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

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.

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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.

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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.)

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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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I Hate Maltitol

Ironbull's Pink of Courtesy

Pink (Ironbull’s Pink of Courtesy)
2003 – 2013

My dog, Pink (Pinky), died Monday morning. She was a nine and a half year old bullmastiff who still seemed like a puppy.  She was a beautiful, gentle giant and we loved her very much.

On Wednesday afternoon, Jessica and I went on a walk, the same walk I used to take Pinky on every day. We passed by the stores I used to take her to and talked about her and our loss.

We went into one of the shops, a deli I go to often, and saw they had a poppy seed cake – “sugar free”. I looked at the ingredients and saw that the second ingredient, after flour, was maltitol.

“It’s not low carb” Jessica said while we looked at the cake.

“I know, but what the hell. Let’s try it. We deserve it,” I said referring to the bad mood we had been in since Monday. Drowning my sorrows in food, even carbs, never helps but I keep trying anyway.

So we bought the cake, went home and made some coffee. We each had a piece of the cake.  Jessica’s was very small and mine was twice as big.

I love poppy cakes and was really excited to try it but after I had a bite I realized it wasn’t the real thing (a feeling I get most times I eat food with artificial sweeteners).  This realization did not deter me from eating more. It was as if the fact that it didn’t really taste good made me want to keep eating it. It was close enough to good that it made me want more in hope that it would some how become the real thing with just a few more bites. I bolused a little for the cake and my blood sugar went up, but nowhere near what it would have if I’d eaten “real” cake.

We went to sleep early that night. When I woke up at 6:45 (Thursday is not a running day), I felt as if I’d been hit by a truck. I couldn’t wake up and my stomach didn’t feel all that well either. I didn’t think I’d had a low during the night, but that was the only explanation I could think of for the way I felt. 

I made coffee and took another piece of cake. I took the kids to school and didn’t walk the dog.  I was depressed and felt horrible but wanted to get some work done. I tried, but my mind wasn’t working.  I ended up going to bed and within seconds I was out. I slept for an hour with out moving. I felt drugged. I dragged myself out of bed and told Jess how I felt.

“It’s probably the maltitol,” she said. It always does weird things.

My blood sugar wasn’t too high, staying at around 150-180 even after bolusing a few times. I know maltitol is infamous for causing stomach issues (nausea, diarrhea…), and although my stomach was bothering me that wasn’t my main concern. I felt drugged, poisoned. And after thinking about it a while I realized this wasn’t the first time I’d felt like this after eating food with maltitol.

At about 5:00 p.m. I crashed again. I fell asleep for another half an hour.  I dragged myself out of bed to drive the boys to judo.

By dinnertime I felt a little better, and my blood sugar was finally back to normal.

“I hate maltitol,” I told Jessica. “Don’t ever let me buy anything like that again.”

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New Basal Settings Not Working for Me

A couple of weeks ago my endo changed the basal settings on my pump, reducing my early morning (2:00 – 4:00 a.m.) and my morning to afternoon basal rates. She did this for two reasons: the first was that I had been waking up a little low for the previous two weeks, and the second, was that she did not like my basal to bolus ratio. She told me that only overweight type 2’s take 65% of their insulin as basal. I tried to tell her it was because I eat a low carb diet, but she did not seem to listen.

Although I didn’t think I needed a change in my basal settings I decided to listen to the doctor, or at least give her a chance. Since then I’ve been spending my mornings chasing down my blood sugar (bolusing without eating) and going low during the night and waking up high.

I can deal with these periods of out of control blood sugar as long as they don’t affect my running too much. I’ve been working hard training for the upcoming Tel Aviv Marathon and there are only 10 weeks of training left (7 if you don’t count the taper).

Friday morning I planned to a 20 mile run with a few friends I’m training with. The first few miles were supposed to be at an easy pace, but most of it was supposed to be at a pace equal to or faster than my marathon pace.

I woke up at 5:00, feeling very alert, but in a strange way. I checked my blood sugar and was shocked to see it was 275. I knew it was too high for running but I was also scared to take any insulin. I decided to delay setting a temporary basal rate until I started to run. I got ready to go, drank a cup of (black) coffee, and checked my blood sugar again, 253. Close enough, I thought to myself, thinking about the 250 blood glucose rule – you shouldn’t run if it’s higher than 250. 

I reduced my basal rate to 30% and headed out.

I ran a mile and a half to the meeting point and checked my blood sugar again. It was down, but still higher than I’m used to – 214. I met up with my friends and we headed off. I explained to them that my blood sugar was totally off and as usual they were understanding.

