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by Matt de Neef
November 14, 2014
Ride, eat, sleep, repeat. That’s how many of us would love to live. The freedom to ride (or race) our bike whenever we want, to eat what we want (within reason) and to get a good night’s sleep before doing it all again. Sure, there are family commitments, work and other demands on our time. But with a bit of juggling most of us can make that happen.
But what if you added another layer of complexity? Another job on top of your current one. That’s the reality for millions of people worldwide who juggle the sport they love with managing Type 1 Diabetes, a chronic illness that has massive implications for how and when they can ride their bike. Where getting it wrong can literally be a matter of life and death.
Today is World Diabetes Day, so it’s fitting that we take a look at how elite level racers can manage a cycling career whilst living with diabetes. Dietitian Alan McCubbin wrote the following article and spoke with Justin Morris and Chris Williams, two Aussies who ride for Team Novo Nordisk.
Type 1 Diabetes is a chronic medical condition, most often diagnosed as a child or teenager, where the cells in the pancreas no longer produce insulin, the hormone responsible for getting sugar out of our blood and into muscles and other organs. There is no known cure, so people with Type 1 Diabetes must take insulin as a medication, either through injections or a pump device that delivers insulin under the skin via a small needle.
Normally our body is very adept at producing the exact amount of insulin that’s required to keep our blood sugar within a narrow range. Not enough insulin and our blood sugar becomes too high (hyperglycaemia). A one-off, very high blood sugar level can cause serious illness, in some cases a medical emergency. But even slightly elevated levels over several years can lead to medical complications, such as kidney failure, loss of feeling in the feet and reduced eyesight.
On the flipside, a mismatch of insulin to blood glucose can also go the other way. Too much insulin can result in low blood sugar, or hypoglycaemia. Think about a time when you’ve bonked on the bike – badly. That’s mild hypoglycaemia. Now multiply that feeling several times over and you’ll get some idea of what it’s like. At its worst a severe “hypo” can end in unconsciousness, or if severe and untreated, death.
For an athlete with Type 1 Diabetes, a large part of life revolves around that balance of trying to match the amount of insulin required to their blood sugar level. And it’s a moving target – blood sugar and the effect that a given dose of insulin will have is often difficult to predict. Eating carbohydrate will raise blood sugars (but the type of food, the quantity and the timing will all produce different results).
Exercise makes insulin more effective, so the same dose will have a greater effect. And other factors like stress and illness can all upset this balance, often making it difficult to keep blood sugars within the desired range. An athlete with Type 1 Diabetes must manage all of this.
But manage they do. In fact there’s an entire ProContinental team featuring only riders with diabetes: Team Novo Nordisk (formerly Team Type 1). These guys line up at many of the same races as other ProConti teams in Europe and North America. You’ll probably even see a couple of them at the Australian Road Nationals in January.
If you do spot them before the race you might notice them using some curious looking devices. To better understand how cyclists manage diabetes whilst racing at an elite level, we spoke to Justin Morris and Chris Williams, two Aussies who ride for Team Novo Nordisk.
Can you describe how your daily routine varies from someone without diabetes?
Justin: 24 hours a day, seven days a week, 365 days a year my mind is making constant calculations about what is going into my body. I also need to make what I eat as consistent as possible.
Chris: I find having a daily routine makes my life much easier. In an ideal world I would eat and exercise exactly the same every day so my insulin needs are, in theory, the same. But life doesn’t really work that way. Sometimes reality gets in the way and eating and doing the same things all the time can get a little boring.
What about training and racing? What do you need to do to manage your diabetes around exercise?
J: The main thing my mates always notice is how full my pockets are … with food. Different efforts on the bike manifest themselves in different ways for my blood sugar levels. After living with diabetes for 18 years and racing for 15, I have developed a pretty good sense of how my body reacts. When my blood sugar starts heading south, I reach for my trusty pockets and eat something.
C: I check my glucose levels regularly while I’m riding to make sure I’m staying stable, and most importantly I make sure I’m prepared with anything I might need. I always have medication with me and pockets full of food for that ‘just in case’ moment. I don’t want to be miles away from anything on my bike and running out of food.
Managing Type 1 Diabetes is a balancing act between the carbohydrate you eat and the insulin you take as medication. Do you eat the same amount of carbs as any other cyclist, or are things different?
C: Off the bike my diet is no different than any other cyclist. However on the bike it can be very different. I don’t have the luxury of eating whatever I want, whenever I want. I can’t just eat a handful of gels and bars in one go as it will cause a sudden change in my blood glucose.
