Taking on KONA with type 1 diabetes.

This is a guest post by Diabetes Sports Project Champion, Ironman and type 1 diabetic athlete Patrick Devlin. 

When I told my parents that I was considering an offer to race the Ironman World Championships, their first response was, “You have been through this before. You know how hard it is to train and race being a diabetic. Why do you want to do this again?”

When I finished 2017 Ironman Texas, I thought my long-course triathlon career was over. Training for a full Ironman is a massive undertaking for a normal, healthy person. For someone like me, it can be even harder. Every athlete must prepare for three disciplines, including a 2.4 mile swim, 112 mile bike and a 26.2 mile run. These activities are consecutive with only minutes in between each leg, and they all must be done in less than 17 hours. Although it may seem less glamourous than the athletic endeavors involved in a triathlon, nutrition is important enough to be considered the fourth discipline for any triathlete. If you do not fuel your body enough with the right nutrients, you will not be successful. For me, I must go a step further than your typical triathlete to maintain proper nutrition, which is where my personal fifth discipline, blood sugar, comes into play.

As a Type 1, I must constantly monitor my blood sugar and nearly everything can affect it. A normal athlete can schedule a run after work. They come home, change clothes, grab a Gatorade and go run. For me, the planning for that same run begins hours before leaving work. First, I make sure my blood sugar is in a good range at least two hours prior to the start. If it is on the lower end, I’ll eat something small like a Clif Bar so that it doesn’t cause a spike. Then, about one hour before the run, I will check my sugar again and reduce or disable my basal rate. My basal rate is the rate of insulin that is constantly being pumped into my body via my Omnipod insulin pump. If I forget to do this, my blood sugar will crash very early in my work out and make it nearly impossible to complete. Not only that, but if it falls too fast for me to correct, I run the risk of losing consciousness. If I reduce my basal too much, my blood sugar has the potential to spike. High blood sugar has many side effects that I won’t detail here, but imagine trying to run through peanut butter while your legs are chained to the ground. Prolonged high blood sugar presents the risk of diabetic ketoacidosis, which basically means that my blood has become acidic.

Dehydration is another concern that is heightened because of my disease. For me, dehydration can lead to high blood sugars that insulin corrections will not bring down. This has put me in Urgent Care to receive IV fluids. When you combine all of these factors, along with normal work and home life, training for ultra endurance events like Ironman, becomes something like trying to complete a Rubik’s Cube, while parachuting, but trying to land on a high wire blindfolded.
In the immediate hours after a major sporting event, most people are desperate for some of the post-race pizza and beer. They are sore, obviously tired, and their bodies are aching for carbs and protein to start repairing the damage they just did. A lot of people experience flu-like symptoms for a few days. I’ve known a few to be out for a run the next morning too. Crazies!

After my first and second Ironman finishes, we realized that on top of those post-race symptoms that most experience, my diabetes does some very strange things. After my first full, I went to bed a few hours after the race and woke up completely soaked in sweat after a massive spike in blood sugar. I changed clothes, corrected with a dose, and woke up a few hours later with one of the lowest lows that ever had. My normal ratios were completely useless. After my second finish, my wife tells me I had a night full of sleepwalking and hallucinations. I have no memory of either of these.  For the first few hours after a major event, monitoring fast swings in my blood sugar, rehydration, protein, and slow-releasing carbohydrates are critical for me. For me, the post-race aftermath on my body, coupled with the unpredictability of my diabetes, is often much harder than the actual event. After I cross the finish line, a whole new battle begins.

Everything I just laid out is experienced every day by people in the Type 1 community to varying degrees. There are inspirational stories everywhere, and I would say that most of them far exceed mine.

Eric Tozer and Casey Boren (and other Type 1s) teamed up to run across America. Don Muchow ran from Austin to Corpus Christi in 3 days covering 223 miles. Frida Carias was diagnosed two years ago and recently become a National Champion cheerleader/gymnast. When I think about deciding to participate in this race, I think back to a previous endocrinology check-up where I overheard this doctor tell a child who was newly diagnosed that he would not recommend sports because of the difficulties associated with our disease. This has stayed with me for years, and I reflect on it often. I have an opportunity to show people how challenging yet entirely possible being an athlete with Type 1 diabetes can be. So when my parents ask me why, my answer will always be, “because I have to.”