The following article was written by Kris and sent to me for editing. I have edited it. I removed one paragraph and one other sentence. The stuff I removed related to Kris’s motivation for writing the article, and might have been interpreted as combative. If he asks me to, I’ll put it back in. However, the entirety of the really informative content is here, with just a word or two modified in a couple of places. - Zach Caldwell
I have been diabetic for seven years. In that time I have never had to compromise my lifestyle because of my condition. I have carefully selected the people I use as resources for information and guidance. My number one requirement for seeking out these people is that they do not use the words “can’t” or “impossible.” A doctor that uses those words is setting boundaries and limitations on what I can accomplish. I live my life without limits.
I appreciate when my doctor tells me that something will be difficult or has never been done before. I am willing to look for new ways to accomplish my goals. There are two choices that I have made that have a huge impact on my control of my bloodsugar. The first is that I do not eat for pleasure or for fun. I eat for fuel. I view my body as a combustion engine. I will only put premium fuel in it. I analyse every food choice I make. From studying nutrition labels and glycemic index charts I can look at a plate of food and know how many carbohydrates, protein and fat are in each dish. I also know how quickly the sugars will be released into my blood-stream. Eating sugars with fiber and protein slows the rate that sugar can be utilized by the body. Thus a high fiber, balanced diet makes it easier for a diabetic to balance their blood sugar with insulin. To break it down simply, a carb is not just a carb. If I were to eat an apple with 20 grams of carbs or a glass of Coca-Cola with 20 grams of carbs in it, and take the same amount of insulin with each, I would have two different outcomes. Because the apple is loaded with fiber, the sugars from it would leak into my blood-stream slowly. The insulin I took would have time to gradually bond with the sugar and pull it into my cells without my glucose ever going into an unhealthy range. The Coke, made up nearly exclusively of high-fructose corn syrup (about the highest glycemic food in existence) would dump all of its sugar into my blood so fast that the insulin would not be able to keep up , resulting in unhealthy high blood-sugar. I would then have to take more insulin to lower my glucose. I would have very little room for error since all the sugar from the Coke would be released at once. If I took too much corrective insulin my glucose would crash and I would be left with a dangerously low level of sugar. To sum up, low glycemic foods have a gradual curve of glucose release that it is much easier to balance with insulin than a high glycemic food that skyrockets and then crashes.
The second choice that I have made is that I will take as many injections of insulin as I have to in order to achieve non-diabetic levels of glucose. Sometimes this means I take as many as twelve shots a day. That may sound horrific to you. But to me a dozen shots is far better than the havoc elevated sugars can wreak on the body. My job is to make my body the best endurance machine possible. I wouldn’t lubricate my cars engine with gritty oil so I will not run my body with excess sugar either.
From constantly testing and monitoring my glucose levels in comparison to the insulin and food I eat I have discovered that the ratio of insulin to carbs that I need varies drasticly. When I am training very hard, the amount of insulin I need has to be reduced nearly 500% compared to when I am not training at all. With a training schedule that calls for periodization, there are any number of insulin to carb ratios that I may have based on the duration and intensity of my training schedule. From diligent testing and constant self analysis I have been able to guess this ratio correctly about 95% of the time.
That probably already sounds very difficult but there is more. Exercise is not the only thing that affects insulin sensitivity in the body. Stress, anxiety, and race nerves all decrease insulin sensitivity which means that the amount of insulin needed increases. Altitude also has a profound affect on insulin to carb ratios. Altitude is a stress on the body so this makes sense. Basically, everything in life affects the way the body uses its fuel and the body’s primary fuel is sugar. The way I have learned glucose balance is by getting to know my body very well. I am constantly making mental notes on my environment and my body’s reaction to it.
I am living proof that a diabetic can control their blood sugar under extreme situations. It’s not easy - far from it - but it is very possible. The main factor that makes controlling bloodsugar while racing difficult is adrenaline. When humans get excited and nervous they release adrenaline from their adrenal gland. This signals the body to release sugar from the liver which is part of the, “fight or flight response“. If a person tripped over a bear in the woods and needed to get away fast, a non-diabetic would instantly start using the released sugar to get the hell out of the woods. A diabetic would just pool the sugar in their blood unless they had previously taken a basal insulin. A basal insulin, or long lasting insulin, stays in blood for 12 to 24 hours (depending on formulation). It provides a means for the body to utilize small amounts of sugar that are not fully absorbed by mealtime or “fast acting” insulins. Basal insulin is most important for diabetics during their sleep. The body leaks a small amount of sugar into the blood-stream during slumber to help the body repair itself and get ready for the next day. Without basal insulin, diabetics would wake up with high blood-sugar daily. I use basal insulin for those reasons, and to help me utilize the sugar I release while I am racing. Due to nerves, and the excitement of the start of a race my blood-sugar rises (it rises in non-diabetics as well). I need the basal insulin to lower the sugar and send it into my cells as the race unfolds. I have learned how much basal insulin to use from simulated races and trial and error.
Another issue that is cured by basal insulin is “feeding” during longer races, thirty and fifty kilometers. “Feeding” means drinking sports drink while racing to keep energy store (sugar stores) up while competing. Most world cup skiers feed every 5k during long races. I do too, but I skip the first one to two feeds to allow my basal insulin to catch up with the sugar released from the adrenaline surge at the start of the race. When choosing my basal insulin dose before the race, I take into account how much I plan to feed.
Being a diabetic endurance athlete is a balancing act. However, all of my decisions regarding insulin doses are based on research, and personal experience. The more I know about myself the better I am. The following is a list of sample results and blood-sugar numbers.
15k classic 2003 world championship, 4th place, starting glucose 140, finishing 210(took one feed)
70k classic 2005 marcialonga world cup, 25th place, starting glucose 140, finishing 80 (approx 20 feeds)
30k skate world cup 2004, 6th place, starting glucose 160, finishing 150 (6 feeds)
50k national championship 2007, 1st place, starting glucose, 120, finishing 100 (10 feeds)
15k skate nationals championship 2007, 1st place, starting glucose 110, finishing 150 (0 feeds)
Reprinted with permission from the Kris Freeman website at http://www.krisfreeman.net/. Copyright © Zach Caldwell and Kris Freeman