Monday, September 27, 2010

Racing Bikes Bionically

Posted by my friend Blair Ryan

Years ago, a teammate of mine on the UC San Diego cross-country team asked me why I carry my garage door opener everywhere. She pointed to the small charcoal-colored device on the waste band of my running shorts. I’m often asked why I don’t just get a cell phone already; by someone assuming my insulin pump is a pager. A few months ago, on the starting line of a collegiate cycling road race, a competitor asked me if I had diabetes. She’d noticed the tube running to my back pocket from underneath my jersey. She commended me for racing bikes at the level I do, with diabetes.

While I acknowledged and accepted her comment as a compliment, inside I viewed it as evidence that there is a lot of work to be done.

People with Type 1 diabetes have won Olympic gold medals, completed Ironman in less than nine hours and summited Everest. Those of us who are athletes with Type 1 know that exercise is a crucial component to controlling our diabetes. Yet, newly diagnosed patients are often discouraged from continuing activities that once defined their lives, and people are still too impressed that I can place in collegiate cycling races.

I was lucky. Before my diagnosis at 13 years old, I was already an athlete. If I wanted to continue to train and race successfully I had to be in good control of this disease. If my bloodsugar was too high overnight, I felt like crap at practice in the morning. If it was too low, I’d be too weak to workout hard. My motivation for good control came from my desire for athletic success.

If you have diabetes, your body is not able to control your blood glucose level. In a person without diabetes, the pancreas senses an increase in glucose level in the blood and releases the hormone insulin to lower it. There are two types of diabetes, quite different from each other physiologically, thus, the daily management can be very different.

The pancreas of a Type 2 diabetic functions, it produces insulin, but the individual’s tissues don’t absorb the hormone. This resistance can occur for a variety of reasons, and is why many Type 2 individuals are not insulin-dependent and can sometimes control their diabetes with medication that makes the tissues more sensitive to the insulin that is there, or by changing eating habits and incorporating more exercise into their daily routine. Exercise increases the body’s sensitivity to insulin and is therefore a crucial aspect in the management of both Type 1 and Type 2 diabetes.

Type 1 diabetes makes up for only 5-10 percent of diabetes cases and is most commonly diagnosed during adolescence. Type 1 is not caused by eating too much sugar, as is sometimes thought. It has an autoimmune basis. It’s believed that something in the environment triggers the body’s immune system to destroy the pancreas’ insulin-making ability.

A friend of mine said he wonders if Type 1 diabetics have stronger immune systems if we can “take out one of our organs just for shits and giggles.”

Symptoms pre-diagnosis include excessive urination, weight loss, fatigue and incredible thirst. These are all symptoms of high blood glucose levels. The blood glucose is high because the insulin is not there to transport the sugar from the bloodstream to the cells. The glucose sits in the bloodstream and doesn’t provide energy to the individual. Over a period of months, sometimes years, the pancreas ceases to produce any insulin, making the individual completely insulin-dependent. Some inject a combination of insulin types with a syringe many times a day. Others use an pump, which infuses insulin through a plastic catheter placed under the skin that is changed every three days. The pump delivers short acting insulin continuously throughout the day at a personalized programmed rate, mimicking the pancreas. Additionally, more insulin is taken for meals and snacks as well as adjustments made to accommodate an exercise, stress, illness, menstrual levels and adrenaline. To control our diabetes well, we are forced to become experts in the arts of prediction and anticipation.

Exercise, stress and adrenaline are all part of being an athlete, and often make life with Type 1 diabetes more exciting than we’d like.

One hundred percent of the time we spend doing our sport, we are trying to balance the amount of insulin active in our body. As mentioned earlier, exercise usually brings blood sugars down.
It is important to have some insulin “on board” so that the food we eat is available to the cells for energy, but not so much that the bloodstream is depleted of the glucose that the brain and nervous system need to function normally.

During my competitive athletic season I require much less insulin throughout the day for good control. I take less insulin to cover a meal after most workouts. Throughout the 48 hours after a long ride or run, I take much less insulin per gram of carbohydrate that I consume, and blood sugars are usually more forgiving and balanced. The more consecutive days I have without exercise, the more insulin I must take and the harder it is to find the correct insulin to carbohydrate ratio. Exercise is so crucial to the control of my diabetes that I often feel I am literally running or riding for my life.

Ninety-five percent of people who die from complications of diabetes do because their average blood sugar level over decades is abnormally high, putting strain on blood vessels and kidneys. Exercise lowers blood sugars by making body tissue more sensitive to insulin, yet there are still people who tell those diagnosed with Type 1 that their lives will be limited and sedentary.

