

“Yes. I remember.” she said, “How can I help you?”

I told her about the MOTOR ERROR and asked what I should do.

She told me she was away for the weekend but said that I should try taking out the battery for 15 minutes and then replacing it and “if that doesn’t work here is the 1-800 number…”

I did as Daniela suggesting, wondering about the “15 minutes.”   Why not just switch the battery?  What’s with the resting period?  

Batt Out Limit - Insulin Pump Error

Waiting didn’t do the trick, instead I got another error BAT OUT LIMIT. So I called the emergency line, preparing myself for a fight.

Surprisingly, there was no need to argue. The man on the phone asked me where I lived and said that their delivery guy, Ronen, would contact me soon. 

A few minutes later I got a call from Ronen. “I’m on my way,” he said with a tired voice.

Twenty minutes later he arrived. He opened the trunk of his car where he had a box with a few pumps and other supplies. I asked for a clear or black pump (please not purple). 

He looked through the boxes. There were Blue, Black and Purple pumps but no clear. So I tool the black.

Happy, relieved and impressed with the service, I took my new pump in my hands, looked at it and felt good.  Then I realized I had to set it up but I don’t remember my settings (they were saved in the old pump). Oh well, I thought to myself, things could be worse.

 

 

 

1 comment

Injecting Insulin: Liberating, Painful, And Not For Me

It’s been over a week since I ripped out my infusion set and decided it was time for a break from my insulin pump. It wasn’t a rational decision, but rather one based mainly on frustration – an inability to keep my blood sugar down.  Even more frustrating: going back on insulin shots did not solve my blood sugar issues. Basically, all it did was make me think a little about life with diabetes and the emotional burden that comes with it.

The first couple of days off the pump I felt naked, like a soldier who’s lost his gun. I kept reaching for my pump every time I checked my blood sugar (to record my result) and every time I wanted to know what the time was. (I like to think of my pump as a pocket watch.) Without realizing it, my insulin pump became a part of me, part of my mannerisms. I wasn’t sure I liked how attached I had become to my pump.

I also felt like I needed my pump to calculate my insulin doses. It had been so long since I injected insulin that I had no clue how much insulin I need when I eat. Not only because injected insulin is less effective than pumped insulin (need less with a pump) but also because I’ve gotten so used to the pump thinking for me, advising how much to inject with my meal and how much to correct when I’m high.

I also realized that when I inject, I don’t remember how much insulin I take and when. I depend on the pump for that, too. So I downloaded an app, MySugr, which helped me with this.

But then what started as a naked feeling, a feeling of being a little lost, turned into a liberating feeling. I felt light and untethered just like everyone else. I didn’t wake up at night to turn over, look for a place to put my pump when I showered or got dressed and I didn’t get stuck on handles and door knobs.

Liberating didn’t last long, though, because there’s nothing like a constant blood glucose of 300 to bring you down. 

Even after somewhat figuring out my correct dosage, I struggled with the issue of the not-so-flexible basal rate. The reason I went on the pump to begin with was because I suffer from the dawn phenomenon, and cannot find a bolus rate which will keep me low enough at night without then causing me to drop all day long.

The other big issue is that the liberating, light and free feeling comes with an awful lot of shots, at least 10 a day. And although I hate inserting infusion sets into my body (not always painful, but always stressful), injecting all day long is painful and annoying. For the first few days I thought it would pass, that I would get used to it, but I haven’t.

So, after a brief vacation, one that I partly enjoyed and definitely learned from, I am back on the pump. 

 

6 comments

Pump Holiday

Sunday the 17th: 106, eat a little and bolus. A few hours later, 265. Bolus some more. Wait. Check, 298, then bolus some more. Wait, check, 255 (getting very frustrated). A few hours later, 222, change my infusion set, break open a new bottle of insulin and bolus. 

Monday morning Aug. 18th: 132, feel relieved. Walk around all morning without eating, 85, an hour later, 91. Eat lunch, bolus, check again later, 217, bolus. Four hours later, 278, bolus, wait an hour, 244, bolus go to sleep (set alarms I don’t hear).

Wake up, Tuesday the 19th, 177, bolus, Eat lunch, bolus, 244, again spend all day high. New infusion set. 214, bolus, go to sleep.

