Leaping Over the Diabetes Hurdle, Athletes Maintain their Blood Sugars Under Extreme Conditions

The first recipients of the Lifescan Prize for athletic achievement were announced at the 1996 International Diabetic Athletes Association (IDAA) Conference held in Tempe, Arizona, March 31 – April 3. This year the $20,000 prize was split three ways by Pratt Rather, Klaudia Birkner and Erick Gonzalez Fritsche, each earning over $6,000 toward equipment and training.

Pratt Rather

Pratt Rather was a high school athletic star when he was diagnosed with type I diabetes at 15 years old. But the diagnosis didn’t slow Rather down, it only became another challenge. After playing football and running track in college, Rather now concentrates on endurance events such as long-distance bicycle events, biathlons, triathlons and marathons. The first time he participated in a triathlon in 1994, he qualified for the National Championship. He has placed in the top ten in every biathlon he has entered. He also ran in two marathons, averaging 6:30 minutes a mile.

Rather’s latest accomplishment was a team victory in the Race Across America. His relay team, The Azio Saddle Tramps, rode from Irvine, California to Savannah, Georgia in six days, ten hours and 30 minutes. Each member of the team totaled close to 130 miles a day, taking turns riding in short, one hour bursts.

Running in a marathon, or riding in a race across the country, demands extended, intense work. Rather can’t stop to check his blood sugars when he’s in the middle of a one-hour relay sprint. Therefore, Rather believes in beginning and ending a race with a normal blood sugar.

“You can’t let your blood sugars skyrocket and trust they will go down. It’ll hinder your performance,” Rather said.

Rather reduces his dosage by about 20 percent before a race from 10 units on a less active day to eight units on race day. He eats a small breakfast, then replenishes his blood sugar during a race with liquid or gel glucose supplements. In a bike race, Rather will ride for an hour, then drink from one of two bottles every 15 minutes to replace his fluids and sugar.

During a marathon, when he can’t carry a blood sugar meter or glucose gel, a friend will meet him at the one-third and two-third markers of the race to provide a meter or glucose if he needs it. Though marathon rules prohibit bystanders from helping the runners, no one has disqualified Rather for receiving assistance during a race.

“I’m not quite at the level of competition where I’m a threat to win a marathon, so they don’t question me. If I were up with the Kenyans, in the top five, I’d probably have to make a case for myself. Even if such a case came up, the officials would probably make allowances for a person with diabetes,” Rather said.

Rather stresses that everybody is different, and the only way to find a method that works is through trial and error. Training close to three hours a day, Rather doesn’t have to adjust his insulin by very much between a practice day and a race day.

“Often you have to train just like it was a race. You can’t do that all the time, but you have to push yourself to be able to compete. At this level, diabetes unfortunately is a hindrance. I just have to work that much harder.”

Rather has managed to compete at the top levels while starting his own business and having diabetes. He says his success has come from maintaining his priorities. Sports has always been his passion and his control medium for diabetes. He doesn’t let anything get in the way.

“Everyone in the world is born with God-given qualities, good or bad, and our service is to do the best we can with the traits we’re given. Diabetes just happens to be one of the cards I was dealt. It’s not a negative, it’s just a challenge. My goal is to make my life positive, to make my light shine.”

Klaudia Birkner

Growing up in foster care with type I diabetes was never easy for Klaudia Birkner. The loss of her vision when she was fifteen did not make things any easier. Birkner says her love for sports pushed her through the difficult times.

Birkner is currently the only Alpine Ski Racing female competitor representing the U.S. in the “Blind Skier and Guide” category of disabled skiing. Birkner regularly achieves speeds of 70 mph in competitions, led by a guide’s verbal commands.

“Downhill skiing is a really big rush. It gives me a sense of independence. You’re not connected to a cane, or a dog, you’re not connected to anyone,” Birkner said.

Birkner is currently studying Communications at California State University San Marcos. When she is not skiing, she spends much of her time applying for contests and looking for corporate sponsors. Her body, however, has a hard time making the adjustment between the slopes and her writing desk.

“When I’m skiing I don’t have to take as much insulin, maybe two to three units of Regular in the morning and about eight units of NPH. But the minute I begin writing letters my BGs go crazy. I have to raise my insulin dosage to about six units of Regular and 15 units of NPH,” Birkner said.

It always takes a few days for Birkner’s body to adjust to a new schedule of either exercise or relaxation, but the sudden adjustments she must make with her insulin doses send her blood sugars on a roller-coaster ride.

