Exercise and sports are my favorite way to get outside of my comfort zone. With type 1 diabetes (T1D), there are more challenges than just the number of miles or the target pace. Participating in high school sports and now in triathlon at the collegiate club level with T1D has introduced me to more obstacles, but I firmly believe that they have molded me into the student, athlete and person that I am today.
The most obvious, and most difficult aspects to figure out, are related to insulin dosing and nutrition during training and races. When racing a triathlon, our team is usually up around 4 am but not racing until hours later, typically around 8 am. For the team, these hours are when we eat breakfast, stretch, see parts of the course, set up our transition area, and warm-up. All of this is the same for an athlete like me with T1D, but I have to carefully plan this breakfast. Having any amount of active insulin while racing makes my blood glucose (BG) plummet, but the adrenaline and excitement of the start of a race usually makes my BG rise. The first leg of a triathlon, the swim, has been made significantly easier for me with the 670G insulin delivery system. The pump and sensor are now waterproof, and operate as hybrid closed-loop, titrating insulin doses based on the sensor glucose value. Starting 2-3 hours before a race, I set a temporary target of 150 mg/dL, requesting that the system corrects insulin delivery down to 150 mg/dL as opposed to the default setting of 120 mg/dL. I also aim to have a pretty big, but easily digestible breakfast at least 2 hours before the race starts, high in carbs, fat and protein. Then depending on the length of the race, I have gels or sports jelly beans every 4-6 miles on the bike and 1-3 miles on the run to keep my blood sugar in my target range. And don’t worry mom, I always keep my glucagon in my transition bag and a road ID on me!
The more important challenges to me are not related to my sensor glucose or making sure to time my breakfast correctly. Sports with T1D have taught me much bigger lessons. I have learned how to self-advocate by standing up to coaches and professors who accused me of skipping sprints because I was lazy despite a low blood sugar or have told the class that exercise will “cure diabetes”. I celebrate all types of victories: from running two miles without going low to getting a best time. I think that competing in sports has given me a more positive self-perception and has given me perspective on what is most important. Being able to exercise, compete, and train is a blessing. It might require more thought and planning for people with diabetes, but the opportunity to train, work, and better yourself for tangible goals is well worth it.
Participating in sports with diabetes has forced me to be adaptable, even creative, and I feel lucky to have learned this trait at such a young age. For example, I typically rely on my continuous glucose monitor (CGM) to display my sensor glucose on my insulin pump, which I use every 2-3 miles to make fueling decisions in triathlons. In my last race, out of nowhere, my pump failed, and stopped giving insulin and displaying my sensor. In the middle of Williamsburg, VA, with one bar of cell service, I had to get a prescription for insulin pens to manually inject for the way home. In another race, I learned after the swim leg, that the container of glucose tablets is not watertight! My glucose tablets had turned into a slush.
So if you’re reading this, and you think that diabetes is limiting your ability to participate in sports, or anything really, let this be a reminder that you can do it. You’re smarter than your non-functioning pancreas. Make a goal, and achieve it. My biggest, scariest, and most exciting goal is just over 6 weeks away: the Marine Corps Marathon. “If you’re dreams don’t scare you, they’re not big enough.”
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