Diabetes triathlete “Iron Andy” is making a comeback!

Diagnosed with type 1 in his mid-30s more than a decade ago, Andrew Holder from the Philly, PA, area made a name for himself some years back, speaking out about diabetes while participating in multiple races and competitions all over the country. But then he stepped away to focus on a career in the diabetes device industry — briefly for Asante Solutions selling the Snap pump before its demise in 2015, and for Insulet with the OmniPod for the past four years.

Now “Iron Andy” is back, working to prove that at 50, he can still conquer the famous Ironman competition despite diabetes. We had a chance to meet him at a recent D-event, and followed up with this interview:

DM) Hi Andy, can you share your diabetes diagnosis story with us?

AH) I was 35 when I was diagnosed. I’d been a drug-free bodybuilder, and my wife and I were just getting ready for the birth of our second son. We had life insurance and I’d worked in that business as an investment advisor. When the blood work came back on qualifying for our new policy, I was “deemed to die” by the same company that I had preferred status insurance with. But they denied me and the underwriter told me that my A1C had come back at a 6.0. I responded with, “What’s A1C?”

They told me that I was technically considered “pre-diabetic” with type 2, and I didn’t know what that meant. As a former bodybuilder, thin and in shape, I felt that it had to be some kind of mistake because I didn’t fit the profile. I went to my primary care doctor and he prescribed a glucose meter, and said to test a few times a week and to come back in a few months. I don’t think I really even tested until right before going back to see him again… Even then, I tested and saw a 300 on the meter, and thought it was a mistake. I even called the company and complained that something was wrong with the device. So I was in complete denial.

Yikes! What happened on that return doctor’s visit?

I went back and my A1C was something like 18. He was shocked, and told me to immediately go see an endocrinologist and I was diagnosed with LADA (Latent Autoimmune Diabetes in Adults, or Type 1.5). It turns out, not knowing what LADA was, that in that six-month period between the original appointment and going in for a doctor follow-up is when everything got worse. It wasn’t a black-and white-change, like you sometimes see with quick-onset of T1 where you’re fine and then in the ER with 500-level blood sugars. It was a slow progression, but even then I was still in denial.

When did your denial mindset change?

It was a quick moment. I kind of just snapped out of it, and thought: “I didn’t do anything to bring this on and couldn’t control that, but what I can control is what I do next.” I can face the rest of my life with this – especially with an infant and newborn son. The thought of them only knowing me as this guy who gives himself shots, or tests his blood sugar… I didn’t like that. If I could do something to overshadow that, to show them and myself and anyone else, that I’m not going to be defined by this disease, then maybe that could change how they see me. Maybe it would become an afterthought that I have diabetes. It was in that self-reflection that I decided to do the Ironman competition. I figured if I could pull all of that off on top of facing this terrible chronic disease, then I could certainly accomplish my goal of having my kids grow up and see my first as an Ironman rather than someone with diabetes.

What was that first Ironman experience like?

Most interesting at the time was that I’d never done a triathlon, didn’t own a bike and didn’t know how to swim. So not only did I have a job and kids, but I had to start by learning the basics.

Honestly, my wife looked at me when I decided to do this and asked, “Do you even know how to swim?” I didn’t. I had never taken lessons and didn’t know how to do a lap in the pool. So I had to teach myself, and I remember on that first day of swimming that I almost didn’t make it one length of the pool. And again, I was in phenomenal shape as a bodybuilder, but just couldn’t make it to the other side of the pool. I was swallowing water and hyperventilating. That was only 25 yards, how was I going to make it 24 miles? But I kept pressing forward and progressively got better and started seeing myself in a position to be able to do the Ironman.

When did that evolve into your Iron Andy Foundation?

It grew from just proving something to myself and my sons, to maybe I could inspire other people and kids with diabetes, and their parents who worry about them. It became a platform to use diabetes to help other people.

