Living Well With Diabetes

I’ve been on the road towards Alaska four days now. Here’s a summary of my rides so far:

• June 28 - Salt Lake City to Brigham City (67 miles)
• June 29 - Brigham City to Snowville (65 miles)
• June 30 - Snowville, Utah to Burley, Idaho (66 miles)
• July 1 - Burley, Idaho to Twin Falls, Idaho (43 miles)

In four days I’ve been able to learn some valuable lessons about bike touring.

1. Ya gotta keep drinking.
   I learned this one the hard way on the second day which was the day I rode from Brigham City to Snowville, Utah. Of course, with about 25 years of cycling in my background, I should know all about the “ya gotta keep drinking” rule, but somehow, it’s something I have to relearn every year and usually during my first ride in very hot weather. By the time I reached I-84 and the last 20 miles of riding to Snowville, I was cramping up pretty bad. I stopped at an exit to rest in the shade of the bridge and chugged an entire 20-ounce bottle of fruit juice. I sat there for the next twenty minutes or so, afraid to move for fear of bringing on another cramp. During that time, I pondered whether I was going to make it and, if I didn’t, how long it would be before anybody discovered me here. It was that thought that finally got me up and moving again. By then, the juice had done the trick. I was feeling much better — the cramping had subsided and my blood sugar was a safe, yet respectable 150. I basically coasted into Snowville and found a very nice campsite at the Lottie-Dell RV park. No internet access, but my computer did pick up a wireless network from the Flying J over a half mile away (think about that next time you set up a wireless network in your home!).
2. Ya gotta slow down.
   I’m so used to trying to go as fast as possible while riding. That’s what you do when you’re training. Except this tour is not training. The first day went pretty smoothly and I was filled with confidence as I left Brigham City on the second day, headed towards Snowville. I was going west on Highway 83, I had a tailwind, it was a cool, comfortable morning, and all those factors encouraged me to go too fast. I think that contributed to the hydration troubles I had. On the third day (Snowville, Utah to Burley, Idaho), I had to force myself to slow down. I set a maximum heart rate of 130 for myself and that helped. I think I went over that only once or twice during the day.
3. Get more than one opinion about a route.
   Last night, I needed some relief from the heat so I stayed in a motel in Burley. This morning, I had breakfast at the restaurant next to the motel. I asked the waitress what she knew of highway 30 from Burley to Twin Falls. She said it was “nice.” That was interesting to know, but extremely unhelpful. So I asked her what the terrain was like. She said “There are a lot of hills. You’ll be going up and down all day” and then she walked off. End of conversation, I guess. As I was checking out of the motel this morning, I asked the front desk attendant what she knew of highway 30. She said it was rural and I wouldn’t see much traffic on it except for the local farmers. Again, I had to ask about the terrain. “Oh, it’s pretty flat” and this leads me to my next rule of bike touring.
4. Ask a cyclist about a route.
   I admit, this isn’t always possible. The concept of “flat” vs. “hilly” is entirely different for a person who rides a bicycle. In the end, highway 30 between Burley and Twin Falls was neither hilly nor flat. It was what a cyclist would call “rollers.” It went up a little and then down a little. It wound around at the whim and convenience of whoever broke trail there first.
5. Consider the Interstate as a possible route.
   The Interstate is not always a bad choice for bike riding. Yesterday, when I woke up in Snowville, I had two possible routes to get to Burley, Idaho. One was a quiet, scenic road though the wilderness of southern Idaho. The other was I-84. The former was longer — about 20 miles longer — with more and steeper climbs and, most ominously, no known sources of water. The latter, the Interstate, had very generous shoulders, climbs that were mild (in this stretch, less than 4% grade), and regular rest stops and service stations. However, I must advise against the Sinclair service station at exit 245 because he charged me 20 cents to fill a water bottle with ice.
6. It’s not always good.
   One of the good things I like about bike touring is how it puts you in touch with the land — the scenery, the weather, the road, the smells, the wildlife. These are things you are not in touch with as you’re driving down the road in a car. On the road leading west out of Brigham City, for example, I saw a fox make its way across the road about 20 feet in front of me. It was rusty red with a huge bushy tail and it seemed unafraid of me as it trotted across the road. The flip side of that coin, however, is something else I saw that day. I had arrived at the interstate (I-84) after riding about 40 miles on Highway 83. I had taken a rest in the shade of the bridge. Curled up in the shade of one of the bridge supports was a dead border collie. It looked like it had curled up there to take a nap and had never woken up. In fact, I had to go over to it to be sure it wasn’t going to wake up. It was a very sad sight for me since Pat and I have a border collie of our own at home. I’m not sure what took this poor dog, but whatever it was, I hope it was quick.
7. It’s not always fun.
   I had two days in a row that were not much fun. My second day out, as I mentioned in one of my previous rules, was not much fun. The next day, which involved no cramping whatsoever, was not any fun either because I didn’t really feel up to riding as much as I did, but I had no choice — there were simply no other options that were any closer.
8. Stuff is gonna break.
   And if it’s going to break, it will probably break right away. For example, there’s my Dexcom continuous glucose monitor which I mentioned in my previous post. It’s still hanging in there, but I can tell something is not right with it. I’m not sure it’s the cable or the Dexcom unit itself, but it’s very sensitive about how the cable is connected to the unit. Unless I hold it just right, it won’t retrieve its calibration reading from the test meter. I’m gong to try to make it last until I get to Wilsonville and there I’ll call Dexcom to get some help with a replacement. Another thing that’s in the process of breaking is my Garmin GPS unit. It’s a model 705 which has a GPS combined with heart rate monitor and cyclometer all in one handlebar-mounted unit. It has started warning me of a low battery even though I know there’s a full charge. That’s kind of annoying, but now it has started shutting itself off in the middle of a ride. I can turn it back on and it works fine for a few more hours. That’s irritating, but now it has started to fail to recognize the maps built into it. When it did that for the first time yesterday, I turned it off for a few minutes and then turned it back on and the maps were available again. Very strange. This warrants a call to Garmin, I think, but again, I’m going to wait until I get closer to Wilsonville where I’ll have a couple days to deal with it.

