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You reach a point in your life when it's time to set an awesome goal for yourself. I was at that point when I saw an ad for the California AIDS Ride 2, a seven-day bike ride from San Francisco to Los Angeles. They called it "the adventure of a lifetime," and they were right!
Even though I hadn't cycled since I was a kid, I knew this event was the perfect opportunity to prove to myself that my having diabetes was not an excuse I could use for any reason. My husband, who had been an active bicyclist in high school, supported me and was excited enough to participate himself.
I was diagnosed with type I when I was 18 years old, and during the past 12 years, I've definitely had my ups and downs with diabetes management. Finally, I realized that I need to self-manage for myself and not for my doctor, my parents, my friends, or any other external motivator. I need to do it for me. Sometimes, I admit, I haven't felt I was worth the effort, but through the years I've become much more disciplined about eating and exercise. I have excellent control, and my A1c test scores are in the low to mid-sixes.
I have been fortunate to always have been surrounded by a top-notch diabetes-care team. But by the same token, only I know what my body does every day and how it reacts to certain foods, activities, and environments. I am comfortable adjusting my own insulin dosages (my total daily dose is pretty low, less than 40 units) and I like "trusting my gut." If I listen to my body, it will tell me what to do. Of course my diabetes education has been excellent so I'm basing my decisions on knowledge and not wild guesses. I know that my insulin will peak at a certain time, I know how much activity I've engaged in, and I test as often as I need to in order to feel comfortable predicting what my body will do. I want to be proactive instead of reactive; that way I can plan my day, instead of letting my diabetes dictate.
Diabetes aside, I've had trouble with athletics all my life. Growing up, I was a little overweight. I had pretty bad asthma and I hated the heat. Physical activity was usually such a difficult and uncomfortable experience that I rarely undertook it without the coercion of a gym class. When I met my husband, David, he was a big exercise fan. I had begun walking but even that seemed a chore most of the time. I had trouble getting up early in the morning, and by nighttime I was just too tired to exercise. Having to juggle exercise with food and insulin made me even less interested. It just seemed like too much work, and frankly, I was scared of having an asthmatic reaction or an insulin reaction.
One day when I was going out to take a walk, I asked David if he wanted to come with me, and he asked if I would be interested in going running instead. I laughed that one off and said, "No thanks, I don't run." In his special way, riding that fine line between encouragement and irritation, he said, "Come on, just give it a try." So we walked down the street and then tried a little jog for a block, maybe two. I was wheezing, but David congratulated me on that tiny accomplishment and encouraged me to try again.
Well, we tackled a few blocks at a time, then a half-mile, then before I knew it I'd entered my first 5K race! I was still struggling up hills, wheezing, and even crying when things got too tough. I couldn't have kept on without David. He pushed me, like a good coach, and didn't coddle me until the end, when he was full of congratulations and constructive comments. He's the best encouragement I have. We've run a couple of dozen 5Ks and even an 8K. I can even keep breathing while I run now!
Of course, sometimes I do get hypoglycemic, and he's learned to spot the signs and help me treat them. Occasionally he expects my recovery to be as immediate as when he swigs some Gatorade and gets back on his way, and I have to remind him that it takes a few minutes for my blood glucose to get on the upswing. It's really empowering to know that, even if I get low, I can get back on my feet and keep going. The best part is that I really enjoy exercise now, and the stabilizing effect it has on my blood sugars is especially important.
In preparation for the AIDS ride, we bought bikes and all the accouterments, and we raised over $4,000 in pledges for local AIDS agencies. We participated in the official training rides offered by the staff, as well as some of our own. There were definitely days when I thought, "What are we doing? This is insane!" But we kept at it.
My biggest concern was that I would "bonk"-a term cyclists use for, essentially, having an insulin reaction. But I put that fear on hold and tried to remember that my disciplined approach to diabetes management (four injections daily, blood sugar testing five to six times a day) and my keen ability to read my body's signals would get me through just fine. I had to work with the diabetes, not against it. This meant not being shy about expressing my special needs to the AIDS Ride crew and medical staff.
It was truly "the adventure of a lifetime!" Not only was it seven days of heavy cycling-our daily average was 77 miles-but when we got into camp each night we had to set up our tents, get our gear out of the trucks, eat dinner, shower (if we had the energy!), and set the alarm clock for an ungodly hour the next morning. And if that wasn't hard enough, the first two days were cold and rainy!
I'd had some practice with the training rides in terms of adjusting my insulin and food intake, but never an all-day, multiple-day event like this one. So I began by cutting my morning dose of five units of Regular down to two. We had rest stops every 15 miles along the route, so I carried my supplies with me and tested at each one. I knew these two units had worked well for me on morning bike rides before, so that was where I started.
It worked great! From an article in DIABETES HEALTH (June 1995) called "ExCarbs, a New Way of Control Through Exercise," I learned that if your muscles are not sufficiently trained for an activity, they begin enlarging their glycogen stores in response to the new exercise. This pulls excess glucose out of your blood stream, and your blood sugar decreases as a result. During the first couple of days, I was still well under 100 mg/dl, even after consuming a ton of food! So I skipped my lunchtime dose, monitoring closely to make sure my blood sugar never got too high. (With this level of activity, I defined "too high" as anything over 180 mg/dl). And as long as I kept riding all afternoon, it didn't. As a matter of fact, it rarely got over 100 mg/dl!
However, once I stopped at night, if I didn't rest and take my dinnertime insulin pretty soon, the lack of residual insulin in my bloodstream soon became apparent. It could jump from 70 to 250 mg/dl in a couple of hours, with no food intake. I also knew that my dinnertime and bedtime doses would have to be adjusted since the muscles would be replenishing their energy stores throughout the night, draining my cells of even more glucose. So I tried another experiment, combining my dinnertime dose of Regular with my bedtime dose of NPH and administering both at dinnertime. I did this because I knew I'd be so exhausted after dinner that I'd want to go straight to bed, and I didn't want to have to wake myself up just to administer my NPH. Plus, this way the peaking action of the NPH would be a few hours farther from the next day's bike ride.
After a couple of days, my body adjusted to the intense exercise and I could no longer get away with skipping my lunchtime dose. I tried taking another 2 units of Regular at lunch, again always testing at the rest stops and enjoying bananas and low-fat granola bars. If I ever had a doubt about whether I was eating enough, I played it safe and had an extra banana or granola bar. And of course I always carried plenty of glucose tablets with me. Better to be a little high coming into camp than to "bonk" in the middle of the Pacific Coast Highway!
Seven days after we left San Francisco, 1,800 riders sailed across the finish line in Beverly Hills. I can't tell you what an overwhelming feeling hit me as David and I high-fived each other while throngs of people lining the street cheered us in. It was a remarkable feeling knowing that I could accomplish anything by listening to my body, by constantly calling on my diabetes education, and by reminding myself when I got tired or scared that diabetes is part of who I am and a part of my total potential for achievement.
The California AIDS Ride 2 raised over $5 million in gifts for AIDS education, prevention, and healthcare services, but the gift it gave me is one I enjoy daily-the knowledge that I can do anything.
Allison's Insulin Dosages
When Not On the AIDS Ride:
Morning: 4-5 Regular
Lunch: 5-6 Regular
Dinner: 9 Regular
Bedtime: 17-18 NPH
During the Ride:
Morning: 2 Regular
Lunch: 2 Regular
Dinner: 5 Regular + 14 NPH
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