Ride: 10/6/18: Levi's Gran Fondo

5:55 am, October 6, 2018, and the anticipation had returned, finally. Awake five minutes before my iPhone alarm, I had slept six hours--more than usual for the night before a big event of any sort. My blood sugar was in range: 163 milligrams/deciliter--slightly high, but not too bad. I injected four units of short acting insulin to counteract my predictable post-waking rise. Though my $168 Motel 6 room was tiny and overpriced, the bed had been surprisingly comfortable. I had no kinks, no sore neck, but did some stretching and yoga anyway in the limited space available on the cold and dubiously clean floor.

Levi's Gran Fondo: the legend had grown in my mind for a number of years. The first time I had heard of it was on vacation with my wife in Guadalajara, 6 years before. A tall, blond, athletic man staying at the same cutesy boutique hotel as my wife and I had participated the year before. "Hardest ride I've ever done! The climb out of Cazadero is brutal and sweltering. I had no idea." My step sister had also done it and claimed it was her second hardest, after RAMROD--Ride Around Mount Rainier in One Day... and she had already completed two full Ironman Triathlons by then. My fortunately inaccurate mental image was of long, steep, rutted stretches of pavement frequented by wandering cows and bulls, no shade and rivers of sweat up to a narrow, wind-swept ridge.

My original plan, before my last big training ride 16 days before, was to do Levi's fourth tier of difficulty, the Gran Fondo with the Willow Creek option, 100 miles, 8,000' vertical. It would be my biggest ride to date. Training was going well. I was psyched up, feeling conditioned and capable. Then, on September 20, things got complicated. I bombed out on my final training ride--the route of the Fish Rock Challenge. 55 miles and 7,500 vertical in, with a bad migraine, little water left, and legs of jelly, I tried unsuccessfully to hitchhike off Mountain View, a beautiful but interminable and isolated back road. The whole experience put me in a bad mental place for the infamous Levi's. Cycling hilly distances always entails some suffering, but never before had I been so miserable on a ride. To deal with the anxious foreboding this had left in my mind, I just had to see how I felt on the day of the ride. If needed, I would scale back my goal to the 60 mile Medio route. In the meantime, I focused on the two major successes of September 20: no low blood sugars, and, in the end, I had done 66 miles and 9,000' vertical before my mother-in-law and son picked me up in Manchester, saving me from the last 8 miles of Highway 1 to my truck after sunset.

Meanwhile, back in that dingy motel room on the morning of October 6, I was feeling 100%. While I stretched, I plotted my carbohydrate/insulin day in my head. Once the ride started, I should shoot no insulin at all, unless my blood sugar went over 300. At Cazadero I would start packing as many grams of carbs into my stomach as possible. The challenge would be to not go too high before then. Breakfast would have to be nearly no-carb: a cup of plain yogurt, some cold black coffee from the night before, and a half cup of peanuts. Letting my numbers rise too much before riding could lead to a roller coaster, with deep lows through the day that would be hard to recover from and set me back unaffordable hours. I would need some carbs before riding, but at exactly the right time. Type 1 diabetes presents many logistical challenges, but adding strenuous workouts into the mix ups the ante enormously.

When I received my diagnosis in April 2009, I read a number of books on the subject, and endless articles on the internet. It seemed so straightforward, a simple numbers game: ideal blood sugars were between 80 and 100 milligrams/deciliter; 1 gram of carbs equaled a 4 point rise, 1 unit of insulin dropped your blood sugar 50 points, thus 12 grams carbs should equal a 1 unit injection. All one needed was a grasp of basic math and a lot of will power.

One year in, the pitfalls in this facile explanation had become obvious. I was often going too high, but more often going too low, which I now know is potentially quite dangerous. At my appointments with my general practitioner or my endocrinologist, they'd plug my meter into their computer and, to my shame, see all those hypoglycemic moments: 42, 38, 64, 45, 52, 41, etc. Once, I was as low as 32 mg/dl, which should have involved a direct trip to the ER, no passing go, no collecting $200. Somehow I stayed conscious, just got all sweaty, weak-kneed, and confused, until the glucose tabs and grape juice kicked in. "If you can't keep your numbers under better control,” my team of doctors (when you have type 1, you get a whole team of doctors) would tell me, “you shouldn't be driving or riding a bike at all. You could black out on the road anytime. Even if you don't crash, it is really bad for your heart and adrenals!"

I got lots of well-meaning advice: "Lower your long-acting dose." "Less fast-acting insulin after eating." “Gymnema silvestre.” “Eat only raw foods.” “Atkins!!” "Less carbs so you use less insulin." “Cinnamon capsules!” "More carbs so you won't go so low!" One friend of Chinese descent brought me a pile of bitter melon, which I... learned to like.

Now I can see that at the root of my problem are more variables than I for one can account for: grams of carbs, types of carbs, grams of fiber (a carb but one that instead of increasing your blood sugar can slow its rise), types of fiber, grams of fat, types of fat, hours of sleep, level of stress, insulin resistance on any particular day (under-recognized in type 1 diabetes), hours and intensity of recent exercise, etc. Everything matters, and only 25% of it is easy to quantify. Label deciphering became my everyday pursuit.

