I'm back today for my second exclusive check-in with Kris Freeman, world-class cross-country skier competing in the Winter Olympics this week. He's the only athlete there with diabetes. And on Saturday, it caught up with him. A blood sugar crash killed his chances for taking a medal in the men's 30K event, where he was a favorite (he fell to 45th place after having to lie down in the snow mid-race for a bit). Naturally, he's disappointed, but still pushing his limits.
Via phone from Vancouver Sunday morning:
DM) Kris, you've had two disappointing races in these Olympics so far, but you're still breaking ground for diabetics in endurance sports. How are you feeling right now?
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I'm discouraged, but I'm certainly not giving up.
As much as it does stink to have a really bad Olympics, people tend to think that's the only focus. We actually have a huge racing circuit, with the world championships every two years. I don't live my life in four-year blocks.
There are also many dominant skiers, but no one contender who wins everything... there are so many variables in this sport and lots of things can go wrong. The blood sugar is definitely another variable that complicates things.
I kind of wish I could be more of a role model (for athletes with diabetes). I'm not really feeling like one right now, but I'm doing my best.
You've been so meticulous working out your dosing strategies — can you tell us what went wrong in the 30k event Saturday?
Obviously the basal rate I chose was too high. I'm kind of stratching my head because this event was similar to the race in Alaska, where I used the same dosing. But this is not the first time I've seen discrepancies in my needs just based on venue and conditions. It was unusually warm Saturday, so that was different, and altitude always makes a difference, although the altitude's not that high here...
I used the same basal rate as in Alaska, and fed the same amount going in: 3 drinks in the first 12k of the race. I was comfortable in the lead group, feeling relaxed, but then I got a 'twinged feeling' that something was wrong...
The problem is that the feeling of low blood sugar and the feeling of the pace being too high is similar. Within three minutes I got to a point where I couldn't make forward progress. I pulled over to the side of the course. People drop out of races all the time, so that didn't look unusual, so no one was really coming to my aid. I yelled to the crowd "Does anyone have any sugar?" Then one of the German coaches came over and gave me Gatorade and some goo.
I considered just staying there. But then I thought, 'It's the Olympics, I'm going to finish the race.' At that point, I'd lost over 3 minutes already, which is an eternity.
Can your experience be useful as a learning point for other Type 1s working to conquer endurance sports?
It's definitely a science trying to figure this all out. I've been doing this for 10 years now, and I figure I could race two ways: I could be conservative with my dosing and get respectable results, and that's OK. But to really shoot for the Olympic podium I need nearly perfect BG control. The narrower the window I shoot for, the easier it is to miss, so I gotta decide how narrow I want to go.
This was only the fourth 30k I've done since I switched to the Omnipod. I've definitely had success in the 15k with the pod, so I'm going to keep working at it till I get it right for other events.
I'll have a meeting with my doctor today (Sunday) with to work out my best strategy for the 50k. Basically, we lay out all the variables, and then guess at what went wrong... Maybe I could have been 25th place if I hadn't shot for such a tight window, but I wouldn't be happy with that either. I've been there before.
Are you working with some famous endocrinologist then?
No. I'm working with a cardiologist in Vail, an incredibly smart guy who's always on the cell phone with me, always talking through these things, figuring it out, and that all helps incredibly. If I'm stressed, for example, it has huge impact on my BG levels and my needs.
You can have the most brilliant doctor in the world, but if he's distant, it's not that useful.
What would you say to people who might say certain types of sport are just impossible for Type 1 diabetics?
I would say that they're wrong. Anyone saying it can't be done is not worth listening to. This is only the third time I can remember a blood sugar low having bad impact on a race, and it really sucks that it happened here. But I think it's because I'm not just trying to be in the race, but to be in the front of the race.
I'm the first guy who's tried to do it at this level, and I'll continue to try. I might make more mistakes, but someone's gonna come along after me and do it better than I am.
I try to take advantage of every innovation that comes along. The Omnipod has helped me in the 15k, and I'm sure I can use it better in the 30k as well.
For sure CGM (continuous glucose monitoring) is the next innovation I'll take advantage of. I'll spend as much energy as possible trying to get ahold of one that will help me.
Speaking of CGM, what about OmniPod's planned integration with the Dexcom? Won't you one of the first patients to get their hands on that device?
I'm sure I will. It's nice to be at the forefront of this. New tech innovations will make it easier to dial in dosing, etc., but there will still be unexpected crashes and things in extreme sports. To a certain extent, it'll still be a guessing game.
Grrrr, life with diabetes! From a previous conversation with Kris on life as a world-class athlete grappling with Type 1:
Insulin is on the banned list for the international Olympic competition, but you can get a medical waver if you can prove that you need it. Obviously, I got the waiver.
It seems you are the one and only diabetic competing in these Winter Olympics. How do other athletes or coaches react to your diabetes?
