Visit Portugal

tldr; version: Portugal is a great off-season destination with mild weather and few crowds, particularly in Algarve where the beaches are full of people during summer. The landscape, history, art and architecture are spellbinding, and the food is some of the best I’ve found anywhere. Bonus: It’s an inexpensive place to visit.

What follows is a travelogue of sorts. Want to jump ahead to specific topics? Here you go.

Why Visit Portugal?

Portugal has been on my radar for years, but it wasn’t until considering and discarding several possible destinations for 2019 that Beth and I committed to visit. Why visit Portugal?

  • History: Portugal is the product of African, Asian and European influences, and played a critical role in early exploration of trade routes. And, the 1755 earthquake remade the country–particularly Lisbon–in a significant way. If you’re a history geek like me, this is a draw.
  • Culture: Portugal shares a peninsula with its neighbor Spain, but has a distinct culture that’s proudly independent and yet welcoming.
  • Food and wine: Portugal is justly famous for its seafood and wine.
  • Mild winter weather: After a few cold Decembers in France we were ready for moderate temperatures and little rain.
  • No crowds: Portugal can be crowded in summer but during winter people mostly disappear.
  • Cost: Portugal is known as an inexpensive destination–even the major cities.

Once we committed to visiting, the big question was where to go within the country.

We had a week-and-a-half, minus an overnight in London on the way home, and wanted to spend time in Lisbon and get out of the city for a while. A lot of poking around in books and on the web led us to the Algarve region in southern Portugal. In the summer, it’s one of the destinations for European beach vacations. In December, it would be quiet. We decided to overnight in Lisbon when we arrived, pick up a car and go south to Algarve for a few days, then return to explore Lisbon.

Beyond that, we didn’t have a particular idea in mind of where in Algarve we would base ourselves. I spent a few weeks combing through maps, looking for a town that offered easy access to the places that were starting to pile up on our visit wish list, where we could rent a suitable apartment, that had good restaurants, and that wouldn’t essentially be closed for the off season. The answer was Olhão, the largest fishing port in Algarve and a perfect gateway to the Ria Formosa natural area. After some searching I located an apartment near the town’s waterfront. The location on a quiet lane, and a rooftop terrace, were selling points.

We flew American Airlines from Raleigh, NC to London Heathrow, then went on to Lisbon on British Airways (an AA oneworld partner). We hadn’t counted on strict security checks when changing planes, so my water bottle and Beth’s hair gel went into the trash. Otherwise, the trip was relatively stress-free. Seven-ish hours to London, 2:45 to Lisbon, a speedy trip through passport control and we were hailing a taxi to go to the center city.

Pro tip: Download the Kapten app before arrival and use it to get around Lisbon. Kapten is a European competitor to Uber; imagine a business that’s doubled down on an economically unsound strategy and recruits legions of taxi-hating drivers to carry out their mission. But Kapten is cheap (seven Euros to return to the airport later in the week versus 45 Euros to take a taxi on arrival; other trips averaged five to six Euros), the drivers are cheerful and full of advice, and it’s easy to get a car anywhere in the city.

A note about languages: Portuguese is the native language, while English is widely spoken. Communication was never an issue for us, even though my Portuguese is “not the worst I’ve ever heard” (said a local).

Our Lisbon Itinerary

Really seeing Lisbon–a city of 600,000 that’s spread across a wide area atop seven hills–was out of the question. We focused on four areas: the neighborhoods of Principe Real, Belém and Alfama, and the riverfront. We were still hard-pressed to see everything we wanted.

Principe Real descends toward the Tagus River past parks (and an organic market on the Saturday we visited), shops, restaurants and bars. It’s the posh part of Lisbon, and if trendy shops and department stores are your thing, this is the place.

Newly arrived, we were focused on getting our bearings and finding a meal. Principe Real was ideal for both; great restaurants were plentiful, and we were able to get a wide view of the city.

A view of Lisbon from Principe Real.

Lunch in Lisbon can stretch on into late afternoon and the sun was dropping as we descended toward the waterfront. The area along the Tagus used to be neglected, but after recent development it has become a popular gathering spot. Numerous restaurants and kiosks serving food and drinks dot the waterfront. It’s a great place to people watch or take in the river view.

Freight ships on the Tagus River at sunset.

