The thirst ...

Tech that could change your life

2018-01-09T09:30:00.000+02:00

At my last doctor’s visit at the CDE, I was introduced to a new form of blood glucose monitoring technology. Truth be told, I’d already seen it before. I know someone who was importing the device from the UK, because it wasn’t yet available in South Africa. They couldn’t stop praising it. So, when I found out that it was available in South Africa, I grabbed the opportunity to check it out for myself.

My diabetes educator helped me unpack the new ‘flash’ monitor and sensor. There was so much packaging, so much to unwrap. It felt like Christmas had come early. The sensor looks the size of a medium sized button, which is loaded into a contraption that looks way too big for what it does. One surprisingly painless click and the hair-fine indwelling sensor was inserted into the skin over the back of my arm. An hour later, I had anytime access to my blood glucose reading within the last 5 minutes. To get the readings, I just had to hold a small ‘reader’ device above the sensor for a couple of seconds. No lancing, no blood, no lengthy procedure - It’s very cool tech. I showed everyone at the office. Little did I know that the true test for this device was only four hours away...

Technology is empowering. It helps you to do more and helps you to do it better. It can change your life. Like the smart phone, good tech changes a little bit of every part of your life. I am still waiting for that artificial pancreas. That would change my life! However, some tech seems really hard to crack - we have been 10 years away from this solution for the last 20 years. Will we ever get there?

Artificial Intelligence (AI) is another tech that’s been making progress. In October 2015, Google’s AlphaGo computer system beat the best ‘Go’ player in the world quite convincingly. This was a huge achievement and way before I expected it. The previous best Go computer player was useless and easily beaten by most serious Go players. (A 4-dan Go player would beat the computer and the best players are 9-dan.) AlphaGo learnt how to play Go by playing online against some of the best Go players in the world. It learnt from each game it played. In the end, it needed to play against itself to improve. AlphaGo was a huge breakthrough in Artificial Intelligence.

Two years later in October 2017, Google announced AlphaGo Zero. This was an AI programme that taught itself to play Go in forty days. In a 100-game showdown with AlphaGo, AlphaGo Zero won every game and used Go strategies never seen before. From nothing to the best-ever in just forty days… Wow! How do you compete with that? Can we?

“40% of jobs will be lost by 2030 because of artificial intelligence and robotics.” “Is your job about to disappear?” “Here’s when machines will take your job.” Those are just some of the headlines from the last couple of months. It’s pretty scary and makes you wonder whether all technologies will change your life in a positive way. Is all new tech good? Routine white-collar administrative roles are most at risk. Could Artificial Intelligence start the fourth industrial revolution?

It’s not the first time I am trying an indwelling sensor-based blood glucose monitoring system. I tried a ‘continuous’ monitoring system a few years ago, and I was not that impressed. When I really needed it, it let me down. Let me explain. I had stopped exercising because of an illness, and the combination of no exercise and being sick meant that I had a sudden massive change in insulin sensitivity. My control was all over the place. There seemed no better time to turn on the continuous blood glucose monitoring. Over the next three days I was let down by the system in every way possible. It told me that I was fine, but I was low. Again, it told me that I was fine, but I was high. It then told me that I was low, but I was fine. Finally, in an apparent attempt to cover all permutations, it told me that I was high but I was fine! After the three days of turmoil, I finally felt well enough to start exercising again. My insulin sensitivity returned to levels that are more normal and once again, I was in control of my diabetes. In the last three days of its six-day life, the continuous monitoring sensor gave perfect blood glucose readings. It worked perfectly just when I didn’t need it anymore…

I wasn’t looking for a way to test my new sensor, but one found me anyway. Four hours after turning on my first sensor, I fell ill with influenza. That same influenza killed millions of people in the early 20^th century. I had the chance to try out another new tech for the first time. When I am sick, my body’s response to insulin and my body’s insulin requirements become unpredictable. This becomes worse the sicker I am. I left the doctors rooms with a box of antiviral medication for flu under my arm - my only hope to try to take on the virus. About to embark on the inevitable diabetes rollercoaster ride that typically goes with my bouts of flu, I needed help. Luckily, I had some.

Well my blood glucose testing was a success to the point that it was a non-event. My blood glucose went all over the place, but at all times, I could scan and tell exactly what it was and what it had been. It made it easier to tell where it was going, which put me one-step ahead. I tested with a finger prick a few times to confirm, but in the end, I just trusted my new sensor system. This time, I had the upper hand on my diabetes rollercoaster ride. I actually stopped worrying about my diabetes, and had a real chance to ‘man up’ and experience a true taste of what it means to have ‘man-flu’. Yes, it was that bad.

My personal thought on technology is that progress is always good and that technology is a potential disrupter. But, we only adopt technology if it changes the way we do things and if it changes lives for the better.

A few things in business can make orders of magnitude improvement in performance or reduction of costs. Technology is one of them. A business cannot compete if it is the only one without the technology. We need to embrace new technology; we need to embrace change. Yes, technology can and will be disruptive. But, I believe that the only people whose jobs are at risk because of technology, are those who resist change.

With my new flash monitoring, I check my blood glucose more often. My finger prick testing had a few ‘blind spots’. With flash, my blind spots are covered. I know exactly what my blood glucose is doing when I am on my bicycle or sleeping. Sure, this system cost more than traditional home glucose monitoring. I also need to remember to scan and this system will not alert me when I leave my target range, nor prompt my insulin pump to suspend insulin delivery. But, it comes at half the price of the continuous monitoring sensors. Now that is progress – in the end, its not just about how much it does - can I afford it? For me, this is such cool tech that I have almost forgotten my disappointment about not getting my artificial pancreas. This tech has already changed my life.

My Team

2017-10-12T13:37:00.000+02:00

Wow it is becoming hard to be a springbok supporter. We got smashed by the all blacks! Even I felt a bit embarrassed and I was thousands of kilometres away. I think I am done watching team sports. Call me fickle, but I have started watching tennis again. Watching Kevin Anderson brought a warm glowing feeling. Kevin, you really made me proud taking on Nadal like that; double faults and all. Greg Minnaar I was rooting for you too. Best Ever Downhill champion; and you had the 2017 championship in the bag too. Well, until your tyre popped off the rim. You have such class; right up there with the best; and show grace both when you win and when you have a technical and loose it all. Individual sports rock; down with the team sports; let’s support our individual sporting hero’s.

Recently I was asked to give a talk about my diabetes. It made me think back on my experience with diabetes and brought back many memories. I cannot believe that it has been more than 9 years since I was diagnosed with Type 1 diabetes. My whole mindset about diabetes is so different from when I was first diagnosed. It is amazing what a journey it has been. Indulge me a bit as I reflect on the journey; I would like to take you back with me. This is how it all started.

“If you are feeling sick you need to see a doctor; and don’t come home until you have.” Those were the words of my wife as she kicked me out the house on the day I was diagnosed with Type 1 diabetes. I didn’t actually feel sick, but I didn’t feel right either. But because of my wife’s insistence, I did see a doctor. Thank goodness, I did. They sent me straight to hospital.

I remember every detail around that time, as clear as it was yesterday. I am not alone in this; just ask anyone that you know who is living with diabetes, and they will be able to recount their story. The reason why I think these details are so important, is because being diagnosed with diabetes is traumatic. In my opinion you can compare it to experiencing other traumatic events; like a car accident; or a crime incident.

If you are not someone who is living with diabetes, to get an idea of what it is like, I would like you to try and remember a traumatic event that you have experienced. Then think of the complex mix of emotions that you felt. Did you feel fear? Maybe a bit anxious? Perhaps you were angry? Were you in denial? … or all of the above together and more.

Think of how hard it was to deal with these emotions.

Think of how hard it was to fit back into society and your routine.

Suppressed emotions tend to become even bigger.

Living with diabetes doesn’t limit you in any way; but does change every aspect of your life in some way. It is hard. It is invasive. It is disruptive. You need support.

I started looking for support. Luckily, I found the CDE and joined their program.

A team is a group of people rallying together to achieve a common goal. The CDE is exactly that; where the goal is to empower you to be able to manage your diabetes effectively. The team is multidiscipline ranging from nutrition and exercise; weight loss; to day to day and psychological; eye care; cardio care; foot care; testing tracking; new tech and how to use them all together. I am sure I left a lot out, but your get the point. The CDE team members are all experts in diabetes, they are extremely well read and generally know a bit more than you would expect them to know. Being part of the CDE program, I really feel empowered by the depth of their knowledge and experience. I feel looked after, and I tap into that experience regularly.

Timing is extremely important when it comes to managing diabetes. The condition is unforgiving. You need to manage diabetes well; as soon as you can or your health will deteriorate. Under that pressure, throw in a couple of forced life style changes with the complex traumatic emotions of fear, anxiety, denial, and anger. You are starting to get a sense of what you need to deal with when living with diabetes.

I didn’t start out in the CDE program. The medical care that I received in the first month of living with diabetes fell far below what I needed. I fired my doctor and joined the program and haven’t looked back. My doctor tells me that my chances of getting any diabetes complication is very low. This is because my HbA1c has been within target right from the start. I owe this largely to the CDE team and their support.

