New Gary Hall commerical

Here's an excerpt from Gary's doctor herself...a little explanation and excerpt from Athens to help clarify this argument. I'm putting the excerpt here but you can read the whole article at: theraceclub.net/.../index.html Gary is more different than most, because he is slightly imperfect. His beta-cells no longer secrete insulin. Watching his blood sugar levels rise and fall with training and racing provides a window into his physiologic needs for fuel, and an understanding of the intense stress athletes face when they compete. Working with Gary has taught me how to treat all of my patients who exercise, whether it is by walking around the block in the evenings or training for and competing in triathalons. The same rules apply. The most important principle I learned is that every rule can be wrong in a given individual. I thought I knew about exercise, that training would make muscles more sensitive to glucose and lower insulin requirements. It made sense. But in Gary's case, that rule doesn't always apply. When he trains intensely he needs more insulin, largely because his carbohydrate intake is so high at 4,000 to 5,000 calories per day, with 60% or so of his calories coming from carbohydrate. When he's training less hard, his caloric intake and percentage carbohydrate ingestion is markedly reduced. So his insulin requirements are less. Another reason his insulin requirements are higher during his intense training sessions is because of the catecholamine response to such heavy training. As a sprinter he doesn't do lots of slow long distance swimming; he does more intense episodes of training, which may be more physiologically stressful. Gary's insulin requirements change if he is training once a day or twice a day or three times a day. They differ if he is doing more weight training than cardio or the other way around. Time spent training in the pool is different than time spent training on land. Calculating doses wrong and he's too low at night, a delayed effect of training, but giving too little insulin overnight results in fasting hyperglycemia and a bad workout the next day. An insulin pump might offer the fine tuning of basal rates that would better match his physiologic needs, but as a swimmer Gary can't stand the drag of the tape and infusion site on his skin against the water. So he has become a master at adjusting his insulin doses, using a multiple daily insulin injection regimen that is more complex and varied than almost any other patient I treat. Most of the time this approach works; the frequent insulin dosing and the 10 or more times he tests his blood sugar levels each day keep his sugars under control and his A1C level less than 7%. Sometimes, as with all patients, it doesn't work as well and hopefully that doesn't coincide with race days. I wish it were easier to manage our patients with type 1 diabetes, but it isn't, not yet. Gary, like all my patients with diabetes, dreams of the day this disease is cured. I dream along with them...I'd like to be out of a job, at least a job of treating blood sugar levels.

Here's an excerpt from Gary's doctor herself...a little explanation and excerpt from Athens to help clarify this argument. I'm putting the excerpt here but you can read the whole article at: theraceclub.net/.../index.html Gary is more different than most, because he is slightly imperfect. His beta-cells no longer secrete insulin. Watching his blood sugar levels rise and fall with training and racing provides a window into his physiologic needs for fuel, and an understanding of the intense stress athletes face when they compete. Working with Gary has taught me how to treat all of my patients who exercise, whether it is by walking around the block in the evenings or training for and competing in triathalons. The same rules apply. The most important principle I learned is that every rule can be wrong in a given individual. I thought I knew about exercise, that training would make muscles more sensitive to glucose and lower insulin requirements. It made sense. But in Gary's case, that rule doesn't always apply. When he trains intensely he needs more insulin, largely because his carbohydrate intake is so high at 4,000 to 5,000 calories per day, with 60% or so of his calories coming from carbohydrate. When he's training less hard, his caloric intake and percentage carbohydrate ingestion is markedly reduced. So his insulin requirements are less. Another reason his insulin requirements are higher during his intense training sessions is because of the catecholamine response to such heavy training. As a sprinter he doesn't do lots of slow long distance swimming; he does more intense episodes of training, which may be more physiologically stressful. Gary's insulin requirements change if he is training once a day or twice a day or three times a day. They differ if he is doing more weight training than cardio or the other way around. Time spent training in the pool is different than time spent training on land. Calculating doses wrong and he's too low at night, a delayed effect of training, but giving too little insulin overnight results in fasting hyperglycemia and a bad workout the next day. An insulin pump might offer the fine tuning of basal rates that would better match his physiologic needs, but as a swimmer Gary can't stand the drag of the tape and infusion site on his skin against the water. So he has become a master at adjusting his insulin doses, using a multiple daily insulin injection regimen that is more complex and varied than almost any other patient I treat. Most of the time this approach works; the frequent insulin dosing and the 10 or more times he tests his blood sugar levels each day keep his sugars under control and his A1C level less than 7%. Sometimes, as with all patients, it doesn't work as well and hopefully that doesn't coincide with race days. I wish it were easier to manage our patients with type 1 diabetes, but it isn't, not yet. Gary, like all my patients with diabetes, dreams of the day this disease is cured. I dream along with them...I'd like to be out of a job, at least a job of treating blood sugar levels.