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

Diabetes Apps and Computer Programs Don’t Help, Really?

This morning I read an article in Reuters about how a new report being published has found that “Computer and mobile phone programs that provide tailored advice and support to people with diabetes may not do much to improve their health and quality of life”. The report, based on 16 studies, found that people with diabetes who used these apps and programs did not manage there disease any better than those who did not and although “Some studies hinted that the interventions increased people’s knowledge and confidence, they did not alleviate depression”.

In other words, what the report says is that all of the diabetes apps and programs being created are not helping anyone.



At first this pissed me off a little, I mean, who’s to say that a tool that makes life a little easier, even if not significantly improving your A1c, isn’t doing anyone any good. But then I remembered my one attempt at using a diabetes app.

It was a while ago, after Karmel Allison interviewed the creators of LogFrog DB, Elon Danziger and Yelena Rubinshteyn, I decided to try the app (one of many diabetes apps available to help people with diabetes manage their disease).

I liked the app. I enjoyed the graphics and I thought the interface was easy to use. I also liked the fact that it wasn’t serious, it had a fun edge to it – something I think people with diabetes need, well at least I do. The one thing I did not like about the app was that I couldn’t download the data onto a spreadsheet.

But did the app help me?

No. It didn’t because I didn’t really need it. I had a pump, where I recorded all of my carbs, blood sugar measurements and insulin intake. So as nice as the app was, it felt like just another extra thing to do. So quickly, once playing with the interface got old, I stopped using it.

But not everyone uses an insulin pump, and many people record their blood sugar and insulin intake on paper, especially when first diagnosed. I know I did.

I don’t think that having an app, back then, would have made me a better diabetic, as far as the doctors were concerned, but it would have certainly made life a little easier for me.

I can’t argue with numbers (in the report), but I think that they don’t always provide a full picture. I believe that most people who manage their diabetes well, would do so with or with out diabetes apps, programs and even community. But there are many aspects to living with diabetes an A1c does not cover.

Making life easier, convenient and fun is important too.

There’s no doubt that real help, for those unable to control there own disease, will not come out of a diabetes app, but if there was no need for them people would stop creating them, buying them and using them.

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Tagged – Getting my First Medical ID

Medical ID - Type 1 Diabetes Dog TagI was excited yesterday when I checked the mailbox and saw a small package waiting for me.  Since I don’t get much real mail anymore, it’s a treat to see something other than advertisements in the mailbox.  Before I looked at the package, I knew what it was, the medical ID I’d ordered from RoadID.

I went inside, opened the box and announced to Jessica, “My road ID has arrived.”

Both of the IDs I’d ordered were in the box and the information printed on them was correct.   All was good, so I relaxed and started to look at my new toys.  I admired the dog tag and the ankle ID and then tried them on. 

I don’t usually wear jewelry, except for my wedding ring, but I instantly liked the dog tag. I wasn’t sure how I’d feel about being tagged and about wearing medical ID. But it felt surprisingly good. I don’t know if it was because the dog tag is kind of cool (in a militaristic sort of way) or because wearing it is the right and safe thing to do.  Either way, it felt good to have it on, and Jess approved, too.

I’m not used to having anything on my ankle, so the ankle ID felt strange. It’s not something I’ll wear all of the time.  But I need to test run both the IDs to see which I prefer to run with.  The marathon is just around the corner.  I need to decide quickly.

At this point, it’s hard for me to say whether I’ll always wear medical idea. But running with it, especially when I’m alone, or far from home in a place where I don’t know anyone, seems wise.  Diabetes wisdom seems to come my way with time.  It wasn’t all that long ago that I ran without a glucometer.  Now I run with one, wear an insulin pump, have medical ID on me… all that’s left to get is a CGM!