Maybe teams aren’t so bad then; after all they helped me manage my diabetes. Is the team always smarter than the individual? Are two heads always better than one? Thinking about it; Kevin Anderson probably has a whole team supporting him. I know that Greg Minnaar has a team. Could there be no such thing and an individual at the top of his game? Do all guys at the top have teams supporting them? I’ve got a team.

Broken Dreams

2017-09-22T08:31:00.000+02:00

South Africa, the ‘rainbow nation’... I must confess to being one of those seduced by the dream. A land enriched by diversity of culture; a land of equal rights, responsibilities and opportunities; replacing a government of institutionalised discrimination - wow; what a sale! It was hard and only someone great could have done it. And, it changed us all, and the world!

This dream caught me hook line and sinker and, for a while, it even looked like it would work. Don’t I feel like the fool now?

What is a dream? To me, it is a future vision of how we see the world and ourselves in it. It is not something that we have now. It’s always better. Dreams motivate us and direct us. They are powerful; and there is nothing more powerful than a shared dream. Like the one that has just been so publicly broken. What will happen to our rainbow nation?

Anger; every day that I drive in to work, I have someone angrily cutting me off when it is my right of way. Occasionally, I have done the same to someone else. Yes, there is much anger out there.

Uncertainty. There is little certainty now - with this, comes plenty of anxiety and fear.

I remember when I was first diagnosed with diabetes. It was a traumatic time and I remember the uncertainty; I remember the anger; I remember the anxiety and the fear. It was as if the future vision of what I had of myself was broken. I always believed that I could do anything that I wanted. I didn’t feel that way anymore after my diagnosis.

Now, all these emotions seem silly. I know now that living with diabetes shouldn’t limit any dream. Anything is still possible with diabetes; it is just a bit more complicated. I may take time to learn how. Although my feelings of uncertainty, anger, anxiety and fear were all real at the time, I just needed just needed to work through them. Now, years later, they have all faded…

Have you noticed that young kids nowadays don’t want to be firefighters and pilots anymore? Dreams have changed. Kids now seem to be so much more sophisticated. They want to be engineers, photographers, businesspeople and millionaires. Isn’t that the best way to recover from a broken dream? Add in that extra complication that keeps it practical, and change the dream a bit.

We still need to work through the current uncertainty. Let’s hope that someday in the not-to-distant future, we will look back on this time and think our present emotions silly…, because we were able to pick up the pieces and enjoy the realisation of our shared dream…

Sometimes you just need a break

2017-07-02T15:57:00.000+02:00

Much has changed in the last couple of months. Trump is no longer just a term in a card game; it’s a populist gamble of massive proportions with international repercussions. Brexit is a new word borne of a disconnect between politicians and their electorate. The Chinese economy is highly educated but restricted. The Russians have global ambitions. Europe is filling up with refugees, and a few terrorists. I could go on, and on, really. Isn’t the world a bit mad at present?

Back home in South Africa, we seem to have embraced this madness and made it our own. We have symptoms of most of the world’s madness with a few extras. We’ve taken the idea of a ‘gravy train’ and refined it into something more efficient - a ‘pilfering ship’ perhaps? Business and politicians are no longer just disconnected; they’re on different planets connected only by wormholes of corruption. It’s a depressing scene on the tipping point of change. Despite all the ‘noise’, we must somehow carry on to survive. But how?

I remember when I was first diagnosed with type 1 diabetes. It was a few years back now, but I can still remember it clearly. I guess traumatic incidents take hold in memory in a similar way that you can replay the details of your first car accident or experience of crime. I remember learning about the condition, injections, insulin, blood glucose testing, management methods and re-evaluating every social situation from family and friends to work colleagues. It was an onslaught and much felt scary. So how did I cope then?

I read books, I read blogs, I spoke to friends and family and I spoke to professionals. I was especially afraid of losing consciousness through a hypo, so I soaked up anything related to diabetes I could find. I then tried things, made some work, made some mistakes and learned from my mistakes. I remember spending up to 10 minutes pondering the cause of a mistake, going through every detail in my head trying to identify the cause. I also remember taking breaks…

This last week I have felt a bit like an ostrich with its head in the sand. My car is at a panel beater so I have been borrowing a car or using public transport and Uber to get around. This has meant that I have not kept up with news in the usual way. I must be honest that the quiet has been a very pleasant change. The extra time has allowed me to get in touch with other things in which I am interested. Perhaps ignorance really is bliss.

In those early days after diagnosis, learning to manage diabetes can consume your life. You can get so consumed or stress about all the details of managing diabetes that you forget to do the other things in your life that matter. I took breaks from managing my diabetes to allow me to get some breathing room to see what was important to me. It also helped me to refocus my diabetes management.

However, you cannot really take a break from managing diabetes. We all know that it’s a 24-hour, 7-days a week job that can be exhausting. I took a break by changing the way I managed diabetes for a few days. I would test three times a day instead of eight. I would eat the same or similar meals for three days just to keep the management simple. I stopped stressing about my diabetes. I then ploughed my energies into other things that mattered in my life.

I decided to read up on the ostrich. It turns out that the ostrich doesn’t really stick its head in the sand. This wasn’t a surprise; but what was surprising was how they got that reputation. Ostriches often lay their eggs in nests that are in slight hollows in the ground. From far, they look like they have their heads in the sand, but instead they are taking a break from looking out for danger and tending their eggs or chicks. They are building something new…

Becoming environmentally savvy

2017-06-25T15:42:00.000+02:00

Everyone was quiet. I couldn’t believe it; even the kids. It’s amazing how the size and presence of an elephant only metres away demands respect. Lions roar in the distance and some hyena arrive for a drink. It’s about half an hour after sunset, and it’s starting to get really dark. I need to concentrate hard to see the hyena, but the elephant is still clearly visible. It’s about time that we make our way back to the car from the hide…

Wow, what a special, drama-filled and very African moment! I’m proud of the heritage we have and that I am able to share it with my kids. I hope that my kids will be able to do the same for their children. I’m privileged to have access to a game farm; but with great privilege comes great responsibility (That is not Spiderman’s uncle’s quote - I modified it a bit.)

Did you notice the smog this winter? It seemed worse than normal. My guess is that there are more fires and less electric heaters. It’s Eskom’s will. It seemed like there were more sick people this winter too. This is all anecdotal, but I cannot help the feeling that we are not as environmentally conscious as we could be. Are we taking our great responsibility seriously?

Everyone reading this has likely been affected by diabetes in some way. Either you are living with it, or you have someone close to you who is. If this is the case, then you also know that coping with diabetes is a collective effort; that success is achieved through collective support. I manage because of my team. Every player has their part, and some parts are harder and more involved than others. This team is made up of both professionals and volunteers. The volunteers join the team because they recognise a need; and through love and compassion they sign up on their own to play their part. They do it because they can and because it makes a difference. My family and friends volunteer to help me every day.

If you have volunteered for one of these teams, then you will also know how easy it was to sign up. It starts with love and compassion… then, making the difference comes naturally and without effort. If you can help, you do. It is a bit sad that signing up to be more environmentally conscious does not come as naturally. We certainly have the love and compassion for our country, land and environment, so what’s keeping us back? Perhaps we cannot see the difference made by our efforts; maybe it’s too technical to understand what to do; maybe we can’t afford to take the first step; maybe the economic and political fingers in all the prescribed rote solutions make us sceptical? Whatever the reasons, not doing something and losing our privilege would be the real tragedy.

Becoming environmentally savvy is a journey. The only way to start is just to start. Here are some first steps I think are worth taking to help us start on this journey.

Understand the threat

To know what to do to help our environment, we need first understand what is threatening our environment. Here are the basics in two parts, namely preventing the pollution of our environment and helping reduce global warming or climate change.

Litter ends up in our rivers and oceans. Certain chemicals like the ones found in batteries, or used by industry can poison/kill our environment.

Climate change has largely been blamed on the combustion of fossil fuels used for air, road, sea and rail transport and anything that either heats or cools.

Become more efficient

Don’t underestimate this step. It not only saves you money, but has the potential of having a ten-fold greater environmental benefit than the billion-dollar bio-fuels industry. It starts with trying not waste and using what you use efficiently. It ends up with complicated optimisation systems and processes for industry. As an example in the logistics industry, an optimisation system can save anywhere from 10-50% of the running costs. The saving depends on how efficient you were at the start.

Choose a fuel economic car, turn off lights as you leave a room, use energy saving lights and make your house more energy efficient by sealing it from the elements and by tinting windows. Some efficiency saving devices cost money. If you are willing to take this step, choose these based on the efficiency they claim to provide and how much energy you use on those appliances. Most of our energy usage is in heating and cooling. Solar geysers would be a no-brainer if they were more affordable and more reliable.

