I had pretty high hopes for a recent switch in my basal insulin. I've discussed it a bunch in my Vlog on YouTube and I promised to write about it here and give a full report. So here is my experience of Toujeo: it's Lantus in a different colored pen with an even sillier name. I didn't experience weight gain or an increase in the dose like some detractors had warned me about online. I didn't experience better or more stable blood sugars as some proponents had predicted. It was basically the same--same dose, same action, same stability. If there were any advantages gained in my switch they were imperceptible.
The one thing that this trial DID reinforce is the very perceptible benefit of splitting the dose of Lantus or Toujeo. I started off taking a full dose of Toujeo and found that it did exactly the same thing as Lantus in a single daily dose: lows up front then increasing blood glucose from hour 18-24. This left me chasing my numbers up and down the spectrum for more than half of the hours in a day. Once I returned to splitting my dose the stability in my numbers followed with it.
One needn't look very far on social media and diabetes forums to find people who will tell you that "injections suck" and that using a pump is inherently superior. I find that many of those who hold to this view never experimented with the nuances of basal insulin and failed to dial in their dosing. I readily admit that's why I didn't have a great experience on the pump. I took the "starter" settings and didn't get far beyond that point. Turns out that's a pitfall that occurs when using injections too.
My purpose in writing this isn't to compare shots vs pumps. I've already done that in this blog linked here. It's to share that in my experience, many times over, splitting a basal insulin into two half-doses daily makes a massive difference in terms of blood sugar stability. I have noticed more and more pumpers taking "breaks" and going back to injections and this technique could be very useful--and it's surprising to me how many doctors don't recognize that. I'd love to see a day when insulin that is advertised as "24-hour" insulin actually lasts that long. Come to think of it, I'd love to see a day when medication isn't wrapped up in marketing, period. In the interest of full disclosure, I am currently moving to trying Tresiba in hopes that it may at least be able to give me that full 24 hour duration. If there's anything to report, I will.
Ready for my disclaimer? Here goes: this blog post isn't paid content and all the opinions here are my own. I am 100% certain that the companies which manufacture and all of the drugs referenced here do not condone my blasphemy in the form of non-FDA approved usage of their products. They haven't asked me to provide an opinion nor have they paid me for this service. They also haven't paid me to shut up, so I'm still here ranting about how we can use older, cheaper therapies to get better results with a little ingenuity.
by Steve Richert
Creation is the opposite of destruction. If it were not for the destruction that type 1 diabetes threatened me with, I may never have seen the value in picking up a camera and creating something from the obstacles in my path. That's a big part of why climbing has always appealed to me as well. It's a process of creation, not just performance. It takes imagination and independence to solve physical problems.
You can't photograph what you haven't seen, a most poignant observation by one of my photographic mentors, David Duchemin- rings particularly true in a time when there are more photographs than ever. Perhaps the value is more in why we go to see these places rather than in the beauty of image alone. The meaning isn't just aesthetic. My vision is to be able to communicate that value with fewer and fewer words to assist the images.
Photographs are like a bank account where we store feelings and experiences for rainy days or to loan to others. They are an escape hatch from the present reality--a reminder that there is more out there to see and do. These particular images are from our time in Mono Lake and Devil's Postpile (California) as well as a few from Oregon and Washington. I look forward to opening this escape hatch wider in the future. It will be a long road to El Capitan and I expect to see many things along the way.
I was recently asked on Instagram: "How do you deal with the emotional burden and sadness of living with type 1 diabetes?" This question is almost always presented in terms of how can we stop the suffering. I want to look at this differently: how can we use the suffering to build something bigger than the pain. I've been thinking about that question in the context of my own recent loss. I think the answers are the same regardless of the specific source of the suffering.
Acceptance: This is the missing link. Trying to substitute avoidance in its place is just kicking the can down the road. If you wake up each day wondering why you have to struggle with diabetes it's because it hasn't become normal. Yet. Some part deep down is expecting or wishing that the struggle is a bad dream and that you will wake up one day and return to an easier normal. That fantasy is often cultivated on social media and it's the surest path to misery and feeling every bump in this road that we are unable to exit. Once the battle is accepted type 1 diabetes stops being special. It stops standing alone, out of reach of all the solutions that seem to work for everything else. My diabetes isn't it's own thing. It's a facet of my climbing. My travel. My photography.
You have to fully let it in so that you can let it out. Struggle needs an outlet. Accepting diabetes fully allows it to access and permeate the conduits that inspire us--and we are no longer left playing the good against the bad. The hardship adds value to what we create, if we can recognize the need to let our adversary out to play.