Medical ID - Road ID

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Hotter than July at the Tel Aviv (Half) Marathon

Tel Aviv Half MarathonExtreme heat and marathons are not a good combo.  So it was no surprise that the 2013 Tel Aviv marathon did not take place as scheduled on Friday.  As soon as the 96 degree marathon day weather forecast arrived last week, the marathon-cancellation-chatter began.  My friends and I were talking to each other constantly – nonstop speculation.  Would we be running or not?  On Tuesday the organizers announced that the race wasn’t cancelled, but would begin at 6:00 instead of 6:30. On Wednesday they announced that the half marathon and the 10k would take place, but that the marathon was officially postponed for a week.


The marathon was still doable, in theory, but the city wouldn’t close down again so runners could fill the streets. Instead they scheduled it to take place in Park Hayarkon, where I run almost every day.  The park isn’t long enough for a marathon, and the idea of running back and forth over a small area rather than a running a city marathon full of cheering crowds was depressing.

I didn’t know what to do, so I did what any normal husband would do… I drove my wife crazy for days.  In fact, Jess claims she lost two work days over this. I couldn’t concentrate on anything.  Should I run the Tel Aviv marathon a week later?  Should I go run another marathon?  The Rome marathon was only two days after Tel Aviv’s. The Prague marathon?  The Milan marathon?  Zurich?  Bratislava?

The biggest problem with a marathon somewhere else is the expense.  But since hernia surgery caused me to miss the Amsterdam marathon back in October, I felt it was okay to splurge now. The question was where to go.  Once I’d decided to run a marathon somewhere else, I decided to go back into training mode.  I would run the half-marathon here, but proper marathon training would require me to run 31k, not just 21.1.  So I would start early.

The start time of the half-marathon was 5:45 a.m. starting time.  It had to be this early to avoid the forecasted heat. So I had to start my own run at 4:30 a.m., the hour when the clubbers are dragging themselves home and puking in the street.

I got up at 3:45 with a BG of 172, not the best but I still had some active insulin in me and for a 19-mile run it wasn’t a bad place to start.  I ran 2 miles at a very easy pace before stopped to check my blood sugar for the first time it was 161. Although it was very early in the morning it was quite hot and there was a warm breeze, a little too warm for comfort. I ran the next few miles at a good pace, a little slower than my marathon pace (8:00-8:10).  At 5:35 I arrived at the race area. My blood sugar was 139 – time for a gel.

When the race started it still felt like night, but as I ran the first three miles daylight began to take over the sky.  And the heat began to take over the land. I was running  at a good pace but then after about eight miles I started to feel bad. I took another gel (as planned) but that didn’t do much. At 7:00 a.m. the heat really surged. My mouth was dry and it felt like I was running in a wool suit. I had only 4 miles to go but I knew I was dehydrated, and my muscles felt fatigued. I kept a decent pace for another mile but then started to slow down. I felt so horrible, as thirsty as I’d been since diagnosis, but I decided I wasn’t stopping for anything. I fought myself to the finish line and crossed it in 1:42:25 according to my Garmin (and with my blood sugar at 158). Not my best run ever but, when I arrived home and began to hear the horror stories of the half-marathon, I realized it could have been much worse: one runner died, four were comatose, and many others were in serious condition, all due to dehydration and heat stroke.

Tel Aviv Half Marathon - Last Mile

Tel Aviv Half Marathon – Last Mile

Before I left the race I met up with my friends and we hung out, talking about the race, the heat and enjoying some post race beer that was being sold for $1.25. I don’t usually drink beer, but I figured I deserved it. I bolused and had a pint.

I walked home in the heat. By 9:00 a.m. it was 90 degrees and people were still running (the 10K races started later). On my way I saw someone looking bad being loaded on to an ambulance.  

At home I took a shower and got into bed to take a nap. I asked jess to wake me in an hour

“Did you check your blood sugar?” she asked.

I hadn’t, so I did.  83.

“I’ll get you something to eat,” she said and got me some dried fruit.

Jess woke me an hour later. I had a very hard time waking up. I guessed it was dehydration but when in doubt I usually test my blood sugar. It was 53.

I had over-bolused for the beer and spent the rest of the day chasing lows.  In between the snacking and blood sugar checks I thought about the race, how despite the severe conditions I’d managed to do it and didn’t screw up my blood sugar until after the race.  And with a sense of trepidation tinged with confidence, I singed up for the Milan marathon.