Recycling waste

Don’t just recycle for the sake of recycling. Driving 20 km out of your way to drop off recycling could negate any of the benefit from recycling. For recycling to be beneficial, it also needs to be efficient. Find out what local support there is for recycling and contribute there. Recycling energy intensive materials is also more beneficial than others. I.e. it is better from an energy point of view to recycle glass and aluminium than it is to recycle paper and plastic.

Back at the game farm, our magical African moment in the bush came to an abrupt end. The large-tusked elephant bull who was in musth and irritated by our presence, and by that of the hyena, gave a large deafening trumpet. Not long after that, we were on our way.

That’s how game viewing should end… on their or our terms, not on neglect.

Motivate yourself

2017-06-18T15:33:00.000+02:00

My alarm goes off just before 5:30, and it is cold and dark. At this time of the morning it certainly feels like winter; and getting up for a spinning class seems like madness when compared to the cosy bed. I wait for a few minutes summing up the motivation to go.

I remember being a teenager and my dad coming home and presenting me with a ceramic donut. ‘Here son; I have got you this ‘round tuit’’. I looked at it carefully and sure enough it had a label stating that it was indeed a ‘round tuit’. I seemed to be missing something so I asked ‘What’s if for?’ Now you can finally do all those thing that you said you will do when you get around ‘tuit’. I had just fallen for a popular eighties joke.

The memory of this joke I find somewhat comforting. It is proof that motivating yourself (or your teenage child) is not a new problem. I couldn’t have been that difficult to motivate when I was a teenager; could I have? Although my kids seem to manage well with their schoolwork; they don’t undertake it in the same way they have naturally taken to TV and games. They still need to be regularly reminded to do it. Ok; I have been nagging them a bit and it is wearing my down. Doing school work is good and important; but perceived as work and only mildly interesting. This is a big problem; I reach for my phone.

Wow; how the world has changed since the 80’s. It has taken 10 minutes and I think I have found the answer. One minute on google; one minute to download the free book in pdf format; and eight minutes of reading and already my perception of motivation has changed. The book I downloaded was written by a psychologist with 20 years’ experience in motivating teenagers. It turns out that waiting to get motivated to do something before doing it is just never going to happen. You have got to start doing it first. Motivation happens when we experience the benefit of doing it. We are then motivated to do more. You won’t get motivated to do something if you are not doing it.

Understanding what drives motivation better is really working for me. I have been getting up to do exercise early in the morning for more than 10 years now. The exercise makes me feel better and helps with managing my diabetes and asthma. It is the feeling better that motivates me to get up on those cold mornings. On the weekend, I am even planning to clean out my garage. Although I am dreading it, I have faith that while I am cleaning it out, I will feel relieved by the extra space and wonder why I didn’t do it sooner.

If there has been that thing in your life that you know you should do, or have always wanted to do, but have never quite got around to it. The answer is simple. Just do it. (Perhaps Nike are onto something.) Motivation comes later.

Understanding motivation better is a good start, however motivating a teenager or someone else requires a bit more. In summary it turns out that it is important to build a relationship on empathy and understanding; and to set precise goals. I am still working through this.

When things go wrong

2016-05-05T21:30:00.000+02:00

This article I wrote for diabetes lifestyle.

I am a keen cyclist that happens to be living with type 1 diabetes. Sometimes things don’t go according to plan.

It is the second day of the Isimangaliso 4-day mountain bike stage race and I have just landed on my head. The guy cycling next to me cycled over a branch that flicked up and got caught in my spokes. I dropped like a brick. My partner and I had come third the day before so we were quite keen on being out in front. This fall meant that not only was my back wheel terribly buckled; but we were no-longer in the front bunch. This was the first of many things to go wrong on the day.

I have done a few mountain bike stage races and have learned that day 2 in a staged cycle race is the most challenging from a diabetes management point of view. The massive change in exercise causes my insulin requirements to change. I use an insulin pump to manage my diabetes so this means that my insulin basal rates and bolus ratios are affected. There is a bit of guess work trying to judge the extent of the change and to get the timing right. I have done this before so I am confident I know what is coming. In hindsight perhaps I was too confident.

After a fall on the bike there is only one thing to do; and that is to get back up and carry on cycling. The best way to cope with the pain from a fall is to cycle so hard that the pain in your legs is worse than the pain from the fall. It only partly works but meant that my partner and I were working our way slowly back into the front group.

The Isimangaliso mountain bike race is a 4-day race though the Isimangaliso wetland reserve in St Lucia. They have the big 5 which is interesting. Shortly after my fall we had a spectacular sighting of a herd of giraffe. We were in a group of about 30 cyclists. As the route came into a clearing we came across a heard of giraffe about 60 meter’s way. I expected them to turn and run, but instead they cantered with us. The scene seemed surreal as both cyclist and giraffe crossed the open plain together; in the bushveld; with palm trees. I believe that the giraffe behaved that way because they were more scared of what we were ‘running’ from than they were of us. Spectacular!

That morning I had planned to dial down my 24-hour insulin basal rate, but didn’t because my morning blood glucose was unexpectedly high. This turned out to be a big mistake. Shortly after my fall I had my first hypo on the bike. I used an energy goo to treat the hypo and made a mental note to set a temporary basal next time we stopped. The next stop was at a fence crossing, but there was a bit of a scramble over the fence and I forgot to make the basal change. My next hypo was much more severe so I took a while to recover. It turns out my balance on the bike is also affected by a hypo so instead of weaving through the bushveld, I seem to be cycling from one thorn bush to another. My cycling partner tried to help by taking a longer stint in front. He then cramped 10 km from the finish. 1km from the finish I got another hypo. I didn’t have any goo’s left so I would need to stop to open some sweets. We were so close to the finish so I delayed treating the hypo to avoid stopping. We took the wrong path and 1km turned out to be 5kms. I did stop to have some sweets but the delay meant that I was cycling all over the place. In the end we did make it to the finish.

Wow what a comedy of errors. I am supposed to be good at this but somehow had made every mistake possible. My partner and I learned a very important lesson that day. When it comes to diabetes management; there is never a good reason to delay. If you need to, stop immediately and fix it. Even if you are racing it is quicker to stop. Sometimes you need to go slower to go faster.

When things go wrong you pick yourself up; try learn some lessons, and get back on with it.

The next day my cycling partner was to learn another valuable lesson about not looking behind you when you are mountain biking; but that is another story…

Family

2016-04-28T21:16:00.000+02:00

This article I wrote for diabetes life at the end of last year.

(Sorry I have been a bit slow to post.)

I have just spent part of the day baking marshmallows with my youngest son. I cannot believe how much sugar goes into making marshmallows and will certainly consider them for treating hypos in the future. They take up to 24 hours to set so I am still waiting to see how they turn out. I am normally not much of a baker so trying something new always starts with a Google; followed by some you-tube watching. Isn't it also amazing how easy it has become to get really good advice on how to do a quite complicated task J? My sons motivation for baking is partly motivated by his sweet tooth, and partly so that we can spend time making something together.

It is silly season again. Isn't it amazing how quickly it has come around again. The end of year is near; it is almost time for a holiday; time to rest and recuperate from the ever more challenging year; and a time for reflection and family. In my reflection I have realised that I am not the only one to go through the experience of learning to live with diabetes.

My oldest son has just finished writing his last exam on Friday. This was his first serious school exams; I now understand that it’s not just my son who wrote exams it’s the whole family. Everyone in the family had to commit something to his exams. It’s the giving up of an evening out; or obeying the ban on TV for the week; or the hours of time helping him study well and testing so see if the knowledge has sunken in. In a similar way my diabetes permeates my whole family.

Diabetes changes everything and it’s not just the things that we give up. Having diabetes is like having a different perspective on the world that affects everything that we do. With diabetes I am more self-aware; I know a lot about more about food; I continuously count the carbs in everything; I exercise all the time; I am always better prepared and better organised; I have the ability to identify, think quickly and react quickly to pending problems; I don’t panic; I am not afraid of hard work; I understand that getting it wrong is normal but there is always a lesson to be learned from it; I don’t take my health for granted; I go for my check-ups.

My whole family support me in my diabetes in big and small things every day. My wife hates to cook; but she does it every day because she knows that I need to eat a regular meal. My kids know that my hypo sweet collection is off limits and don’t question it. My kids from an early age have known what to do in an emergency and who to call. From this they have taken on a bit of responsibility and learned to be aware of others in a way that is not normal for their age. My family know when I am having a hypo; they know about food and carbs and what is healthy to eat; they know the importance of being prepared and learning from mistakes; the list goes on and on…

Many of my friends and colleagues have commented on how well I have embrace living with diabetes; and made my management of diabetes work. The truth is it would have been a lot harder without the support of my family. I love you guys.

Making my own

2015-10-17T13:51:00.002+02:00

How diabetes lead me on a journey to discovering great beer.

This is another article that I wrote for diabetes lifestyle.

Soon after being diagnosed with type 1 diabetes, I started taking a lot more interest in food brands. I remember almost being in tears the first time I could not find a particular food brand that I had become dependent on. That triggered and interest in food labels. Understanding the food label helped me to find alternatives, but sometimes you cannot find what you are looking for. This started an interest in making my own.