Again, back to October 6: 7:45 am, and I was lined up in the 18 mph average group, feeling racy. There is nothing like standing in a mass of 5,000 plus cyclists, ready to roll. Sleek carbon frames, vintage steel, multi-colored helmets, matching turquoise socks, sunglasses and smiles. Flashy jerseys announced past rides (and corporate sponsors): “Sierra Triple Crown; Moab Gran Fondo; Dairyland Dare; 2015 Death Ride—5 Pass Finisher; Bike the Big Blue; RBC Gran Fondo Whistler; Novalog, Bank of America, Tillamook Cheese, Lagunitas Brewing, Sierra Nevada, Air Emirates, etc. The multilingual excitement was dizzying. Out of the din of English chatter, I could pick out UK accents, French, Spanish, Japanese, Mandarin maybe, and other tongues I couldn't identify. People had come from around the globe for Levi's.

I had to deal with my condition before pedaling. I poked my finger and dipped my test strip into the drop of blood, both hoping that people around me wouldn't see--and would. I am proud of being an insulin rider—and anyway who doesn't want everybody else to know just how much they suffer. The meter let out a soft beep: 226 mg/dl. I have to go high or I will go low. I gulped down a juice and munched an apple: 40 more grams of carbs. It seemed like a lot, but I would need those grams before I had another chance to stop in Cazadero, 30 miles and a few hills up the road. If I didn't get there by the 10:00 cutoff time, I would be waved onto a shorter route, so I would only stop if absolutely necessary.

From there, the day streamed by: beautiful ups and downs through the vineyards and forests to Occidental. A rather treacherous downhill to Monte Rio, with two riders in front of me nearly losing control, putting a whole group of us into momentary panic. Overpriced houses in deep shade on stilts and steep hillsides.

9:45 in Cazadero: 227 mg/dl. At the well-stocked pit stop I ate watermelon, banana, strawberries, and a handful of nuts. I didn't even attempt to count carbs. 10:53 on the phenomenally gorgeous King's Ridge Road: 85 mg/dl. This was on the edge of too low, and I assumed I was dropping further, quickly. Standing at a pull-out sucking down 75 grams of carbs worth of energy gels, riders streamed by checking in: “All good?” “Need help?” “Everything okay?” I gave the thumbs up, mounted, and headed up the next long hill.

I know I am not the fastest cyclist, but I do consider myself in good shape. Still, when a line of riders sporting matching chiseled calves pass on a 15% uphill grade going twice as fast as me, or when two women in their seventies pedal by in the midst of a relaxed conversation about flank steak with lemon pepper and just the proper cabernet pairing, it's humbling.

11:48 at the King's Ridge Pit Stop, just before the perilous descent to Hauser Bridge over the Gualala River, where a rider had flown off the road and died in 2015, I tested 153 mg/dl. This was a good number, but, with ample elevation gain to go, I was free to stuff my face: more watermelon, more strawberries, potato chips, salty nuts, even a few jelly beans. The weather was perfect, cool, sunny, a tail-wind from the North, the riding superb, the mood at the pit stop one of general elation. Endorphines filled the air. Though I had only gone 47 miles out of 100, I knew then that I could do it. I would be finishing the whole ride. The big challenge left, other than finding the will power to make it up the many remaining hills, would be to keep my blood sugar in range.

At the moment, things were going well: 117 mg/dl at 12:53, heading up to the Ritchie Ranch Pit Stop, where delicious sandwiches awaited, made to order by a smiling team of volunteers from the Santa Rosa Cycling Club. I had turkey and ham with onions and pickles, and, just to be on the safe side, a non-diet soda, a rare treat for any diabetic. The Meyer's Grade descent followed, one of the high points of the ride, three miles of steep downhill curves from the ridge top to the beach, the biggest danger after speed being the possibility losing yourself in the picture-postcard views down the coast to Bodega Bay and Point Reyes.

2:32: 194 mg/dl. 3:24: 114 mg/dl. If you're wondering why I don't use a continuous glucose monitor—I do. But for me it is inaccurate and unreliable on strenuous rides, so I am left with the faithful finger prick blood test. I squeezed more tubes of energy gel, ate more apples. Through the touristy town of Jenner, across the Russian River, up the 8 miles of dirt and gravel through the Redwoods at Willow Creek, with its short and torturous nearly 20% gravel grade, down the swooping curves into Occidental, more juicy melon, more strawberries, across 10 miles of flats, up the bike path to the bustling festival at the finish line in Old Courthouse Square, smack in the center of Santa Rosa.

Done at 5:01 with a satisfying reading of 104 mg/dl. My 9 hour time was slow in comparison to the majority of the other riders, but I was only racing myself. I had made it through my first Grand Fondo with no hypoglycemia, no muscle cramps, no flats, my mood high. The ride had by no means been easy, but neither had it been torture. My training had been effective. I will never win a race, but this was definitely a victory, and a damn good time for ice cream.