There is a growing community of athletes with Type 1 diabetes working to demonstrate to anybody that’s willing to watch or listen, that people with Type 1 can do extraordinary things. This movement is facilitated by the non-profit organization Insulindependence.

I just drove 10,900 miles in 68 days, through 24 states, documenting a team of ten people with Type 1 diabetes who were brought together to train and race the Ford Ironman St. George in May, 2011. Some Triabetes team members were not previously endurance athletes, others have competed in athletics since childhood. Some were told upon diagnosis that their time as an elite athlete was over. This is Insulindependence’s third year pulling individuals from all over the country, pairing them with a young person with diabetes, and working to correct misperceptions about life with diabetes and revolutionize diabetes management.

Anyone placing limitations on those with diabetes are likely fearful of possible situations on the extremes of living with Type 1. The immediate danger is hypoglycemia, low blood sugar, the lack of glucose supplied to the brain. The first signs of hypoglycemia can be irritability, shakiness, weakness and confusion. The condition can often resemble someone who is intoxicated, which can be dangerous if people around us don’t understand diabetes.

Hypoglycemia can cause loss of consciousness and seizures, but it is preventable. A person with Type 1 under good control can sense oncoming hypoglycemia and consume carbohydrate to raise their blood sugar level and avoid the effects above. It is crucial that Type 1’s get in the habit of carrying fast acting carbohydrate snacks all the time for low blood sugar situations and pay attention to their body. I always have fruit snacks and bars with me on rides.

The biggest risk for Type 1 diabetics are complications later in life. The dangers associated with high blood sugars can include, heart disease, neuropathy and retinopathy. These can all be prevented with good control. Exercise facilitates good control.

Over my ten years with diabetes, I ran collegiate cross-country and track. I competed for UCSD as the President of the Triathlon team. In 2008, my teammates and I won the women’s overall USA Triathlon Collegiate National Championship. I dedicated 2010 to bike racing and competed in road races, crits and Team TTs for the University of Oregon cycling team.

There are many factors I take into consideration when preparing for a workout. Morning workouts are less likely to cause blood sugars to drop dramatically because of the steroid hormone, cortisol, which humans produce overnight. I notice an increased resistance to insulin I take in the morning and a decrease in the effect exercise has on my blood sugar. While the normal blood sugar for a non-diabetic is 80-110mg/dl, in the morning I like to start workouts with a blood sugar raised to about 150mg/dl. The exercise will lower it some and I want to prevent low blood sugars during the workout. In the afternoon my tissues are much more sensitive to any insulin I take. Later workouts, even just easy warm up spins, make my sugars drop rapidly. I try to get my blood sugar close to 220mg/dl and must eat something with protein in it to sustain blood sugars over a long PM workout. I sip ACCELERADE on the bike because of its high protein content, which helps to sustain my blood sugar without me having to eat a lot of other food throughout the ride. I also have those emergency snacks in my back pocket.

Emotional stress has a huge effect on blood sugar levels. On race days I fight to control blood sugars because the more nervous I am, the more my sugars creep up over time due to adrenaline release. I give small doses of insulin to bring my blood sugar down throughout the morning, warm up and even on the starting line. This routine would be far too much insulin for a training day, but is necessary to battle the adrenaline caused by racing. Even the stress of school exams and travel wreak havoc on blood sugars. Rarely are two days the same. Every day is trial and error.

Until recently very few people knew I had diabetes. Before my involvement with the non-profit organization Insulindependence, I had an objection to being involved with something because I have diabetes. In my head the longer people knew me without discovering I had diabetes, the better. This meant that I had succeeded in seeming normal. This was my way of showing that someone with diabetes could do anything.

The resumes of the individuals with diabetes involved with Insulindependence make the organization impressive and unique. After watching the movement that is Triabetes, I see the flaws in my previous philosophy. If people didn’t know there was no way for them to learn. I wasn’t proving anything to anyone.

The organization founders and each Triabetes team member I spent time with this summer, are on a mission to change the way people approach diabetes. They are telling the world. Please visit and join the community and discussion.

It was such a pleasure to meet and ride with Coach Alex Matteucci at Finkraft Coaching when I was visiting New York this summer. Coach Matteucci, thank you for your support, interest and for giving me the opportunity to ride along the Atlantic and do some diabetes teaching from the bike that day.

You can follow my project from the summer at

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