“I have to adjust my insulin the day I go up to the mountains, and I don’t have time to decrease it a little every day. I’m more concerned with the lows than the highs. On those first few days of skiing sometimes my blood sugars gets up to around 300 and I can taste it in my mouth.

“Before a race I start stressing and my adrenaline starts pumping so hard that it’s hard to distinguish a low from an adrenaline rush. But a Snickers bar will keep me steady,” Birkner said.

Birkner, who is totally blind, sometimes loses contact with her guide. If she misses a gate in a competition her trainer makes her hike back up to hit it so the judges don’t disqualify her. She doesn’t crash often, but if she does, it’s usually after she’s crossed the finish line. Birkner doesn’t get embarrassed by such mishaps.

“I actually think it’s kind of cool to crash after the finish line. They say if you don’t crash you’re not trying hard enough.”

Klaudia Birkner doesn’t have to worry about that.

Eric Gonzalez Fritsch

Eric Gonzalez Fritsch has lived with type I diabetes for 28 of his 30 years. When he’s not working as a Diabetes Educator for the Eli Lilly company in Mexico City, he keeps himself in shape for climbing mountains. Fritsche has climbed a few of the highest mountains in Mexico including Popocatepl, Iztaccihuatl and Citlatepetl, all averaging 5,500 meters. He crossed the Bering Straits during the winter of ’95 after a solitary hike of 100 kilometers. He also walked over 850 kilometers, reaching latitudes close to the Arctic circle.

Fritsche has taken it upon himself to encourage diabetes education in Mexico. He plans to climb Mt. Forel in Greenland with a film crew this summer and use the footage from his climb for a television documentary called Diabetes Under Extreme Conditions. In addition to winning the Lifescan award, Fritsche has helped raise $300,000 in conjunction with Citibank to construct a clinic for athletes with diabetes. Both the documentary and the clinic will help to make people aware of the need for more diabetes research, especially in Mexico, where the occurrence of diabetes is growing at an alarming rate.

“With seven million people with diabetes in Mexico and only 350 endocrinologists, there is a greater need than ever before for diabetes education. Many millions of diabetics are dying because they lack education, treatment and care,” said Fritsche.

Outside of his 40 hours a week at Eli Lilly, he spends another 20 hours biking, climbing and lifting weights. Besides his love for climbing, Fritsche exercises regularly to keep his blood sugars down and to enjoy another pleasure-eating.

“If I keep up my exercise regime, I can continue eating what I want. Eating is always a pleasure!”

While trekking through the Arctic circle, Fritsche made sure to stock up on high-fat foods to keep his blood sugars up and to help ward off the cold. The temperature once dropped so low crossing the Bering Straits that Fritsche’s insulin and meter froze. He had to stop in his tracks and set up camp. In a bind, Fritsche was forced to resort to a less-than-desirable solution that could have damaged his insulin-he defrosted his supply and meter by holding them close to his tiny portable stove.

Fritsche made sure to keep his diabetes kit close to his body after that. He also carried a .357 magnum to protect himself against wild animals.

In the north pole, between Point Barrow and Kaktobek, Fritsche found a sign warning against polar bear attacks. He hurried out of the territory with his pistol ready. To his horror, he journeyed straight into another sign warning of Arctic wolves. Luckily, he didn’t have to use the gun.

Fritsche may not face the same challenges as every person with diabetes, but his struggle with the disease is the same. Just as Rather had to maintain his blood sugar while bicycling across the country and Birkner had to overcome her blindness and diabetes to ski, Fritsche had to sit next to a portable stove with his insulin and meter to continue his journey.

Every obstacle becomes another stepping stone forward. From marathons to triathlons, from blindness to downhill speeds of 70 mph, from polar bears to wolves, diabetes is where Rather, Birkner and Fritsche begin. Where they end is left up to their determination and ability to manage diabetes.

To apply for the LifeScan Award, each athlete had to be an IDAA member, submit two letters of recommendation and a 250-word essay describing their experience with exercise and diabetes, as well as how the award would be used. The judges base their decisions on each individual’s athletic accomplishments, his or her potential to continue to succeed in the sport and the ability of the grant to assist the individual’s future goals.

Phyllis Furst, RN, MA, ANP, CDE adds this note: These are obviously not your typical examples of exercise. Readers should consult their health care professionals to develop individual guidelines for proper medication, meal planning and adjustments for exercise. Klaudia Birkner’s plan is particularly radical.