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

#DBlogWeek Day 2 – Keep it to Yourself

A few days ago, after we put up our Short and Sweet interview with Karen Graffeo, I looked over the D blog Week topics to see if any of them “spoke” to me. The first was right up my ally – I Can. But I didn’t think I would have much to say about today’s topic until I read Molly’s blog about not discussing or posting her A1c results.

The reason I didn’t think I would have anything to say on this topic is because one of the first decisions I made when diagnosed was that I was not going to be embarrassed about anything that has to do with diabetes. Don’t get me wrong, I’m embarrassed of plenty of things and I have many things I don’t like to discuss with others, but when it comes to diabetes I feel like there is nothing to be ashamed of, success or failure.

I made this decision after meeting people who tested and injected in private and even some who kept their disease a secret. I decided that hiding implied that I’d done something wrong.

When I started blogging on ASweetLife, I took my diabetes public. This wasn’t an easy decision for me but when I made it I knew that there could be no secrets. I couldn’t boast about my success (running marathons, eating low carb and just living well) with out sharing my failures. (I caught myself with a BG of 42 a few hours ago.) And I had to paint a full picture of my life with diabetes, and dealing with my A1c has always been big part of that.

I’ve posted my A1c many times on this blog, usually voicing my frustration and occasionally my satisfaction.

I have had results which I had a hard time sharing but doing so has always felt better than not. My A1c is far from where I would like it to be and it seems that no matter how hard I try I can’t get it down for more than a quarter (three months).

So, when it comes to diabetes I have no secrets. I work hard to stay alive. That’s something to be proud of, not to hide.

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One New Year’s Resolution (on the run)

One New Year’s Resolution (on the run)

Last year, when I registered for the NYC marathon lottery and received my automatic entry message (after registering three years for three years in a row and not getting in), I was so happy. I was in a good mood for days. And I was equally unhappy when I had to accept that my hamstring injury would prevent me from running the marathon.

This all came up again a few days ago when I received an email from the NYRRs that I’m guaranteed entry to the 2015 NYC Marathon, and that I have from January 15 – February 15 to claim my place.

My first reaction was excitement. I hadn’t been sure I was guaranteed entry after cancelling my registration last year, and the only thoughts I have had lately about marathons have been doubts about ever being able to run long distance again.

So, when I received the message letting me know I was guaranteed entry I wasn’t sure what to do. I’ve been back to running for a little over two months now and my progress has been slow and far from pain free. It kind of feels like two steps forward and one step back, or two steps back depending on the week.

I‘ve been running three days a week, usually 2-3 miles and then walking a little and then running again. Yesterday, I ran a little over 5 miles with out stopping for the first time. It was at a slow pace, and I felt my hamstring during the last mile of my run.

I was hoping to be in much better shape at this point. I had set a 10K goal for December 31st, but it just didn’t happen. Although I’m a goal-oriented person (especially when it comes to running), I’ve been trying to not set any distance or speed goals and just listen to my body.

I know that registering for a marathon doesn’t mean you have to run it. (I should know, since I have registered for at least three I didn’t participate in.) But to me registering for a marathon is a commitment, and I really don’t want to commit myself to anything at this point, since that would only add pressure to my running, which is exactly what I’ve been trying to avoid. But then again, this is the NYC marathon. It’s been my dream for years.

So, while I’m not prepared to make a New Year’s resolution and push myself to train to the maximum, I won’t give up my place in the NYC marathon so easily. I’ve resolved to register for the marathon, but not let it affect my training. Wish me luck.

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Too Low to See the Food Right in Front of My Face

Too Low to See the Food Right in Front of My Face

Sleeping is something I don’t usually have trouble with. I fall asleep easily and can sleep late (not that the latter happens all that often). But the other night, I was totally wired. I don’t know if it was because I’d gone for an evening run or because the day had been nonstop and my body was having trouble unwinding. I simply couldn’t relax.

I lay in bed reading for over an hour before I put down my iPad. (I usually don’t last more than 20 minutes.) But even after all that reading, I still couldn’t fall asleep. I tossed and turned for a half hour until I sat up and started to read again. Then I felt like I had a little heartburn. I tried to ignore it, but it didn’t go away. I tried to sleep again. Useless. I was totally alert.

I don’t know why, but at 12:30 a.m. I decided to check my blood sugar. I felt fine, aside from the heartburn. Still, I reached for my glucometer and using just the light from the Freestyle, I tested.

I looked at the little screen and said, “Oh, shit” as I saw the number 32.

“What is it?” Jess, who had a nasty cold, murmured. It sounded like she was talking in her sleep.

“I’m 32,” I said, still not moving.

“I’ll get you something,” she said.

“No. It’s fine, I’ll go,” I said.

“No,” Jess said.

Before she could remind me of the glucose tablets next to the bed, I’d gotten up and walked to the kitchen.

I opened the refrigerator, and looked in. I couldn’t see anything to eat. I had a hard time seeing anything at all, except black spots. I couldn’t focus. Was I passing out? I was dropping. Must be below 30, I thought. Where was the food? Where did all the fucking food go? The cold refrigerator air on my bare feet reminded me where I was standing. But I closed the door because there was nothing but black spots in there.

I wondered why we didn’t have any food in the house (we had plenty). I heard Jess asking if I was okay. I answered yes because the problem wasn’t me, but the fact that there wasn’t any food around. Then I saw it – not in focus – but still identifiable plastic container of dried pineapple on the counter. My feet moved in the right direction. I grabbed it and shoved a few pieces in to my mouth. A few more. The room came back into focus. I remembered we had some sweet granola in the pantry. I ate.

I went back to bed and waited, telling Jess (cynically) that we should really have some sweet food around.  She sneezed in reply. Next blood sugar check was 61. Much better, but way too low to go to sleep.

I felt flattened, defeated, my head hurt, and I was nauseated. I tried to read while I waited to see if my blood sugar was going up. When I saw it in the 90s, I set an alarm to check again in an hour. Then I closed my eyes.

When my morning alarm went off at 7:00, I couldn’t get up. My head was pounding. I checked my blood sugar. It was high, as expected – 204. I took a little bit of insulin, cancelled all work and plans for the morning, and fell back asleep.

Many hours after my hypo, I still felt weak and dazed. When that passed, I felt traumatized. I know what a close call I had. I felt how close it was. What if I hadn’t been wired? Was ‘wired’ my body’s way of telling me something was wrong? Why hadn’t I felt hypoglycemic?

Things could have easily ended differently.

My body’s cry for sugar had been silent. I happened to check my blood sugar. Luck? Intuition? I could just as easily have closed my eyes like every other night, and then drifted into a deep, all-consuming sleep.

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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).

 

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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.

 

 

 

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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. 

 

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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.

 

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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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