In regards to feels, diabetes provides an endless supply to the senses. We become numb to the finger-sticks, with an occasional 1 in 100 resulting in a real sting. To an extent, injections and pump site changes become familiar or at least expected. With respect to the most commonly asked questions of people with diabetes, here’s another addition to the list: does that still hurt? My response usually follows these lines: Well, no. It’s still the same pain I’ve always felt, but now I’m used to it. With most of our emphasis on our acclimation to these not-so-positive sensations, the single best feeling in the diabetes world remains unexplored and never taken for granted. Continue reading →
We’re an analytical bunch. Numbers flow through our brains alongside most thoughts. Numbers can dictate our emotional states–ever been feeling great, get a blood sugar, see it’s at 250, and then start to feel high? That blood sugar number courses through everything we do, everyone we meet, and everything we think. But, does it have to? Continue reading →
With crossed fingers and pump tubing, I hoped for a one week placement on Endocrinology during our six week Pediatrics rotation. All that crossed tubing paid off–granting a chance to be around my people for a week. During a four year education, opportunities for type 1 diabetes exposure are slim, surprisingly.
It felt good to be back in the peds endo office after a 10 year hiatus, although a tad disorienting. Lies about logbooks were absent (all numbers are now downloaded straight from the meter), parents know even more than they used to (thanks to Dexcom share and all those other meter apps), and 504 plans are a mainstay (my plan used to involve proving to my high school teachers that I was low with my meter and stumbling to the vending machine). Continue reading →
It’s Saturday. I look around my kitchen like, “How many nutrients can I pack into one meal?” The kitchen counter holds the answer: fruit. A meal based on the classics: oranges, apples, and bananas. The excitement mounts… but simultaneously, the anxiety builds–how can I balance that many carbs? Instead of running in fear from the carb-load, I decide to embrace it, count it, and ride the wave of a high-carb, plant-based diabetes meal. Continue reading →
Sparked by our conversation with Robby Barbaro on the last podcast, I tallied each bite of food entering my esophagus, for an entire day. This was a new experience. I do not actively count carbs, but go by feel alone. Inherently, some people are thinking, “WHAT?!?! How can you possibly do this and have type 1 diabetes?” Yet, some people are thinking, “Makes sense to me.” Regardless, Robby lit a spark and I embarked on a one-day journey to reexamine lifelong habits. Continue reading →
‘Tis the season to begin all things with ’tis the season. Colder temperatures inspire big lifestyle changes. Our diet shifts, time in the sun drops, and daily movement declines. We tend to think of these change as burdens on our healthy lifestyles (and diabetes management), but really, it’s all natural. We’re supposed to slow down, go inside, and be by a fire. Continue reading →
It’s fall, and it’s glorious: foliage, football, and family. Thanksgiving is my favorite holiday. Don’t feel like rationalizing my choice, it just is. Some say Halloween marks the start of the holiday odyssey–a sentiment I respect–but now we flip the switch. Summer’s in the rearview, winter’s on the doorstep, and diabetes is ready to reap the harvest of holiday decisions…. unless we turn the tables. What if Thanksgiving went to plan? Continue reading →
We all aim for that flat, consistent beam of blood sugars shooting straight across the horizon, right? Well, my mine are that shooting star, then the shooting star rising back from the dead, then to fall out of the sky again… before lunch. I’m in one of those strange spirals, where the true etiology remains unknown, but more than likely a combination of my daily choices and changes in circumstances underlies the imbalance. Continue reading →
It’s almost insulting, right? There you are, an adult, being asked to take your shoes off for a foot exam. This was always puzzling as a kid, leaving me thinking, “Yo Doc, if I had a foot ulcer or something, don’t you think I’d know?” But nevertheless, I always take my shoes off–hoping I have on matching socks and my feet are tolerable in scent–and let the endo do his or her cursory 3 second glance, eventually sliding my socks back on to a good report. Continue reading →
I used to think it was untouchable–beyond reach. Out of my control and me at its will. But, as time often allows, things soften. A small sliver of space has opened; the space to be me inside of a low or high blood sugar.