Alone with My Blood Sugar

I’m one week away from the Tel Aviv marathon and me and the guys from my running group are starting to get very nervous about our up coming event.  It’s not the distance we’re worried about (we’ve all run marathons before) but the weather. 

On Tuesday (the 5th), ten days before race day, we started looking to see what kind of weather we could expect. The 10-day forecast predicted that Friday would be wormer than usual, but much better than the rest of the week, which is supposed to be hot with highs at around 90. But as the days have gone by, and the forecast has become more accurate it looks as if Friday is going to be pretty bad, with highs in the mid to high 80’s.

It’s true that the weather may change and may turn out to be better than predicted, but after months of training none of us want to find ourselves running a bad race, slowing down trying not to dehydrate.

So we’ve started thinking about Plan B, another marathon somewhere else. Although most of the big marathons are closed by now there are some – Milan, Hamburg, Zurich… – that we may be able to get into. This is far from ideal, since it means postponing the marathon by a few weeks, but it may be better than trying to run a marathon in a heat wave.

The nice thing about all of this is that I’m not alone in this and if I do decide to go abroad to run, I won’t be doing it alone.

What I am alone in is my crappy blood sugar control. The last few weeks have been a little bit of a blood sugar roller-coaster ride. I’ve had more morning highs, most of which felt like rebounds from nighttime lows, than I’ve had since going on the pump. I don’t know why this has been happening but it has been frustrating me and making me feel like a bad diabetic.

This morning when I woke up my blood sugar was 230. An hour later, before I started running – I didn’t take any insulin – It was up to 265. As expected my blood sugar dropped after I started running, and after 5 miles I felt fine, not good but fine.

This has been happening so often that I’ve stopped telling my running mates about it. I feel as if it’s turned into an excuse, something to say so if I don’t run well it isn’t my fault.

Unlike the weather, which is out of my control and shared by all, my blood sugar is mine and mine alone and although friends may be understanding and sympathetic. I feel alone in my worries and frustrations. 


Diabetes Doubts as Marathon Approaches

Tapering before a marathon brings with it a lot of doubt. I’ve done it six times before and each time I find myself doubting my ability, and feeling as if maybe I should have done more or maybe I did too much. 

My ritual goes something like this: the first week of the taper my body is exhausted from all of the hard running. Two weeks into the taper I start doubting my ability to run 26.2 miles, thinking maybe I should run a 20 miler right this minute, just to see if I can. I know these doubts are not unique to me  but last week when I ran my last long pre-marathon run, 24 miles, I wasn’t just nervous and worried about all the things runners worry about before such a run like, Will it be a good run? Will I hit the wall?  Lucky for me, I have the bonus blood sugar worry.  It’s particularly bad this time because my BG has been consistently inconsistent over the last few weeks.

After my bad half marathon experience, in my following run I was very disciplined about sticking to my running plan, making sure not to run faster than I was supposed to. I ran the first 4 miles at an easy pace (8:35) before getting into more of a marathon pace. I ran the next 8 miles at an 8:00 minute mile pace, which felt good, and the next 6 miles at a 7:45 pace, which felt comfortable, too.

I was supposed to run the last 6 miles at a 7:30 pace but I couldn’t hold it and ended up running at a 7:35-7:40 pace.  During the run I checked my blood sugar every 3 miles. I was very nervous that it would stay too high during the run, but to my surprise my blood sugar behaved and, as planned, I took a gel every 6 miles, which kept my blood sugar in the 130 – 200 range.

I was in a great mood after the run. My body didn’t feel too bad, my blood sugar seemed to be controllable and my average pace for the run was 7:56 (a pace that will earn me a new personal record). All of this made me feel confident, like I was ready to run a good marathon.

I also realized that it is okay for my blood sugar to go over 180 or even 200 during the marathon (as long as it doesn’t go much higher than that) and that it will come down.