BG 300 - pump holiday

Aug. 20th: wake up, 300. Bolus. wait, check, bolus more, 295, bolus more, eat a little, bolus, wait 3 hours, 235, change infusion set, use new pack, bolus some more.

A few hours later, 126. Go to sleep, relieved, hope things are back to normal. Wonder why on a day with no carbs I still needed 30+ units and was high all day.

Aug. 21st: wake up, check my blood sugar, 238, WTF? Bolus. Check a few hours later. 220. Start thinking about going back on shots. Eat some berries and yogurt, bolus, check a few hours later, 241. Bolus some more, wait an hour and check again, 205, bolus again, wait some more, 133. Have no idea what is going on.

Go out to dinner, check, 265, bolus, eat some carbs and try to cover, check when I get home, 295, bolus, half hour later, 305, bolus, hour and a half, 255, watch a movie, 219, bolus again, take shower, get ready for bed, 253, bolus, read, check, 275, bolus, set alarm. Sleep through alarm.

Aug. 22nd: Wake up at 7:00am, check, 295, bolus, try to sleep. Get up at, 288.

Take out infusion set. Get insulin pen, inject for the first time in over a year. Start feeling the fog lifting, check after an hour and a quarter, 145. Happy. One hour later, 82. Heading for a low but happy to see a two-digit number.

It’s time for a pump holiday.

 

5 comments

Taking a Break from Running

Sometimes your body tries to tell you something and the smart thing to do is to listen to it. But apparently I’m not that smart. My body tried to tell me it was time for a running break, but instead I ran two marathons back to back. I ignored my pain and bore it like a champ, until I couldn’t take it anymore.

Last week I had an MRI that revealed a partial tear in my hamstring. I realized this meant I wasn’t going to be running any marathons in the near future, but I didn’t know what my doctor was going to say.  My hope as that he’d say I could keep running, but less and slower.

The doctor was very nice about explaining my injury.  He showed me the MRI video, and I could clearly see the tear. Then he told me what the treatment plan is: Total rest for a few weeks (I was sure he said 6-8 weeks of no running and then starting again slowly with a lot of physical therapy. But when I reread his notes I saw that he recommended 3-4 months of rest.) and a slow return to running.  If that doesn’t help, I can get PRP (Platelet-Rich Plasma) injections.  And if that fails, there is always surgery.

I was a bit shocked and felt like I’d just been told my running career was over.  I asked more questions, trying to get some good news out of him. He told me not to worry and that the first thing I needed to do was to let my leg rest – no running at all for a while.

I know things could be worse, but to me, not running for 3-4 months is terrible. Running keeps my blood sugar in control, helps me keep my weight down and keeps me sane.

The only sport he told me I could do was swim (no breast stroke though). The problem is that I don’t really swim. For years I’ve been putting off swimming lessons, never having time. Now that I’m not running, I guess have the time.

Who knows maybe I’ll turn into a triathlete.

 

2 comments

Blood Sugar Isn’t Everything

When I started long distance running I did it in part to help me cope with my diabetes. I found that running a couple hundred miles a month kept my blood sugar in check and helped me deal with the emotional stress of having a chronic disease.

Over the last few years, running has become much more to me than just a part of my diabetes management program. It has become a way of life. Diabetes remains a motivator, though, something that helps get me out of bed to run before dawn, and keeps me going at the 23rd mile. But I know that even if I were somehow miraculously cured of type 1 diabetes, I would continue to run marathons. 

That is why the last couple of months have been so frustrating.

Since the Tel Aviv marathon in February (which was a disaster), I have been trying to recover from what has been diagnosed as a Proximal Hamstring Syndrome. I’ve gone to a few doctors and physical therapists. I took a break from running, started again slowly, and I’ve done a whole bunch of exercises to strengthen my hamstring. But after all of this, I’m still in pain. I feel like I’m exactly where I was when I started.

 

On the other had my blood sugar has been better than ever, except for a bunch of hypoglycemic episodes. Replacing my leaky pump, and adjusting my diet and insulin rates to a lower running mode have brought great results. But this doesn’t make me feel much better.

