How I Run 100-Mile Races with Type 1 Diabetes

"I'm forced to be stronger because of it."

In 2014, I was diagnosed with type 1 diabetes, a chronic disease where your pancreas produces little to no insulin. I had just returned from a month-long trip to India and thought I had jetlag because I was feeling really sluggish and was experiencing really bad dehydration. My mother is a physician, so she stressed that I get some blood work done. It was a super quick, rapid diagnosis-within a day I was on insulin. Thankfully I was never hospitalized, something a lot of people with type 1 experience when they are first diagnosed because the symptoms start quickly and can be severe.

The diagnosis came as a shock. I'm an ultramarathoner, I run 50 and 100-mile races, and this was certainly not something I anticipated. The first question I asked my endocrinologist was: How was I going to continue to run ultra-marathons? This was not a question she had never heard before.

The percentage of runners that do this kind of racing that I do is small as it is, let alone with an autoimmune condition such as type 1, so I really didn't have many examples. There were definitely doctors and practitioners who were extremely doubtful about my ability to continue doing marathons. I'm also a vegan and they tried to get me to move to meat-filled diets to control my insulin levels, and I was just like, "You know what? I'm just going to figure this out myself." And I kind of have. I had one friend who was doing 100-mile races as a type 1 diabetic so I was able to reach out to him and get some advice, but what works for somebody else might not work for you since everybody's levels and needs are different so largely I've had to figure this out on my own. I started looking into the technology out there for type 1 diabetics, and I think within 10 days of my diagnosis, I was on an insulin pump and glucose monitor, which allows me the freedom to not have to deal with injections. I can adjust my insulin level as needed, which is very often.

Life as a type 1 diabetic is a 24/7 tightrope walk. My insulin pump is underneath my skin and something I need to think about literally all day. There isn't a moment in the day that I'm not aware of the fact that I'm responsible for making sure that I'm walking, talking, and breathing. There are horrible cases of type 1 diabetics who go to bed, hit a low throughout the night, and never wake up. People can die from this condition; it's a very real reality. As a type 1 diabetic, you give yourself insulin for every bite of food. You change your insulin levels for movement. So if I'm going boxing, I know my insulin is going to increase because of the cortisol. I know that if I'm doing a long run it's going to drop, so I need to reduce it at certain times. I need to eat sugars at a certain time, before, or after, or during. It's all about math and timing. I haven't eaten a bite of food in three years and not thought about my insulin to the carb ratio and how much I should be taking, what I plan on doing in the next hour, or what I was doing beforehand. I don't think I've slept through the night since I was diagnosed because I have devices that go off to tell me if I'm high or low or's crazy. I don't even remember what it's like not to function without having to think about those things. Still, I think the transition would have been much harder if I wasn't an endurance runner with such an awareness of my body-I was already so aware of how I'm eating, how I'm moving, and how I'm feeling at any given moment especially when I'm racing and training.

Thankfully the technology gives me the ability to adjust my insulin levels and reduce the risk as much as I can. But I'm risky by nature. When I was approached by National Geographic to trek across the Serengeti in Tanzania I said yes. I trekked with a group of people almost 200 miles, foraging and living off the land-no tents, no food. My insulin was kept with the film crew, but other than that, I didn't receive any assistance. I'm pretty sure I'm the only type 1 diabetic to have ever done that. Yeah, there were definitely really scary moments where I thought I was putting my life on the line. It might sound stupid, but I still really believe in living boldly and I don't really consider myself a victim. I'm forced to be stronger because of it. (

Still, it's unpredictable. In a marathon, people are often concerned about hitting the wall. I would say a blood sugar low is a wall x 100, and it's a wall that can really bring you into an emergency circumstance, which is what happened at the recent Shape Half Marathon. My first was at the Tokyo Marathon in 2014. As a diabetic, there's a risk of going too low and a risk of going too high with your blood sugar levels. When you're doing an endurance sport, of course going low is horrible cause you don't have enough sugar to function, but it can be more easily remedied by Gatorade or having sugar. But both at Tokyo and the Shape Half, my insulin pump failed and I stopped receiving insulin so my blood sugar skyrocketed, and without insulin to reduce your blood sugar levels, your body is working way too hard. It makes it really unsafe for your heart to be doing something like a marathon, which is already causing it to work pretty hard. The fatigue was like running with a refrigerator on your back-my organs were just struggling. But since I'm also really stubborn, I finished both of those races anyway. At the Shape Half, I knew that I had one more loop of the park, so I just ran slower and did it. I knew that if I kept it within a comfortable range that I would be fine because I have a pretty high tolerance, but it was frustrating to deal with a set-back.

Type 1 diabetes is a 24/7 thing that is a complete pain in my ass. But there's one benefit: I have multiple opportunities a day to show myself that I always have a little bit more strength.

And luckily, now I'm able to help other people in my position as a member of the leadership council of Nick Jonas' nonprofit, Beyond Type 1. It's really about raising awareness and creating a supportive, relatable community. A lot of the content out there is geared towards children, but type 1 can happen to anyone at any time (that's why it's no longer called 'juvenile diabetes'), so it's a great outlet for other adults out there, and a necessary one. There's a lot of fear-based information out there. Some of it is practical, but a lot of it I disagree with. I just don't think that we can operate living in fear.

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