I mentioned the lack of crowds. This is mostly true, but our first evening in Lisbon coincided with the “Spanish weekend,” which a local described as the time Spaniards visit Lisbon before Christmas. After sundown we wandered through the Christmas market at Praça do Comércio and took a meandering walk back to our hotel. Many streets were so full of vacationers that we had to force our way through the crowds.

One noteworthy thing I’ll mention: From the time we arrived in Lisbon until we returned after our time in Algarve, we never encountered a single American tourist. In Algarve, most locals thought we were French or English, because it’s so unusual for Americans to visit during the off season.

Christmas tree at Praça do Comércio.

We stayed in Alfama after returning to Lisbon from Algarve. It’s a fascinating neighborhood–a former Jewish quarter that was heavily influenced by the Moors. Because it was the only part of Lisbon that wasn’t destroyed by the 1755 earthquake, it isn’t built on the grid that characterizes the rest of the city. Instead, it retains its narrow, winding streets.

Street cars share narrow lanes with cars, tuk-tuks, cyclists and pedestrians. The famous #28 line travels from near the river to the top of Alfama; cars pass within inches of sidewalks, and in some places the streets are so narrow that vehicles take turns passing each way.

Alfama is incredibly vibrant. I enjoyed walking the streets and shooting photos of people and places, but there are cathedrals, shops (including those specializing in tile), restaurants and bars, street art, public plazas, and other sights to see. A week in Alfama would be time well spent. One evening I followed the tracks of the #28 line all the way to the river; it’s a perfect tour of Alfama.

We enjoyed a couple of memorable meals in the neighborhood, and it’s a great place to find one of Lisbon’s famous rooftop bars and watch the sun set.

The famous #28 tram in Alfama.
One of the ubiquitous tuk-tuks in Alfama.
Street art by our hotel in Alfama.

Beth’s interest in Lisbon included learning about Portuguese tiles. We picked a rainy day to visit the National Tile Museum, which is housed in a former convent that includes an impressive church. It’s worth visiting; we learned about tile design from the Moorish era through today, and watched conservators restore tiles in the workshop.

The highlight for me was a 75-foot mosaic showing pre-earthquake Lisbon. It’s among the most rare and valuable artifacts in the museum, as it’s one of the few works of art that depicts pre-1755 Lisbon.

Tile mosaic showing pre-earthquake Lisbon, in the National Tile Museum.
Church in the National Tile Museum.

Most recommendations of places to see in Lisbon include the Belém Tower. It was typically the last place 15th century explorers saw when leaving Lisbon, and the first thing they saw when returning. We visited at low tide, when we were able to walk around the base of the tower. I had read that the interior of the tower is less than impressive so we passed on that; I loved being able to spend time looking at the exterior from different perspectives.

Belém Tower.

The Tower’s less well-known neighbor is worth visiting: The Memorial to Overseas Combatants, which includes the tomb of the unknown soldier. This beautiful but somber memorial remembers those who lost their lives in the Portuguese Colonial War, which led to the downfall of Portugal’s fascist government. We wandered around the memorial and spent time looking at the names of soldiers and NGO workers who gave their lives in the “Overseas War.”

Monument to Overseas Combatants, and the Tomb of the Unknown Soldier.

Our path through Belém took us from the Tower to Jeronimos Monastery, a UNESCO heritage site with an impressive cathedral.

Jeronimos Monastery cathedral.

From there, we took a short walk to Pastéis de Belém for some of their famous pastel de nata and coffee. Refueled, we took a meandering walk past the Presidential Palace and back across the main avenue to the waterfront.

Entrance to the Presidential Palace.

We could have easily burned a couple of days along the river in Belém, where there are numerous museums, including a memorial to Portuguese seafaring exploration, and the striking MAAT, or Museum of Art, Architecture and Technology, as well as a busy marina. Short on time, we wandered while I shot photos.

Compass rose plaza in Belém.

What We’ll Be Sure to Do Next Visit to Lisbon

We plan to go back to Lisbon, and a few things are already on my itinerary:

MAAT: A stunning contemporary building on the Lisbon waterfront.

