Arguments for getting a diabetic tattoo

After many weeks of deciding what do I have just received my Medic Alert bracelet, from www.theidbandco.com.  It arrived a day too late for my big bike ride last week so just to be safe I drew myself a sharpie tattoo. Thankfully I didn't need it and hopefully I will never need my Medic Alert, but if I did maybe it would be better to have something more permanent.

Why a tattoo? It will always be there just like my diabetes.  I will never be able to take it off or lose it.  If anything were to happen to me and I did not have my Medic Alert bracelet on then this could save my life.

Why not wear your Medic Alert all the time? Honestly I don't like it that much.  I have been Diabetic for 8 years and never even come close to needing something like that.  My arrogance could get the better of me and though I will always wear it while riding my bike (Assuming I remember to put it on at 5am when I get out of bed for training) I most probably won't be wearing it the rest of the time.  With a tattoo I wouldn't have that issue.

here are some examples

I am not really a tattoo person.  I like them on other people, I have even thought I might get one.  But I could never really get my head around the permanence of it.  I grew up religious, tattoos are not allowed in Jewish law, so there has always been that feeling in the back of my head that its just not something I should do. I have also felt that I do not need any more marks on my body.  I have many scars primarily from pouring boiling coffee on myself when I was two and walking through a plate glass window when I was 30.

Lets say that the order of importance of issues for getting a Tattoo are:

1. Religious objection
2. The permanence 
3. What to get

1. I have two answers to this.  Firstly I am far from observant, I have not been for many years.  Secondly I wonder if there is an argument here for Pikuach Nefesh (saving life).  I have discussed this topic before in relation to Yom Kippur.  The holiest day in the Jewish calendar where many Jews will fast for 25 hours to repent for their sins over the past year.  I am not allowed.  It is considered too dangerous for my health so I must eat and take insulin normally.  Many other laws are allowed to be broken not just for the possibility of saving someones life, but also to protect their health.  ie the issue does not necessarily have to be life threatening.  So here we have a very good argument against any Jewish objection to getting a Diabetes related tattoo.

Additionally you may have thought living in a Jewish country that there would not but such opportunity for getting a tattoo.  This is certainly not the case.  I feel that there are more tattoos here than I saw in the UK.  This could be because Israelis like to be "Davka" (doing something just because its the opposite of what they are supposed to).  Alternatively it's so warm here and so cold in the UK that there is just more skin on show so I am more likely to see them here.

2. This is much less of an issue with a diabetes tattoo.  My diabetes is permanent so is a tattoo, it almost makes sense that I SHOULD get one because of this.

3. Not a problem, a Medic Alert symbol with Type 1 Diabetes written over or under it.

Well I certainly have convinced myself.  Will let you know if and when I do it.

What do you think?

Gran Fondo Hermon 2013

This was to be my first time riding in a Gran Fondo.  I have done other much shorter organised rides, but this was different: Timing chips, stops along the way to fill up with water food and isotonic drinks, closed roads, and support vehicles.  I signed up weeks ago for the full 170km ride along with a few guys from my club (X Team). Some others signed up for the 100km start. Regardless there was going to be a lot of climbing

The profile of the 170km, most of the last 100km are uphill!

My Ride

The night before the race I got everything ready and loaded up the car.  Changes of clothes, energy gels, sandwiches.  Everything I could possibly think of.  I went to bed nice and early.  My alarm went off at 4am and I woke up a little disorientated.  I shook it off and tested my blood sugar - 255mg/dl - not a great start to the day.  In the days running up I had lowered my Levermir to 24 units, and I took a lower amount of insulin for dinner the night before.  I took 8 units of NovoRapid and ate a cheese sandwich along with an espresso to get me going.

My food for the day, sandwiches, granola bars, energy bars and gels

My Medic Alert bracelet sill hadn't arrived so I drew myself a little tattoo with sharpie

I set off and go to meet Alon, He comes down and we pack the car up just as its starts to rain.  It rains the entire way there and he tells me that it is supposed to be cold and wet at the start.  This is not looking like its going to be the day I was hoping for.  We arrived at the start, still raining, in time for "Sunrise," 6am.  Normally it would be a beautiful view over the Jezreel valley, this day not so much.  Everyone looks unhappy, especially the people directing traffic, just standing out there in the rain.  Two guys from our group are threatening to turn around and go home.  I ran to the coffee shop to get us some coffees, I did a quick test - 277 mg/dl.  Not ideal, but still plenty of insulin on board and when I start riding that's gonna drop fast.