A conversation sparked last weekend at the JDRF One Walk in Oklahoma City, surrounding just this concept. I was catching up with an old friend (who also has T1D) and we discussed the subtle impacts that diabetes has on a day, by changing the course of a single moment; his feeling that blood sugars alter the flow of conversations. Citing specifically how it impacts his engagement in meetings, and I chimed in with how it sometimes impacts empathy with patients. And, in an accumulation of altered moments, he mentioned a friend of his had recently attributed a divorce to type 1. It’s there, the invisible (sometimes visible to others) blood sugar force. Continue reading →
Never fails. The thought enters, I love my pump, never had better control, and so thankful for it. Then, subtly the morning sugars are a little off. Then, I find myself chasing blood sugars. Then, I start doubting the pump and begin thinking about insulin resistance in pump site locations. Then, I switch back to the ol’ long-term/short-term game. Every couple of years this sneaky process plays its way out. Continue reading →
Welcome to the dog days… and the unofficial closing summer ceremony, with Labor Day less than a week away. In this window of time, I usually remember that baseball exists still. To the baseball purist, my following of the sport is somewhat reprehensible, as most of my interest peaks in October (after neglecting the first 5 months of the season). We sit roughly 1 month out from the beginning of playoff baseball, meaning this is where I start to tune-in. Continue reading →
Time to borrow from the game of golf. It’s on the mind, as I watched the PGA Championship over the weekend. Diabetes makes for an interesting viewing companion, always finding a way to relate anything back to itself.
I like golf. Haven’t found another activity that reflects the inner state of mind better. Much like diabetes management in that aspect. Getting to the point now, playing golf in Oklahoma means playing with the wind. The song doesn’t lie, the wind sweeps down the plains.
My own definition of insanity: doing the same thing, over and over, getting the same result, while simultaneously knowing the definition of insanity. Over the past two weeks, I’ve been on loop mode. I knew I was on loop mode, but history kept repeating itself. Until… a recent lunch with Amber and our friend Trish (and podcast 17 guest) said, “Ya know, you could just stop eating so many carbs in the mornings.” Let’s backtrack, mainly because I feel the need to justify why I needed to be told this essential truth in diabetes management after 18 years.
It’s been hot here (Oklahoma) and everywhere else. Especially hot for this early in the year. 100° is normal in August, not June. Plus, the humidity been’s flirting with Amazonian levels. Nonetheless, despite the warnings from weather people and health officials, I’ve been out on the trails (not recommending anyone try this out per se, please exercise extreme caution). A justified decision based primarily on an irrational personal desire to be outside, I’ve survived by consuming liters on liters of water out of the Camelbak, keeping Clif Bars in the pocket, searching for shade, and pounding back bananas every 30 minutes. Gotta be careful. Continue reading →
We like to consider ourselves experts. On the spot, we can spew carb counts for all things edible. We alter our insulin rates and corrections on intuition. Always a step ahead of our endocrinologists, we people with type 1 diabetes appear to have a superiority complex, the by-product of years of acting as the human, oftentimes inaccurate form of a beta cell.
Coming from this background as I started medical school, I was shocked by many things subsequently presented over the last two years–more or less on a daily basis–that were completely off my limited radar. Really though, almost every day I found out something new about diabetes. There was no waiting until the endocrinology class started. Diabetes complicates every disease process. Diabetes knows no bounds: immunology, genetics, neurology, nephrology, dermatology, cardiology, and any other -ology (sorry, forgot ophthalmology). Continue reading →
A few days back, I took the first medical school board exam (Step 1 USMLE). As always, diabetes did its thing, always in the background, making subtle moves, maybe influencing things, maybe not, but nonetheless, it was there. In itself, the whole day is its own marathon–7 separate 40 question exams spaced out over 8 hours. Having the knowledge is one thing, but putting yourself a place to access that knowledge is another (the test results arrive in 3 weeks, so it’s hard to ascertain whether I truly accessed said knowledge). Continue reading →
Oftentimes, in the wake of shock from a surprising blood sugar, I have no answers for why the number isn’t where I desire it. Maybe I’ll spend 30 seconds playing detective, sifting for causes over the last few hours or days (or minutes). My detective work, on occasion, will yield an answer, like Oh yeah, I forgot to bolus for lunch today (somehow, yes, this still happens). But, for the most part, either from subconscious repression or the nature of the diabetes beast, no clear answer shows up. Just take insulin or eat a snack, then move on. Continue reading →