What We Chose to Skip

There were a few things we avoided in Lisbon:

  • The #28 tram, which winds through Alfama. It’s crowded and a magnet for pickpockets. Plus, the walk that follows the tracks is much better.
  • The elevators and funiculars that carry passengers between different street levels. They’re tourist attractions, and lines were long and our time was short.
  • Tuk-tuks. They’re everywhere in the city; expect to get a sales pitch on seeing Lisbon from one of these three-wheelers. Again, Lisbon is a great walking city so we opted for that.
  • Fado. Not that I’m not a fan of this uniquely Portuguese music, but many performances are part of an expensive dinner service. I was tempted to visit the Fado History Project in Tavira, where artists in residence perform.

Algarve

After looking at train and bus options to get to Olhão we chose to rent a car and have the additional flexibility it would offer. I picked up our Fiat 500 from the Europ Car office near our guesthouse then we were on our way.

Driving in Portugal is easy, thanks to one of the best road systems in the world. We used Google Maps for navigation; this only let us down once, when we lost cell coverage in a rural area along the coast. No problem–the roads were well-signed and we were able to find our way to our destination.

A straight shot down the A-2 and A-22 would get us to Olhão in under three hours, but once we were out of Lisbon we veered west on the N120 and followed it and secondary roads to travel along the coast. Our route took use through Alentejo, which is a major cork-producing region where stripped tree trunks, numbered by the year of the harvest, are a common sight.

Stopping among the cork trees in Alentejo.

We wound our way through olive and orange groves while looking for a good view of the Atlantic Ocean. We found it in Azenhas do Mar, where a street ended in a small parking lot and restaurant perched atop a cliff. A couple hundred feet below, fishing boats launch behind a breakwater.

We walked along the clifftop, then followed a boardwalk toward an overlook about the boat ramp. I noticed a trail snaking up a nearby hill and discovered a rope hikers use to descend from the road to the trailhead.

Azenhas do Mar

Pro tip: Use Auto Europe to book car rentals. They’re an agent for many popular rental companies and allow price comparisons and online booking. In most cases they’ve directed us to rentals from Europ Car, but it’s helpful to be able to compare rates with Avis, Hertz, Sixt and other companies. The majority of rental cars in Europe, and the least expensive, have manual transmissions; you’ll pay a premium for a car with an automatic. In Lisbon, picking up and dropping off the car at a city office saves you a significant airport franchise fee. Tolls are common on major roads; rent an electronic pass to save time.

Pro tip: Technically, it isn’t absolutely necessary but getting an international drivers permit from a local AAA office before traveling overseas is a good idea. It’s not a license, but a multilingual translation of a USA state license that’s valid for six months. While I’ve never had trouble renting a car without one, it might save time if encountering non-English-speaking police or other authorities.

We arrived in Olhão late afternoon, quickly found a parking spot along the main street, and carried our luggage through narrow lanes to our home for the next few days. In central Olhão, homes are mostly multistory and…elevators? Forget it. Climbing the steep steps wasn’t an issue, particularly once we made our way to the fourth level terrace, where we had a stunning view of sunset.

Terrace view, Olhão.
A typical street in the center of Olhão.

A few thoughts about Olhão: It’s a wonderful city that turned out to be a perfect base for exploring Algarve. The town’s cubist architecture is typical of much of Portugal, and we loved walking the narrow streets in the central part of town. There’s a relaxed vibe, and we were often surprised by small acts of kindness. At one point, Beth and I were trying to figure out how to get to a restaurant; a local woman noticed, came over and introduced herself, and guided us there. The sheer number of wonderful, creative restaurants was overwhelming. I’d love to go back.

Our plan for the next few days started with a trip to Tavira, a few miles along the coast. It’s a small city bisected by the Gilão River. Originally settled by the Phoenicians, then Moors, then Romans, it was mostly destroyed by the 1755 earthquake.

Tavira is a great walking town. Our path took us across the Roman Bridge, which was built on the foundations of a Roman trading road and is now open only to pedestrians. From there, we walked around the central plaza, then headed up a hill toward the Tavira Castle.

The castle sits atop a high point in the city, houses a quiet garden where people picnic, and offers a panoramic view of the city from atop the fortifications. The nearby Camera Obscura was also on our list to see, but was closed for maintenance.

Tavira, seen from the fortress walls.