 

I need to run. It makes me feel strong, healthy and happy. Not running, or running very little very slowly with lots of pain, does the opposite.

Tomorrow morning I am scheduled to have an MRI. I don’t know it will show, but I hope it’s something, which can put me on the road to recovery.

2 comments

Doing Diabetes Right, but Getting it Wrong

I woke up feeling extremely tired last Thursday morning, and could feel that my blood sugar was high. I couldn’t sit around drinking coffee and bolusing until I got it down because I needed to get blood work done that I’ve been putting off for the last month. It couldn’t be put off any longer or the results wouldn’t all be in for my endo appointment at the diabetes clinic tomorrow.

My blood sugar has been high pretty much all the time for the last few months. I’ve increased my basal rate and increased my bolus ratio, but I’m still always correcting my high blood sugar, even when I haven’t eaten anything. Even running doesn’t always get it down.

I’ve had plenty of things to attribute my high blood sugar to. First, I attributed the change in my blood sugar to hard marathon training and increased food intake. Then, I thought it must be a result of a decrease in training after the Tiberias marathon. Then I ran the Tel Aviv marathon (a total disaster) and then I was sick for a couple weeks. There were endless changes in my life to attribute the increase in my blood sugar levels to.

My fasting BG on the morning of my blood test was 285.  When I returned from the lab, it was 304. Feeling lousy, I bolused.  I checked my blood sugar 40 minutes later and was happy to see it was slowly moving in the right direction. It was 280.

An hour later I tested again and it was 317. 

I decided to replace my infusion set, hoping that would do the trick.

When I removed the set from my body and took the reservoir out of the pump, I was overwhelmed by the smell of insulin. I looked at the reservoir and saw it was wet, covered with insulin. I looked into the chamber where the reservoir goes and saw drops of insulin.

At that point I called the Medtronic rep who helped me last time my pump broke. She told me to switch to a new batch of reservoirs and asked me if I could come in to their office (not far from my house) to get a new pump.

I drove to the Medtronic distributor’s office and got my ‘new’ pump, which with a new infusion set and reservoir got my blood sugar levels down to normal quickly  (a couple hours).

When my blood test results started coming in as the day went on, my BG issues were clear as a vial of insulin.  My fasting BG was 347 (40 points higher than the glucometer – go accuracy!)  and my A1c was 7.4%. (I also had ketones in my urine.) 

I don’t know if all or most of my blood sugar issues over the last couple months have anything to do with my pump or faulty reservoirs. But, at least I’ll have a good excuse for my endo tomorrow.

Suffice it to say that it is so hard to figure out where the problem with out of range BG lies.  You can do every step of the equation correctly, and the answer still comes out wrong.

 

4 comments

We Need to Figure This Diabetes Thing Out; It’s Holding Us Back

I met my running coach for coffee this morning to go over my running plan for the upcoming Tel Aviv Marathon (this Friday).

I wasn’t planning on running another marathon six weeks after the Tiberias marathon, but the desire to erase the bad experience with a positive one (especially before I set out to train for the New York Marathon), and the fact the Tel Aviv marathon is right outside my door (I will actually pass by my window at the 21st mile) made me decide to register for the full marathon.

When I arrived at the café, my coach was there siting with his laptop and a summary of my training, including the ten or so 20+ milers from before Tiberias, the Tiberias marathon splits, and the two long runs I completed in the last few weeks. We both looked at the numbers, and agreed that it would be best to start relatively slow and hope for a strong finish.

Although my coach knows my first concern is not having a repeat of the Tiberias, or even Milan marathon, and that I really want or need a positive experience, he told me he believes that I should be able to improve my PR by at least half a minute or so. The funny thing is that originally, when I suggested running in the Tel Aviv marathon, he thought running another marathon so soon after Tiberias was a very bad idea.

After he typed the paces for each part of the marathon into the spreadsheet, he looked at his notes, turned to me and said: “you know we really need to figure this diabetes thing out. It’s holding you back.”

“You need to figure out what you can eat the day before the marathon, try it out during training (the day before you run long runs), so you can really perform in the marathon.”

Really?

