Wednesday, February 24, 2010
It usually takes a medal winning performance to make headlines during the Olympics, but some of the great performances occur in the middle of the pack. Often there is adversity to overcome and this may be especially true when medical issues require even greater commitment to go higher, faster or stronger. Lindsey Vonn won gold after recovering from a leg injury but there are some conditions that never go away. Consider the story of Kris Freeman, a cross country skier who just happens to be a diabetic.
Cells in the body use glucose as an energy source. Insulin opens the door to allow that glucose to enter the cell. In diabetes, either insulin isn’t being produced (type 1) or the insulin that is being made, isn’t effective (type 2). Without adequate insulin, cells cannot function and if enough cells can’t function, organs and the body begin to fail.
Normally, the body is able to manufacture enough glucose as an energy source to meet the demands of its cells and the pancreas can produce enough insulin. In exercise, muscles need more energy and the body ramps up to meet that demand. In quieter times, when energy demand is less, the body can adjust. This normal feedback mechanism is lost in patients with diabetes. They need to predict their body’s energy needs and balance their calorie intake with the amount of insulin that they inject into their body. Poor planning can cause blood sugars to be too high or too low. Not enough sugar (or too much insulin) and the body stops working. The brain is especially sensitive to low sugars (hypoglycemia) and the patient can become comatose quite quickly. Fortunately, the body and brain respond well to getting sugar into the body. Not enough insulin in effect starves cells and causes them to look for alternative energy sources resulting in toxic byproducts.
Not so long ago, type 1 diabetes would put a halt to any potential athletic career for a kid. It was too complicated to predict how exercise would affect the body and predicting insulin dosing was too much guesswork and not enough science. With technology and research, new types of insulin were developed and the delivery systems improved. Instead of using a single injection of insulin each day, patients began giving themselves multiple doses, trying to mimic a “normal” pancreas’ work through the day. Insulin pumps were developed to give continuous flow insulin to common even closer to normal body function.
Mr. Freeman is an elite athlete in an endurance sport, where races can cover more than 30 miles and take hours to complete. Aside from training, studying opponents and planning race strategy, he has to assess his calorie and energy needs and plan how much insulin he will need to get that glucose into his muscle cells so that they can power him through the race. And this calculation has to happen not only in races but also with every practice and training session.
When miscalculations occur, Mr. Freeman needs to know the warning signs and adjust on the fly. If his blood sugar drops too low, not only will his muscle cells lose energy, but his thinking might get foggy, his judgment impaired and he may pass out. This scenario happened in the middle of the 30 kilometer race in Vancouver and as while lying in the snow, he was able to take a sugar goo solution, recover and continue to finish the race.
For diabetic athletes around the world, Mr. Freeman won an Olympic medal. Diabetes is a disease that requires vigilance to keep the balance of sugar and insulin in fine control. It is often too easy for patients to be discouraged from athletic pursuits and from pushing their own envelope for training and performance. It takes role models to make most opportunities possible and it takes research to make diabetes less of a life changing diagnosis.
Citius, Altius, Fortius.