Further along the coast, we stopped at Cacela Velha. It’s easy to miss this tiny town that overlooks the Ria Formosa. There’s a parking lot on its outskirts; stop there and then walk through this village that consists of a fortress wall, a church, a few homes, a couple of restaurants, an art-filled plaza, and a cemetery. This Moorish and Roman-influenced town was one of the most fascinating places we visited.

Clothes drying on a line in Cacela Velha. This is a common sight across Portugal.
The Ria Formosa, from the walls of Cacela Velha.

Below Cacela Velha is Praia do Cabeço. We followed a rural lane to get there, and found parking lots full of campers with off-season beach vacationers. Even with the December “rush,” finding a quiet spot on this gorgeous beach was easy.

Praia do Cabeço

The next day, we drove an hour or so west to Portimão, a medium size port city that’s a launching point for tours of the Benagil sea caves. We took a two-hour guided tour along the coast that traveled through several sea caves, and introduced us to some of the more popular beaches in Algarve.

Getting to the caves and many beaches requires a boat, board and kayak. The quick intro to the area was good, but if I returned I’d prefer to rent a boat or paddle a kayak to the caves.

Inside a sea cave at Benagil.
Explorers at the caves of Benagil.

Sagres and its famous fortress were next. We drove an hour to the fortress, which sits inside a natural area overlooking the ocean. It only took a few minutes to see the fortifications and unusual wind compass, before we spent a few hours exploring the grounds, which stretch across the cape. Aside from the foundations of earlier fortifications, there’s a chapel, an art installation that amplifies sound from a grotto, and lovely views of the coast. We watched serveral

Sagres holds an important place in Portuguese history. Henry the Navigator, who supported the opening of new trade routes, established a navigation school at Sagres during the 15th century. These days, it’s become a mecca for surfers. The shape of the cape creates multiple surf breaks, so beginners to pros can find the experience they want.

Sagres, where surfers congregate.

Our last day in Algarve began early in Faro, with an excellent breakfast and dodging drizzle as we walked around the waterfront and old city. Beth hoped to see the famous ossuary, a chapel made of the bones of monks, but we were denied by another seasonal closure.

Fortunately, the showers cleared before we started our boat tour of the Ria Formosa. The barrier islands near Faro are home to flamingos, egrets, cormorants, ospreys and numerous other birds. The area is also known for its fishery and salt production.

Maybe it was the threat of bad weather, but we lucked out and it was only Beth, me and our guide, Fernando, on the boat. That gave us plenty of time to ask questions, explore different areas while we looked for birds, stop on a beach next to an inlet between the Atlantic and the Ria Formosa, watch kite boarders, and learn about the fishing village that’s slowly disappearing from a barrier island. Though I’m not really a birder, I thoroughly enjoyed the tour and was excited to see one of the few ospreys that live in the area.

Ria Formosa, with Faro in the background.

Checking a Box: A Couple Hours in Spain

The day we visited Tavira we were only 45 minutes from the Spanish border. Sometimes you just have to check a box, and in this case that box was visiting a new country. We crossed the famous bridge over the Guadiana and went to Ayamonte, where we parked and walked along the Estero de la Rivera (a river with a large marina) for a couple of hours, checking out the Christmas market.

Pro Tip: You’ll see this in many European tourist cities–”entrepreneurs” (sometimes military veterans) will “claim” a free parking lot and direct cars to empty spaces, with the expectation that drivers will tip them for their help. This happened in Ayamonte (as it has in other cities), and I appreciate the assistance finding a spot in a crowded area. A Euro or two is customary, and it’s worth the time and aggravation it saves. You won’t have to find them; they’ll find you.

Eat, Drink, Stay

Lisbon

Magnolia Guesthouse: We spent our first night in Lisbon in this comfortable bed and breakfast in the center of the city that is also a short walk from our car rental office. There are only four rooms, each with a private bath, and cozy communal areas. The proprietor, Raquel, knows the city inside and out and has great suggestions for places to see. Highly recommended.

Dalma Old Town Suites: Our base for part two of our Lisbon stay. Located in Alfama, the old city, where the roads are narrow and wind up and down steep hills. We stayed in the Garage Room located just off the lobby; you might want to avoid this room if you’re averse to having a tiny bathroom with glass walls. Despite the lack of privacy, Beth and I enjoyed our stay and would return. At about $55 a night, it’s a fantastic bargain for a comfortable, well-located inn. And, the restaurant has an excellent breakfast for eight euros a person.