"Sunrise" over the Jezreel valley

Getting ready at 6am in the rain

Miserable looking skies and people

The weather at the start

The weather at the 100km start

Over the course of the next hour the rain stops and it brightens up.  Our team mates decided to stay and there is good humor among the participants while we get ready.  Then an announcement over the speaker.

"We are not starting from here, it's too dangerous.  The roads are too wet."

They were drying out but clearly the police were unwilling to allow us to go the planned route.  We were all invited to the start for short ceremony to remember a fellow cyclist- Gavriel Lerner, killed in a hit and run earlier in the week.  He had registered to ride the Gran Fondo but had been killed while training for it.  His team mates from Eshcolit were all there to commemorate his passing.  We were given black arm bands to commemorate Lerner on this ride.  After the short ceremony we went back to the car and drove to the newly scheduled start.  It was beginning to feel like this year's Milan San Remo. There were a number of groups that rode to the new start.  Some opting to do the climb others rode through the valley and cut out about 30km.  The organizers had said that they were not offering transport back to the original start so we decided to follow the instructions and just drive.

Ceremony for Gavriel Lerner

We arrived at the new start, having passed plenty of groups riding along the way, with plenty of time to spare.  Alon put the seat back and went to sleep for an hour.  I checked my sugar around 815am - 256mg/dl - still high but hungry I took another 7u of insulin and ate half a cheese sandwich.  I went to find the start and go for a little warm up ride and ate a couple of dates along the way.  I realised at this point that I had taken 15 units of NovoRapid since waking up.  Despite being high and having eaten predominantly carbs I was starting to get worried that as soon as I started riding I was going to drop very quickly.  My test just before 9am was 150, this was much better, but worried that I was going to drop more I helped myself to a tea with some sugar and a couple of dates.  Twenty minutes later I was back up at 174 and I was relaxed that things were going to be OK.

Driving through the Jezreel valley

New start and weather was improving

I went back to wake up Alon and we finished getting ready.  I packed food into every pocket that I could and stuffed a bag with more and some warm clothes for the finish.  We rode together to the start and dumped our bags and spare wheels in another team's follow car.  (This turned out to be a huge mistake as we had the option of putting our stuff in a FedEx truck that would take it to the finish. We thought that we would see the car again during the day, sadly we did not.)  One final test just before the start - 138mg/dl.  Finally in my target range, the sun was out.  This was going to be a great day.  I took arm warmers off and slipped them in a pocket.  I still had a short sleeve and long sleeve top on over that, and my bib shorts and leg wamers on too.  I reasoned that I might be a little warm at the beginning but it was definitely going to get colder.

Refreshments at the start

final preparations

Lining up for the start

Lining up for the start

Finally the start. A couple of kilometers of flat and then straight in to an 8KM climb.  There were many switchbacks and tough ramps.  There was nothing to do but stand up on the pedals and grind away on the steepest bits and try to recover on the shallower sections.  My heart rate monitor had me well of 90% for far too much of this climb.  But at the same time I was feeling really good.  The weather was warm and I knew my increase heart rate was partially due to the fact I had too many layers on.  I was encouraged by the fact I was passing a number of people.  At the start I was with a few X-Team guys but none of us were riding at the same pace, while one guy rode ahead of me and a few others trailed behind, I just stuck to what I was comfortable with and found my rhythm.

Leaders on a switch back

Looking back down the hill, riders and their support cars

Climbing

More climbing

Riders in groups drafting on the flatter sections

As the climb flattened out I had reached another member of X-Team, Doron.  Doron and I recovered from the climb and worked well together.  I was worried about the effort I had put in on the climb and began eating.  Between the start and the first stop I ate 2 gels and a granola bar, along with plenty of water with electrolyte.  At some point this train of about 6 riders starts to come past us.  Doron and I pick up the pace and joined the train.  We were hammering on the flatish section at 40+kmph.  My heart rate was coming down and I was feeling good about the rest of the ride.  We made it to the first rest stop.

Pelotons are formed

The first rest stop

I filled up my water with sugary isotonic liquid, drank a bottle of water and ate a granola bar and a gel.  Way too much all at once.  I should have done that more slowly over the next 15 minutes.  My meter read 116 at 1120am, still had some insulin on board and the effort clearly helping keep my blood sugar from rising.  Doron waited for me but the rest of the group we were with had left already.

