A few months late, but here it is - the report I sent out to those who donated to my Tour de Cure ride in Oregon, so pardon the remedial explanation of hypoglycemia:
I booked an Amtrak ticket from Seattle to Portland on Friday, July 29, and paid the extra $10 to put my bike on the baggage car for the 200-mile trip. Seattle’s King Street Station is about 8 miles from my house, so I decided that if I could carry everything I needed for the weekend I could ride there and have a car-less weekend. I stuffed bike gear, emergency supplies, toiletries, diabetes supplies and a change of clothes into a backpack and a messenger bag, hoisted them both onto my back, and set off for the train station at 10 AM. About 4 miles away I realized that I was probably going to hurt my back and be unable to ride the next day, so I had to adjust the position of the packs. When I reached the station I discovered that the train was boarding, but I hustled and got my bike and myself on board. Despite all my preparation I had misread the time on the tickets. It’s a good thing that TSA has not arrived to bog down the ticketing and boarding process like it has at airports.
The 2.5-hour ride was a pleasant trip, with a nice view of the Puget Sound and Olympic Mountains. In Portland, I gathered my bike and belongings at the station and rode 6 blocks through downtown to a light rail train stop, where I could catch a train to Hillsboro. I had plotted out my course and selected a Hillsboro hotel that was close to the stop and to the start line of the Tour de Cure the next day. Earlier in the week I watched the videos on how to board the light rail with a bike, and the message was that bikes needed to yield to passengers and were to be hung up on hooks near the back of specially marked cars. It all looked so easy and calm on the video. When my train pulled up, I saw that it was packed. And the Friday-afternoon crowd gathered with me at the curb began surging forward as the train approached, so I was swept up in the tide when the doors opened. We were packed into the light rail car like a Tokyo subway, and I couldn’t see where the bike was supposed to go. All I could do was hold on, and try to keep my bike chain from getting grease on the clothing of those around me. This was Portland, which proclaims itself to be the most bike-friendly town in the US, so other passengers were accommodating. But it was a long, hot ride to Hillsboro and I had to stand up the whole way.
After the thrill of last-minute train boarding and congested light rail travel, the rest of the day went well. I pedaled ¾ mile, found my hotel, and checked in. The air conditioner worked. I walked a few blocks to a restaurant and ate dinner, and I read up on the event the next day and reviewed the course. The official start of the 100-mile century route was 6:30 am from the Hillsboro Stadium, so I would go to sleep early. I walked to a grocery store called “Good Friends Market” or “Happy News Market” or something chirpy like that, and I stepped in to grab some soda pop, snacks, and juice. I must have walked right into the set of the tv show “Portlandia.” The store featured mostly organic produce and goods, so I had trouble finding a Diet Dr. Pepper. I eventually found soda near the deli section, in the refrigerator beside falafel wrap sandwiches. There were locally bottled organic root beers and ginger sodas, and a single bottle of Diet Dr. Pepper on the shelf. My lucky day. I had to settle for off-brand, whole wheat Fig Newtons and some sort of pomegranate concoction for juice, though. Back at the hotel, I got into bed at 7:30 and tried to sleep. I turned on the tv and watched the Mariners give up 7 runs in the first inning. No sense staying up to watch the rest of this.
Bright and early the next morning, I dressed in my cycling clothes (with my Seattle Red Rider jersey), slathered on sunscreen, and loaded my jersey pockets with glucose gels, my continuous glucose monitor (CGM) my blood test meter, a spare tire and a mini-pump. My blood glucose began at 145 mg/dl, so I had a cup of coffee and rode the 2 miles to the start at the Hillsboro Stadium.
I got my bib number and fell into a pack of 200+ cyclists preparing to leave for the century ride. I suddenly realized that I had not filled up my water bottles, so I hustled back to the start area and filled them as the century ride began. So I spent the day passing stragglers from this main group as I rode solo. Riding in a group or paceline where others could share the work would have been preferable, but staying hydrated on what was already a warm day was more important.
The route went through the Willamette Valley, the ending point for the wagons of the Oregon Trail (unless an 1850s settler took an earlier cutoff and decided to head to California or resort to cannibalism.) The area was farmland, with tall evergreens in the surrounding hills. It was very pretty, but the downside became apparent as the day wore on: there was no shade, the wind swept down off the hills and always seemed to be in my face, and the heat radiated off the blacktop. Yeah, but I had my water bottles. I stopped at a rest stop after an hour and looked at my CGM. The display read “Sensor Failed.” Great. I had the sensor and transmitter in the back of my arm as I normally do, but the slight discomfort told me that the sensor needle had contacted muscle. The “Sensor Failed” message confirmed it, and I would not benefit from this device for the rest of the day. (I considered tearing it out, but there was the possibility I would lose the transmitter piece, and that area with the adhesive had no sunscreen. So I kept riding with what felt like a minor cramp in my triceps.)