That was all I could think to myself. I know he meant well and really wants me to be able to run as if I don’t have diabetes. But that’s the thing about diabetes: even when you have good control, it’s still there, and always unpredictable.

I tried to explain. “It changes all the time…. I don’t know why and I don’t know what affects it, besides the food, that is. Hormones, weather, sleep, stress, coffee, you name it, it all effects blood sugar.”

“I can try hard but I can’t figure it out, get over it and move on to the next challenge. There is no formula, and just when you think you’ve figured it out, you’ve finally learned to deal (or gotten over it), something – a cold, gaining 2 pounds, the weather changing – happens and you find you’re self starting from scratch again.”

My coach stared at me blankly.  I could tell that on some level he was blaming me.  He didn’t really believe I couldn’t do diabetes better.  This kind of thing used to piss me off, but I’m kind of used to it now and I try to let it go.

I don’t like people feeling bad for me because of my diabetes.  It’s true that in the case of a marathon, it’s a handicap.  But that’s my life and that’s my challenge.    Okay, my coach doesn’t get it.  No one outside of the D-world really does.  And that’s what I reminded myself as I kept myself from saying, “If I could figure this fucking diabetes thing out, don’t you think I would?”

 

4 comments

Hypoglycemia: Living On The Edge With Diabetes

Hypoglycemia - BG 35Hypoglycemia is dangerous. It can actually be deadly. But somehow when I have a real episode of hypoglycemia, I mean a truly low low, the kind that wipes you out, it seems like just another part of the day. It has a very significant physical effect, but emotionally it doesn’t really register.  No post trauma or even much reflection, although it is essentially a near death experience. 

Last Saturday night I went out for a post marathon celebration with a few of the guys I run with.  I don’t go out or drink beer very often, but I decided that I deserved to have some fun, and since I wasn’t in the mood for any serious drinking, I joined the crowd and had a couple beers. I also had a Caesar salad topped with grilled chicken.

I bolused three times, once for each beer (something I’ve learned I must do) and for the salad (I ate all the croutons J.)

At around 10:30 I was tired and decided I was going home. I had planned to walk home (it’s only a mile and a half) but when my friend offered to drive me, I didn’t refuse.  But I did tell him to let me off a few blocks from home so he wouldn’t have to go too far out of his way. 

I enjoyed the fresh air and felt good, well, at first I felt good. When I reached the turn onto my street I suddenly felt very weak, like I was about to fall. I started to sweat and realized I was going low. I continued walking thinking to myself, like during the marathon, just don’t stop.

Then I realized I didn’t have a house key. Shit, I hope Jess isn’t sleeping.

I took out my phone and started to text Jess, with a shaky hand, to “please open”.

As I reached the door, she opened it. Without saying much I headed for the kitchen counter, where I had left my glucose meter, and checked my blood sugar. It was 35.

I was totally out of control, and I felt like I was about to pass out. I grabbed a mini Snickers bar from the kids’ treat drawer. Then I ate some fruit. And then a mini Twix.

After checking my blood sugar a few times to making sure I was on the way up, I went to the couch and fell asleep.  I was sound asleep until I felt Jessica pulling off my shoes.  I don’t really remember what else happened.  Somehow I made it to bed.  Jessica has a more accurate account of the evening.

The next day the roller-coaster continued. I woke up high, bolused, dropped to 44….

That evening Guy asked me who had the last Snickers bar.

“I did,” I said

“Really?” Guy asked in disbelief.

“Yup,” I said.

“Was it good?” He asked.

“I don’t know,” I said.

I’m not sure he understood, but not being able to remember what the candy bar tastes like made me realize how serious and dangerous the situation was.

4 comments

Tiberias Marathon 2014: A Humbling Experience

Tiberias Marathon 2014

Last Friday I ran the Tiberias marathon, my 8th marathon, and my fourth Tiberias marathon.  Since the race, I have felt more than ever before just what a humbling experience running a marathon can be.

I’d been hoping to set a new personal record and although I have a hamstring injury, I believed I would.  The race, however, did not go as planned. But, hey, I have type 1 diabetes… I know about things not going as planned.  Surprisingly, though, the experience bothers me less than I would have expected.