Live readings of serum glucose, tracking along on a touch screen panel–essentially a bigger, more accurate version of a continuous glucose monitor. A vial of straight glucose ready to put into the IV line. The ability to keep the glucose levels in perfect range. Insulin ready to infuse. Continue reading →
Situations arise (and will continue), where I can’t troubleshoot a reason for being high. This is our life. I like to think of the body as your local philharmonic. When everyone shows up to play the show, you’ve got great harmony. When all of the violins forget to show up (consider this our pancreas deficiency), various other members of the orchestra (consider this cortisol, growth hormone, epinephrine) will come across a little louder, and distort the quality of the show (the random high blood sugar). For historical purposes, it’s important to point out those last few sentences will serve as the first and last philharmonic-related analogies on the website. Continue reading →
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I came to take research for granted. Why? Well, it’s complicated. When first diagnosed, you jump in every clinical trial around, usually at the first mention by your doctor. I joined three as a kid. We’re beyond gun-ho at this point, we’re pushing the needle toward a cure. Subtly, the years go by. You look around and think, Man, this technology development is pretty awesome, but I’m still on insulin. To hold the belief that one day you’ll eat with no conscious weighing of risks and benefits (I’m not advocating this for anyone, just getting at a point) while also weighing all the risks and benefits of every choice in your life every day for most of your life, is tough. Continue reading →
Being low does not permit coherent thought, most of the time. Thus, this article will not follow much of a format. Instead, we’re going to examine my thoughts, close to sequentially, as I navigated the grocery store, at dinner time, with a blood sugar of 54. (This was not a planned experiment. I tested to calibrate my CGM right before going in. The CGM was off.) Continue reading →
If you, like me, grew up viewing life through the periscope of sports, the random sports idiom knows no bounds. Sport is often sold as the character molding force that teaches the lessons of life, builds camaraderie, and strengthens resolve. Being one that only knows my own experience, I cannot discount these assertions (recently though, I’ve met a few people who never played sports and seem alright). Continue reading →
Nah, that’s not a typo in the title. This is an article about the opposite of a low carb, high fat way of life. Instead, it’s an embracing of the carbs, a going out of your way to eat more of them discussion. The spark for this recent exploration into the ultra carb life was inspired by a recent (but upcoming podcast release) conversation with Amy McKinnon.
She, like myself, stumbled into the plant-based way of doing things, but has a different outlook on fat. Inherently, a vegan diet will consume more carbs than any other nutrient. So, it’s not like I was not eating carbs prior. I ate plenty. But, before our conversation, I’d been consuming about a third of my calories from fat (roughly 90 grams/day) in the way of almond butter, trail mix, walnuts in cereal, and olive oil to saute veggies. Amy aims at less than 30 grams per day, claiming that this has had remarkable benefits 2-3 hours post meal in the way of more consistent blood sugars. Continue reading →
We all get locked into patterns, habitual ways of doing things, mostly because it’s just easier that way. When you find a pattern that works, those repeated steps conserve brain power in the form of less decisions, saving energy for the rest of the day. As long as those patterns lead to beneficial outcomes, all is right. Recognizing the less desirable outcomes takes awhile though, and oftentimes we need a change of scenery to shine awareness on the need for change. Continue reading →
At any moment, we have the chance to join the current – that magnetic force of connectedness to something. Trying to describe the exact feeling it tough. I’m coming up short, but perhaps the force stems, simply, from mindfulness. In the moments where we feel that easy flow—whether it is on a hike by ourselves, during a night out with friends, or in conversation with the pharmacist—things just flow naturally out of awareness.
When in the current, I feel most like myself. This is not a continual existence, even with perfect blood sugar. More rare than constant, but something I look to join when the opportunity presents. Continue reading →
Alright, I’m holding myself to our mission–real support for the diabeteslife. Really, why is it so hard to share an a1c that isn’t up to snuff? Maybe it was the branding of the number 7 on our being upon diagnosis, or years of anxious waiting in the doctor’s office for an a1c that doesn’t out our crafted out of thin-air glucose log, but more likely in my case (and I suspect for many others), it’s an admission that after 17 years I still have work to do. It’s vulnerability.