Finally, here is a collection of photos from my rides during the last three days.

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First day on the road and already there’s a casualty in my equipment. Well, possibly a casualty. I’ll have to keep an eye on it. More on that later.

Today’s ride was 65 miles or so from home to the KOA in Perry, Utah (about 3 miles south of Brigham City). From here, I’m heading generally northwest, paralleling I-84 towards Boise, Idaho. From there I’m cutting across Oregon. My target there is Wilsonville, about 30 minutes south of Portland, where my friends Jane and Dick run a company called iSense. Here’s a map of my route to Wilsonville:

(Click on the map to see a larger version.)

I’ll be dropping in at iSense to say hi and park my bike, even if just for a minute, in the bike rack they installed outside their facility. If it were just your average everyday bike rack, I wouldn’t bother. But, this isn’t just any old bike rack. Above the rack there’s a plaque that reads “Reserved for Peter Hoogenboom.” Who wouldn’t want to ride to Wilsonville and park in it? You can read more about this bike rack and why it has my name attached to it my my posting Visiting Friends in Portland, Oregon.

So, now, about that casualty. It’s my Dexcom continuous glucose monitor. It requires that I calibrate it at least once every 12 hours with a standard glucose test meter. I had inserted a new sensor just before leaving Salt Lake City this morning. Two hours later, it asked for it’s initial two glucose readings (it always asks for two readings on the initial calibration after a new sensor insertion). No problem. Around lunchtime today, I tested again and provided it with another calibration reading (I find it gives me better readings the more often I calibrate). This time, the Dexcom couldn’t retrieve a reading from the test meter. They both seem to recognize each other’s presense, but the Dexcom can’t retrieve the meter’s readings. It sits there draining the battery trying to get something and eventually gives up with an alert. I’ve found, however, that if I insert the plug into the Dexcom gently, it will work. I think I’ll keep that in mind, but I suspect I’m looking at an intermittent failure that is probably only going to get worse. If it does, I’ll be shipping the Dexcom and all its peripheral equipment (charger, extra sensors, test meter) home.

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When I submitted my post, One Week and counting, I had intended to start writing daily entries. I thought it might be interesting to have a countdown of the last days — the planning, the training — before my departure.

Well, clearly, I was not able to fulfill that goal. What prevented me from achieving that goal was also my single most time-consuming activity in the past few months: a creative writing class. Last October, before I ever had the idea of riding my bicycle to Alaska this summer, I signed up for an independent study creative writing class. It has been finishing that class that has taken up nearly all of my spare time since early March.

Since the class was offered as an independent study course through the Continuing Education department at the University of Utah, I was able to work through this class at my own pace. I had no classes to attend, but I had quite a bit of reading and writing to do over the past eight months. I would do the assigned readings, prepare the written homeworks, and then hand them in at the Continuing Education office. A week to two weeks later, my graded homework would show up in my mailbox. I never met the instructor or the grader for this course. My college days are a distant, fading memory for me, but I do believe I worked harder at this course than any other course in all my years of undergraduate and graduate studies.

So, I handed in my final project yesterday! Just in the nick of time, I finished it. Pat will have to mail me the graded final project when it arrives from the grader.

Last night, since I didn’t have any writing to do for my class, I was able to spend the entire evening getting together all of the gear I’ll be taking with me on the bike tour. It’s all laid out in a spare bedroom in the basement. It doesn’t look like a lot, but I know from the three-day tour I took a couple weeks ago that I’ll have some difficulty fitting it all into the four panniers. I have about 5300 cubic inches of storage in the panniers themselves, plus the top of the rear rack which is where I’ll strap on my sleeping bag and tent. Tonight’s goal is to experiment with packing it all up in such a way as to provide a balanced load, front-to-back and side-to-side.