It started with diabetic muffins. They were quite hard to make, but their low sugar recipe makes them easy to eat. Next I tried a diabetic cake. The recipe reminded me of brown bread dressed up as chocolate cake. It not only tastes great but also healthy. I don’t know why all cakes aren’t made that way. I then tried my hand at making chili sauce. There are not that many sauces that are not laced with sugar. I suppose I was looking for variety. I made a few, each recipe slightly different. It is here that I learned the value of having great ingredients. Next I bought a bread maker. Nothing beats waking up to the smell of homemade bread. Carb counting at breakfast sorted. It turns out that the bread maker also makes great pizza dough. That is good fun and involves the whole family. Next my wife bought me a beer making kit for my birthday and then went on a 10 day business trip oversees. Neither of us knew what she had started.

The first beer that I brewed was easy. I followed the recipe exactly, added the yeast, and then left it for two weeks. It was almost too easy so I got bored and started getting into making cheese. For a few weeks the family enjoyed freshly made feta, cottage, blue and finally cheddar. Then my homemade beer finished fermenting and … it was awful. What could have gone wrong? I followed the recipe exactly. So I started reading. The more I read the more fascinated I became. The biology, the process, the engineering, the history; the bug bit; I am hooked; I am a home-brewer.

Brewing Beer is a biological experiment that was optimised through centuries of trial and error, with little understanding of the science behind it. The solution is quite brilliant; I love it.

Barley on its own doesn’t contain any ingredients that can be converted into alcohol by the yeast. If you grind up barley and add it to a bucket of water with yeast. It won’t make beer. It will go off. The problem is that the sugars are too complex and are unavailable to yeast as a food source. I.e. yeast can only eat the sugars that as a person living with diabetes, I generally avoid. When barley starts to germinate, it releases enzymes that can break down the complex carbohydrate into simple sugars. You cannot let the barley plant grow too much because it will then use the sugars you want to create, so you dry it out when it has reached a certain size. Now you have barley as a complex carbohydrate and the enzymes that can convert it into simple carbohydrates. This is called malted barley and is the main ingredient in making beer. If the malted barley is crushed and allowed to soak in water at the right temperatures and PH, the right enzymes will work and you end up with simple sugars that the yeast can eat. Wow how did they come up with that considering what brewers knew at the time.

The Reinheitsgebot is the German Beer purity law that was passed in 1487. This old law that is not in use today insists that beer can only be made from water, hops and barley. It doesn’t mention yeast because at the time it was thought that yeast was a by-product of beer making and not one of the core ingredients. This is astonishing because in 1487 we were already a couple of centuries into making great beer. Historically beer styles were regional not only because of preference, but because the water chemistry of the local water meant that the perfect mashing PH was achieved with the styles of ingredients. This must have been worked out by trial and error. Beer brewing technique and beer styles are tightly linked to region, history, politics and the technology available at the time. Well worth reading about.

My first flop seemed to have been my last; Homebrew hobby is easy to get into and has massive depth. I am constantly adding to my equipment; making up or changing recipes, reading and listening to podcasts. Everyone seems to be open to sharing their knowledge, and this makes for a dynamic hobby. Did you know that some beers are like wine and can take years to make? I don’t drink a lot, but I love beer, and this hobby has made me love it more. As I have learned about what can be done in a beer and learned how to taste and identify beer; I have become fussier too. Home brewers are quite willing to experiment and share their results. Because of this world wide knowledge sharing community, in my opinion some of the best beers in the world are now being brewed at home.

For me; being able to control the amount of carbs in the beer and the flavour and recipe; opens the door to and infinite variety of tasty lite beers that are easy to drink.

Managing hypos well

2015-06-25T14:40:00.001+02:00

Another article that I wrote for Diabetes Lifestyle.

I still remember my first major hypoglycaemic episode (or hypo for short) after being diagnosed with type 1 diabetes.

The symptoms are the typical symptoms I remember reading about in a pamphlet that I picked up in the hospital only days earlier. I am shaking; I am sweating. I have already treated the hypo and now am 30 seconds into the 15 minute wait before I re-test and potentially re-treat the hypo. It is half an hour since I took my evening meal’s bolus and I must have got something wrong. I try working out what went wrong when suddenly things are much worse. The shakes and sweating seem 5 times worse; the walls seem to be closing in and I am struggling to keep my train of thought together. 14 minutes and 20 seconds to go. I don’t know how I am going to make it...

Hypoglycaemia or a hypo occurs when your blood glucose is lower than it should be. If you have diabetes and are using insulin, then this can occur if you have given yourself more insulin than you need to balance the requirements of your body.

Well I didn’t exactly come to my senses, but rather panicked at the thought of rapidly falling into a state of unconsciousness. Breaking the advice I had been given to treat hypos, I started eating and drinking large quantities of quick-acting carbohydrates. I didn’t stop until I started feeling more normal. At the time, it was the right move...

What a scary introduction to the not-so-pleasant side of diabetes management! There is more to this story. Just as hypos can be scary, the fear of hypos can be deadly. Fear of hypo’s leads to poorer diabetes management as insulin or other medications may be reduced or even missed. Fearing hypos may also cause you to over-treat a hypo, and when in doubt you tend to err on the side of high blood glucose. Just to compound the issue, both frequent hypos and poor diabetes control (frequent ‘hypers’) lead to reduced hypo awareness, and the even scarier hypo unawareness, albeit via different mechanisms. In other words, if you have diabetes and take insulin, you are going to have to deal with hypos. It is best if you can do this without fear.

Is this even possible? I think so. The key is in the understanding of when a hypo may be severe and therefore when to ‘over-treat’ and when not to. What you need is a better plan for treating hypos. I recommend that you devise one for yourself. Here are three things that you should consider when treating a hypo.

Active Insulin

We can get many things wrong in our self-management of diabetes that can cause a mismatch between our insulin dose and life (food, exercise, stress etc) and a resultant hypo. It is the role of your diabetes educator to help guide you through this. For example, it could be timing and amount of insulin vs. amount of food; the glycaemic index (GI) of the food vs. the action profile of the insulin taken; exercise intensity, duration and frequency; stress levels; bolus vs. basal insulin etc… It is complex. However, a severe hypo is most likely to occur when the insulin levels in your body are highest relative to your needs. This is related to remaining active insulin. I.e. if you feel the onset of a hypo, think back to how long ago you last took insulin and how much. If it was a large amount of insulin and you are within the active time of your insulin, then you need to take treating the hypo more seriously. Don’t delay.

Blood glucose level

Test your blood glucose while treating a hypo. A lower blood glucose reading requires more quick acting carbohydrates. You can adjust the amount of carbs based on your blood glucose test result.

How fast is your blood glucose dropping?

Unfortunately, your test kit cannot tell you this unless you perform serial measurements. This is important because if your blood glucose is dropping quickly then you will need additional quick acting carbohydrates to stop it dropping. This is in addition to the amount you need to correct your blood glucose.

I would like to share my personal hypo treatment plan with you. It works for me as I try to balance the physiological demands of a sedentary desk job and a highly active lifestyle, which includes competitive cycling. This approach may not work for you, but is presented to provoke personal reflection and consultation with your diabetes team.

1. I test immediately. If my blood glucose is below 3.0 mmol/l then I double the treating carbs. I do this for two reasons. Firstly because the lower blood glucose requires more carbs to treat, and second because if I am already below 3.0 mmol/l then my blood glucose is probably dropping quickly. I always use a quick acting carb. This unfortunately means no chocolate. :-(

2. I will try to wait at least 2 minutes. If I suddenly start feeling worse, or if I test again and find that my blood glucose is significantly lower than my first test; then I will treat again by repeating step 1. The reason for re-treating is because I am concerned that my blood glucose is getting worse quickly. Please note that I do not expect my blood glucose to be normal yet but I am just checking to see if my blood glucose is getting worse or not.

3. If I am still not correct 15 minutes after the last time that I ate carbs, then I will treat again by going back to step 1.

The reason why I like this method of treating a hypo is that it scales quickly. If I have a normal hypo then the treatment is normal; however if the hypo is severe, then within 2 minutes will have consumed 4 times the normal amount of rescue carbohydrate. Hypos that are treated quickly and effectively without risk of over treating are a lot less scary.

There is a lot more you can do to fine-tune the amount of carbs you take to treat a hypo. Everybody is a bit different and will need a different approach. Additionally, even the best plans may need to be changed with time. Devise your own plan in the light of your experience and in consultation with your diabetes educator, dietitian and doctor. You should regularly check your plan by testing 2 hours after a hypo (and its treatment) to make sure that you have not over corrected. This will give you vital feedback on the personal applicability of your plan – act on this and adjust your plan if necessary. Take back control!

People with diabetes have scary tempers! Why?

2015-01-27T08:35:00.002+02:00

Here is the latest article that I wrote for Diabetes Lifestyle!

True or False

Did you know that people with diabetes have awful tempers?
Sometimes they’re just scary to be with!
They blow up at the smallest thing and it’s better
that you’re not in the way when this happens...

