People with type 1 diabetes must inject themselves with insulin 4 to 6 times a day, constantly draw blood from their fingers to monitor their blood sugar levels, keep track of every carbohydrate they put in their bodies, account for changes that result from athletic activity, and be ever-vigilant of dropping glucose levels. Despite the seriousness of the condition, there are a handful of professional athletes who, on top of mastering the rigors of their particular sport, are afflicted by T1D and contend with the disease during competition. NASCAR driver, Ryan Reed, is one such athlete. We sat down with Reed to get a better understanding of what it’s like to be an athlete with T1D.
Type 1 diabetes is an autoimmune disease in which the immune system attacks the pancreas and kills the insulin-producing beta cells therein. Reed’s symptoms paint a familiar story for the three million Americans who are currently diagnosed with the disease. They emerged when he was seventeen years old while on a cross-country road trip. “I was driving back to California near the end of 2010 from North Carolina after a race with a friend. It was a 36 hour road trip, and I was stopping every hour to pee,” said Reed. As soon as he returned to the car after each stop, thirst set in. “I would have to exercise all of my self-control not drink another bottle of water.” His road trip partner was annoyed. “He kept telling me to stop drinking, but I couldn’t,” Reed said.
Why so much water? When the pancreas isn’t producing insulin, glucose cannot be transported into cells to be used as energy, and the sugar builds up in the blood stream. As a result the body demands huge amounts of water in an attempt to flush the system, while the starved cells begin to break down fat and protein in a desperate attempt to acquire energy. This state, called diabetic ketoacidosis, disrupts electrolyte levels and deposits ketones (waste from fat breakdown) into the blood stream. Liters and liters of water are consumed to compensate for build-up in the blood, inadvertently flushing away electrolytes, and thereby increasing the risk of severe dehydration.
Reed lost 30 pounds prior to his diagnosis. When his condition was finally confirmed, he was devastated. “My first question was ‘How is it going to affect my racing?’ They told me I would never race again. It wasn’t fair to tell me that,” he said. It wasn’t fair, because, of course, Reed has returned to racing — but the body-awareness, medical preparation, and constant threat of making a mistake in his moment-by-moment treatment now makes competing at the highest level an entirely new mental animal.
The tremendous heat, adrenaline, and dehydration that arise in a professional NASCAR race produce a cortisol stress response and cause Reed’s blood sugar to rise mid-race. This is certainly problematic, as it increases the risk of DKA, but the lows can be more immediately life threatening. Going hypoglycemic (low blood sugar) is commonly the result of giving too much insulin and taking in too little sugar. A serious low can result in seizure, coma, or death. The antidote to hypoglycemia is, simply, sugar. Some athletes with T1D must adjust for plummeting blood sugar levels in the middle of their events.
“I have never gone seriously hypoglycemic while racing,” said Ryan. “If I do happen to go low, which is a very rare situation [given the stress-inducing conditions], I have a Camelback bladder and a rubber hose that connects to the front of my helmet. Inside the bladder, I have an endurance formula that includes dextrose and electrolytes.”
Type 1 diabetics use various monitoring methods to keep track of their blood sugar. Ryan uses the Dexcom Continuous Glucose Monitor — a sensor that he injects subcutaneously. It relays information about his sugar trends to a PDA. He injects insulin with a syringe in accordance with the information gathered from a combination of the Dexcom sensor and more accurate finger pricks. While some athletes opt for an insulin pump, the environment of Reed’s sport excludes the option of using a pump for insulin delivery. “The number one reason I don’t use a pump is that it gets really hot in the race car [upwards of 140 degrees F]. It would be hard to maintain the temperature of the insulin. There is a lot of risk for error,” Reed said.
Reed started the Drive to Stop Diabetes organization with the American Diabetes Association and Lilly Diabetes in 2013 to educate people within his own community about both forms of diabetes. “It was an idea we had to spread awareness about the effects of type 1 and type 2 diabetes,” said Reed. “There are a lot of people living at risk with type 2 or living with type 2 in the NASCAR community.”
Along with Reed, there have been a handful of athletes who have competed at the highest level with type 1 diabetes. Notable examples include Olympic swimmer Gary Hall Jr. and professional ultra-marathon runner Missy Foy. “The story of each athlete is a little unique in their own disciplines and sports,” said Reed. Different types of output and different bodies result in different trends in blood sugar and each diabetic athlete must learn how to deal with his or her own bodily response. “I lean on their stories for support,” said Reed.