But now doubt is settling in again. I keep wondering if my last long run was the exception or the rule. I’ve had a few bad blood sugar nights during the last week, including one that left me feeling half asleep even after running 11 miles.  That really made me worry.

I know I will get more nervous as the marathon approaches, and that no matter how good my blood sugar control is I will be nervous about it until I cross the finish line.

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Exercise Resistant Diabetes

This morning I ran 6.5 miles at a 7:20-7:30 pace, 15 seconds quicker than my target marathon pace. I ran a 4-mile warm up, checked my blood sugar – it was 130 – took a gel and started my run. I ran the 6.5 miles without stopping and although the pace wasn’t supposed to be hard for me, it was. When I was done I checked my blood sugar again and it was 172. 

On Thursday morning I am running my last long run before the marathon.  The fatigue I felt during my run this morning doesn’t bother me so much, I imagine that it’s a result of all the hard training – Friday’s half marathon and that fact the I ran intervals yesterday.

What’s bothering me, really bothering me, is my blood sugar.

When I finished my run this morning I expected my blood sugar to be somewhere in the vicinity of 100 or at least back to where it was when I took my gel. That would mean that during a long run, or a marathon, this would be the time to take another gel. In all of my past marathons, and during training I took a gel every 6-7 miles (40-50 minutes). That routine kept my blood sugar between 130 and 200, and kept my body fuelled.

But now it’s as if something has changed. I run 10 miles and my blood sugar doesn’t seem to go down at all. During the half marathon when I stopped to check my blood sugar, 5 miles after my only gel, my blood sugar was 187.

You could think that this was a good thing – not going low when I run, but it’s actually a disaster. If my blood sugar doesn’t go back down after 6-7 miles I can’t take gels and if I can’t take gels, I won’t have the energy needed to keep up my pace.  I might not even have enough energy to finish the race.

This has made me very nervous, especially because I’m running out of experimentation time. If I had a little longer I might try playing with my temp basal rate, setting it at 40% or 50% instead of 30%. But I’m too scared to try anything like that now. So I guess I’ll run my last long run sticking to what has worked in the past and hope that all the pieces fall into place.

Right now, it feels like my diabetes has become exercise resistant. 


The Wind and the Blood Sugar

I had set out to break my half marathon personal record yesterday, but things didn’t go as planned.  

My (running) week started off well with an early Monday morning interval workout. I ran well enough, taking into account that I ran 23 miles on Friday at a 7:50 pace. But during Monday’s intervals I had stomach cramps. I didn’t think much of it but when I got home, I started feeling terrible. My stomach felt like someone was ripping it out and my head started to hurt, too.  For 24 hours I couldn’t do anything but sleep. My blood sugar did surprisingly well throughout the day, probably because I didn’t eat anything.  

On Wednesday I felt a little better, and decided to run. I ran 7.5 miles, running the last 2.5 at a 7:15 pace, a little quicker than my half marathon pace. I was happy I did it but it felt much harder than it should of.

Thursday, the day before the race, I tried to be very careful with my food and checked my blood sugar frequently. I was trying to make sure my blood sugar wouldn’t surprise me on race day. But it did.

I set an alarm for 5:00 a.m., a half hour before I planned to get up, to check my blood sugar, just in case there was a problem. When the alarm went off and I tested myself, I was very surprised, my blood sugar was 220. I had a long time before the race, so I decided not to panic. I took some insulin and went back to sleep for a half an hour, well at least I tried. 

I got out of bed at 5:30, made coffee and checked my blood sugar again. It was 240. I decided not to take any more insulin and wait it out. I got myself ready to go and checked my blood sugar again. It was down to 190. 

Okay, I thought to myself, everything is under control

I got to the race area early, picked up my bib and chip and went out for a mile and a half warm up. I checked my blood sugar expecting it to be down but it was 187.

The race itself was a catastrophe. I started a little too fast but got into a good 7:15 pace, which I thought I could hold through the race.  I was wrong. I couldn’t relax about my blood sugar and couldn’t make up my mind when I should take my first gel. I decided to take it after 3 miles, but when I got there I decided to wait, scared my blood sugar was still too high. When I reached the 5-mile water station I decided it was safe to take a gel, which my body seemed to need.

