ironguides

Today, November 14th, 230 million people had a reason to drink a glass of champagne, it was the World Diabetes Day. The reputation is still out there, they are chronically sick, have no flexibility into their lives and have sugars banned from their diet, but fortunately, most of those aspects are changing, and FAST! Early in the days, being diagnosed with diabetes meant a death sentence, now, you can become an Olympic champion as a diabetic.

The insulin was discovered in 1920, but it didn’t came out to diabetics until 1922 and before that people diagnosed with the “sugar disease” only had one treatment, that brought very poor results, it was a no carbo diet. Then the first types of insulin came out, it was made out of the pigs and cattle pancreatic islet cells. The impact in the diabetic population was so huge, that the inventors were awarded the Nobel Prize.

Diabetics lived on pigs and cattle insulin for almost 60 years (and they are still available now days!), but by 1978 the human insulin was finally produced. The first versions were called NPH and REGULAR, they were still the main drugs up to the late 90’s when the new insulins were developed, NPH and REGULAR are long acting insulins with their peak at 6 and 3 hours respectively, that means, no need to be an expert in a way that the timing of your meals are going to match the insulin peak, and forget about skipping a meal or eating a high GI (Glycemic Index) meal, you want to have a sure and steady blood glucose level. This is where the “NO SUGAR” reputation came from.

Then just before 2000, the fast-acting and the basal/no peaks insulins were produced and it totally changed the routine of diabetics. Combined with NPH (long acting) diabetics had the option of eating as many chocolate bars as they wanted (although this is not healthy to anyone!) and they could have their meals at anytime.

Next step? Insulin pump and continuous blood glucose monitor. Those are small devices attached to the diabetic via a catheter that works 24/7 by delivering small doses of insulin every few minutes, exactly like the human pancreas does. It is not yet an artificial pancreas, as the patient is still responsible for making executive decisions as setting their “basal” that depends on physical training, and set “bolus” for each meal, an amount of insulin that is supposed to carry the glucose released into the bloodstream into the muscle and fat cells.

Technically there are still some problems to create an artificial pancreas that the diabetic would just plug in and forget about it:

• the rate of glucose increase (i.e the derivative function would deliver more insulin for a rapid increase in blood sugar);
• the peak of the glucose curve (i.e. the proportional function would deliver more insulin for a higher peak in the blood sugar); and
• the duration of elevated glucose (i.e. the integral function would deliver more insulin for a long duration of high blood sugar

And those are the problems that a non-athlete would face. I can see another few challenges that our average diabetic triathlete would face.

Race start stress would be the main one. In my first few ironmans, I remember reading letters in my glucometers instead of numbers like you are supposed to. When I tested my BG after the swim, it said “HI”. I was pretty sure that the glucometer wasn’t greeting me, instead, my blood glucose levels were so high that it went past the limit of that glucometer (600mg/dl).

It took me a while to understand the impact of a high stressful situation had on my BG levels. And once past that post swim period, and after adjust the BG with a few units of fast acting insulin, the BG would stay sure and steady. So perhaps the artificial pancreas needs also a meter for adrenalin and cortisol, at least if you plan on do some racing.

So while we are not 100% healthy yet, and for sure diabetics triathletes do face way more limitations than the “healthy” athlete out there, we are slowly getting up there. As we are exposed to situations when hormonal changes have an impact on our performance, diabetics naturally learn how to trigger (or not) all those hormones for their own benefits in training and racing. Gary Hall Jr. (USA) won a few gold medals as diabetic type 1, Steve Redgrave (GBR) did the same, I had a couple of sub 9h ironman performance, and a team made out of diabetics type 1, won the RAAM in 2006-2007.