Basically I so rarely have problems with it that the other athletes and coaches frequently forget I have it. I've been diabetic for 10 years, and I've never lost consciousness; I've only gone low in a couple of, but I knew something was not right.
Otherwise I'm always incredibly prepared. I have at least two coaches out on the course ready with sports drinks — and have had this in every race over the last four years. In that sense, the coaches are kind of wondering, "What is all this preparation for?" I have to remind them that if I'm not totally prepared, there can be severe consequences.
So you don't carry sugar yourself?
Carrying the extra weight would be a disadvantage, so I depend on the coaches' help. It has worked well so far.
Last March, you ended up needing surgery for "compartment syndrome" in your legs — how did that go with the diabetes? Did the doctors let you keep your pump on while hospitalized?
They wanted to know what my daily insulin regimen was, and I explained that I use a floating scale depending on my activity level. They didn't really like that very much. But I had my main physician with me. He was by my side, so if (the surgeons) wanted to mess with me, they had to get through him first. I was very aware that if my BG was out of whack, it would take much longer to heal.
Tell us about your diet.
It's strictly controlled. I take in about 4,000 to 5,000 calories a day during heavy racing and training, and then cut down to 2,000 calories when I'm not moving so much. Then I'm fairly low-carb. When activity picks up, I need more fuel.
How much carbohydrate would you say is the right amount?
When you're not moving much, the answer is not very much! I really look at food as fuel. That's the biggest key to keeping my BG in control. My last A1C was in the mid-5s. I've had no A1C over 6 in the last seven years.
Basically, I stay away from processed foods, foods that are high glycemic. I eat foods in their natural form. For example, I get much less of a BG spike from eating an orange than from drinking a glass of orange juice.
I like to know where my food came from. If can't think of reason why I need that food, I don't eat it. I know that's hard for many people, but that's just the way I do it.
As an athlete, you must be testing your BG all day long...?
Whenever I have a repeatable routine, it's so much easier to manage my BG levels — like when I'm at home and my activity level is more even, then I only maybe check my BG twice a day.
On the road and training? I check as many times as I have to. If I'm not in range, then I keep at it till I am. If my BG is too high, I simply won't go to sleep. I've been known to do 200 jumping jacks in my bedroom to get BG back down. I will not rest while my BG is high. Because I know my body is not truly resting... it's under stress. The human body isn't designed to be over 120.
You take a lot of 'correction' doses then?
I don't take a corrective bolus if I'm at 180 or lower. My doctor and I believe that the enemy of good control can be great control... meaning if you're at 170 and correct, then you often drop down to 70, and then treat and bounce back up. It becomes a yo-yo effect.
So was there a special methodology that would allow you to accomplish extreme sports with a 'bad pancreas'?
I just treated it like a winnable science challenge. I began working with a doctor from Vail and the coaches. We devised custom insulin regimens. We actually hooked me up to stress tests and heart monitors, etc., to test how different basal rates effect my body under different exertion states.
The most striking correlation is that when my BG gets over 200-250, the lactate level goes up. That makes your muscles go heavy and tired and feel dead. I think that's a big part of it for people whose sugars run high alot. But if you're truly out of shape, everything is an anaerobic effort, and that in turn makes your BG rise.
Obviously you're an exceptional guy and athlete. Are there lessons for us 'regular' diabetics here?
Someone once said that I don't like adversity. My reaction is: who likes adversity? But I'm also very driven. If I encounter adversity, I just face it. I hit blocks in the road, but I go around them and I never stop.
The surgery was a big block, the diabetes was another... There are ways around them.
When anyone tells me I can't do something, it infuriates me. Even when I'm offered piece of cake at a party and I say no thank you, and someone says "Oh, you're diabetic so you can't have that," it makes me mad. Don't say I can't have that. I CAN. I just don't want to take a big bolus and deal with the consequences.
The first message I got from both my first doctors was that my athletic career was over — that I couldn't do it. Now it's 10 years later and look where I am.
I'm planning to compete for another four years, and do another Olympics after this one. After that I'll probably call it a career, and pack up and go to school...
Meanwhile, you're doing a lot to be a role model for kids with diabetes, right?
I hope so. I visit eight camps for kids with diabetes. I go and try to send the message that as long as you stay in good control, you can do anything. These kids get told over and over again that they can't do something because they have diabetes. That's just wrong.
Were there any diabetic athletes who served as role models for you?
Few. There was Gary Hall Jr. (Olympic swimmer), but his event only takes a few seconds. My sport is a totally different thing. I couldn't find a lead-level endurance diabetic athlete. So maybe I'm the first.
btw, why are you nicknamed "Bird"?
Growing up I was a Nordic and Bind skier. I got the nickname FreeBird from jumping. When I got into cross-country, apparently three syllables was too much (chuckles)
Well, this diabetic bird may not be soaring at the moment, but you're still doing us proud, Kris. Thank you!