Influence: I know that the term "control" in relationship to diabetes is inelegant because it sets us up for an unrealistic outcome. I don't intend to get into the technical aspects of managing blood sugar here. Still there is tremendous psychological value in exerting all possible influence over our health. Diet matters. Exercise matters. Lifestyle and happiness matter too. There is much we can't control and that is much more bearable if we are making the best use of the variables that we can control. It won't solve all your problems but you will certainly learn something and even if it improves one small facet of your life it's a win. Small wins add up.
Investment: As I wrote in an earlier blog, the only thing that endures beyond us is the way we make people feel. The "good shit" we create in our lives and the lives of others that they can hang onto when times are tough. The truth is that sadness is inevitable. There's no way to be happy all the time. There's no way to have stable blood sugar all the time. I'm meticulous with my diet and exercise and lifestyle and I can tell you that the sadness and "burden" is always there. The trick is that I don't expect it to be otherwise, so I make sure to set that burden aside at times so that I'm not buried beneath it. I fully feel the low points in order to move beyond them. I've given myself permission to be vulnerable but not to wallow.
This understanding of alternating periods can guide the way we invest the time we have. Between the waves of sadness we start to see opportunity and hope. We exploit those moments and expand them. The alternative is waiting for the undertow to return, cringing at the knowledge that we are powerless to stop its inexorable onslaught. We use that harsh truth as motivation to invest the moments between and put good things in the bank--because the inevitability of suffering will certainly make it worthwhile.
The whole world is trying to remove burdens. Remove suffering. We are told to think of that as a solution. I don't believe that's the case. Burdens are the foundations for the monuments we are building that will carry the legacy of what we stand for, long after we have fallen by the way. I don't climb things because it keeps me from being sad. I climb things because I know that I can't help but be sad at times--and when those times arrive, I need to look back at the photos of the joy and times spent in the mountains and they become windows beyond my current sadness. They are an outlet for my diabetes and an escape hatch for my soul; reminding me that there is a reason to go on because sadness is just a middle, not the end.
When friends pass we realize this reality; but it's ever-present. We are just living in a bubble of perpetual unawareness. The numbness at this truth is temporary--it must ultimately be replaced with some feeling. Some resolution. Nothing outlives us besides what we make people feel. In some ways there is nothing more important because that is ultimately our legacy, nothing more--and nothing less. I've been struggling with the loss of my friend who had taken me and my family in over the last few months when we were in Las Vegas, stranded, after my car was totaled in a hit and run accident. He'd give to others to the point that it was absurd. It didn't seem possible that someone so generous could keep nothing left in the tank to sustain the joy that he gave to everyone else.
Chris Pittman always managed to make everyone feel important. He'd take you seriously if you shared a big goal. He wasn't the guy who'd ask 'Yeah, but are you sure that's a good idea?' or 'How are you going to get funding for that?' He had a special appreciation for the outrageous. His habit of living with life with no half measures was comforting in an odd sort of way. He'd always manage to catch his shoe laces on a Manzanita bush while hiking along the edge of a 500 foot cliff and somehow still walk away and be able to laugh about it. His approach was like that of a child on a playground. Always ready to share what he had and be your friend with no expectation of return or benefit.
Now he's gone and suddenly everything seems more dire. The bubble has popped--for a time at least. His levity was able to shield some of us and lift others to great heights. Still it couldn't pull him from the sinking sands. None of us could. The last time I spoke to him he said 'It's good to hear from you. I haven't really been communicating with anyone.' He had given up his seat on the lifeboat--not to be heroic. He said he just wanted to go for a swim. None of the outstretched arms could make him stay on board.
In the last few days I've had this feeling where I'm going along with my day, happy and then suddenly I'll trip over that hole that he left. While comforting me, a friend told me that this type of thing never goes away. She said, 'You can't try to understand it all or make it stop. You have to accept the pain and be content with holding on to the good shit. That's how you keep from falling in that hole'.
The loss of my car in Las Vegas and the delay that had me wracked with anxiety over the last few months--gave me the chance to spend my last times with Pittman. That's a special anchor to hold onto. I got to tell him how I loved him and that he was important to me. We talked about trying to turn his struggle with depression into an adventure project that could reach other people and shine a light into their world.
Time that I had anxiously spent waiting to get back on the road became a gift in hindsight. Sheer boredom forced me to focus on creation while I passed the time. I didn't have anything grand or adventurous to photograph so I took pictures of my friend. Those are the last photos of him. Even with the solace of knowing that I didn't miss opportunities with him--he's still gone and it still hurts. Some things are out of our hands and when that realization hits, we can only hang on to the good shit, because that's all that's left in the end. That's all that's worth investing in, every day.