Memmo Alfama: A highly regarded boutique hotel on a side street in Alfama. We looked at staying there but decided it was too pricey compared to other options. However, they have a lovely rooftop bar where we sipped excellent cocktails while looking out over the Tagus River. Despite it being December, the temps weren’t bad and the blankets offered by the server kept us plenty warm. If you visit the terrace at night, watch out for the swimming pool–there’s nothing to prevent you from falling in.

Os Gazeteiros: My favorite meal in Lisbon. They have a fixed tasting menu that’s derived from the ingredients found at market each day. It’s a bargain at 35 Euros per person. We had three main courses followed by two desserts. These were dorado in broth with seaweed; purée of pumpkin with cockles and sesame seeds; polenta, mushrooms and artichoke cream sauce; poached pear with caramelized ginger; and chocolate mousse with matcha crumble. We paired this with a bottle of local orange wine. The staff clearly loves their work, and our interactions with the servers and chef made for a great evening. Highly recommended–be sure to make reservations.

Time Out Market: Think gourmet food court, though that’s selling it short. Many of Lisbon’s best chefs have opened outposts here, and it’s a compelling concept. Grab food that appeals to you and sit at communal tables in the middle of a vast but crowded warehouse. After a drink at the Time Out Bar, Beth got a burger from Ground Burger while I opted for sardines and roasted peppers on toast from Cozinha da Felicidade. Afterwards, we sampled pastel de nata from Manteigaria. Recommended, particularly if your party can’t agree on what to eat. You’ll be spoiled for choices here.

Tapisco: In Principe Real, this was the first place we ate after arriving in Lisbon. We settled into a tiny table and immediately got into a conversation with a local couple who filled us in on the Lisbon scene. Spanish and Portuguese tapas share the menu, along with several excellent wines and a vermouth bar.

Canto Da Vila Bistrô: A nice surprise in Alfama we found while investigating another restaurant. Beth had pasta and I ate bacalhau (cod) and potatoes in cream sauce. We were there for lunch and the place was inexplicably empty. We would have gone again if there weren’t so many other places we wanted to try. The lunch menu at about 13 Euros each is a bargain.

La Campania: Competent Italian food served by old school, taciturn servers. A local told us she got the cold shoulder there until she told them she lived in the neighborhood. There aren’t a lot of options near the Magnolia Guesthouse, and this was the best available. That’s not to say it’s a bad choice, but in a city of great restaurants it’s solid but not a standout.

Pastéis de Belém: There’s a lot of debate about where to find the best pastel de nata, or egg custard tarts, in Lisbon. After sampling several contenders, Beth and I agreed that Pastéis de Belém, where the recipe originated, was our favorite. Just out of the oven, their tarts have a flaky, crunchy shell and warm, not-too-sweet center. Expect crowds–the left door is for diners who want a table, and the right is for take-out.

Conserveira de Lisboa: An entire store devoted to canned fish. I brought home several tins of smoked trout, sardines and cod.

Algarve

Salt House, Olhão: Our home in Olhão, this beautiful place has a second-floor kitchen and living room, a third-floor bedroom, bathroom and balcony, and a terrace that overlooks the waterfront. There’s no parking on the street, but during the off season it’s easy to find a spot nearby on the main street, and there’s only a short walk to the house. Centrally located, with multiple great restaurants and bakeries within a three-to-five minute walk.

Tapas e Lendas, Olhão: Sometimes you just need to put your foot to the culinary throttle and not let off. We did that here, and asked the kitchen to keep bringing us fantastic tapas (olives, cheeses, marinated peppers, beef, an octopus tentacle that was out of a Jules Verne novel, etc.) along with a couple bottles of wine, dessert, espresso and port wine to finish. You would imagine this would cost a fortune, but it’s Portugal so the price tag was ridiculously low for the amount and quality of food we ordered. Eat here. You won’t regret it.

7imeiowinebar, Olhão: Octopus, black pudding and sweet potato seared in olive oil was the very best thing I ate while in Portugal. I would go back to this place again and again, just to eat that one dish. However, everything we had at this tapas bar was superb, and the service excellent. Highly recommended.