Not to worry, though – I had my blood test meter. I pricked my finger and tested, and found that my blood glucose level had inexplicably risen to 280 mg/dl, despite an hour of exercise and no carbs. Worst of all, I saw that I had only 1 test strip remaining. I planned to ride for 5 more hours, and I would have to eat, take insulin via my pump, and monitor my blood glucose closely. I briefly considered quitting the ride. I asked a few other riders with diabetes if they had any compatible test strips but no luck. I was embarrassed to ask and admit to others with diabetes that despite all the training on the bike, I was ill-prepared and had forgotten something so simple and so important. I signed up for this ride because the course went near Gales Creek Camp, a diabetic children’s camp that I attended in the late 1970s and early 1980s. Back then, we didn’t have blood test meters and we certainly didn’t have CGM’s. We had to monitor blood glucose by how we felt – am I dizzy, tired, hungry, or shaking? The only testing available was urine testing, where we had to pee on a test strip and match the color to see if our blood glucose was dangerously high and we were spilling ketones. It’s a little like driving a car without a speedometer or gas gauge, and you only knew you low on gas or driving too fast when the car sputtered to halt, or crashed into a ditch. Hypoglycemia (low blood glucose) is pretty easy for me to recognize when exercising, because I begin to feel tired, hungry, and weak. But on a 100-mile bike ride I expected to feel that way anyway. My symptoms of hyperglycemia (high blood glucose) are thirst, frequent urination, and a sluggish, sick feeling. But again – I was exercising in the hot sun, and I would definitely be thirsty. But before blood tests and CGMs we were able to do it. So I vowed to save my test strip for the end, and continue on. (I had a full vial of strips back at my hotel.) I would follow my usual regimen of eating and bolusing insulin, and be confident that I could make it work. Later, I joked with another diabetic Red Rider that I was “flying without instruments” or “navigating by terrain.” One guy laughed and admitted he had been in the situation many times, and we talked about how, like cell phones, we all felt dependent upon our new devices.
Fast forward 5 hours. (See it here: http://connect.garmin.com/activity/103236149 )
The route featured nonstop rolling hills, and the temperature reached 95 degrees. Although there was 3,400 feet of total elevation gain over the 100 miles, the highest point of the ride was 400 feet above sea level. It was a rollercoaster. I wondered if it would have been easier to get 3,400 feet of climbing on one or two big climbs. I felt good the whole way, and I kept eating and drinking and taking insulin as I normally would. I didn’t cramp and my legs didn’t feel terribly fatigued after 5 hours, so I was pleased. I met some nice people along the way and we chatted at rest stops or along the route when the wind wasn’t deafening. When I rolled back into the Hillsboro Stadium and the finish line, I pulled out my test kit and used my final strip. My blood glucose was 114 mg/dl. Perfect. I took some insulin and headed for the shade of the finish line tent, where I had a hamburger and a beer. For the first time all day I really felt sick. I should have skipped the burger and beer as recovery carbs! I got back on the bike and rode to my hotel, where I showered, changed, and rested for ½ hour. I had a more grueling event ahead of me.
My friend Rick is a big soccer fan, and when he heard I was in Portland over the weekend he offered to meet at a Portland Timbers MLS soccer game on Saturday night. The game started at 8 pm at the stadium in downtown Portland, conveniently located across the street from a light rail stop. I walked the ¾ mile from my hotel to the light rail stop at 5:00 pm, boarded a train, and ½ hour later I was seated at a bar with Rick outside the stadium. He had taken the train down that day and had purchased two tickets for the game. We ate pizza and he told me how obnoxious he found Timbers fans to be. They were an enthusiastic bunch, I’ll give them that. Maybe it’s all the Portland microbrews that the fans drink before the games. We entered the stadium and had a bratwurst and more beer. My stomach was turning by now, and when Rick tried a piece of “Timber bacon,” strips of chocolate-covered bacon, I was nearly sick at the sight. The first half of the game was all Timbers, and they had a 2-0 lead at halftime. The Timbers mascot is a guy dressed as a logger who runs around the stadium revving up a real chainsaw and working the crowd up into a delerium. After each goal he sawed off a piece of some old-growth fir tree located down in the endzone (or whatever they call that area in soccer.) For an ecologically minded community like Portland this seemed like a strange tradition, but no matter. The Toronto club scored two fluke goals in the second half and the game ended in a 2-2 tie. The once-exuberant Timbers fans left the stadium, dejected. The lumberjack turned off his chainsaw and walked away. Rick and I walked to a café outside the stadium and had more sandwiches, then got on the light rail train back to the hotel at Hillsboro, where Rick checked into a room. I got into bed at 1 AM, exhausted.
I awoke Sunday and met Rick for a quick breakfast, then packed up and walked with my bike to the light rail stop, where Rick and I rode to downtown Portland. We checked out Powell Books and some other touristy things (while I pushed my carbon fiber bike around and carried two backpacks full of sweat-soaked bike gear.) Rick is able to read Amtrak itineraries correctly so we got on our train to Seattle on time. We sat in the bar car and enjoyed the free Wi-Fi connection for the return trip to Seattle. Back in Seattle at 3:30 pm, Rick and I parted ways and I rode home on what was the slowest 8 miles of bike riding that weekend. I was still flying without instruments, but mission accomplished!