There was a time—say, the fourth grade—when I was sure my genetic destiny was to be an athlete. My father was a three-time All-American wrestler in college. My mother was a runner and a yoga teacher. At school, whenever teams were picked, I was among the first chosen, and, without exception, the first girl. But at 11 a different genetic fate revealed itself when I developed type 1 diabetes. The disease—which I and about 3 million others in this country have—develops when the pancreas stops producing insulin, which the body needs to turn glucose into energy. As a type 1, my life is a perpetual balancing act that requires me to check my blood glucose level several times a day. If it's too low, I feel shaky, tired and confused and must give myself sugar or risk passing out. Too high, and I feel listless and nauseated until I give myself more insulin. Over time, too many "highs," as I call them, can lead to the disease's nastiest complications—blindness, kidney failure and limb amputation, among others. At 33, I have recently started to experience some problems, including early-stage damage to my retinas and severe, arthritislike pain that spreads through my fingers. After three rounds of surgery, my hands are better. But my body has clearly put me on notice that, among other healthy practices, daily exercise now is nonnegotiable.
That hasn't always been part of my diabetic prescription. Early on I was told to limit physical activity, because it increased the body's sensitivity to insulin, which could lead to dangerously low blood sugar. Today, however, thanks to new types of insulin and faster, more accurate devices to track blood glucose, diabetics can enjoy the classic cardiovascular benefits of exercise. Working out is now considered essential for avoiding or at least delaying complications. To open a new, healthier chapter in my life, I recently spent a week at the only triathlon camp designed specifically for type 1 diabetics. A daily report:
MONDAY: With a morning blood glucose level well within my target range of 100mg/dl to 180mg/dl, the day started out A-OK. After shoving some carbs (toast) and protein (scrambled eggs) into my system and dosing with a bit of insulin, I headed to a warm-up session. Dr. Matthew Corcoran, founder of the camp (www.diabetestrainingcamp.com), had assembled a roster of elite coaches—Olympians and national champs among them—including Michelle Adams, a type 1 diabetic and personal trainer who aerobicized our group into a frenzy. It felt unfamiliar. But it prepared me for the next shock to my system, a clinic with runner Ray Appenheimer—who, among his many accolades, coached eight athletes to the 2004 Olympic trials. He also has type 1 diabetes. Several drills later, I could feel my blood sugar dropping, and started sipping Gatorade. Normally, I would have stopped right there. But since I was surrounded by medical and moral support, sticking it out was actually an option. After one more session, I'd done more physical activity in one day than I had in a long time. I went to bed tired and overwhelmed, but feeling good.
TUESDAY: I woke up to a high blood-sugar reading—280—and realized immediately that it was my mistake. Afraid that after all the exercise my glucose levels might fall dangerously low while I slept, I ate a snack before turning in. Turns out I shouldn't have. At lunch, I bungled things again when I grabbed a slice of pizza. By then, I'd given myself enough insulin to normalize my blood sugar. But in diabetic circles, pizza is known to send glucose levels skyrocketing. Soon enough, my glucometer gave me a reading of 340—sky-high, with not much time before I was scheduled for another running clinic with Ray. Worried, I gave myself six units of insulin—a big pre-exercise dose—and started the run. It was a risky move, but 50 minutes later, at the end of the run, I measured again: 145mg/dl, near perfect. A small but meaningful demonstration of my fragile-but-growing athletic prowess.
WEDNESDAY: The best of days, and worst of days. On the upside, Jim Carr, a diabetes educator with pump maker Medtronic, hooked me up to a continuous glucose monitor, a new tool for diabetes management. Like the insulin pump I wear every day, the monitor was about the size of a beeper. Sexy—if optimal glucose control is your fetish. (I am open-minded.) Every five minutes or so, the device calculated my approximate glucose level. In turn, I could take steps to correct a developing problem—be it a high or a low—before it happened. By looking at patterns, you can fine-tune your insulin regimen, narrowing the margins for error.
After my morning cycling session and lunch, I was scheduled for a VO2 max test, where I would ride a stationary bike at increasing intensities while breathing into a mask attached to a computer. The test would assess how I utilize carbohydrates, fat and oxygen. Ideally, it gives an athlete valuable data with which to refine a training program. I was nervous. I ate, but soon after, I thought I felt my blood sugar start to spike. Mild panic set in. I didn't want to be "high" for my test. So, in an act that for years has been my Pavlovian response to not feeling well, I gave myself a mess of insulin. But I forgot to test my blood sugar first. I grabbed my glucometer and got some bad news. It was a near-perfect 150, but with the insulin I'd just given myself, it would start plummeting in about 15 minutes. Subconsciously, at least, I had set myself up for failure, and fail I did. My results were a disaster. Corcoran and Will Cross, the evening's guest speaker, observed the fiasco. I had been looking forward to meeting Cross, who last year achieved the seemingly impossible when he became the only type 1 diabetic to summit Mount Everest. I explained what I had done to myself, and Cross winced. "I hate when I do that," he said. I thought he was kidding. "No, really," he said, "I do the same thing sometimes. It's so frustrating." I almost started to cry. At that moment—even now, for that matter—what he said made me feel less alone with the foibles of this disease.
THURSDAY AND FRIDAY: I spent the final training days trying to put into practice the techniques Corcoran had taught us. I was able to keep my blood sugar relatively stable or quickly make a correction. If I had any questions—about athletics or diabetes or both—an answer was always close by. "Whatever your skill level, this is a safe place for people to come and learn," says Corcoran. "People come out of their isolation and into their community and they flourish." Friday we had a practice run-through of Saturday's main event: a mini-triathlon. Supermini. Tongue-in-cheek mini. Swim the length of the pool, circle the parking lot on the bike and run about 150 yards. But competitive juices started flowing early.
SATURDAY: Mini-tri day. Although many of my fellow campers were getting up early for one final morning workout, I opted to sleep in for fear of depleting precious energy that would be better spent beating everyone. And to be honest, there was some performance anxiety. But then I joined a relay team with Dan, a swimmer, and, Rose, hell on wheels. I was the natural-born sprinter (really). The race began and within minutes we took the lead. Rose tagged me and I was off on the final leg. With victory a tasty 10 feet away, I sensed another runner catching up. I lost focus. I lost my balance. I wiped out, hard. Sporting bloody knees, hands and elbows, I quickly figured out that the moment might only be salvaged with comedy. I crawled in dramatic fashion over the finish line, as if the grueling race had left me totally depleted. I got my laugh and, even though I was beaten to the finish, a plastic gold medal. Sweet.