Wow, generalisations really suck, especially when you are on the receiving end! I have been told such things more than once by people who truly believed their statements. This is of great concern to me because I have a young family and I live with diabetes. I don’t want to be ill-tempered and unapproachable. Is there any truth to such statements?

I've been writing a Blog for a couple of years now, and this article is based on one of the first posts that I made. That post is still attracts more reads than any other article I've written. Its popularity tells me that this is an important issue. It also suggests that there may be some truth to these views and I would like to share some ideas as to how they may arise.

An element of truth...

Such assertions do contain an element of truth. When living with diabetes, we experience hypos, hypers and stress. Hypers make me feel just generally unwell. Hypos make me unaware and a bit abrupt,but some people can respond violently when experiencing a hypo. Insulin therapy, although good and life sustaining, is still far from ideal and puts the body under a certain amount of stress. This can make you feel ill at ease. These symptoms can make people with diabetes seem irritable and short-tempered; but, in my opinion, these symptoms only account for a very small percentage of situations.

Here’s an example. During a hypo, I switch into ‘survival mode’. I try to behave normally, but I am completely unaware of any communication subtleties, such as the tone of my voice, my body language, etc....
I have been told that I come across as terse, insensitive and rude.

Hiding symptoms

I have random bouts of hypers and hypos but I want to be seen as normal. So, when I am having one of these symptoms, I don’t tell anyone and try to just carry on ‘as normal’. You can get quite good at this. Often people around me are completely unaware of the diabetes problem. However, I can’t hide the symptoms of problems with my diabetes completely. I am not as good at hiding them as I would like to think, and sometimes the symptoms are too severe to hide.
The result of this is that friends, family and colleagues can no longer tell whether I am having a diabetes related symptom or not.
The people we spend time with identify that sometimes you are rude because of a diabetes related symptom. They then may incorrectly start assuming that whenever you are rude that this is because of a symptom of a diabetes-related problem.

Your friends, family and colleagues may incorrectly start assuming that all bad behaviour is related to your diabetes.

Becoming the monster

Have you ever wondered why road rage can reach such extreme proportions, and why people don't behave like that normally? One of the reasons for this is that we don’t get sufficient feedback when we are in our cars. If you walked up to a stranger and started swearing at them and calling them
names, they would probably respond to you in a similar way. If you didn't back down at some point, the chances are that you would end up in a fight. This doesn't happen in a car. The natural social feedback that helps keep this bad behaviour in check is not there. I believe that a similar issue occurs around people who have diabetes.
When others assume that you're behaving badly because of diabetes related symptoms, they don't respond normally. They don't give you that 'back-off' look and they aren't rude back to you. The natural feedback that keeps bad behaviour in check is absent. If you have diabetes, you may not even be aware of how rude you are being. Unchecked, this bad behaviour can reach epic proportions.

Habit or crutch?

We're all sometimes rude, but as a person with diabetes, you always have an 'excuse' for behaving badly. When confronted, it’s easy for you to offer the ?"I wasn't feeling well" excuse, even if this wasn't the case. Behaving badly can become a habit and a crutch.
How can you avoid this trap of behaving badly? For the last couple of years, I have broken this cycle of bad behaviour by doing the following:

I communicate to those around me about my diabetes-related symptoms. I have explained to those close to me how I feel and what I'm going through during each of these events. I also ask how others perceived me during these episodes.I was surprised by what they told me!
I have started letting others know when the symptoms are occurring. I also try to let them know how long the symptoms will last.
I no longer use the diabetes symptom "excuse" when I am accused of behaving badly.

It has worked for me...

Some of the comments left in response to the original post on my Blog still bring me to tears when I read them. Bad behaviour can ruin lives... don’t let it ruin yours!

The write way to heal!

2014-07-10T22:00:00.001+02:00

This is an article that I wrote for Diabetes Lifestyle.

It’s twelve a clock at night and all is quiet. Well all is quiet except for the fan of my pc that seems to be working in overdrive. I am writing an article for diabetes lifestyle. A thought: ‘Why?’ I try and erase the thought quickly with a ‘because you said you would’. Which did not work so well because my next thought was: ‘I could be sleeping. Everyone else is’. Yet I don’t go to bed. There is something keeping me here. Writing has become important to me.
I started writing a blog about my diabetes almost a year ago. I had never written anything like this before, and the reasons I gave myself were:

I wanted to help others that were in a similar situation. The thought of other type 1 diabetic sufferers not coping was overbearing to me. I was coping. I felt this need to dispatch with some of the wisdom that I had gained in the hope that it would help others.
There were certain experiences that I had that I thought were worth discussing. I wanted to vent.
I always wanted to write but never seemed to have a reason. I had one now.
My once creative job was not so creative any more. I needed another creative outlet.

My eyes suddenly feel heavy so I get up and turn on the kettle to make a cup of coffee. It has been quite a busy day that ended with my wife being called to the hospital in the middle of my son’s birthday dinner. My father in-law is not well. On top of that, my responsibility suddenly changed from finishing my beer lite to looking after four kids that seemed to only want to play on different sides of the restaurant. It’s quite stressful if you are not used to it. The coffee seems to be working and I start to think about when I first realised that the process of writing is healing too.

After my third blog post it occurred to me that I may not be the first person to think of writing a blog on my experiences as a person with diabetes. I investigated a bit deeper and discovered that there were over two million blogs like mine. I must confess to feeling a bit hurt at not being original, but then it dawned on me. Writing is about healing too.

Being diagnosed with diabetes is traumatic. It is also likely that other traumatic times will follow. Yet we don’t go for trauma counselling, or at least I did not. I did some reading about dealing with trauma and there are similarities with how I sometimes feel. The denial: “I feel fine.” “I know I am different. This will pass.”; the anger “Why me?”, “It’s not fair.”; the depression “I cannot get this under control. What’s the point in trying? Pass me that slice of cake.” You are supposed to go through all of these phases before you come to acceptance. I seem to go through any one of these phases at random times. Lucky for me I spend most of my time in acceptance; or is it luck, perhaps it’s the writing.

There was a bonus too. When searching some of these two million blogs, I found a community that is incredibly supportive and accepting. I also discovered some very inspiring stories. Like the woman who was a type 1 diabetic for 63 years and has not yet had any complications; or the long list of successful sportsmen and celebrities who are living with diabetes; or the mother who has turned her sons type 1 diabetes into a story of hope and success. Living with diabetes can also be isolating and this is perhaps the last reason why I and two million other diabetics around the world have chosen to write and heal.

Lilly’s in the park

2014-06-09T08:33:00.000+02:00

This is an article that I wrote for Diabetes Lifestyle a few years back.

The traffic was better than expected so I am early. Wow how often has that happened? I am going through the notes that I made last night while sipping a coke-lite. Inform your friends; Be realistic; Be motivated; Take ownership; Don’t delay; You are not alone. I am a bit nervous because this is the first time that I am going to give a talk about diabetes management.

Take ownership seems to be a key point, I make a mental note. The coffee shop that I am sitting at is adjoining a clinic and there is a group of paramedics at the next table. “.. Dextrose ... diabetes”. My ears prick up and I can’t help but start listening to the conversation of the paramedics. They are discussing technicalities of using dextrose when treating diabetes patients. Having type 1 diabetes myself this is right up my street so I join in the conversation. ‘What about glycogen as a treatment?’, I ask. It turns out glycogen is too costly for them to keep. I feel privileged as I remember the just-in-case glycogen injection in my bag. This theme would continue. My lift arrives and we are off to the park ... Eldorado Park.

To say that I didn’t know what to expect would be an understatement. In Eldorado Park there are no luxuries. Everything there seems to serve a basic need. The community hall turned out to be a container placed on the side of the road just off the pavement. Our car was the only one parked in the parking lot. I think I saw one car drive past the whole time. There was no new paint or any paint that wasn’t peeling. The experience for me was both depressing and full of hope. Eldorado Park is a community in need.

I was there with Razana who is a diabetic nurse and educator during the week and working for DIABETES SA on weekends. It was a Saturday and the event had been organised by LILLY OF THE VALLEY FOUNDATION aka Marlene Frankfort its founder. Shortly after sitting through a conversation with a grandmother of the community going on about her discontent with how their community was always being overlooked; I met Marlene. Marlene started Lilly of the valley foundation as a feeding scheme for schools. I was there because she had noticed the impact of diabetes on her community and she understood that her community would benefit from better understanding. Marlene is the hero in this story. She is community focused and able to recognise what her community needs. Then goes out and gets it.

The biggest surprise for me came out in the discussion on diabetes. It turns out that the most import advice given was that patients should insist on correct health care. Diabetes patients need to take ownership of the management of their condition, but this was taking it a bit further. Here is an example. “If you are testing your blood glucose at the correct times, and you know that your medication is no-longer working. If the doctor doesn’t change your medication, you need to insist that he does or at least ask him why.” This is starting to tear at the fabric of the patient - doctor relationship.