So, it came back at 7.9 last week.The mantra–judge yourself by your effort not the results–has underscored 2016 for me. That said, the number wasn’t all that surprising. The holidays did their holiday thing (or I allowed the holidays to do their holiday thing). For the last few months of 2015, I went CGMless due to losing the battery charger (which I located a month ago and have been wearing the CGM since). School was a roller coaster ride. At the end of the day (with a pile of excuses), my effort over the past 3 months didn’t reflect an a1c under 7. Continue reading →
I forgot my lunch in the car. By itself, not all that significant. In the midst of any day with diabetes, it has ramifications.
By the time this truth was realized, it was 11:55AM and morning classes were a wrap. On an aside, things like this have happened to me for most of my life. Due to the customary nature of the event, I’d already convinced myself that it was good for me to forget lunch in the car. It’s a chance to get in a few more steps. Maybe even get some vitamin D. So, I embarked on the 10 minute walk back out to the car.
As I left the school building, my strides meeting a classic Oklahoma gust head on, I stole a glance at the Medtronic CGM (continuous glucose monitor). I didn’t freak out when it read 87. Continue reading →
Oh yeah, it introduces uncertainty to our internal diabetes algorithm. But, so does coffee and most of us have found ways to incorporate that habit into our lives.
Last weekend, I enjoyed giving a presentation, The Sports Performance Guide To Diabetes, at OKC’s JDRF TypeOneNation Summit. During the talk I outlined the fundamentals that allow us to manage the uncertainty introduced by exercise, and harness the massive benefits of movement (will be outlined below). In today’s post, my thoughts are combined with what I learned from discussions with parents and other PWD. Continue reading →
I’ve always believed that I can do anything with diabetes. This idea of freedom is one of the primary reasons we started the site. For sanity’s sake, it’s good for me to venture the great unknowns, test the boundaries, and find new possibilities for my life with the disease.
Yet… as the saying goes, there’s a time and a place for everything. And maybe, just maybe, there’s more freedom in understanding of our own limitations first. To demonstrate what I’m getting at (this just recently came to conscious awareness in my own life), let’s examine a few of my daily choices: Continue reading →
IT’S 9:45PM, fine, closer to 11PM (friends will point out that 11 is still an early bedtime, but I don’t care because I love mornings more than everything, including Netflix) and I start jotting down thoughts. Whatever comes up. Sometimes insightful, sometimes forgettable, but nonetheless I enjoy the ritual.
Periodically, an entry will start off with, “Man, today was pretty smooth until…”, “Things ended up turning out alright today after…”, or “What would today have been like if…” Each of those sentences usually end in one of the varying manifestations of a low blood sugar: strange conversations, funky moods, bad workouts, or disrupted flows. When a low BG introduces turbulence to my day, it receives deference in the writing. Why? Probably because low blood sugars tend to trigger strong emotions–hypos aren’t known for producing stable mood states. Continue reading →
Life is an apt teacher. 2015 didn’t disappoint in regards to the diabetes lessons. I went back through this year’s posts and pulled a few observations that I’d like to act upon in 2016. Maybe these connect with your own diabetes management. If not, at least it was therapeutic.
Have a Happy New Year everyone!
Denial exists even after 18 years
You’re thinking “how can a person who writes for a diabetes website have denial about diabetes?” Pretty valid question. Let me explain.
This fall, I was listening to a professor talk about how he radically changed his own diabetes management. After he visited his endocrinologist, received an a1c of 11 after getting the diagnosis a few months earlier, the facts had to be faced. He was a diabetic (person with diabetes). His pancreas is not coming back. Sugar is a toxin. Every added gram he put in his system jeopardized his heart disease risk. He stopped eating a jar of jelly beans every morning. His a1c dropped to 6.
I don’t eat jars of jelly beans but I did buy cereal that has added sugar, trail mix with chocolate, and put maple syrup in my oatmeal. After I heard him describe his own denial, I stopped buying those foods. Perhaps you’ve already made this subtle choice, but using my otherwise healthy vegan diet as a crutch, I too faced the facts and have felt a significant change in my blood sugars. Continue reading →
We all want to ring in the New Year with style. Pop bottles. Watch the ball drop. Kiss a stranger. These are not recommendations, just possibilities. There’s only one way to keep these option available–control the glucose. So, how do we do set ourselves up to enjoy the biggest celebration of the year?