We ran a couple miles and stopped to stretch. I checked my blood sugar again. Usually this would be the point where I’d have my first gel of the day, but my blood sugar was still too high 187. We continued running, 5 miles later we stopped to again to drink, take gels, and allow me to check my blood sugar. Finally my blood sugar was low enough to take a gel – 114. We continued running increasing our pace. I felt weak, but hoped it would pass. We stopped again 7.5 miles later. Everyone took a second gel; I checked my blood sugar thinking it would be somewhere around 100. I was totally wrong. My blood sugar was 201. I needed to wait with my gel, although I really needed it. I felt totally empty. I ran another mile and a half with my friends and stopped again. I told them to continue without me.

I felt bad and hoped my blood sugar had dropped which would explain my weakness and allow me to take a gel, but my blood sugar was 186. I ran another mile and a half and checked again. I was desperate, hoping things would some how work out but my blood sugar was still too high, 163. I had run more than a half marathon on one gel, and was too high. I continued for another mile and a little but started feeling dizzy. I stopped running after only 16 and a half miles (out of my planned 20). I felt terrible, both physically and mentally. I walked home, cold and tired.

When I got home I checked my blood sugar again. It was 171.

“That’s it,” I said to myself, “I’m changing my setting back.”

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My Diabetes New Year’s Resolution: Not to Give Up

This morning I realized I hadn’t made any New Year’s resolutions for 2013. I don’t know why, but it kind of just caught me by surprise. 

Well, it’s not too late, I thought to myself It’s still New Year’s and its not as if they don’t happen if made a day later. They don’t usually happen because I forget about them.

So I started thinking about what I should resolve to do this year. Naturally, my first thoughts were about my diabetes New Year’s resolutions. What am I going to shoot for this year? What should I try to improve? I thought about it for a few minutes. The first resolution should be a better A1c. I should resolve to get my A1c down to 6% or even 6.4%. But then I realized that that’s what I’ve been trying to do for the last few years and it seems ridiculous to resolve to do something that you’ve been trying to do, unsuccessfully, for the last two years.

I also thought of making a New Year’s resolution regarding my weight, but realized that I’ve already been trying to lose a few pounds, the same few pounds for a long time.  So, another ridiculous resolution.

I kept thinking, trying to come up with a good diabetes New Year’s resolution. I mean there has to be something I can improve (not just should improve) in my diabetes management.

And then I realized what my diabetes New Year’s resolution was going to be. I’m going to keep on fighting. Not give up. Not let the lack of good past results (i.e. improved A1c), or the endlessness of this process break me. I’m just going to keep on trying, keep on doing my best and maybe, just maybe, I’ll actually see an improvement.

 

 

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Batman And Diabetes Devices – Am I The Only One Who’s Anxious?

Last weekend I rented the newest Batman movie, The Dark Night Rises, and watched it with my older kids. Having young sons allows me to watch superhero movies and play on the PlayStation, and I can call it parenting, not procrastinating or wasting time!  Anyway, while I enjoyed the Batman movie, I was disturbed by one of Batman’s new tricks. During some of the chase scenes, which take up most of the film, Batman managed to disable all of the electrical equipment around him using some kind of frequency.  Since in this movie, unlike most Bond films and previous Batman films there weren’t many explanations about the new gadgets being used, it’s hard to now how the gadget worked. The reason it disturbed me was because I kept thinking about my insulin pump.

What if someone with diabetes, a pumper, was nearby? Would his pump be disabled? Would it come back to life or would he need a replacement, the way I needed one after going through the x-ray machine at the airport?  For some reason this line of thought did not leave my mind for a few days.

This morning while running by myself, again I started to think about Batman’s gadget, realizing that there are people out there with much bigger problems than my pump. I mean, what would it do to a pacemaker? This very cool gadget that turned off city lights could kill innocent people.

I know it’s only a movie, and that Batman, even as the dark night, certainly wouldn’t risk innocent people’s lives. What I really want to know is do other people think this way? Do others have an ever present anxiety that the thing, the device, they count on for survival could be destroyed at the press of a button?

YouTube Preview Image

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My New Medication: An ACE Inhibitor

I just came back from a surprising visit to the diabetes clinic. I’ve been prescribed a new medication – new for me, that is. An ACE Inhibitor.

I went to my appointment thinking I was just going to renew my scripts and say hello to my endo. My periodic checkups at the diabetes clinic are usually uneventful, and include praise for my good control, especially the infrequency of hypoglycemia.  I had no reason to think this time would be any different especially since my last A1c result was identical to the one before – 6.8%. 

The appointment started out fine. I saw the nutritionist, not my usual one, who was nice and thought my diet is a little crazy and that I don’t eat enough. She had a hard time believing I’ve been eating this way for two and a half years, and asked if I’m moody and if I feel tired. I told her I’m not moody and that I’m tired, but having three kids, waking up to run most mornings around 4:30, and working pretty much non-stop until 10:00 p.m. would make anyone tired, right? I don’t think it was surprising. She looked at my numbers, which she downloaded from my pump and glucose meter, and said that if it works for me…

Next I went to the nurse, also new. She was really nice and thought I had very good control. She did however think I should lower my basal rate during the early mornings. This, a result of the fact that I have been waking up relatively low for the past two weeks. I don’t know why this is. I have been eating a little less lately and running a little more, but I’m not sure that’s what causes the lower numbers. In any case, she suggested I lower my basal rate which is 0.75 units per hour to 0.65 from 2:00 to 4:00 a.m. (then it goes to 0.45).