I aligned myself with JDRF in Philadelphia as a way to raise awareness and fundraise. I met with different companies over time and eventually became national spokesperson for Good Neighbor Pharmacy, traveling across the country for speaking engagements every month talking about diabetes and also doing triathlons. I spent about seven years doing that, and what became my job was speaking and meeting with kids and families, and probably for the last five of those seven years I focused on the Iron Andy Foundation and it was in high hear. So I was doing all of that to inspire kids but also raising money to send kids to diabetes camps. That’s what got me involved with the Diabetes Education and Camping Association (DECA) for several years, too, where I was raising awareness about camps in general.

When did you start working in the diabetes industry?

After my run as a national spokesperson for Good Neighbor Pharmacy came to a close, I found myself scratching my head about what to do next. I wasn’t an investment banker any longer and definitely wasn’t in the spokesperson role, and I ended up connecting with a guy named Chris Leach who was just starting up a new digital publication called Insulin Nation at the time. I had been working with Wilford Brimley in his campaigns with Liberty Medical, so Chris and I connected through marketing there. I wrote for him there and was networking within the diabetes world.

That led me to Asante Solutions that made the Asante Snap insulin pump, and I did some PR work before going to work for them full-time – which ended up being only about seven months until they went out of business (in May 2015). Through CDE Gary Scheiner here in the Philly area, I connected with Insulet (makers of the OmniPod tubeless pump) and went to work for them.I am now a Regional Territory Manager in the Philadelphia area and am coming up on four years, connecting with people about the OmniPod.

Why did you step away from that “Iron Andy” persona?

Not only was it so hard to manage diabetes while training for an Ironman and triathlon competitions, but wearing that persona and being out there speaking about it… I was being paid to be a traveling spokesperson on diabetes, which was frankly really hard and I was a little burnt out. And then going to work for an insulin pump company… I thought it would just be too much to do both. I didn’t have the time to train, and I fell out of doing it. Before I knew it, three or four years had gone by. Except for some people in marketing at Insulet or those who know my story, I wasn’t really Iron Andy anymore.

But now you’re getting back into training again?

One day I was out at the track, and it sort of hit me: I had kind of lost a piece of my identity a little bit. For the longest time, I was widely known as “Iron Andy.” I’d be traveling the country and would bump into people in the community wearing Iron Andy gear, or meet someone who had been inspired by me. That was my identity. And so getting away from that and losing that identity… started to bother me. I wanted to get that back.

A couple friends that I’d inspired to get involved in triathlons now inspired me to get back into it. That’s what led to my return triathlon in 2018. It was more than just “one more triathlon” for me, it was about getting that Iron Andy identity back. It was so impactful for a lot of people, and for me personally – especially since my boys are 16 and 14, old enough to appreciate this more than when they were young. That’s what brought me back. I have a new goal of doing the Ironman championship.

What’s involved with that?

It’s known as the Ironman Legacy Program, where you can get into a special lottery if you do a certain number of different Ironman competitions. For the big one, you have to qualify – which is not something I’d ever be able to do. Or you win a lottery slot, which is also pretty impossible. But the legacy program is a special lottery without a lot of people in it, so the Ironman in Lake Placid that I’m doing this summer will be number 10. If I do two more, I’ll be able to get into that special lottery as a legacy. That’s my new mission and big goal, to keep this going for a couple more years.

Can you share some details about how you manage your glucose levels, especially during intense workouts?

I’ve been on an insulin pump since day one, but they are pretty insignificant during a race because you don’t really need insulin. Now I’m on the tubeless OmniPod and have used that during my triathlon most recently (in 2018).

Early on, I used the early Dexcom with the oval-shaped receiver, but it wasn’t as accurate back then. So I didn’t use it much. I was testing my blood sugar 60-70 times during a race, and that’s one of the most difficult things to do during a competition. You certainly don’t want to go Low so I was constantly checking my blood sugar.

There is really no set advice or routine as far as training that I can give. It’s a different disease for everyone, and that’s one of the things that made it so difficult for me getting started. I was trying to figure it all out on my own, and there was a lot of falling down and getting back up, so to speak. There’s a lot of work involved and it can all go out the window on race day. There is no single how-to guide, it’s very fluid and is about finding what works best for you.

Thanks for sharing, Andy. Good luck on your upcoming competitions and getting into that legacy program!