Terra i Mar, Olhão: Here’s a sign of how good the food is in Olhão–my meal (a whole fish) was wonderful, but it was also the least memorable of all the meals I ate. Beth’s steak and gargantuan shrimp were similar in quality. This isn’t to fault this place; it just has some stiff competition from many creative restaurants. The wine list is good, and we had a tasty bottle of vinho verdé (Portuguese green wine).

Saaz Craft Beer House, Olhão: Portugal is wine country, but sometimes you want a beer. This quiet spot, off the beaten path, has a good selection of reasonably-priced craft beers, including a lightly-hopped, tasty regional IPA.

Chelsea–Coffee & Brunch, Faro: You can get tired of eating pastel de nata and bollo de arroz for breakfast, so we opted for brunch in Faro at this roomy, friendly spot. I was happy to see shakshouka on the menu; with a cup of excellent coffee, it made for a great meal.

Portugal Photographs and Map

See a complete gallery of photos from Lisbon and Algarve. You can also view a map of places we visited.

Postscript: London

Our travels home included an overnight in London. Check back for details about that part of our journey.

Thoughts on the Dexcom Share Outage

Some background for those wondering “what’s a Dexcom?” and “why should I care about a ‘Share’ outage?”: Dexcom manufactures a popular continuous glucose monitor, or CGM, that allows people with diabetes who wear it to monitor their blood glucose levels in almost real time. It reduces the need for manual BG checks using a glucometer, provides advance warnings of low and high blood glucose events, and can interface with a popular insulin pump model to partially manage delivery of insulin. Dexcom’s Share server allows their CGM users to share blood glucose data with friends and family, so that others can remotely monitor them using a smart device. Share has been down for much of the Thanksgiving weekend, and to put it mildly, a lot of people are not happy. 

Online service outages happen, and the more essential they are to our daily lives, the more angry we are when they happen. We’ve come a long way from the days when the worst that could happen was a website going offline. Online services are more deeply embedded in our lives, and the consequences of outages are – or in some cases feel – more serious.

A couple of suggestions for Dexcom

Companies that deliver essential online services, and I’m looking at you Dexcom, would do well to remember two cardinal rules:

  • First, be clear with users about whether you are delivering a core product or a secondary service. As the anger over the outage spread, I began to think about the nature of Dexcom Share and whether it can be classified as one of Dexcom’s core offerings, or an add-on service that supports the primary product (their G6 CGM). The messages are mixed. It’s part of a very expensive product set (and I know – I just dropped a lot of money for G6 sensors and a transmitter), but it’s free to use. IMHO, anything that’s free – email, social sharing, etc. – is a crapshoot in terms of reliability. A paid service also comes with the right to complain when things go wrong. But here, we have a free-but-essential service. See the potential conflict?
  • Second, communicate in a clear and timely way. Look at the screenshot below. It says everything about the poor quality of Dexcom’s messaging, and the confusion it’s creating. The timeliness of updates on social media isn’t any better.

Rush to judgment

In the type one diabetes community, everyone’s journey is different. My experience as a person who has lived with diabetes for 43 years is radically different than that of the parent of a newly diagnosed child. I managed my diabetes for years without access to a glucometer, using pork insulin; new initiates to the diabetes community may have access to insulin pumps, CGMs, more sophisticated types of insulins, and other treatments, drugs and tools, including Dexcom Share. That’s their normal, and it informs how they deal with the disease. I may not necessarily understand the venom that’s directed at Dexcom, but I understand that it’s coming from a place of concern about loved ones and the feeling that something they depend on has failed them.

But here’s something that needs to the mentioned : Access isn’t the whole story. Tools to manage type one are expensive, and the majority of people with type one diabetes aren’t able to afford them. Relying on Dexcom Share implies that the user has a privilege that many can’t enjoy.

Many who enjoy that privilege took to social media to vent their frustration with Dexcom and assign blame for the outage. The frustration is understandable, but the conjecture wasn’t helpful or constructive. Suggesting that Dexcom doesn’t care about their users, isn’t properly staffed to deal with an emergency, hasn’t paid for reliable cloud infrastructure, and demanding a full accounting of what went wrong –while it’s being repaired – doesn’t solve the problem.