I wasn’t so sure she was right but waited to see what the doctor would say.

When I walked in to the doctor, she seemed very unhappy. Unhappy with my LDL, which went up to 140. Unhappy with my decision to stop taking statins,  and unhappy with my morning lows. (I woke up in the 60‘s twice this week, once 71 and once 91, which is a little low if you’re going running.) She was also a little unhappy (in a caring way) about my eyes. She told me to get a second opinion. My A1c, she said, is fine.

She was also unhappy about my insulin regimen. She told me that young athletic people (with diabetes) should not take 67% of their insulin as basal insulin. She decided that not only should I lower my basal rate during the early morning but I should also split the day into two, lowering my basal rate during the morning hours from 0.45 to 0.35.

Then she told me she was prescribing me a lower dose statin and that she wants me to take and another pill I’d never heard of – Ramipril. Ramipril, marketed by Sanofi as Tritace, is an ACE inhibitor used to treat high blood pressure and congestive heart failure.

I asked the doctor why she was prescribing me another drug, but I didn’t receive much of an answer. She said something about my eyes and small blood vessel damage. Realizing I wouldn’t learn much from asking, I accepted her opinion, at least until I got home.

When I got home I looked it up and found out a little about it, including the fact that ACE inhibitors were originally made of snake venom. But didn’t see much about diabetes.

So, I called a friend, an endo, who told me it was the right thing to do. She also said I had to get my LDL cholesterol down.

“…take the statin, if you feel muscle pain try a different one but you can’t walk around with high cholesterol, it’s like not getting your blood sugar under control.”

So here I am again, with my list of medication growing, getting ridiculously long. I never thought I would be this way, definitely not at 43. On the other hand, I didn’t think I’d be a marathoner either. 

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Medical Alert Bracelet, Should I Get One?

Last week I was in Boston for the first time in over 20 years and as I do everywhere I go, I woke up early and went for a run. It was cold and I dressed in a few layers, covering my pump and supplies.

I headed out at 6:00 a.m. for an 11 mile run excited to see some of one of America’s prettier cities. I was told to go down to the Charles River so I did. I thought it would be simple enough to get there but I took a wrong turn and needed to ask for directions (something guys hate to do). I saw someone coming out of a building dressed to run so I asked him for help.

“Follow me,” he said. “I’m heading down there”.

 I did, and after a few minutes I was on a great running path.

“How far down are you going?” he asked me once we crossed the bridge and reached the path. 

“I need to run 5 miles and then come back” I said.

“That sounds good,” he said.

But I told him I needed to stop for a few minutes to check my blood sugar.

“Go ahead. I’ll catch up,” I said. I checked my blood sugar and had a gel. Then I started to run alone. 

Being alone, in a strange place, I started to think about what would happen if something happened to me. I was in a place I don’t know and where no one knows me. What if my blood sugar dropped while I was running and I passed out? Would someone realize I’m diabetic? Would they see my pump and know what it is?

That wasn’t the first time these thoughts have come into my head. I remember how happy I was when I saw that there was a place on the back of the bib (number) to write medical info at the Rotterdam Marathon. I often think I should get a runner ID or a medial alert bracelet. But then, when I get home from a run and everything is fine, I don’t.

RoadID - Cool Medical Alert Bracelet

Then… yesterday I woke up to a new Glu question of the day:

Do you wear a medical alert bracelet or piece of identification? 

 

Seeing the question made me think about it in a serious way. What’s holding me back, why haven’t I ordered a runner ID that says “Type 1 Diabetes” on it? 

I know I have mixed feelings about the medical alert bracelets but a runner ID, that’s kind of cool.

To check myself out I asked Jess what she thought. 

“You should have one,” she said.

“Really?” I said quite surprised.

“Yes. It’s a good idea.”

So why do I have mixed feeling about medical alert bracelets?

Is it just because I don’t wear jewelry, except for my wedding ring?  Or is it more than that?

I remember as a kid, I would stare at medical alert bracelets, wondering what was wrong with the person wearing it. I remember seeing kids I knew had diabetes with medical alert bracelets and feeling bad for them.

The problem with the medical alert bracelets is that they do exactly what they’re supposed to do, announce to everyone that there is something wrong you, that you have diabetes.  

But I’m not ashamed of my diabetes. I don’t hide my pump, I check my blood sugar in public and I talk about it regularly and openly.

So maybe Jess is right. Maybe a medical alert bracelet is a good idea. Maybe it’s time to get over it and get myself some diabetic bling, or at least a runner ID.

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