In my doctor-patient relationships, I like to ask as many questions as I can possibly think of; and challenge every decision made. A bit like shaking things up just to make sure there are no cracks; and if there are cracks I want to know where they are. In the last +-30 years of doing this, I have only had one doctor who didn’t answer all my questions. In his defence the reasons were time, but still I soon after found a replacement. I have had a few discussions on this topic and I realised that my approach is unusual. Most people just take doctors advice. Doctors are just people too. They can miss things, make mistakes. They might be extremely tired or just not understand the patient. When a doctor dispenses incorrect advice, what is a patient to do? Not taking doctor’s advice is also generally a bad idea so where do you draw the line. For me I think that everybody should ask enough questions so that they can decide for themselves whether the advice given seems good or not. If the advice doesn’t seem good, then they should ask more questions and/or go for a second opinion.

The health department has put together the Patient’s rights charter that details the doctor-patient relationship. Asking questions; being part of the decision process and going for a second option are all patient rights. It is a very good document and is worth a read. Search in Google for ‘Patient’s rights charter’ if you want a more detailed reference. Here is a summary.

The Patient’s rights are:

A healthy and safe environment.
Participation in decision-making. It is your right to ask questions and shake things up.
Access to healthcare
Knowledge of one’s health insurance/medical aid scheme
Choice of health services
Be treated by a named health care provider
Confidentiality and privacy
Informed consent
Refusal of treatment
Be referred for a second opinion
Continuity of care
Complain about health services

Yes these rights come with patient responsibilities:

to advise the health care providers on his or her wishes with regard to his or her death.
to comply with the prescribed treatment or rehabilitation procedures.
to enquire about the related costs of treatment and/or rehabilitation and to arrange for payment.
to take care of health records in his or her possession.
to take care of his or her health.
to care for and protect the environment.
to respect the rights of other patients and health providers.
to utilise the health care system properly and not abuse it.
to know his or her local health services and what they offer.
to provide health care providers with the relevant and accurate information for diagnostic, treatment, rehabilitation or counselling purposes.

I find it hard to understand why some diabetes patients who have access to world class diabetes care are non-compliant and in danger of being removed from the program. Diabetes is unforgiving. This level of care is a privilege.

JoBerg2C - Ride the beloved country

2014-06-06T17:31:00.000+02:00

Joberg2C day 8 overlooking the Umkomaas

This is an article that I have written for Diabetes Lifestyle magazine. I tried to summarise the whole JoBerg2C experience in one article which is impossible without leaving out a lot. There are some paragraphs that are similar to previous posts - sorry.

It is 40 minutes before the start and I am about to panic. The Google navigation on my phone has very efficiently directed me to the middle of nowhere. I should not have trusted the site name lookup and I have no-idea which direction to drive in. I glance at the clock again.

The build up to get to this point has been intense and not dissimilar to the organising of an expedition. Planning the logistics; getting all the equipment for all eventualities and in working order; making sure that my bike and I are in tip top condition; making sure that I trained enough; making sure that I tapered my training correctly; avoid getting sick; and not to mention other work and family commitments. Now I could miss the start! Suppressing the urge to panic I remember seeing co-ordinates of the start on one of the documents that I luckily downloaded to my phone at the race briefing. I pull off the road and search my phone. My wife calmly and accurately enters the co-ordinates into the Tom-Tom. We are 15 Min away and it is going to be tight but we should make it. One detail missed and the race almost compromised. The huge investment that I have made in time, effort and money to get here seems on a knife edge.

As a person living with type 1 diabetes I use exercise as one of the key tools in managing my condition. Only regular exercise really helps so I have pretty much been exercising without more than a couple of days break for the last 6 years. Exercise has really become a large part of my life. My exercise of choice is mountain biking. A large staged mountain bike race has been one of my dreams, but the uncertainty of how this would affect my diabetes management has made me hesitant.

Family photo at the start

We are not the last to arrive which is a relief. Bike boxes and bags at the trucks; preparing bikes; checking gear and food; finding my partner; just enough time to take the kids to the toilet and take a family photo. Goodbye’s all round; the helicopter with cameraman take off; the gun and the tractor leads us off; and so starts my 9 day cycling adventure. There is only one hill in the area and we head straight to the top. On the other side the pace picks up on single track. I settle into the first stage’s 114 km as I confidently bunny hop straight into that diabetes management uncertainty.

My confidence stems from the diabetes strategy that I put the finishing touches to a few weeks before. During the intense training for this race I got a glimpse of how my body would respond. My plan involved making sure I have all my diabetes equipment and a strategy to counter any of the problems I saw glimpses of during my training. It helped to write it down.

Crossing the Vaal River

First day went well without a hitch. We had to cross a 400 meters long floating bridge across the Vaal River. For me it floating just above the water, for the tandem in front the bridge was floating just below the water. This made the crossing into the Free State a little tricky. The days ride was long and in the first part there were many district roads. This allowed us to form a peloton which kept our speed up. So although it was a neutral day and didn't count towards the race, we finished the day in 5 hours 15 minutes.

The first camp was at a school in Frankfort. This is another theme of the JoBerg2C race. It turns out that this race is basically a major fundraiser exercise for seven schools and one sports club along the route. This is how it works. A school gets paid a fee for hosting the JoBerg2C camp. For this they provide facilities like tents for all the teams; prep the tents with mattresses; a dinning tent; toilets and showers; and not to mention the food. The camp is run by the parents of the school who work tirelessly without pay to keep everything running and to provide the food. Where possible the schools look to cover most of their expenses with sponsors. The money from the race is used by the schools to improve facilities and to sponsor those who cannot afford to pay fees.

A properly cold start to Day 2. We woke up at 5 am to heavy dew which then soon froze. My fingers were too cold to risk taking a photo so I will try and describe the start.
Soon after the start the route descended into a mist filled valley and followed the river. The temperature dropped even further. On the left the sun was barely breaking through the mist, but enough to show off a white world of ice crystalline grass fields. On the right we cycled past a river of cloud. For an hour we cycled in this absolutely beautiful but hostile place. We passed a lone house. Respect!

We finished the 91 km ride in 4 hour 27 minutes. The great time hides the fact that it was a really tough day. I discovered that morning that my blood glucose test kit doesn't work when it is too cold. I only managed to test 1 hour before the start and my blood glucose was very high. It was a bit late but I corrected anyway and got it wrong. I had a massive hypo 1 hour into the race. This set the theme for the day. I needed to eat a lot more than yesterday and got it wrong a few times. A strong head wind picked up after the half way mark and continued to the end.

Day 2 was the toughest day from a diabetes point of view. In hind sight this should have been expected as my body started adjusting quickly to the sudden onslaught of exercise. For the rest of the race managing my diabetes became easier. I had to continue thinking about and managing my diabetes, but it almost stopped featuring as an issue. Every subsequent night I slept with my test kit in my sleeping bag to keep it warm. This allowed me to test as soon as I woke as per my strategy. I didn't have another morning hyper.

Getting through a race like this requires continuous maintenance. By this I am referring to both myself and my bike. My bike was being serviced every day; I was getting a massage every day. Despite this I still picked up a few minor injuries that I never completely recovered from; and was lucky to only pick up minor technical bike problems.

This is a long race and everyone had some good days and some bad ones. My good and bad days didn't always coincide with my partners. For me: day 3 was a great and day 4 was amazing. Despite being the toughest I felt and finished strong on day 4. Day 5 was hard because of the accumulated effect of all the cycling. Day 6 was dreadful. I started feeling sick and felt that I couldn't eat. I finished day 6 on goo's juice, granny gear, will power and the patience of my partner. Day 7 was terrific. (Everything felt easy after day 6.) Day 8, another tough day was amazing and I felt strong throughout. Day 9 was the easiest day of the race and was fast and fun.

Day 4 on the edge of the Drakensberg

This race also passed some spectacular scenery. Most memorable was the descent off the Drakensberg on day 4. It was fast technical and very scenic. On day 8 the decent into the Umkomaas valley was not just extremely beautiful but also an amazing piece of single track cycling on the side of that mountain. (I feel a bit like a spoilt child only mentioning those two, because there were many more spectacular bits in between.)

Every day further into this race I would eat more, and take less insulin. Towards the end of the race it got to what seemed ridiculous proportions. For half my normal breakfast insulin I was eating three times the amount of carbs. Stopping at the watering points during the ride, I was eating fair portions of foods that I cannot normally go near. It felt like I was on an eating binge and a holiday from my diabetes. This unfortunately stopped the same day the race did.

Day 9 ended on a floating bridge across the lagoon to the finish on the beach. Crossing the floating bridge was quite interesting. At the halfway mark the bridge narrowed and a small wave came in so I sped up to get in-front of the wave. So I ‘surfed’ on my bike through the last part of the bridge. The bridge was moving sideways back and forth and you had to steer the bike to follow. Staying on involved just as much concentration as the descent off the Drakensberg. Wow! What a way to end a 900 km 9 day staged race.

