Combining sport with type 1 diabetes: Elite athlete Alex shares his experiences

Alex Kozeniauskas is not your average athlete. He has just cycled from Melbourne to the Barossa Valley in five days as part of the Type 1 Challenge to raise awareness and money for type 1 diabetes research, in support of the JDRF One Ride. Alex spoke to myVMC about how he balances the demands of living with a chronic illness with being able to train and compete at the highest level.

Living with type 1 diabetes

Alex is one of over 150,000 Australians living with type 1 diabetes.¹ It is a chronic condition in which the body is unable to produce the hormone insulin, which lowers blood glucose levels. Insulin is usually produced by beta cells in the pancreas, but in type 1 diabetes these cells are destroyed by the immune system, meaning no insulin is produced. Without insulin, the body cannot process glucose from food into energy for the body, and the glucose levels in the blood can become too high.²

For people with type 1 diabetes, maintaining their blood glucose levels within the optimum range is an intricate task. Insulin injections are required throughout the day to keep blood glucose levels stable.³ Alex described it as “a 24/7 management to keep it stable. The more things you do, the more active you are, then the more that has an impact on your blood sugars and insulin level.”

Physical exercise, insulin dosing and food intake need to be carefully balanced to avoid blood glucose levels becoming too low (hypoglycaemia) or too high (hyperglycaemia).⁴ “Everything that you do has a consequential impact over the following hours. So what you do in the morning impacts what happens at lunch time, then impacts what happens at night, which impacts what happens overnight and then the next morning as well,” Alex said.

Combining sports with type 1 diabetes: The challenges

Sport has always been an important part of Alex’s life. “I’ve always done endurance sports, from swimming when I was a teenager, then I got into cycling. At the moment I’m doing various types of triathlons.”

But participating in sport has added challenges when you have type 1 diabetes. Different activities can have vastly different effects on blood glucose levels.

“Swimming, riding, running, walking the dog: they all have a different impact on blood sugar levels, which means you need to have a different approach on how you manage your insulin and food,” said Alex.

In order to manage type one diabetes, individuals need to regularly monitor their blood glucose levels, follow a healthy diet and dose with insulin up to six times a day.⁴ Alex revealed that this can be draining at times. “Every time you do a blood glucose reading you get positive or negative feedback on how you are going. Even if you are doing the right thing and you think you are managing it well, for some reason your sugar levels can be high or low or not stable, and that can take a toll on you mentally.”

When Alex is preparing for an event he does his best to simulate the conditions that he will face come competition.

“With an Ironman [triathlon] I know I’m going to swim, get on a bike and then run. I’ll do training sessions to simulate those scenarios to the point that if I’m going to start an Ironman at 8 am, I’ll do sessions where I do the Ironman swim at 8 am and then I’ll get out and do a ride on the bike,” Alex explained.

This means that when Alex competes in an event he can predict how things will play out.

“When I go into an event I have an idea about what is going to happen. Sometimes it happens and sometimes it doesn’t. You have a bit more confidence that you can focus more on the race and less on your diabetes just by having that preparation.”

Everyone’s experience of type 1 diabetes is different and what works for some people might not necessarily work for others. It is important that before participating in any types of sport, type 1 diabetics seek medical advice from trained professionals. For Alex, doing research and being well informed is a major part of his approach to physical exercise and training.

“I’ve researched for myself, done trial and error, and then gone and spoken to my endocrinologist, diabetes educator and nutritionist to try to figure out things for myself and how I can manage it,” said Alex.

Alex uses a continuous glucose monitor to keep track of his blood glucose levels when he is training. This gives a continuous reading of his blood glucose levels, which is something that a finger prick test cannot give.

“When I’m training I check my [blood glucose] levels every fifteen minutes. I use a continuous glucose monitor. It gives a continuous readout of where my sugar levels are. That has the advantage of being able to see where the sugar levels are tracking so you can predict whether you’re running high or low or stable.”

Combining sports with type 1 diabetes: The benefits

There are many benefits in being physically active for people with type 1 diabetes. For a type 1 diabetic, physical exercise can increase their sensitivity to insulin, meaning that they do not need to take as high doses as if they were not active. Being physically active not only helps keep diabetes under control but can also help prevent long-term complications. It can reduce stress, lower blood pressure and help reduce the risk of other chronic diseases such as heart disease.⁵  Alex has noticed these benefits first hand.

“[There is] no doubt that exercise has a very positive impact on type 1 diabetes.

“On a normal weekday I would use 30 units of insulin. When I was doing the ride to Adelaide where we were riding from 7 in the morning to 4 in the afternoon, my insulin would have been about 15 units for the day.”

Alex’s most recent endurance event saw him complete the Type 1 Challenge which he founded this year. Alex, along with 15 others, rode from Melbourne to the Barossa Valley from Monday 1 May to Friday 4 May. This preceded the annual JDRF One Ride which took place on the Saturday.

“The JDRF One ride is one of JDRF’s big fundraising events so that was held over the weekend. Through my involvement with JDRF I was helping organise that event, and then I had the idea to do something different to help with fundraising. I was going to ride from Melbourne over to Adelaide,” said Alex.

“It couldn’t have gone any better. We raised over $140,000 in our riding group, which was massive,” he said.

Alex hopes that the money raised through the Type 1 Challenge and the JDRF One Ride will have a positive impact on type 1 diabetes research.

“My big thing with JDRF is that they’ve been the primary global driving force in both research and technology that has come through for type 1 diabetes in the last 20 years.”

“[What we are doing] is promoting awareness of type 1 diabetes so people actually know what the condition is like. We raised $140,000. That will fund someone’s research for a year and a half to two years. Who knows what they are going to achieve in two years’ time,” he said.

Alex encourages others with type 1 diabetes to keep fit and healthy, and to not let diabetes be a barrier.

“Having type 1 diabetes doesn’t have to stop you from doing anything. You should try and be doing more, because it will not only help your type 1 diabetes but it will help with everything else.

“The healthier you are, the better your body is going to be. Having a chronic a disease just means you have to have that under control first.”

Quick tips

• To avoid blood glucose levels being too low or too high, people with type 1 diabetes need to carefully balance physical exercise, insulin and diet.
• Being physically active can help keep your insulin doses under control.
• Keeping physically fit also has benefits for your health and can reduce the risk of long-term complications such as heart disease.
• Having diabetes does not have to stop you from being physically active. It is just important to keep well informed and discuss your management options with your healthcare team.

To read more about Alex’s fitness endeavours and how he manages his diabetes and prepares for events, head over to his blog: www.type1athletic.com.au.

References

1. Australian Bureau of Statistics. National health survey: First results, 2014-15. 2017 (cited 28 May 2017). Available from: [URL link]
2. Juvenile Diabetes Research Foundation. What is type 1 diabetes. 2015 (cited 28 May 2017). Available from: [URL link]
3. Diabetes Australia. Type 1 diabetes. 2015 (cited 28 May 2017). Available from: [URL link]
4. Diabetes Australia. Managing type 1. 2015 (cited 28 May 2017). Available from: [URL link]
5. Diabetes Australia. Exercise. 2015 (cited 28 May 2017). Available from: [URL link]