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

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.

 

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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.

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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.

 

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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?”

 

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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.

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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.

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Rain, Running, and a Button Error on my Insulin Pump

Yesterday morning at 5:30 I went out for a 22 mile run. It was cold, around 40o , and raining. My run, went well for the first 18 miles (with only light rain and with a few rays of sun warming me up every once in a while). But after 18 miles it started to pour. I was soaked from head to toe and my legs were so cold they hurt. 

All I could think about during those last 4 miles was how much I wanted to get home, take a hot shower and get in bed and sleep.  Somehow I pushed myself to finish the run, and when I got home, freezing and drenched, I took off my shirt and removed my infusion set, which was due to be changed the day before.

I took the reservoir out. And went to rewind the pump so it would be ready when I return from my shower. I scrolled down to ‘Reservoir + Set’ in the menu, pressed ACT and then chose the set up. But the pump wouldn’t react. I tried ESC but that didn’t seem to do much either.

Cold and wearing only wet running tights, I decided to deal with the pump after my shower.

Showered and dressed in warm clothes, I returned to my pump. It was still stuck on the same screen. I pressed ACT again and again nothing happened then ESC – Nothing.

I took out the battery (which was less than a week old) and put it back after a few minutes. At first it seemed my pump was coming back to life but then a message in large letters said ‘FAILED BATT TEST’ (or something like that).

I thought that was weird, and decided to change the battery. The new battery came with a new message – ‘BUTTON ERROR’.

Button Error - Medtronic Insulin Pump

All I could think was ‘here we go again’

Last time this happened I was travelling and it was the weekend (yes, these things always happen on the weekend) and I had such a hard time getting my replacement pump that I actually decided I hated the local Medtronic distributor and have tried not to contact them unless I had no choice.

Today was one of those no choice situations so I went to their website, found the emergency phone number (which wasn’t easy) and called.

My initial conversation started off just as I feared. When explaining what had happened to the pump I mentioned that I had come home from a run.

“Did the pump get wet?” The woman on the phone asked me.

“Yes, but your pumps are supposed to be water tight and not affected by rain.” I said.

“Well, we’re not used to this kind of weather around here,” was her reply (a very strange reply, and I’m not sure she actually was thinking of the pump).

“My pump is from abroad,” I said (all pumps are made abroad). 

Annoyed she asked me where I lived and said she’d get back to me soon. 

About 20 minutes later she called me back and told me that one of their sales reps lives near me and has a pump for me.

I called the sales rep, named Daniela, who invited me to come to her apartment and pick up the pump.

I walked over, just a three-minute walk, thinking I would just pick it up at the door and come home. But when I got there Daniela invited me in and made sure I knew how to set up the pump. She also looked at my broken pump, which seemed to go crazy when she tried to restart it.

“It’s not water damage, it’s just lost it,” she said.

I was so happy to have a pump again and was very happy to have had a good experience with the Medtronic rep. I was also happy because I was given the clear pump, which was the color I originally asked for but did not get.

 My Replacement Pump

Running Update: I haven’t been writing about my training lately not only because I’ve been very busy with other things (like the Diabetes Media Foundation) but also because I’ve been training while injured with pains in my right leg, most probably a hamstring injury, and I wasn’t sure I would make it to the marathon. (I’m still not sure I will). So, I’ve been keeping it a little under the radar. 

 

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Diabetes False Alarm

Most nights before I go to sleep I set a diabetes alarm (a timer) to wake me after an hour or two so I can check my blood sugar. I set diabetes alarms when I‘m worried about going low, have a lot of insulin on board or if I have a big run the next morning and I don’t want surprises.

The problem is that I usually don’t hear my diabetes alarms and I don’t wake up to check my blood sugar. I don’t know why that is since I always hear my regular alarm that wakes me up at around 4:15 a.m. at least three mornings a week.

Last night I fell asleep quite early.  At around 10:00 p.m. I was reading in bed and suddenly felt very tired. I didn’t know if it was a result of a drop or spike in my blood sugar levels or just a result of being tired. I checked my blood sugar, which didn’t tell me much with a reading of 112 and a half a unit of insulin on board.

I decided not to fight it the need to sleep. I set a 4:01 a.m. alarm and a back up for 4:11, since I was meeting a friend at 5:00 for a 11 mile run, and to be on the safe side, I set an alarm to wake me an hour later to check my blood sugar.

I slept.

I heard my alarm go off and hit it quickly so as not to wake Jess. I must have dosed off because the next thing I remember is looking at the clock and seeing a 14.

“Shit, I over slept,” I said, waking Jess as I got out of bed.