"I'll take mine to go"

The route was heading uphill in long drags punctuated by short steeper bumps.  Each time I looked at the sky it was less blue, with white clouds turning to grey and the temperature dropping sharply.  We caught our previous group who had slowed their pace.  Then we started to push on.  Soon we were pretty much on our own, passing occasional riders and one or two passing us.  The weather closed in and started to rain.  At first it wasn't so bad, almost refreshing.  The water running down my face and washing the salt into my mouth was less pleasant.  The change in temperature made my legs feel tight and the food in my stomach was giving me cramp.  I told Doron to continue and I kept a slower pace.

Deteriorating weather

I was by myself starting to feel the pain of the earlier exertion and regretting everything.  I was now starting to feel the cold.  I kept pushing myself, knowing at some point there would be some downhill where I could relax even just a bit.  I kept an eye on the time so that I knew when I needed to check.  I kept pushing myself, when I get to the next top I will stop and check. It never came, the cloud was all around me, so every time I thought I was close to a peak it just kept going up.  Finally I was starting to get worried, I knew there couldn't be much insulin left floating around my body but I was cold and working as hard as I could to keep my body temp up.  I didn't just want to eat if I didn't need to.

Riders caught in the downpour

Finally I found some flat ground to stop.  As I unclipped my foot from the pedals I hear a chink of metal on the floor.  One of the bolts from my cleat had fallen out.  I laid my bike on the ground, and fished out a tool from the saddle bag.  It was pointless the thread was gone.  I checked that the other bolts were tight and that there was no movement in the cleat.  All seemed OK.  I put my shoe back on and started checking my blood sugar.  For a while I was standing there completely alone wondering where everyone else had got to.  Then two police bikes came past and told me to stand more to the side of the rode.  The made sure I was ok and carried on.  Then a couple of groups came past and they slowed to check I was OK.  The last group contained two of my team mates, so I quickly finished up and jumped back on my bike.  The meter read 119, an hour and 20 minutes after my previous reading.

Having had a few minutes rest and the terrain flattening out I was motoring along and despite eating a gel and an energy bar along the way I caught up with my team mates (Roni and David) from X Team.  I was feeling good, but it was raining and even hailing hard.  I had no jacket as Roni quickly reminded me.  We turned a bend and the wind hit me.  The rain was driving in to my face.  My sun glasses were no use and were hanging off my jersey but the rain was coming down so hard that I couldn't see anything.  I wanted to climb off my bike and give up, but there was no where that could give me shelter.  I was praying for a petrol station or somewhere that I could stop and take refuge.  Alas nothing.  The road began to go up hill again and I just rode at my own pace.  Drafting was impossible the spray from other bikes was worse than going it alone.  My legs were sore due the cold and I was running low on energy.  I was cold, wet and uncomfortable.  I tried to push myself harder hoping that the increase in heart rate would warm me up.  Unfortunately my legs wouldn't respond.  My heart rate would not go up and I was feeling terrible.  I looked down at my computer and I could see that we were closing in on 65KM.  I remembered from the schedule that there was supposed to be a food stop there.

The second stop for refreshments at Ein Zivan

Soon enough I could see people through the spray pulling off to the side of the road into a car park.  I saw plenty of bikes stacked up against a coffee hut.  This hut turned out to be a shipping container covered in wood, but it was a place to find some respite for many of my fellow riders.  I propped my bike up and ran for cover.  The container was full of cyclists all soaking and freezing, and two increasingly annoyed women trying to sell coffee tea and snacks.  Everyone was happy to pay for a warm drink as long as it kept them inside, out of the wind and rain. Despite most people being very cold and shivering people were in good humour.  Alon was there, he had been way ahead of me but wearing only a short sleeve jersey and cycling shorts.  I watched him shiver for an hour.  Pretty soon we heard that the rest of the ride had been cancelled.  Some had made it 15km further on, in the next town, but no one was going further.  After quite some time coaches were sent to pick us up and take us first to the town where everyone else was and then back to the start.  Two coaches came and filled up quickly.  They sent another one but by this time we had been kicked out of the coffee hut and I sought refuge inside a portaloo.