I try to spread out my food by eating a little all the time, and foods that aren’t packed full of quickly absorbed carbs. I still check my glucose levels regularly and sometimes I even need to take some insulin while I’m riding, which can be tricky. In a race I need to be especially cautious, as the surges and changes in effort add unpredictability, and I don’t want to be caught out at a key moment!
A professional cyclist also spends a lot of their life travelling. How do you manage that when the type, quantity and availability of food can be very inconsistent?
J: Travelling can be one of the biggest challenges for anyone with diabetes. Transferring time zones can be a huge shock and can throw the diabetes management rhythm into a spin. This is something I’ve learned to deal with, having done it so many times now. The first long-haul flight is always the hardest, but definitely possible for anyone with diabetes. Like everything it just requires a bit more planning.
I remember about four years ago I raced the Tour de Rwanda and we were told to not eat any meat, salad, fruit or anything washed with water. For an eight-day mountainous stage race, this was a challenge. My body took a few days to adapt and it took a lot of help from some awesome medical staff to effectively manage.
Does it get easier to manage as you get more experienced?
C: A doctor once told me that no one will ever understand the body of a person with diabetes like a person with diabetes. At the time I didn’t understand what he was saying but after five years of learning from experience, I definitely agree. The last five years have taught me there are many variables that need to be taken into consideration. The type and amount of carbs I eat, the amount of exercise, allergies, illness, altitude, nerves and even the temperature or time of day can all affect how I need to manage my blood glucose levels.
Diabetes is a very individual condition. How it affects you is something you need to learn along the way. It frustrates a lot of people when they ask for advice and all I can really say is, ‘everybody is different’. It definitely gets easier over time, but the key is to learn from your experiences.
What’s changed (medications, technology, management) since you were first diagnosed? Have these advancements made it easier to manage your diabetes?
C: There is always new research and technology and it is difficult to keep up with it. I tend to adopt the philosophy of ‘if it ain’t broke, don’t fix it’, so I haven’t made any massive changes to my management regime. But there is one piece of technology that we use on the team which makes life a lot easier and that is a continuous glucose monitor (CGM).
A CGM reads blood glucose levels every five minutes and allows me to see it in a real-time graph without having to prick my finger. This can give a lot more information than a single measurement, as I can see how my levels are trending and make better decisions around my management. It even allows me to analyse days, weeks or months of data so I can pick up on patterns and adjust accordingly.
A CGM also makes checking my blood sugar levels on the bike easier as I don’t have to get out my testing kit and prick my finger. In a race, it is invaluable.
J: Much has changed in the 18 years since I was diagnosed. We now have much smaller devices that make treatment quicker and more discreet. The most important benefit though is support. I was lucky to grow up in Australia with organisations like the Australian Diabetes Council and the Juvenile Diabetes Research Fund (JDRF), which have been a huge support and helped me with healthy management.
What’s it like to ride with a team where everyone has diabetes?
C: In the past, I have ridden for a smaller Continental team [ed. Team Champion System, in 2011] where no-one knew about my diabetes. I would manage everything myself and would do my best to do it in private. I would sometimes get questions about it but the team only had a basic understanding. If I was having a bad day, they couldn’t really understand why.
On Team Novo Nordisk we support each other both on and off the bike and are able to share our experiences. We also have a medical team that come to races with us and make sure we do everything we can to manage our diabetes the best we can.
J: Riding with Team Novo Nordisk for five years has been a massive boost to my diabetes management. Being surrounded by other diabetics helps remove the often conscious stigma associated with the disease and has helped me understand different methods and strategies of managing. It’s funny that what once seemed such an odd thing to do in public becomes the new normal when surrounded by diabetics 24/7.
What advice can you give to any cyclists reading this that are struggling to manage their sport and their diabetes?
C: The team gets a lot of questions from people that want to start cycling or just exercise in general but they are very nervous about it. Diabetes can be unpredictable and easier to manage when things stay the same, so people can be reluctant to try something new. They may be too cautious to get out there and ride their bike or go for a run even though they really want to.
When you are first diagnosed with diabetes, everything is a massive learning curve, so I can totally understand the hesitancy to complicate things with another unknown. But the best thing you can do is talk to your healthcare provider and come up with a plan, and make sure you are prepared and carry supplies with you at all times. The key is that you get out there and learn from it. Sure, you may have some bad days, but you will have a lot more good ones and at least next time, you will know better!
Do you have Type 1 Diabetes? How has it affected your cycling, if at all? How do you manage it?
Alan McCubbin is an Accredited Sports Dietitian, Accredited Practicing Dietitian and the President of Sports Dietitians Australia. He is the founder of Next Level Nutrition, an online sports nutrition consultancy, and works with the search2retain p/b health.com.au cycling team, the Tour de Cure cycling charity and a range of athletes from recreational to Olympians.