The race was so exhausting, both physically and emotionally, that I needed some time to reflect and recover before I could write about it. And although it has been a few days since the marathon, and I’ve given it a lot of thought, I’m still not entirely sure what went wrong.  So all I can do at this point is recount the difficult experience.

I was very careful with my eating during the days before the marathon. I tried very hard to keep my blood sugar in range while eating some carb with my meals. On Thursday, the day before the race, though, I was very careful not to eat carbs – a lesson learned from my disastrous carb-loading attempt before the Milano City Marathon (this may have been a mistake).

On the morning of the marathon I got up at 4:30, three hours prior to the starting time. Things were good. My blood sugar was 85 (a little low, but I expected it to go up). At 6:45 I was out warming up, and my blood sugar was around 130.

Things seemed to be going well. It was a cool day with no rain, but with some wind that didn’t seem too bad between the buildings (the race starts in the town and heads south along the lake).

At 7:20, I was in the starting area near the 3:30 pacers. I decided I would run with the pacers at least for the first half of the race and then, depending on how good I felt, I would break away and try to set a new personal best.

I checked my blood sugar again once more before the start of the race. It was up to 151. Perfect, I thought to myself, I can take my gels as planned (mile 3, 11 and 19).

At a little after 7:30, the marathon started. It took me 30-40 seconds to pass the starting line. There were over 2,000 runners, a record for this race, and it was a much slower start than I’d expected. I ran with the 3:30 pacers, hoping they would keep me from running too fast. After a while, I realized they were running at a faster pace then they should.

I felt good and decided to stay with the group heading south towards the southern tip of the Sea of Galilee. When we turned north, on the eastern side of the lake we were hit by a strong wind.

I knew this meant trouble, but decided I would continue to run with the pacer, thinking I would be better off running a little too fast than fighting the wind on my own.

I reached the halfway mark a 1-2 minutes faster than I had planned. I felt good and continued to run at the same pace. The wind was at my side and back most of the time, which didn’t seem to help, but didn’t bother me either.

When I reached the 16th mile mark, I started to feel weak. I slowed down a bit thinking I would pick my pace up again when I hit the 20 mile mark. At 19 miles, I decided to take only half a gel. I was worried about my blood sugar and thought it safer to take half now and half in 4-5 miles.

Tiberias Marathon 2014 - Finish Line

Tiberias Marathon 2014 – Finish Line

I continued running, stopping every few minutes to stretch out a cramped foot or leg.  Runners kept passing me by but I didn’t care.  I was in pain and I wanted it to be over.  The time didn’t matter anymore.  It was only about finishing.By the time I reached the 20-mile mark, I knew it was over. I considered dropping out and saving my legs for the Tel Aviv marathon (Feb. 28th), but knew I would never forgive myself if I did. I tried to keep an 8:00 minute mile pace but found it harder and harder to do. My legs felt as if they were about to cramp on me and during the 21st mile, they did. My left foot and my right calf cramped at the same time. I stumbled to the side and grabbed the road barrier. It took me 2-3 minutes to get them loose, but once I did, I continued to run. I tried to increase my pace, but my legs cramped every time I did.

With just one mile left to go I felt out of breath.  In a scary way. I tried to breath but had a very hard time getting any air in. I thought I was about to die, which was rather stressful, but I kept going anyway, and, luckily that feeling passed and I was going to finish the race alive.   

I continued running towards the finish line. The pain in my legs got worse with every step.  I crossed the finish line after 3:40 minutes (personal time 3:39:43). When I got there, again, I found myself gasping for air. I thought I was going to cry and throw up at the same time – which was unpleasant, but not nearly as upsetting as thinking I was going to die. Fortunately, I did none of the aforementioned, and after a few minutes I felt fine. Tired, but fine.

I wasn’t sad or disappointed. I felt good for completing another marathon and for not giving in. I also felt calm, like I was on the other side of a near death experience. Just not being dead was as glorious as breaking a personal record would have been… well, maybe not! J

I’m not sure I know what went wrong during the race or why my legs cramped. Should I have eaten more the day before? Did I run too fast? Was it the wind? Or maybe a little of all?

I imagine I’ll keep trying to figure it out until next time.

2 comments

Page 1 of 2412345...1020...Last »