We all need to vent, but as a customer I’m more interested in knowing what went wrong and how the company plans to prevent it from happening in the future. If the answer isn’t satisfying, that’s the time to press the case with Dexcom and maybe consider moving to another solution. The latter step admittedly isn’t easy because of the few available CGM options, which is driving some of the online anger.

But if the tech is essential to keeping someone alive, venting is the least constructive thing to do in the moment. If there’s not a Plan B for a tech failure, health care providers can help. Facebook comments are a distraction.

This is going to happen again

There will be future outages. If not Share, with some piece of technology that lessens the burden of type one. I’m not going to offer advice about how to respond to those failures. My circumstances (pump/CGM user who doesn’t Share) are probably different than those of many reading this. But regardless of how you or I respond, everyone with type one needs to have constructive plan to manage the disease when technology fails. We can’t press pause while we wait for some piece of tech to start working again. We have lives to live.

Disclosure: I’m a longtime Dexcom user, but other than giving them a lot of cash over the years I have no relationship with the company. So I can say whatever I want, within limits.

Categories T1D

Unfinished business

More than 30 years ago I was a pilot. I held a private pilot license and flew gliders, with most of my 125+ flights in the Schweizer 2-33, Schleicher Ka-8, Blanik L-13, and Grob G103. Because of type one diabetes, I wasn’t able to get a medical certificate needed for power flight, so my seat time in planes with engines was limited to flying with friends in a variety of 1940s-era taildraggers.

The FAA will now grant exemptions for private pilots with T1D* and this sparked my interest in going back to flight school. After research into medical waivers and local flight schools I booked a discovery flight with Elon Aviation at Burlington-Alamance Regional Airport (KBUY). My goal for the flight was to get reacquainted with flying and see if it’s something I want to pursue.

First, props to Elon Aviation for a great experience. I booked my flight in a Cessna 172 that was well-equipped and maintained, and that had seen some serious cross country flights. My instructor, Nick, quizzed me about what I wanted out of the flight, walked me through the preflight checklist, and then laid out the plan: I’d taxi, he’d take off, and once we reached 500 feet I’d take the controls.

Cessna 172, 738 Bravo Golf

Taxiing to runway 6 reminded me of how much I don’t know. Coordinating throttle, rudder and brakes turned out to be the most challenging part of the flight, though it was easier on the return trip to the hanger.

Waiting to turn onto runway 6

Nick quickly had us airborne and after we passed 500 feet I took the controls. One memory from 30+ years ago came back: The workload involved with flying a plane. At first I focused on getting the feel of the controls as we climbed and making coordinated turns. After we gained altitude I turned toward Greensboro, dodged clouds, practiced climbing and descending, turning to headings, and managing the throttle. And I kept reminding myself to keep my eyes outside the cockpit and watch for traffic.

Then time was up and Nick said, “You fly the pattern.” A lot of credit goes to Nick for talking me through my approach, but the experience of juggling throttle, carb heat, flaps, yoke and rudder while maintaining our glide slope (not perfect, but close enough) and staying on the runway centerline was a confidence booster. Nope, I didn’t get to fly the landing; I passed controls back to Nick short of the runway.

So what’s next? I have some unfinished business with flying, and the next step is a medical waiver. It’s not a simple process, so it might be a while before I know whether I can get back into the cockpit and continue training.

*There’s an alternative to the private pilot license for people with T1D–the light sport certificate, which requires a drivers license but not a medical exam. I’m not enthusiastic about the light sport rule, because it includes a long list of limitations about what, where and when you can fly, as well as a prohibition on passengers.

Type One Diabetes and the Injured Athlete

I wrote this article for Heidi Armstrong’s Injured Athletes Toolbox. Heidi is a friend and tremendous resource for athletes who are struggling with the mental aspects of an injury.


This was my July: Recovering from a bicycle accident that left me with a broken clavicle and rib. Suddenly, I couldn’t ride my bike, and couldn’t run or engage in any of my other normal activities. A long, unhappy summer stretched out in front of me.

My recovery had one additional component: Type one diabetes, or T1D. I was diagnosed 42 years ago, and though I’m active, healthy and free of complications, T1D casts a shadow over the recovery process. Athletes with T1D can face distinct physical, emotional and spiritual challenges related to our disease. Understanding those challenges and learning how to adapt to them are essential to not only becoming whole, but maintaining health during the recovery process.