Everyone crammed into the coffee hut

The coffee hut was full to bursting with cold riders

A few of a nearby winery and fields 

Finally the last coach came and picked us up.  It was a huge relief.  While I was standing in the container I checked my blood sugar it was 186 mg/dl at around 13:21.  Later on the bus at around 1500 I checked again 471 mg/dl.  Where did that come from, there must have been something on my finger.  I checked again 395 mg/dl.  Not ideal but not as bad.  Hopefully it will come down soon.  An hour later I checked again - HI.  That could not be good.  HI usually means over 500.  I have never been that high before.  I would have expected to feel terrible but I was already feeling bad from the cold, even though I was on the bus.  I reached for my NovoRapid.  I took 20 units and ate a cheese sandwich to keep me from dropping too quickly.

Everyone and their bikes on the bus

Alon and I feeling worse for wear 

My meter reading just HI indicating I was over 500mg/dl

Over the next hour I checked a couple of times, remaining extremely high and starting to get worried.  Fortunately by 1800 I was getting readings around the 350 mark.  Not at all ideal but heading in the right direction.  This was about the same time we made it back to the start.  The weather now sunny and warm again. We picked up our bikes and finally got our bags back so we could change into some warm clothes.  I asked Alon to drive us home as I was not feeling up to it.  By 1900 my BG was down to 145, and of course just as I got home I went a bit hypo.  Fortunately my wife had prepared a lovely dinner including a great soup to warm me up.  I had a hot shower and went to bed by 2200.

It was not the best day riding for me.  It was quite horrible in fact and not much better from a blood sugar point of view.  Some of it was my fault.  If I had taken a rain jacket with me it would have been much better, I may have even finished the 80KM.  I really do not know what happened to my sugar, feel free to leave me a comment if you have an idea.  I think the organizers did a great job changing the logistics at the last minute to accommodate the unseasonably bad weather.  I look forward to trying again next year.

The pictures of X Team

All the official pictures from the Gran Fondo.

Holocaust Rememberence Day - A Diabetic Perspective

I am pulling out of the car park after stopping somewhere on the way to work.  The low key music on the radio playing a song I like.  The song ends and the radio announcer says in Hebrew, in a moment we will hear the siren.  I am driving along the road and coming to a traffic light when the siren starts.  I put the car in park and along with many others I jump out of the car and stand to attention.  Two minutes pass like this as we remember what happened to our ancestors during the Holocaust.  It is an amazing sight.  Nobody moves, everyone just stopping where they were, whatever they were doing.  One car is stranded in the middle of the junction.  I must say that living in Israel, where everyone is in a rush all the time, seeing this timeout is rare.

I have two minutes to think and meditate on the horrors of the past.  It has always been difficult for me.  My family were incredibly luckly to have left Lithuania and other parts of Europe in the early 1900s.  My mum's grandparents settling in Scotland as well as the family on my father's father's side.  Both my grandfathers served during the war.  One in the RAF and one in the British army.  But they never had to endure the horrors of the Holocaust.  It makes it harder to relate.  It wasn't until I met my wife's grandparents that I had a real relationship with any survivors.  All three of the grandparents that I met survived the concentration camps in eastern Europe during World War II.

I often think about myself when I hear stories of survival, what they had to go through and what they had to do in order just to make it through the day makes me wonder if I could manage it.  Add to that my diabetes, how would I survive? how could I survive?  I think about being stranded on an island, or surviving some apocolypse.  Where would I get insulin? How much could I get? And what would happen when it ran out?  These are questions I hope I never have to answer.

So my thoughts came back to an article that was sent to me by my friend @NotThatSweet a fellow person with diabetes from the UK.  The article was the story of Ernest Sterzer, an Austrian Jew who was diagnosed with diabetes aged 3.  He lived through the Holocaust in one of the most amazing stories I have read on the period.  His survival was not like any other, many survived in similar ways but getting through all that with diabetes is just incredible.  His story is one of luck, ingenuity, random acts of kindness, risk, and the sheer will to carry on.  Just avoiding detection as a "weak specimin" and hence being sent to die was difficult, but managing to get enough insulin to keep him from severe hyper glycemia is too much for my words to describe.

It is an inspiring story.  Whether touched by the Holocaust or not, whether diabetic or not, Ernest Sterzer's story shows you what you can achive when faced with the worst hardship immaginable.  It shows me that whatever complaints I have about my diabetes, or any other part of my life for that matter, I am lucky and I am blessed.  I live in a modern world, in a comfortable way, I have great diabetic care and I should never have to know the attrocities of the Second World War in my lifetime.

If you do one thing today for Holocaust Rememberence Day read his story, share it with others, and know that whatever you want to do, it is achievable.

Live long and stay healthy.