Pick up that camera. Take that photo. Write that email. Climb that mountain. Your legacy doesn't belong to you. It's not the monolithic magnum opus of the driven competitor that is too easily romanticized and too quickly forgotten. It's not the act of ambition--but the way you make people feel along your path to the top. Those are the ashes which remain to commemorate our fire long after it has gone cold; they filter down through the sheen of our bubble-walls in which our life is guaranteed and suffering is optional.
I've had an unfinished project that's been nagging at me for a long time and you can't slay big walls just by talking about it from an office chair. I've spent the last several years hating my limitations while doing very little to challenge their preeminence in my life. Some of that has been practically motivated--supporting a family does take time and money. A lot more of it though, was a fear of getting shut down. Failure. Now I'm back on a mission to do what scares me and share it in hopes of raising awareness and empowerment for type 1 diabetes.
It's easy to talk about going beyond limitations but the truth is that before you can approach your limits you have to accept them. You have to love them, own them. Without them there would be no opportunity to transcend the challenge--which is how value is earned. We are not all special snowflakes. Value is earned, not given away like a consolation prize. I stopped earning and started coasting at some point in the last few years. I wondered why I found my well running dry.
I searched back through my past to try and tease out the point where I first started to coast--and I found it in Yosemite National Park, California, May 2012. I met my match on El Capitan. I came away from that climb defeated in a way that I have never really moved beyond since. That's why I'm going back there this fall. I'm going to find my limits and dance with them. I expect a main course of humble pie and suffering. It's not supposed to be easy--that's not why I love my limitations. It's an opportunity to struggle. It's my genuine hope that this project will reach those who need it with a message of empowerment--and that it will reach the public at large with awareness of type 1 diabetes.
In the last couple of years I've enjoyed learning about optimizing my diet using ketosis. I've been so privileged to have access to a CGM. I've spent countless hours checking my graph to see that number, like a rat in a maze, running for the promise of the cheese at the end. I kind of got addicted to winning the diabetes game because I could keep my numbers really tightly controlled--within a really tightly controlled environment. I spent many years advocating for type 1 as a reason to get outside and challenge fear--while ultimately succumbing to the trap myself. Turns out that having great numbers while living your life in service to a numerical readout isn't really winning anything. Winning boils down to investing success in the opportunity to fail.
I'm not beating myself up about the past--it's important to confront failures. We are too often scared of words like "right" and "wrong", "good" and "bad" because everyone wants to know that they're not the sum of their failures. Ignoring failure is the greatest failure of all though. It prevents us from growing and putting that shortcoming under the boot on the way to a higher summit. This is how I know that there is still a need for empowerment. For awareness. For a reminder that just because we aren't wearing an orange jumpsuit doesn't mean we can't be held prisoner. The tools we use to create a brighter future can become a hindrance if we are not vigilant to look beyond them.
I'm calling it The Unfinished Project.
As we are concluding the hateful process of replacing the car and preparing to get back on the road after a MONTH of crazy pitfalls the question of "why" keeps coming up--as in 'why are we bothering to do this?' Is full time RVing really worth it? Is there a better way to enjoy travel and adventure--by balancing the spectacular with the mundane? These are tough questions because we knew from the beginning that there would be hard days--weeks even.These types of difficulties are the "stress-testing" of this type of lifestyle.
I don't know what the right choice is going to be for our family in the long run. I fully intend to ride this out and make a solid year of it before considering plan "B" (pull the ripcord and bail). It's totally possible that we just had a rough patch and will pull through it brilliantly and won't ever want to consider quitting again. The question always comes down to quality of time spent together on adventures--which is not always congruent with quantity of time spent in pursuit of adventure! If there is anything I've learned from the last month it's that being out on the road can actually slow you down and kill a lot of time when things go wrong. That's not just inconvenient and costly, it slows down momentum of climbing and creative projects that I am working on to change the landscape of type 1 diabetes.
Like most difficult decisions I believe the answer will be some form of compromise--choosing the downside that allows for the greatest upside. The option for no downside at all doesn't seem to exist. Accepting the realization that a sacrifice must be made under the best circumstances is the best way to make deliberate decisions rather than being victimized by mishaps. This is a major part of my view on life with type 1 diabetes. The time we have is an investment and death and discomfort will come to us all sooner or later no matter our choices or station in life. It's better to figure out what is worth suffering for than trying not to suffer.