I quickly got my morning routine going, making sandwiches for three boys, drinking coffee, getting dressed and ready to run, checking my blood sugar (it was 124) and reducing my basal rate.

I felt very tired but also very wired. I was running a little late and hurried to get myself out the door.

As I was walking down the stairs, feeling bad about being late, I glanced at my pump to see what the time was. It read 00:07 (I keep my clocks on military time).

That’s strange, I thought to myself. I took a better look at my pump this time unhooking it from my pants and turning on the backlight. It still read 00:07.

Next I checked my Garmin for the time. It said 00:05.

I stopped on the stairs feeling a little crazy and then went back up to our apartment. I walked in to the kitchen and looked at the clock on the oven it read 00:07.

 

I suddenly realized what had happened. It wasn’t my morning alarm that had woken me.  It was my diabetes alarm that had gone off at 11:00 p.m. not 4:01 a.m.  Ridiculous and frustrating, but at least I woke up and checked my blood sugar this time.

 

For a second I considered going out and running but then figured it would ruin the next day. And I had set to meet friends anyway.

 

I checked my blood sugar again after cancelling my temporary basal rate. It was up to 145. Perfect for running, not so much for sleeping. I took a little bolus and feeling totally awake I went back to bed.  I woke Jess again and told her the whole story.  It took me a while to relax, but I finally fell asleep until my real alarm woke me at 4:01 a.m.

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A Diabetes Holiday in Italy

Last week we went on a long awaited trip to Italy. The trip was a family success, but a blood sugar disaster.  I love Italy but it seems my body, or at least my pancreas, doesn’t feel the same way.

I knew ahead of time that when visiting the land of pizza, pasta and gelato, I wouldn’t be able to follow my usual rule of travel, which is eat no carbs. I thought I would just taste a little bit of the kids’ pizza and pasta, but stick to my usual protein based diet of eating meat and fish most of the time.

My plan failed.  It failed because it wasn’t easy finding meat and fish while on the road with little kids (especially when they want to eat pizza and pasta all day long) and because the pizza and pasta were so good, it was hard to say no.  And weirdly, although I wasn’t feeling so good with blood sugar in the 300’s, I didn’t care. 

Usually seeing a number like that would make me crazy.  But I didn’t stress.  I simply decided that I would do my best to balance out the pizza, taking much more insulin than usual and trying to eat other things, too.  I was not going to beat myself up over my lack of control. It was like taking a little vacation from diabetes.  Not that having roller coaster blood sugars is easy, but I enjoyed myself. (Don’t worry, I didn’t go as far as tasting gelato).

I’m back home now and back to my usual diet and running. I’ve signed up for the Tiberias marathon again (this will be my 4th) and am trying to get my back in shape.

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Hypoglycemic Rage

I don’t always feel my blood sugar dropping. I don’t know if I’m starting to develop hypoglycemic unawareness or maybe it has to do with the speed at which my blood sugar is dropping. I used to always start to sweat and shake a little when my blood sugar headed down into the 50’s and 40’s, or at least I’d feel some sort of weakness coming upon me. 

But lately, on the few occasions that I’ve been low, I haven’t really felt it. At least not like that.

On Sunday at around 10:00 p.m. while I was washing dishes, I noticed Tom’s light was still on. I couldn’t believe it. After he had stayed out late the night before and had spent all of Saturday saying he was too tired to do anything, including his summer homework assignment that he didn’t finish before school started.

I was annoyed and angry. I assumed he had stayed up reading without noticing the time (or just not caring). When I got to his room I saw him sitting up in his bed with headphones on listening to music and looking half asleep.  This pissed me off even more.

“You’re so tired you can’t even read and you still don’t think of going to sleep?” I shouted. He just looked at me with a tired face as I continued, “You’ve been saying you’re tired all day long and you have school tomorrow.  Go to sleep.”

I walked out of his room and went back to the kitchen. I was annoyed at his lack of responsibility, but I was way too angry.  My reaction didn’t fit the crime.  I knew it. So, as I always do when something seems off, I checked my blood sugar. It was 37.

Shit! I looked at my pump and saw that I still had 3 active units of insulin in me. How did this happen and why didn’t I feel anything?

I opened the refrigerator.  I was startled, confused, and worried.  I had a Hershey’s kiss, a few M&M’s, an apple… and that was just the beginning. As I ate I felt guilty and humiliated about my hypoglycemic rage. Sure, I was justified in being annoyed at Tom’s behavior.  But my response was way over the top. By morning Tom probably forgot all about my outburst.  I, however, have to live with the knowledge that this can happen.  Diabetes can steal my reasoning abilities and self control.  Worst of all, I didn’t even feel it coming. 

 

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