What I Wish I Knew About Exercising With Type 1 Diabetes

Desperately hanging on to the corner of the buoy, I frantically ripped into a sports gel as hidden arms of the choppy lake water pulled me under. I was less than a mile into my childhood dream of completing a 140-mile triathlon, and I thought I was going to drown from an unexpected low blood sugar. Whether it was panic or just poor planning creating the low, consuming the gel got me back on track.

The triathlon dream was formed as a child watching the Ironman race on ABC’s Wide World of Sports but later killed by a medical diagnosis. I wish I knew at the time of my diagnosis that type 1 diabetes wasn’t a dream killer—it was just the start of a new journey. 

Type 1 diabetes is an autoimmune disease in which your pancreas doesn’t make any or enough insulin. This is because the body’s immune system mistakenly destroys the pancreas’ insulin-producing cells. Insulin is supposed to move blood sugar into the cells for energy. But because people with type 1 diabetes have little to no insulin, blood sugar isn’t properly moved into cells and instead builds up in the bloodstream. The build-up can cause several symptoms and complications.

When I was 26, I began displaying the classic symptoms of type 1 diabetes: frequent urination, unquenchable thirst, and unexplained weight loss. 

At diagnosis, my doctor unleashed a mountain of fear from things I had to do (take insulin shots, measure blood sugar) and things that I should not do (walk barefoot, take risks, most sports). I immediately went to Google to see how long I could live with type 1 diabetes. In that moment, while I learned I could live a long life, my athletic dreams died. How could I possibly be an athlete while constantly managing my blood sugar level?

Ten years later, a new approach to exercise led me to the biggest athletic accomplishments of my life: 110 miles run in four days, 24-hour obstacle course races, and even finishing the Ironman Triathlon where I thought I would drown. With my diabetes diagnosis, I became an adaptive athlete. Everything had to be done knowing that my body will not automatically regulate blood sugar levels by releasing insulin or stored carbohydrates. Therefore, I had to teach myself and my body to operate in manual mode.

I began by starting small distances like walking around the block. Beforehand, I’d ask a question: What could I need for this exercise? On those trips, I carried a backpack that included:

• A glucometer to test my blood sugar levels
• Glucose tabs and small bites to raise my blood sugar
• Insulin pens and needles to lower my blood sugar
• A glucagon kit should I need to be rescued from an extreme low

Additionally, I had to address the normal athletic needs like wearing the right clothes and hydrating. 

Eventually, as I repeated the same sort of exercise, my body became more trained, and I experienced fewer episodes of low blood sugars. Every unexpected outcome became an opportunity to learn something new. Diabetes was just another obstacle like the ones in my races that I had to find the way over, under, or through. Over the years, events would get easier, and I would push myself further. My mindset was always to be an adaptive athlete—modify actions to adjust for the chronic condition. 

Here are some of the key elements to being an adaptive athlete with type 1 diabetes:

Insulin 

While exercising, your body becomes more sensitive to insulin. How much your insulin levels decrease can depend on the intensity of your activity, but the sensitivity to insulin from exercise can mean that your blood sugar can decrease up to 24 hours or more after a workout. However, remember your body needs insulin to transport fuel to your cells. Make sure you have some insulin available to feed your activity. Trial and error will be key to getting the best results.

Energy 

Generally, athletes need carbohydrates after 60 minutes of exercise to help sustain themselves. But while exercising, the body’s digestive system slows down. Blood moves away from the core of the body to bring oxygen to the muscles, powering the exercise. Therefore, carbohydrates that can dissolve in the mouth, like glucose tabs, sports gels, or sports drinks, can bring up low blood sugar more rapidly than something chewed and swallowed. For longer activities like hiking, consuming some protein beforehand can help provide slower-released energy. 

Community 

Probably the most important thing in my journey from thinking “I can’t” to conquering exercise with diabetes was community. There are now many athletes and organizations that can help someone who is early on their exercise journey. Organizations like the Diabetes Sports Project are filled with athletes living with diabetes who can help you kill your fears rather than let diabetes kill your dreams.