The finish at Scottburgh

JoBerg2C - Reflection on my diabetes strategy

2014-05-11T19:53:00.000+02:00

As a person living with diabetes, I feel like I have just been on the largest sweet food binge ever. While cycling on this race I got to eat a lot of sweet food that I would not normally consider eating. Fudge, brownies, chocolate coated crunchies, flap-jacks, koeksisters, cake, chelsea buns, doughnuts were all consumed in fair quantities. This tough epic journey also seemed like a holiday from diabetes. Unfortunately this didn't last as a day after the race I was back to having diabetes and being careful of what I eat.

Before doing the JoBerg2C I wrote a post outlining my diabetes strategy for the race. In this post I reflect on that strategy and discuss what worked, what didn't work and what I missed.
Insulin

My insulin storage worked like a charm. The cool packs kept my insulin cool well into the late afternoon. An unexpected bonus were the really cold nights. 2 degrees C is even cold for a fridge. This meant that I didn't need to refrigerate my insulin overnight and could just leave the insulin cool packs at the bottom of my tent.

Supply container
My diabetes container also worked well.

Hypo plan
Goo-s. I used almost all of the normal goo-s (energy gels). This was unexpected as I planned to only use them for emergencies. During normal training a goo would be great for hypo treatment but too much for normal use. During the race this was different. I sometimes used two goo-s to treat hypos and had no problems using a goo when I felt I lacked energy during the race.

I will speculate as to the reason for this. During the race my body became extremely efficient at breaking down and burning up carbohydrates. I needed less than half the normal dose of insulin that I use during training. In addition I found that I needed to eat much more than I normally would during the cycling. (This is after I lowered my basal rates.) If I needed to eat more it only makes sense that I would also need more goo.
I didn't need to use any of the tube goos. That was because every time I felt I needed a goo, I also felt that I needed a whole one.

The super C's where great for treating any hypo's between cycling. The coke didn't work mainly because it didn't fit in my bag. I occasionally used one of the free drinks supplied at the end of each stage, however they didn't have good nutrition information on the bottles so this was less than ideal.
Test kit
Having a spare test kit was great piece of mind. I didn't need it though.
Nutrition during the day
My nutrition plan generally worked well. As the race progressed I ate more, but the general formula worked stayed the same.
I needed to sleep with my test kit in my sleeping bag to keep it warm. (A cold test kit will not test.)
One thing that I would do differently if given the chance again, is to dial down my insulin settings sooner especially early on during the race. E.g. if I had changed all my insulin settings down after the end of the second day's cycle, I would have saved myself quite a few hypos.
The dawn phenomenon only occurred once.
After the race
Now I must confess to not planning this far when considering my diabetes strategy, but my experience is worth mentioning. What surprised me after the race was how quickly my low insulin settings returned to normal. It took two days. Two days after the race I was in-fact using more insulin that just before the race. My insulin requirement almost tripled in those two days. My crazy hunger is starting to subside and this is a week after the race finished. Soon I will be back to my normal routine.

JoBerg2C - Day 9 and Finished

2014-05-04T09:00:00.000+02:00

What an amazing journey. The theme for this year's race was 'Ride the beloved country'. What an apt phrase for this journey. On this race I have seen parts of this country that I didn't know existed. As a South African I feel proud to be part of a country so beautiful and communities that are so friendly and hospitable.
Today was 84 km with only 850 m ascending. It started with climbs in the plantations and sugar cane fields. Then we had this amazing descent through a game reserve which was fast and beautiful. We then climbed through a coastal forest for 20 km and ended on a floating bridge across the lagoon to the finish on the beach. Crossing the floating bridge was quite interesting. At the halfway mark the bridge narrowed and a small wave came in so I sped up and caught the wave through the last part of the bridge. The Bridge was moving sideways back and forth. Staying on involved just as much concentration as the descent off the Drakensberg. Wow! What a way to end a 900 km 9 day staged race.

Day 8 - JoBerg2C

2014-05-03T15:08:00.002+02:00

On the way down into the Umkomaas Valley we stopped to take a photo. An amazing 17 km downhill into the valley below. The views were breathtaking but I didn't dare look because the track was technical, fast and potentially dangerous. I have done this track before many years ago, and although is has changed a bit it is just as spectacular. This is an amazing piece of mountain biking trail.
Soon after the downhill the uphill started and this was the theme for the rest of today's race. The up went on for what seemed like 60km.

Today my partner and I both felt strong however bike issues plagued us. One of our group members couldn't finish which is a huge pity. We were delayed by an hour so spent the rest of the race overtaking people.
My diabetes management is going smoothly. I haven't had a hypo or hyper for the last two days, and whenever I test I am in normal range. My insulin sensitivity is very high and I am giving myself very little insulin for the amount of food that I am eating.
There have been other surprises. Normally one whole goo would be too much to take at one time. From day two onwards I have been able to take a whole goo without any ill effects. The times that I have had a hypo while cycling I have had two goos. This is different response to any of the training that I did. So it must be because of the accumulated affect of exercising between 4.5 and 7 hours every day.
For example I had a bowel of porridge, 5 small flap jacks and a banana for breakfast. I took 1.5 units of insulin for this meal. While I was training it would have been 3 units, and that is without eating the flap jacks which I wouldn't normally eat because they are high GI.
At the first water stop today I ate three doughnuts and took no insulin. This is the second time that I have eaten a doughnut since being diagnosed. My first was yesterday. During a training cycle, if I had eaten something like a doughnut, I would certainly not have eaten a whole one. For all the meals that I have had today I have used a total of 9 units. This is less than half what I normally take and I am eating almost twice as much. Incredible.

Day 6 and 7 - JoBerg2C

2014-05-02T14:40:00.000+02:00

A terrible day followed by a good one.
A combination of a stomach bug, altitude, massive climb and hypo all conspired to break me.

Broken; half way up one of the passes.

2300m ascent in 91 km we scaled huge mountains and passed terrific scenery. Thank goodness for photos so that I could appreciate it after the fact. Cycling and being sick was not a great experience. I was flat and couldn't eat. I finished the day on goo's juice, granny gear, will power and the patience of my partner.

Fast section through indigenous forest

The 7th day in contrast was a great day. I was feeling better and it is a shorter day with a later start. This meant a warmer start. Throw in some incredible fast single track and you have a great day of cycling. Day 7 has been dubbed the 'rest day' of the JoBerg2c. 84km and 1300m of climbing doesn't sound like a rest day but because of the conditions and where it is in the race, it certainly felt like one. Looking forward to tomorrows stage which is made up of an amazing down hill followed by a massive up hill.

Day 5 - JoBerg2C

2014-05-01T21:02:00.000+02:00

Today started off cold again but warmed up sooner which was pleasant. Out here in the farmlands showing off a custom built tractor like the one in the picture is like showing off your Ferrari in Sandton (without the asshole factor that normally accompanies such a car). This one lead us out to an awesome day of cycling.
Ever since day three this race has been more of a tour than a race. Today my partner was feeling fatigued because of the effects of 4 days of racing, so we took it slow. It was still a hard day in the saddle with lots of climbing.
We are well into Zululand and the scenery was once again spectacular. It reminded me of a TV series that I watched as a child called Shaka Zulu. Rolling hills of open savannah.
Something that I have noticed on this race is that you don't succeed at a race like this without maintenance. Coming in to this race I had the romantic idea that if you did your preparation and got your equipment right, the rest would fall into place. This is wrong. In an event like this preparing helps, but things will go wrong anyway. It is how you deal with these mishaps that allows you to complete the race.
Currently I have a pain on my shin which means that I cannot walk that well. (Luckily I can still cycle. ) I have misplaced some of my equipment. My bike's gear changer is not working that well, and I have a crack in my bike frame that looks like it may just be superficial, but needs to be watched.
My diabetes management is no different. It needs continuous maintenance. I needed to lower all my insulin requirements again. At the moment I need only 1.5 units of insulin for my breakfast - a large bowl of porridge with a bit of muesli. This is less than half of my usual insulin requirements.
My diabetes management plan is still working and I had great control today.

Day 4 - JoBerg2C

2014-04-29T18:33:00.002+02:00

The longest and the hardest day of the JoBerg2C, but also one of the most spectacular. The day started in a cloud. The route took us up above the cloud briefly to see the sunrise before taking us back down. We stayed in the cloud for another hour. It was freezing! (Even colder than day 2) After another hour we climbed above the cloud again. The views were spectacular.

This set the scene for a great day of cycling. The descent off the Drakensberg was exhilarating! Fast and technical, with amazing views. In fact there was not a part of the route that wasn't great today.
Well done to the organisers.

My diabetes management went well. Except for a hypo 2 hours in, it was completely uneventful. I have started using goos' for more than just hypos. I will take a goo (energy gel) when I feel low in energy. I have not tested to be sure that this is correct, but I do feel more energised afterwards and haven't cramped yet.
Today en-route I got to eat the second best fudge that I have ever tasted. What a spoil! (My wife makes the best :) )
I finished the 114kms strong. A group of us worked together to set a fast pace that ended with a sprint. What an exciting end to a great day.