It all starts with knowing where we’re at to start the night. Always, my goal is to keep my blood sugar in a place where I can be present and mindful of my choices. If you go into the evening in your range, this gives us the opportunity to actively make choices: Continue reading →
Flexibility is opting to hit the trail, instead of the weights, on a December afternoon (when it’s 60 degrees outside). I couldn’t resist the urge and have no regrets. It was beautiful, I took the GoPro along, and the ride evened out the blood sugars. A few of these details are hinted at during the video, but here’s the ride logistics:
So what do you eat? Once upon a time, I use to respond to my name. Now, I respond to that question only. Okay, I’m somewhat kidding, but I get that it’s a curious decision: going plant-based with a type 1 diabetes diagnosis. To shed light on the question and provide guidance, I’m rolling out the mini-grocery list of essentials for the person looking to make the plant-based leap, while keeping the whole pancreas deficiency thing in mind. Continue reading →
Maybe you’ve heard the adage: HALT. Take precautions when Hungry, Angry, Lonely, or Tired, especially when it’s decision making time (this skill is sufficiently difficult by itself for me, not withstanding additional emotions). Let’s add another L to the acronym: Low. Trying to do much of anything while hypoglycemic is already a challenge, but oftentimes the tiniest decisions turn tortuous.
How important is this understanding? Well, important enough to write a blog about it. Looking back, I think things would have just been easier if used the thinking plan I use now, “Okay, Ryan you are low. I know this feels like something really important that you should do right now, but this will be simpler in 1o minutes. Find some food.” Remind yourself of the past experiences where things were never as bad as they seemed when you were low. Really though, it’s never that bad.
Pager? Pedometer? Pacemaker? Curious folks have inquired in regards to what that thing is in my pocket with those questions. Despite not being any of those devices, an insulin pump can be quite handy. Could the manufacturer have anticipated any of these extra, notable functions? Perhaps. If so, I’d like to meet that person. Some of the following functions have become such indelible facets of my life, it would hurt considerably if they vanished (if the cure ever arrives I’ll keep my pump in my pocket).
So, with that said, let’s jump into the unorthodox, kinda questionable, uses of an insulin pump: Continue reading →
This is a different subject matter than the aforementioned methods, with it probably standing on loftier moral ground. Brittany got the dating ball rolling earlier in the week, and lately I’ve been pondering this very concept as I traverse the first few weeks of getting to know someone I really like, while not really knowing how much they’re into me, knowing that I’m into them, guessing she’s kinda into me because we definitely wouldn’t be spending this much time together if not, but all the while just ‘playing it cool’. As unnecessarily complex as that last sentence sounds, the diabetes intro is simpler… or it should be. Continue reading →
As a person with a type 1, we develop immunity to the supplement (cinnamon) ads and the “one food to stop eating to cure diabetes” ploys. This immunity, albeit strong, is still willing to identify things that do work on blood sugar, every time. Exercise (let’s use this under the assumption that the word exercise comes along with the idea that fun is also happening at the same time) is one of those things. It works every time. Every time. Continue reading →
I do like definitions, and that’s where we’ll begin the Jenga and risk management discussion: “To assure uncertainty does not deflect the endeavor from the goals.” When it comes to diabetes management, what is our endeavor and what is the uncertainty?
The possible endeavors can be divided into two distinct camps: today’s and life’s.
My life’s endeavors tend to aim in the big picture category; or they amount to very specific things in which I hope won’t happen, in regards to diabetes: keeping my feet, maintaining my vision, seeing my grandchildren graduate from high school, traveling to places I haven’t yet imagined, and having an incredible marriage.
My today’s endeavors include the reach for more immediate goals; albeit important priorities to get the most from the moment: be able to exercise when I want to do, have my mind in a place to write, genuinely connect with people, and continue to grow into a healthier, complete person. Continue reading →
The low mind is a desperate mind: consumed by negativity much like myself after a Dallas Cowboys’ loss and uncompromising like an addict. In such a state, our mind can be taken by our deepest fears. If uncertainty finds itself anywhere near you life, you’ll find out when you’re low. A little worried about your job performance lately? You’re getting fired. Got a test in the morning? Bombing it. Things been off with your girlfriend lately? She’s cheating on you.
It’s one thing to have those thoughts; it’s another to carry them back into your presence as a sane, otherwise normal person, at a normal blood sugar. But this does happen. All the time. Think about it like a dream where your boss walks in and lets you go from a job you love. You wake up, go to work, and it takes until lunch to really trust your boss again. It takes awhile for the root of the thought to be dug out. Continue reading →
On trail to Mt. St. Vrain in the Rocky Mountain National Park
2 days. 8 low blood sugars. The numbers tell the story: the higher you climb, the lower you fall. We all enjoy good paradox, right?
