This year, and among the thousands of ueber-athletes striving for Gold at the 2010 Winter Olympics, there's one ueber-diabetic. His name is Kris Freeman, and he's a star cross-country skier, poised to break the USA's decades-old "Olympic medal drought" in that sport — and also the first-ever athlete with Type 1 diabetes to compete in an Olympic endurance event.

Needless to say, I was excited to have the chance for several one-on-one phone briefings with Kris recently, including one last night!

{Kris has been getting a lot of press on his "unprecedented story" lately, including a hottie cover-shot on Outside magazine this month. Even diabetic Olympic swimmer Gary Hall Jr. has gone out of his way to say Kris is an inspiration.}

Despite a disappointing 59th place in the men's 15k event on Monday, Kris remains "America's best chance for a cross country Olympic medal," with his sights now set on Saturday's Men's 30k event.

Innovation 2015

{See my previous interview with Kris here, and updates on Kris' own "FasterSkier" blog here. }

Via phone from Vancouver yesterday evening:

DM) Kris, your aim and dream is to score a Gold Medal this week. How are you feeling after Monday's disappointment?

Really frustrated. The conditions are just so tricky up here, with a lot of soft snow. Then something unexpected happened before the race. We're supposed to have a full one-and-a-half hours on the course for final testing, but since the women raced before us and tore up the course, they decided to close it for repairs, so we only got 15 minutes.

This was a big catch for me, since I always use those last 15-20 minutes to do my glucose testing and adjust my pump dosing. Unfortunately, the change meant I only had time for testing glucose and not testing the skis and course.

So the diabetes was at the heart of what went wrong?

Not entirely. I never skied on those particular race skis until the start of this race, which is very unusual.  It's all about the nature of the snow. There's some pretty funky snow up here, so having the wrong flex ski can change the whole dynamic.

I don't know if people realize I have 30 pairs of skis here, for every imaginable snow condition. We usually go out and test and narrow it down to 3 pairs, and then I pick and test them first. But we had so little time...

I always focus on my health first, and the skis second, and that kicked me in the ass this day. Still, I'm not sure I would have done anything different...

On the plus side, I nailed my glucose.

Do people there 'get it' how intricate diabetes management can be?

Half the people around here have some understanding, but half would say, "Why didn't you test your skis??"

I like to do my BG testing 15 minutes before the race, in a heated environment, so I can have faith in the numbers I'm looking at.  There are so many variables in this sport, and the glucose definitely complicates things.

So what was your dosing strategy?

What I ended up doing is .7 units/hr 24/7, and then leading up to the race, three hours before, I upped my basal to 1.0 units/hr to cover the sugar I release from being nervous. Twenty minutes prior to the 15k race, I actually upped to 7units/hr, and then took a half-unit bolus, because the amount of sugar I release in an event like that is incredible.

I only take a bolus before a race if I'm in an upward trend. If I get much over 200, I'm putting myself at a disadvantage, because my lactate levels go up (the substance in your body that kicks in when oxygen is in short supply), and that creates that heavy, nasty feeling people sometimes get when exercising. It hurts. I don't want that.

Most diabetics would be more worried about going low during extreme sports, so they'd rather let their BG levels run too high...?

That would be fine if my goal was just to finish the race, but I'm trying to win the race.

Also, I had four coaches positioned on the course ready with sports drinks if I needed sugar.

So what's your strategy for Saturday's Gold Medal event?

This next race is going to be interesting. I had more confidence in my insulin strategy going into the 15k than into the 30k. But sometimes confidence is not such a good thing. Maybe it's better going into it a little agitated...

From a previous conversation with Kris on his life as an extreme athlete with Type 1 diabetes:

You talked a lot about prepping for these Olympics when I interviewed you three years ago.  What have been some of the biggest changes for you since then?

In terms of insulin dosing, I've just been less aggressive than what I tried in Slovenia that didn't work. I found I was needing more and more insulin in my system while racing. I was going high because of the adrenaline. The more anaerobic the activity, the more it makes your BG rise; the more aerobic, the more it makes you go low. So a shorter event has your body in a more anearobic state.

This is the reason I switched to the pump: in order to get the amount of insulin in my system that I needed using Lantus, I had to take doses that left me with too much in my system still the following day, which didn't work for my events.

So you started on the OmniPod in 2008, correct?

Yes, now I can change my basal rate on the fly right before an event. I hadn't switched to the pump before because my coach and I had concerns about the insulin freezing. It's legal to race in temperatures down to minus-4, and we were worried about the insulin in tubing freezing up.

With the OmniPod, I raced all last season on the pump... and I was able to dial in the dose I wanted for 15K events, but not for 30K events. That was trickier. To figure that out, I stopped during a race, and took 30 seconds to test blood sugar.

So you test yourself in the middle of races?  What's the technique?

A guy in my support staff held the monitor in his hands for me. But last year during the 30K event at Nationals was the first time I ever tested in middle of an actual race. I knew that by stopping I was probably sacrificing a title... but the data point was so valuable...

And the big advantages of pumping are...?

Just the on-the-fly control. I can use different basal rates at different times of day. I can fine tune rates for training and race days. And if get sick, I can ratchet up my basal rates to counteract the highs.

So with your level of activity and sweat, does the pod stay on well?

Yes. I did a 20-mile run and swam over a mile in the same day and it stayed in place.  The adhesive is really strong, so it generally stays on great — except that walking through door frames is bad because I mostly wear it on my arm, and door frames often knock it off.

Have you used any continuous glucose monitor (CGM) systems?

My doctor and I haven't found one that would work well with exercising — not with reliable real-time data. So the deterrent is the time lag, and also a lot of CGM sensors don't work well when you're sweating or moving a lot.  Obviously I would like to have a continuous glucose monitor that works well for my sport!

I've had fantasies of wearing a watch that would give me real-time readings — but so far I haven't found anything like that.

Without real-time data, you're kind of 'flying blind,' no? Do you have a handle on how competition nerves affect your blood glucose levels?

In practice events, I try to dial in the basal rate I need, but adrenaline changes things, so you need that data point.  In training, without the adrenaline working, my BG tends to drop.  For races, I've started changing basal rates up to 2 hours in advance, in anticipation of the adrenaline spike. I know it's coming.

I can lie bed and see my BG rise 80 points just from race nerves...

I try to use relaxation techniques to bring my levels down the day or night before events. I use the standard forms like visualization focusing on calming influences, like people in your life who are soothing to you, and listenening to music that calms you.  The thing that works best recently for me lately is just reading — something I like that takes my mind off the race.

Well, we hope you have a good book to curl up with tonight, Kris.

Best of luck this weekend!!

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