As we got closer to the end of the park, towards the beach, I started to feel the wind. It wasn’t too bad and, working hard, I kept my pace up.

After six miles in the park we reached the beach and turned north for a mile. There was a strong southern wind pushing me uncomfortably from behind, so that I felt I needed to stop myself from running too fast. I knew that this meant trouble since we had to run back in the other direction.

When we turned around the wind was so strong I felt I was wrestling my way back. My pace dropped to 8:35. When we got back into the park I tried to get back into my pace but I couldn’t. I tried to keep up a decent pace thinking that maybe by some miracle I would get over it and save the race. At around the 11th mile, I felt terrible. I had no energy. I thought it might just be my blood sugar. Or maybe I was just looking for an excuse to stop. I decided I needed to check my blood sugar. It was 187. It wasn’t my diabetes it was just me. I had wasted another minute of the race and I felt dehydrated and fatigued. I continued running at a much slower pace than I wanted but my body wouldn’t go any faster. I finished the race running after 1:40:02. 

Feeling depressed and exhausted I went to the refreshment area. They were giving out all kinds of things that I don’t eat – fruit, cookies, and sugary drinks. There was also a beer stand from a local brewery giving away beer. Although I don’t usually drink beer especially not at 10:00 a.m, I decided to give myself a break. I canceled my temporary basal rate, bolused, drank my beer and although the day had not gone as I had planned, I tried to enjoy myself. After all, I did just run another half marathon.


Legs Over Pancreas

I’m six weeks away from my next marathon, the Tel Aviv Marathon, and I have only two long runs left to run, with a half marathon in between, before I start to taper. 

I’ve been training hard, running 55-60 miles a week for the past couple of months. I feel faster than I’ve ever been and stronger, too. I feel like I’m almost prepared. But as a diabetic runner there is another aspect of training, one that other runners don’t have to deal with – getting blood sugar under control, finding what to eat before and when to take energy gels during a run so blood sugar will remain at a “good” level – not too high and not too low (somewhere around 150) – while also getting enough energy to not hit the wall.

I have been much less successful in the diabetes aspect of my training and I feel very unsure of what to do. In the past, I succeeded in finding a pattern, which allowed me to run the marathon with out stopping to check my blood sugar. But this time around it’s as if each run is totally different. In some my blood sugar has stayed high allowing me only one gel (instead of two or even three) during 20+ miles. I would raise my basal rate (or lower it less), if not for the fact that during other runs my blood sugar behaved as it has before, dropping every 40-50 minutes, forcing me and allowing me to refuel with an energy gel two or three times during the run.

All of this has made me very nervous. It has also made me wish I had a CGM.

I’m hoping things will fall into place in the next few weeks and that luck will continue to be on my side. I will, of course, help luck along by being stricter with my diet and checking my blood sugar more often on the days before I run.

I know I have a new personal record waiting for me in my legs, but I’m scared my pancreas, or lack of a fully functioning one, will keep me from doing my best.


Sugar Fingers

Last night I went to bed at around 10 p.m. I was tired and needed to get to sleep early since I had a 20 mile run ahead of me in the morning, which I planned to wake up for at 4:20 a.m. 

I got into bed and checked my blood sugar. We had eaten dinner relatively late and I had taken a substantial amount of insulin (around 4.5 units) because my blood sugar was a little high to begin with.

At bedtime my blood sugar was 173. I plugged the number in to the bolus wizard on my pump. It told me I didn’t need to bolus (well it actually read bolus 0:00 units) and said that I had 4.2 units of active insulin on board.

Well, I couldn’t go to sleep like that.  So, although I was very tired I decided to read for a while. After half-an-hour or so I started having a hard time staying awake, I was reading the same sentences over and over again. I decided to just go to sleep.  My blood sugar was 104. I knew that was not good, so I set an alarm to wake me 45 minutes later. Knowing I probably wouldn’t hear the alarm, especially if I was going low, I asked Jessica to make sure I checked my blood sugar when it went off.