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After going on such a big bicycle tour in 2006, my big disappointment for 2007 was not doing some kind of bicycle tour. Don’t get me wrong, I certainly did do a lot of cycling in 2007. I even did a little bit of racing, but no touring. So, in 2008, I’m going to make amends and go on a bicycle tour to Alaska. Alaska will be the forty-ninth state I’ve visited by bicycle.

The plans are shaping up. I’ve gotten approval for nine weeks off of work this summer. Last week, I took delivery of a touring bike suitable for self-supported touring. (I’ll post some pictures of it soon.)

The plans look like this so far:

Salt Lake City to Bellingham, Washington Segment

I will depart Salt Lake City on June 28, 2008, traveling by bicycle. During this segment, I will ride solo at approximately 60 miles per day. At this pace, I will arrive in Bellingham on July 24, 2008.

(Click on the map to see a larger version.)

Alaska Segment

During this segment, I will be joined by my wife, Patricia. We will travel primarily by the Alaska Marine Highway Ferry System. On the way to Juneau, three coastal cities will be chosen for intermediate stops. During those stops, we will make day trips by bicycle. We will return to Bellingham on August 9.

(Click on the map to see a larger version.)

Bellingham, Washington to Salt Lake City Segment

I will depart Bellingham, Washington on August 10, 2008, traveling by bicycle. During this segment, I will ride solo at approximately 70 miles per day. At this pace, I will arrive in Salt Lake City on August 30, 2008.

(Click on the map to see a larger version.)

Sounds like fun, doesn’t it?
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I’m a believer in the value of an insulin pump and have been since 1996. Its precise and constant delivery allows a level of control of my blood glucose levels that I could never achieve using multiple daily injections of insulin. On top of that, there’s the whole convenience factor: dialing in a bolus on the insulin pump is much easier than collecting all the necessary equipment for an injection, especially when I’m in the middle of a six-hour bicycle ride.

I mention all this because the warranty on my current insulin pump (a Cozmo made by Smith’s Medical) recently expired. I was fully expecting to purchase a new Cozmo pump which I would happily use for the next four years. But then I happened across a report on a recent survey about insulin pumps:

Updated survey on insulin pumps and continuous glucose monitoring

(you’ll need the Adobe Acrobat Reader to access this report.)

In this report, they mentioned the OmniPod, a relatively new addition to the insulin pump marketplace. They entered the marketplace in 2005. Their product is unique (at least so far) because it doesn’t have the traditional architecture of other insulin pumps. In fact, Insulet, the manufacturer of the OmniPod, doesn’t like their product to be called an “insulin pump;” they prefer “insulin management system.”

In all other insulin pumps on the market today, a supply of insulin is stored in the pump itself and delivered continuously through a flexible piece of tubing and a cannula which is inserted subcutaneously.

The OmniPod, however, does away with the tubing which can be unwieldy, can get snagged on doorknobs and other objects (happens to me all the time), and is potential point of failure due to occlusion (happens occasionally) or being severed (happened to me once). With the OmniPod, the cannula, insulin supply, and all the mechanical and electronic components to accomplish insulin delivery are stored in a small device attached to the body (the “pod”). The pod receives instructions on insulin delivery via wireless communication from a personal diabetes manager (PDM). The PDM is a hand-held device about the size of a calculator. The pod, after it is attached to the body, delivers insulin for three days after which the pod is discarded.

So, I’m describing all this to you because I’m trying out the OmniPod right now. I’ve tried three pods so far and so far I like what I see. The PDM gives me roughly the same insulin delivery programming features as I have on my Cozmo insulin pump. So, the PDM itself doesn’t give me a good reason to switch. The pods, on the other hand, are very interesting. For the past 12 years, I’ve dreaded and struggled with the infusion site rotation process which is done every three days. It’s painful. At best, it’s only mildly so; at worst, it’s excruciatingly painful to the point that I’ve had to pull the whole infusion set out to make the pain go away. Perhaps I’m doing something wrong (I doubt it), but that’s my experience. Your mileage may vary, as they say.

So, instead of having to manually insert a cannula subcutaneously, the pods have an automatic insertion process. Given my painful history with infusion sites, I was especially leery of an automatic process. As I preparing to apply my very first pod, I braced myself for something very painful and you know what? It wasn’t. It was so unpainful that I had to laugh. I thought for sure it had failed to insert a cannula. But, four hours after insertion, my blood sugars were still normal, so it had to be working correctly.

Now, I’m at the end of a three-day run for this pod. It’s been through three bike rides, two of which were very sweaty rides on my indoor trainer. It’s still firmly attached, doing what I need it to do: worry-free delivery of insulin.

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