Kevin Powell is an athlete, first and foremost. Twice a year, hecompetes in an Ironman event, a grueling test of endurance thatentails a 2.4-mile swim and a 112-mile bike ride, topped off by afull marathon of 26.2 miles.
On top of that, he adds a few half-Ironman races just to keep hishand 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 of24, after he'd already been a triathlete for two years. One day hewoke up and couldn't get his eyes to focus. "Over the next fewdays," he says, "the frequent urination and the unquenchable thirstjust took over, and I thought, uh oh, this is a problem.
My sister has had type 1 diabetes since she was eighteen, so Iwent 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 fitexercise into your insulin schedule – let's fit insulin into yourexercise schedule.' So I didn't miss a beat. To be honest, I feltgreat once I was on insulin because all the cramping went away. I'dgo out to run for two hours, and the cramping in my hamstrings wasjust unbearable. The doctor explained that my body couldn't processthe glucose, so my muscles were working on nothing."
About five hours every single day, Kevin is out there exercising. Hegets up around four o'clock in the morning and rides his bike fortyto fifty miles in a little over two hours. Then he's off to hisregular forty-hour job in the insurance industry, but during hislunch break he swims for forty minutes.
As soon as he gets home again, he runs for about an hour and ahalf, 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 everyday for the last twenty years.
Kevin describes his medication regimen as "kind of old school." Heuses twelve units of NPH in the morning and twelve at night, andthroughout the day he takes shots of Humalog, between two to fourunits each time. His endocrinologist believes that "if it ain'tbroke, don't fix it."
But, says Kevin, "He's ready to pull the trigger and move on toLantus." His insulin regimen works well with his standard extremeexercise routine and he rarely takes a break from it, except maybeto recover right after an Ironman event.
To monitor the direction his blood sugar is headed, Kevin tests aminimum 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 bloodglucose is trending. "Monitoring," he says, "you can't stress itenough. When I am preparing for longer distance events, I'll go to apark, I'll sit my blood glucose meter on my car's front seat, andI'll ride my bike in a loop for a mile, checking my blood sugarevery ten minutes just to see if it's going up or down. You justhave to learn to adjust. You can't let it rule you."
He uses the Ascensia meter with the ten-disc cartridge. "I'mactually on my third one. My endocrinologist says it's good becauseyou don't have to code it. I like not having to put the extra stripsin, and the meter doesn't rush you to get the drop of blood on thestrip. I just love it to death." His blood sugar is usually in therange of 120, and his last A1c was around 6.7 percent.
Since his diagnosis in 1993, Kevin's probably had a dozen episodesof very serious low blood sugars. "My last one was really bad," hesays. "I happened to be on vacation in Puerto Rico and there was alanguage barrier, so it was just godawful. The hotel calledparamedics, and I was handcuffed and shackled and taken to ahospital.
I remember waking up in the hospital with the garbage bag tiedaround my shins to a gurney, and handcuffed to the rails of thething. They didn't hit me at all, though; they just didn't want todeal with the potential of violence."
Kevin doesn't do carb loading before an event like many enduranceathletes do. He says, "I stick to my basic schedule. I like to eatbasic foods, so I'll just have peanut butter and jelly the nightbefore. While I'm racing I use a lot of GU, an energy gel that'slike pie filling with the consistency of toothpaste. It's basicallya 100-calorie shot of easily digestible carbohydrate, so I take thatwith 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 Clifbar too, just to build up a bit."
Kevin has gone low in a couple of races. "You just have to slow downso you can get your digestive system working again," he says. "Allthe blood is working somewhere else, so your digestive system slowsdown and you can't absorb those calories. You really have to justwait it out until you start feeling better. It's disappointing whenit happens because you have these lofty goals, but you just have toreadjust and go from there."
Speaking to budding athletes with diabetes, Kevin says, "It's noteasy for us to compete, but we don't have to settle for just being aparticipant. You can be competitive at whatever you try. I haven'twon any races, but that has nothing to do with my diabetes. Diabetesforces us to jump over certain hurdles, but it's not a limitingfactor. Look at Adam Morrison, who's a rookie in the NBA now. He'scompeting 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 letthings hold you down," Kevin adds. "I've been able to push beyondwhat 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 tobe healthy until the day I die. I want to be able to go for a runevery day. I've talked to people in their late seventies andeighties in marathons, and I just hope that's me."