I recently announced on Facebook my decision to quit drinking coffee. This declaration was met with some disbelief and horror given my erstwhile penchant for drinking coffee. I'm still a little bit surprised at how personally people take it when you announce that you're choosing to do something differently with your diet. I promise, I didn't quit coffee in order to disrupt social conventions and that there is a legitimate reason for my choice. That reason is a combination of two factors: type 1 diabetes and El Capitan in Yosemite.
I failed on El Capitan in 2012 during Project365 and I vowed to return, but conveniently avoided doing so for a number of reasons that all seemed legitimate at one time or another. No one wants to fail and it's even less appealing when people are watching. It's also a lot more difficult being marooned on a tiny island in a vertical sea of granite for days at a time when you know that your body could revolt against you at any point, potentially with dire consequences. It's incredibly committing to feel medically vulnerable in a position that is so isolated.
Fear. It either becomes the reason to DO or to NOT DO.
Once I chose to let fear into the decision making process, I stopped making forward progress. Everything devolved into a circular holding pattern. It's totally reasonable to be afraid of having a low blood sugar on the wall. It's fine to be afraid of getting dehydrated and cramping up, or hauling too much extra or not enough extra. It's not ok to let that fear paralyze you.
Fear is a useful ally if it's not allowed to dominate the conversation. For that reason I am training. Preparing. Working out ways to mitigate situations that I am afraid of. That's what the next several months will entail--and here is where the decision to quit coffee comes in. I have found that one of the biggest factors that hindered me on past bigwall climbs has been dehydration which leads to cramping. Dehydration has also gone hand in hand with my most erratic blood sugar swings--which is anecdotal, but it is a pattern that I've noticed.
It's also worth noting that low carb diets definitely leave you more vulnerable to dehydration if you don't take consistent and fairly aggressive action to mitigate the diuretic effects of carb restriction. This is definitely one of the downsides that significantly offsets the blood sugar stability and energy that I have enjoyed in the last year of following a ketogenic diet. There's always a catch! It's not a deal breaker for me--it's a trade off. Coffee is part of what I'm choosing to sacrifice in order to be able to climb further and harder--and hopefully it will make it easier for me to stay adequately hydrated.
I will follow up on this in upcoming blogs because I am genuinely curious to see if this change will impact the way that I feel and my blood sugar as I am training. I have to say that so far I don't miss the jittery nerves, anxiety and insulin resistance I used to experience every morning with my coffee.
In the past few months I have been circling the wagons and getting the website rebuilt with the aid of Splitter Designs. I was confronted with the disparity between what I wanted to create and the reality of what I have been producing . The last few years have felt pretty unfulfilling--hollow, as though something has been missing from my work. I looked back at the posts and pictures and kept thinking 'Is this the vision? Is this the best you have to give? Where is the passion, the fire and the cutting edge?'
One of the things that has been skewing my vision over the last few years is a desire to be perceived as successful in order to attract sponsors. How else does and athlete/speaker/artist feed make a living? No one wants to sponsor failure. I needed to make a living doing what I do--creating adventure media that inspires people through my struggle with type 1 diabetes. As that reality grew, it stole my fire--my joy. I stopped speaking to the people who were supporting me and I moved on to the people who didn't care, who needed to be convinced of the value of the LivingVertical mission. I wanted to convert new followers more than caring for my existing ones. By simply reaching more people, I hoped that I could develop LivingVertical into a quazi-Team NovoNordisk, replete with corporate support and hundreds of thousands of followers--and a salary that could support my work and my family.
What I have found reflecting on all of this is that there is no shame in failure if you choose carefully the hill on which you are prepared to die. There is no honor in measuring success in terms of mass appeal or financial gains. I am returning to LivingVertical--full time until I cannot sustain it further. I have returned to the reason I started blogging and filming in 2011--to shake things up. To challenge the perception of chronic illness as weakness and to inspire interaction with the natural world around us a the means to win the battle for our minds. I don't think my work will ever be a "good fit" with selling drugs or devices. I am fine with that. I'm done measuring success based on distracting people who don't care. This may be the hill on which LivingVertical goes to die and while it may never be trending on Twitter, it will be honorable and true to the vision that inspired its origin.
I am thankful to have every one of you here--because you do care (or you wouldn't have read this far!)--and you are the audience that I should have been serving all along. I am sorry for failing to see that over the last few years. I am lucky to have finally put my finger on what was missing in LivingVertical. Now let's go rattle some cages and challenge the conventional wisdom, the marketing drivel and the stereotypes. There's still work to be done around here.