Those Pesky Numbers

Type one diabetes is a numbers game. Good health demands monitoring blood glucose (BG) numbers and the quarterly A1c, which provides insight into average BG numbers for the past three months. Regular exercise is a critical part of maintaining stable BG numbers within a target range. Athletes with T1D who are regularly active have a higher, more consistent sensitivity to insulin. This consistency removes some of the unpredictability about T1D from decisions about how to manage insulin, nutrition and activity.

Eliminating exercise triggers a series of cascading problems. Insulin sensitivity decreases; more insulin is needed to have the same affect. This can throw BG management off until the athlete recalibrates their bolus and basal doses to adapt to a lack of activity.

Athletes have to immediately adapt to this change in sensitivity following an injury. Whenever possible, they should look for opportunities to build mild activity into their recovery plans. Even a twenty minute walk following dinner can have a profound impact on increasing and stabilizing insulin sensitivity, and managing swings in BG. And, transitioning back to a normal training routine will be easier to manage if the athlete takes steps to stabilize insulin sensitivity.

Apart from keeping BG in range, athletes with T1D need to be conscious of other physical complications. In the case of my clavicle injury, keeping my arm in a sling placed me at risk for adhesive capsulitis, or frozen shoulder, a common complication from T1D. My recovery plan included progressive stretching as soon as I was able, to maintain my range of motion.

The Emotional Side of T1D

The emotional side of T1D is less understood than the physical side, but it’s coming into clearer view for those who study the disease. Athletes can see training and competition as essential to their health and well being. Take those things away, and depression and stress may take their place.

Both have a powerful impact on athletes as they navigate the recovery process. They also have a physiological effect on athletes with T1D. Stress triggers the release of counter regulatory hormones that increase blood glucose. These episodes can be intermittent or ongoing. Either way, they can lead to a roller coaster of high and low BG, complicating management.

How we manage the emotional side of T1D is as individual as the athlete. For me, focusing on interests that had been sacrificed to time on the bike and reconnecting with friends were two tactics that helped me manage stress while I recovered this past summer. More than distracting me, those activities felt productive and fulfilling.

Time in recovery gave me time to think creatively about new projects. Difficult as it was, when I realized that I would spend at least six weeks not cycling, I embraced the opportunity to do deep work that I had been putting off, and appreciated the value of having uninterrupted time to think and plan.

Like everyone who goes through recovery from an injury, I had my tough days. The best antidote for those was to rest on the couch with my dogs and read a good book. 

When an Injury Becomes an Existential Crisis

T1D is a chronic disease, and there can be a dark outlook associated with it. Those of us with the disease are aware of the possibility of possibly fatal complications, diabetic ketoacidosis , and life threatening hypoglycemia.4Injury can cause an athlete with T1D to suddenly confront, in a tangible way, evidence of their fragility and mortality. It becomes an existential crisis that threatens our identity as athletes and shakes faith in our ability to manage the disease.

That’s the spiritual side of recovery. Athletes with T1D can respond in several ways, including: Meditation or other contemplative practices, turning to faith, or despair. July and August were an opportunity for me to press pause on a busy life and use my time to be intentional and ask big questions about my goals as a cyclist and how the sport fit into my life. Even when a powerful sense of fragility was staring me in the face, I could look at the answers from those big questions and see a path back to wholeness.

Don’t Neglect Your Team

I’ve read here that recovery is a team effort. That’s particularly true for those with T1D. Injury brings the importance of having a team into sharp relief. I’m fortunate to have a network of athlete friends with T1D who I can call on for support, health care providers who understand and encourage my cycling, and family and friends who stand behind me. Having that team, before I ever needed them to help me though my injury, made all the difference.

Notes

  • Type one and type two diabetes are distinctly different diseases. For information about T1D read http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/. 
  • A BG of 90-120 is a typical target, though this can vary depending on the individual and their activity. 
  • Basal insulin is either fast acting insulin administered in tiny doses via an insulin pump, or slow acting insulin injected once or twice a day. Bolus insulin is a single dose of fast acting insulin given to counteract food that is consumed. 
  • Diabetic ketoacidosis, or DKA, is a result of extreme uncontrolled high blood glucose. Hypoglycemia is low blood glucose. 
Categories T1D