Day 3 - JoBerg2C

2014-04-29T18:27:00.000+02:00

Another amazing day at the JoBerg2C. Today was a long day. In addition to it being the longest day of the race, my partner got sick. The bug is going around the camp. Well done to him for completing the race. We slowed the pace and that meant that we were cycling for more than 7 hours ... a good opportunity to take more photos.

The day started cold but with clear skies. The sunrise looked like those you see from an aeroplane. More sun meant my fingers and toes thawed sooner than yesterday.
What was marked about today's ride is how the landscape changed from flat open terrain with maize fields to being more mountainous. It ended at the escarpment.

Diabetes wise, the day went well. I needed to adjust all my insulin settings down, but the ride nutrition plan went perfectly. Looking forward to tomorrow where we cycle down the Drakensberg.

Day 2 - JoBerg2C

2014-04-26T17:52:00.000+02:00

A properly cold start to Day 2 of the JoBerg2C race today. There was a heavy dew which then froze. My fingers were too cold to risk taking a photo so I will try and describe the scene.
Soon after the start the route descended into the mist filled valley to follow the river. The temperature dropped even further. On the left the sun was barely breaking through the mist, but enough to show off a white world of ice crystalline grass fields. On the right we cycled past a river of cloud. An hour of an absolutely beautiful but hostile place. We passed a lone house. Respect! (I am sure that it was very pleasant there 2 hours later.)

We finished the 91km ride in 4 hour 27 minutes. The great time hides the fact that it was a really tough day. I discovered this morning that my blood glucose test kit doesn't work when it is too cold. 1 hour before the start I had a hyper. It was a bit late - but I corrected anyway and got it wrong. I had a massive hypo 1 hour into the race. This set the theme for the day. I needed to eat a lot more than yesterday and got it wrong a few times. This along with the strong head wind that hit after the half way mark continued for the rest of the ride.
I will be reprogramming my basal setting to avoid the hypos. I will also sleep with my test kit in my pocket to keep it warm. I am sure that tomorrow will be better.

Day 1 - JoBerg2C

2014-04-25T20:51:00.001+02:00

Day 1 is over and pretty much went according to plan. The whole family joined us at the start which was awesome. I must admit that the last couple of days have been quite stressful.

Three days ago I was worrying about whether I had done enough training. Two days ago I was worrying about the logistics and some event that could end my participation, like getting sick. This morning I was worrying about not getting to the start on time. It is a relief to only have to worry about completing the days stage now.
Even the 400m floating bridge crossing across the Vaal River seemed easy in comparison.

My diabetes management went exactly as planned. For breakfast I added 0,5 units extra insulin to counter the affect of adrenalin. Later I tested and needed to add another 0,3 units. My blood glucose didn't go above 8.5 mmol/l - which is great.
My nutrition also went well. I ate small amounts every 30km. I even got to eat a koeksister* :) After 80km I ate more food and more often. i.e., every 15km. I have a similar plan for tomorrow.
I did have a hypo after the cycle despite my 30% basal. Tomorrow I will eat a fruit without any insulin to counter this.
We did 116km in 5 hours and 15 min. I am very happy with the time.

* Koeksister: A traditional South African pastry covered in syrup.

JoBerg2C - Diabetes Strategy

2014-04-21T22:41:00.004+02:00

Friday's training picture

Cyclists in the mist! Cycling will definitely show you a different side to Johannesburg. Such a beautiful morning with a chill. The mist only lifted late in the morning and the winter gear is out.

Final preparations for the JoBerg2C are under-way. It is about time that I revealed some of my diabetes strategy.

1: Insulin

My Insulin Pack

I use an insulin pump and will need to change my infusion set every three days. The race is nine days. That means that I will need to replace my infusion set at least twice but probably three times. For this I will need to carry insulin. Insulin needs to be kept cool. If my insulin gets lost or misplaced, it could mean the end of my race. So I have decided to carry my own insulin. (At least this way if something is forgotten it is my own fault.) I have stuffed my insulin bag with two cool gel packs. This should keep the insulin cool in my bag while I am cycling. My intention is then to find someone in each camp who can refrigerate and re-cool the gel packs overnight . One of the vile's I will keep with me for insurance. In addition I intend to put more insulin in my pump reservoir than I need for some additional insurance.

My diabetes supplies

2: Diabetes supplies

I have a water tight container that I will keep all my diabetes related supplies in.

3: Hypos

My intention is not to have a single hypo, however I am exercising in a way that I have never exercised before and this is likely to have some unintended consequences. I am also terrified of running out to things to treat a hypo with, so my plan is to be a little over prepared for this.

High GI nutrition while cycling

The quickest way to treat a hypo while cycling is with a gel. My cycling nutrition plan is also to have a gel or two after 80-90 km's in the ride. So I have stocked up on USN gel's and cycling juice.

For me a gel on it's own will spike by blood glucose, so I have chosen the 'toothpaste' gels for normal use. Being able to close the tube means that I can consume them more slowly. The other gel packs are for hypo treatments.

For treating hypos between cycling

Super C's glucose tablets are great for treating hypo's in-between cycling. One box is probably sufficient for all eventualities. I am going to use Coke to treat any night time hypos. (I don't what to brush my teeth in the middle of the night after eating super C's.)

4: Test Kit
You have probably picked up a trend here. I feel comfortable with a bit of redundancy in my preparations. I am taking two blood glucose test kits. I will cycle with my old test kit, and keep my new test kit in my luggage.

5: Managing nutrition on the day
I know a few people with diabetes who exercise a lot, and everyone is a bit different. This is my nutrition plan that I have built up over the last few years of cycling. It is not hard to build up your own plan. Just start small and test a lot, and adjust the plan to fix any problems. As an example a friend of mine sets his basal rate (he is on a pump) to 15% during his exercise so that he can maintain his blood glucose. I don't need to change anything. I exercise with a 100% basal rate.

When I wake up I will test my blood glucose to check for any dawn phenomenon that may need correction. I start the day by eating breakfast. I take my normal amount of insulin for this meal. I don't change my basal rate during the cycle. For me this means that my blood glucose will slowly drop. This is perfect because you need to eat and drink during the ride. During the ride I no-longer consider myself as having diabetes. I can eat and drink anything provided I don't over do it. Overdoing it may cause a high blood glucose > 10 mmol/l. This will cause me to cramp. So only one koeksister at a time.

There are two approaches to managing nutrition during the cycle and I use both. Low GI foods that I start to eat early on, and high GI foods that I eat later on during the cycle.
Here is an example of what I eat/carry on a ride. (This is very similar to most cyclists.)
High GI foods

One double sized goo that can close.
Two litres of energy drink.
6 rolls of super C's or 6 goo's. This is for just in-case I have numerous hypo's during the ride. I don't plan on eating any normally. If I do start to have hypos during the ride, I will set a 70% basal rate for the duration of the ride, and after the ride I will need to lower my standard basal settings.

Low / mixed GI foods

Peanut butter sandwich
I have about 3-4 portions of some energy food. I often change it for variety. Here are some examples of the foods that I have tried and work well. Peanut brittle; Energy bar; Power bars; Nougat; chocolates; chocolate coated peanut/raisins etc.. There is plenty of food at the nutrition tables and I plan on using these too.

I need to be particularly careful after about 90 km as my blood glucose starts to drop faster. I plan to start eating more than during the first part of the ride.

After the ride I almost immediately regain my diabetes and avoid any high GI foods and sugars. I set a 30% temporary basal rate for 8 hours. I will take slightly below (-10%) normal doses of insulin for the food I eat.

Tapering - one week to go

2014-04-16T22:42:00.001+02:00

Tapering has meant a bit more family time and a chance to catchup with some of the DIY chores on my list. It has been a pleasure. I cannot wait for this long weekend to have even more 'free' time interrupted by short bursts of 90%+ intensity cycling.

Tapering your training before an event seems to be the agreed method of preparing for an endurance event. Long events need two weeks of tapering. The best results are got from high intensity and low volume tapering. First week reduce training time by 50-70% and second week 80-90%. The number or training sessions can drop 20%. I.e. slightly more rest days.

Here is quite a good link on the subject.
How to begin tapering prior to an endurance competition.
Here is another great link on the subject of endurance training. Not related to tapering but still interesting if you are an endurance athlete.
The two best ways to build endurance as fast as possible.

My diabetes control has be generally fine. My insulin sensitivity has slowly been increasing so once this week I needed to reduce my insulin requirement across the board. I.e. all my bolus insulin / carb. ratios and my basal amounts all needed to be reduced marginally at the same time. I anticipate a similar change during the JoBerg2C race.

Occasionally I get a dawn phenomena. My night time blood glucose is normal however when I wake in the morning, my blood glucose is around 16 mmol/l. I find this very concerning; but as my diabetes educator pointed out, it has only happened 4 times in the last month. Because it is infrequent and impossible to predict, the only way to handle this is to measuring every morning and correct. This phenomena is linked to a release of one of the blood glucose increasing hormones like cortisol. During the race I need to be careful of this. I will need to test as soon as I wake up so that I have enough time to correct by blood glucose before the day's race starts. I will probably use the super bolus technique to bring my blood glucose down quickly.

I cannot wait for the long weekend.