Kevin Powell is an athlete, first and foremost. Twice a year, he competes in an Ironman event, a grueling test of endurance that entails a 2.4-mile swim and a 112-mile bike ride, topped off by a full marathon of 26.2 miles.

On top of that, he adds a few half-Ironman races just to keep his hand in. It's beyond the imagination of most of us couch potatoes, but what Kevin brings to the plate makes it even more impressive.

Kevin has type 1 diabetes. He was diagnosed in 1993, at the age of 24, after he'd already been a triathlete for two years. One day he woke up and couldn't get his eyes to focus. "Over the next few days," he says, "the frequent urination and the unquenchable thirst just took over, and I thought, uh oh, this is a problem.

My sister has had type 1 diabetes since she was eighteen, so I went to her house and tested my blood after fasting. It was crazy, in the 300s. I got up the next day and went to her endocrinologist, and sure enough, I had it."

That very first day, Kevin's doctor told him, "'Let's not try to fit exercise into your insulin schedule - let's fit insulin into your exercise schedule.' So I didn't miss a beat. To be honest, I felt great once I was on insulin because all the cramping went away. I'd go out to run for two hours, and the cramping in my hamstrings was just unbearable. The doctor explained that my body couldn't process the glucose, so my muscles were working on nothing."

About five hours every single day, Kevin is out there exercising. He gets up around four o'clock in the morning and rides his bike forty to fifty miles in a little over two hours. Then he's off to his regular forty-hour job in the insurance industry, but during his lunch break he swims for forty minutes.

As soon as he gets home again, he runs for about an hour and a half, and later that night, he lifts weights for about a half hour. "I've been doing it for a long time," he says, "pretty much every day for the last twenty years.

Kevin describes his medication regimen as "kind of old school." He uses twelve units of NPH in the morning and twelve at night, and throughout the day he takes shots of Humalog, between two to four units each time. His endocrinologist believes that "if it ain't broke, don't fix it."

But, says Kevin, "He's ready to pull the trigger and move on to Lantus." His insulin regimen works well with his standard extreme exercise routine and he rarely takes a break from it, except maybe to recover right after an Ironman event.

To monitor the direction his blood sugar is headed, Kevin tests a minimum of eight to ten times a day. Before going out for a workout, he might test two or three times just to see which way his blood glucose is trending. "Monitoring," he says, "you can't stress it enough. When I am preparing for longer distance events, I'll go to a park, I'll sit my blood glucose meter on my car's front seat, and I'll ride my bike in a loop for a mile, checking my blood sugar every ten minutes just to see if it's going up or down. You just have to learn to adjust. You can't let it rule you."

He uses the Ascensia meter with the ten-disc cartridge. "I'm actually on my third one. My endocrinologist says it's good because you don't have to code it. I like not having to put the extra strips in, and the meter doesn't rush you to get the drop of blood on the strip. I just love it to death." His blood sugar is usually in the range of 120, and his last A1c was around 6.7 percent.

Since his diagnosis in 1993, Kevin's probably had a dozen episodes of very serious low blood sugars. "My last one was really bad," he says. "I happened to be on vacation in Puerto Rico and there was a language barrier, so it was just godawful. The hotel called paramedics, and I was handcuffed and shackled and taken to a hospital.

I remember waking up in the hospital with the garbage bag tied around my shins to a gurney, and handcuffed to the rails of the thing. They didn't hit me at all, though; they just didn't want to deal with the potential of violence."

Kevin doesn't do carb loading before an event like many endurance athletes do. He says, "I stick to my basic schedule. I like to eat basic foods, so I'll just have peanut butter and jelly the night before. While I'm racing I use a lot of GU, an energy gel that's like pie filling with the consistency of toothpaste. It's basically a 100-calorie shot of easily digestible carbohydrate, so I take that with some water or Gatorade."

He uses one GU every half hour to 45 minutes while he's racing, to level off his blood sugar. "While I'm on my bike in an Ironman, every twenty minutes to a half hour I'll have about a half a Clif bar too, just to build up a bit."

Kevin has gone low in a couple of races. "You just have to slow down so you can get your digestive system working again," he says. "All the blood is working somewhere else, so your digestive system slows down and you can't absorb those calories. You really have to just wait it out until you start feeling better. It's disappointing when it happens because you have these lofty goals, but you just have to readjust and go from there."

Speaking to budding athletes with diabetes, Kevin says, "It's not easy for us to compete, but we don't have to settle for just being a participant. You can be competitive at whatever you try. I haven't won any races, but that has nothing to do with my diabetes. Diabetes forces us to jump over certain hurdles, but it's not a limiting factor. Look at Adam Morrison, who's a rookie in the NBA now. He's competing at the highest level." (See our article "Adam Morrison Above the Rim With Basketball and Diabetes Control", December 2006.)

"Diabetes has shown me and my children that you don't have to let things hold you down," Kevin adds. "I've been able to push beyond what some people would call limits. My kids hear it, they see it, and I think they're pretty proud of me. I would like to be able to be healthy until the day I die. I want to be able to go for a run every day. I've talked to people in their late seventies and eighties in marathons, and I just hope that's me."