When the alarm went off I did not hear it and when Jessica woke me I felt groggy and disoriented, all I wanted to do was fall back to sleep. Jessica insisted, and I checked my blood sugar again. It was 62 and, as far as I could tell, falling. I didn’t want to eat anything, both because I wasn’t hungry and because I didn’t want to wake up in the morning, before my run, with very high blood sugar.

“Have some glucose tablets,” Jessica suggested. “There’s a new container in the bathroom drawer.”  She offered to get them for me, but I didn’t want to make her get out of bed.

I stumbled through our apartment (thankfully, we don’t live in a big house) and found the bottle of dex4 glucose tabs. I had a hard time opening it. But I finally did and had a glucose tab.

“How many did you have?” Jessica asked me.

“Just one”

“That isn’t enough.”

So, a little more alert, I went back and had a few more glucose tabs (at this point you’re probably wondering why the hell I don’t keep them near my bed). I ate some dried fruit, too.

I got back into bed and set another timer.

“Did you brush your teeth?” Jessica asked.

“No,” I said. “I want to sleep and I’m not getting up again.”

“Did you wash your hands?”

“No,” I said.

“There’s probably sugar on them.  It’s going to screw up your next test.”

45 minutes later my alarm went off again. I had no trouble waking up. I grabbed my glucose meter and checked my blood sugar. 285.

I was about to panic, but then I remembered Jessica asking me about washing my hands. I tried another finger. It read 110.

Relieved, I went back to sleep and when I woke up at 4:20 my blood sugar was 150. Not perfect but good enough.

I got up had my coffee and went out to run a good 20 mile run in the rain. (It took me 2:37:16.)


Never Take Insulin Before You Run

I have eight weeks to go until the Tel Aviv Marathon and I’ve been training hard. I feel good and I’m faster than I was a year ago when I set my marathon record

For the last couple of weeks, though, my long weekend runs have suffered from diabetes issues. For some reason, I’ve been waking up with relatively high blood sugar (220-250), which doesn’t come down during my run. Last week I ran well for 18 miles but then, after taking only one energy gel during the first part of my run, I slowed down and ran the last 2.5 miles at a slowing pace until I just stopped half a mile early.

Yesterday, I woke up early for my run sure that my blood sugar was fine. I had even set an alarm during the night to wake me up to test. I was 190 during the night so I bolused and went back to sleep for a few hours.  But when I tested my blood sugar a few minutes after waking up, at around 4:30 a.m., it was 223 and I was shocked. I got myself ready to go running hoping my blood sugar would come down a little before I had to go. I didn’t lower my basal rate either, thinking it would help bring me down to a decent level. A half hour later I checked again. This time it was worse  – 243. I was annoyed and worried. I decided I would do what I never ever do before a run – I bolused. I plugged the number into my pump, which recommended I take 2.8 units of insulin. I decided it would be safe to take half that amount.

A half hour later I was ready to go. I checked my blood sugar again – 222 – and reduced my basal rate. I ran two miles and stopped to check my blood sugar. It was 142. I noticed that it had dropped quickly, but didn’t think much of it. I continued running and stopped again 5 miles into the run. I drank some water and checked again. This time it was 54. I couldn’t believe it. I checked a second time. The meter read 63. I tried not to panic. I was running well, feeling strong but I knew that it could all be over in a minute. I took a gel and kept on going. 

I ran another 2 miles hoping I had caught  myself early enough to save the run. I checked my blood sugar – 99. I continued for three more miles and tested again – 90. I decided to take another gel.

I continued for 12.5 more miles, checking twice more and taking another gel, and feeling great. Tired but great.

I ran 22.5 miles in 2 hours, 55 minutes, and 30 seconds, and felt like I could have run another 3.7 miles (that would make 26.2 aka a marathon).

After two bad long runs and a near disaster I finally ran a long training run that made me believe a new personal record is very possible. I just need to keep training, not get injured and keep my blood sugar under control.

I also have to remember to never take insulin before I run. Never.


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