Am I a mountain man? No, partly because it takes me 3 weeks to grow a 5 o’clock shadow, and I spend the majority of my life at sea level. Oxygen likes to have a good time at sea level. It glides into my lungs with relative ease, slips into my blood, and enjoys homeostasis. At high elevations, especially those approaching 10,000 feet, oxygen gets depressed. It hides out with its cats and starts crocheting. In response to this hermitism, the heart works double time. Being that the heart is a relatively selfish organ in its oxygen (and subsequently glucose) use, it singlehandedly elevates our metabolism, by 10-20% at my best guess. Continue reading →
A classic dual worth a bit of contemplation, chiefly due to autumn’s arrival, apples (we’re simplifying by omitting yellow) have been a staple of human society since possibly the Stone Age. The bulk of the apple’s use in history can be chalked up to the recreational buzz from a good glass of cider. Only within the last hundred years have breeds been cultivated for the palate; out of the 1000s of apple phenotypes, only about 10 are sold for widespread commercial consumption, including the subjects of today’s discussion.
I will eat any apple: red, green, small, large, sweet, bitter, cider, pie, etc. I love the sour first bite, and subtle sweetness of a Granny Smith. I crave the overwhelming sweetness with light tart of a Fuji. With all this apple talk, wish I could teleport into New England for a few weeks. Whatever, I’ll settle with the watermelon in OK.
The choice of apple, largely the selection of color, can result in substantial differences in both blood sugar considerations and nutrition benefits. So, let’s weigh the options: Continue reading →
Ever had one of those frozen taquitos? Okay, so you’ve been to college. Ever had one of those frozen taquitos, without thawing it? Alright, you might have been low. Do you remember it? Then you weren’t that low.
Given my level of consciousness teetered between an anesthesia-like blackout and that first 10 minutes of falling asleep, we are relying mostly on the story-telling accuracy of my father to describe some of the events; needed that established.
The story’s genesis involves the the high cost of test strips (Sorry, every chance I get to hammer them for this fact is seized). Even back in 2001, the era of this story, test strips were, as they always are, at a premium. If you had ample supply, you hoarded those things like Harry Potter fans collect sticks that happen to look like wands. My family enjoyed a few extra boxes due to the recent Pfizer inhaled insulin study we’d joined when I was 10, the year prior. Continue reading →
(Ryan is not currently scanning the coast but the pathophysiology of asthma. Authored July 2015.)
Let it be known: I am not a real surfer, yet. Can I swim? Aptly enough. Can I catch a wave? Yes. Can I stand up? Occasionally. Can I turn? Sure.
That said, as I scan a nice break off the coast of Maui, humbled is my main qualification. Surfing is an art honed through decades of work in salty water, watching the sun rise and descend on opposite horizons, all on the same day. I have observed real surfers. Those who are the art and the religion–no separation between their body and the waves, riding the earth’s energy. Gorgeous stuff.
Having paddled out now over 30 times, blood sugar themes do their emerging thing, and I know what to expect. In many ways, I’ve found surfing to be a simpler, more-straightforward cause and effect relationship between movement and glucose levels (compared to running or cycling). Continue reading →
I do love a good distraction. We all love a good distraction: Facebook, Candy Crush, Netflix, essentially anything on our phones. You know when we really dig a distraction? When we’re high. That’s when the bear in me comes out. I do suppose that getting high is a good high distraction, too, but I’ve yet to experiment with its potential. Anyways, we do anything to get our minds off an undesirable state, high blood sugar. It’s time to explore an alternative route, outside the mind-numbing process. What if we turned toward our own high experience?
Exercise is quite the paradox in diabetes management. On one hand, it provides long-term stabilization and a natural lowering of glucose. On the other, it supplies the most significant swings in glucose levels possible. As outlined in previous posts, depending on the kind of exercise being performed (aerobic vs anaerobic), one can expect different glucose results. Today, I’m exploring a couple of principles that I’ve noticed over the past two years of marathon training and duathlon events. I’m no professional. Just a guy who likes to get his heart rate up every once in awhile, while avoiding the catastrophic low. Continue reading →