Iron Woman Diane: The Rewards & Challenges of Exercise With Diabetes
Iron Woman Diane, a recently retired power industry executive with Type 1 diabetes, has completed three full Ironman triathlons, numerous marathons and many lengthy cycling events, such as the New England Tour De Cure where My Body Odyssey first met her.
One day, though, Diane drinks some juice just before a yoga class and “next thing you know I’m inside an ambulance.”
Maintaining healthy blood sugar levels is a delicate, often dangerous balancing act for the many millions of Americans with diabetes, especially those with Type 1 or juvenile diabetes, like Diane. Unable to create insulin, she wears an insulin pump to maintain normal blood chemistry. Even so, Diane’s triathlon race plan “consists of a two-page spreadsheet that’s nothing but…how to manage my blood sugars.”
This episode also features expert commentary from Dr. Michael Riddell of York University, someone with Type 1 diabetes himself, and one of the world’s great authorities on diabetes and exercise. “I was diagnosed at a time when insulin came in a vial and you took one or two shots a day… to keep your blood sugar in a reasonable range,” says Riddell, who on top of his research has helped world class athletes like the NHL’s Max Domi with their diabetes management.
If Maxi Domi routinely handles the intensity of a pro hockey shift, and Diane has conquered 13-hour triathlons, how then did a simple yoga class land her in the emergency room?
Listen in to find out on “Iron Woman Diane: The Rewards & Challenges of Exercise With Diabetes,” the second full episode of My Body Odyssey, a Fluent Knowledge production.
Original music by Ryan Adair Rooney.
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Diane
I think it was maybe June or July of 2020. And I just got my new pump. And my blood sugar was a little low on the way to yoga. So I drank some juice to get my blood sugar up.
Robert Pease (Co-Host)
Diane has type one, or juvenile diabetes, meaning her body cannot create insulin to control her blood sugar. So she wears an insulin pump. A little device on her hip.
Diane
Well, my pump saw my blood sugar going up and said, oh, I need to give her insulin, gave me a big dose.
[Intro to a yoga class plays]
Diane
And then I started doing the yoga class.
[Yoga class continues]
Diane
Next thing you know, I'm inside an ambulance.
Valerie Wencis (Co-Host)
The paramedics rush Diane to the hospital. They stabilize her and soon, she’s back to normal.
Robert Pease (Co-Host)
Crisis averted. This time at least. But it is a reminder that people with diabetes are always at risk of blood sugar crashes or spikes or both– and, all too often, trips to the emergency room.
Valerie Wencis (Co-Host)
Diabetes poses a serious challenge for anyone who loves to exercise. Yet, exercise is one of the main ways Diane controls her blood sugar. It’s like Diane’s walking a blood sugar tightrope even for a simple yoga class.
Robert Pease (Co-Host)
And for Diane, yoga is pretty much the least challenging exercise she does.
Diane
I've done three full ironman races, my longest took me 13 and a half hours. My race plan consisted of like a two page spreadsheet that was nothing but how I was going to manage my blood sugars.
Valerie Wencis (Co-Host)
This is my Body Odyssey, a show about the rewards and challenges of an active lifestyle. I’m Valerie Wencis
Robert Pease (Co-Host)
I’m Robert Pease. And this episode we’re introducing the odyssey of Ironwoman Diane. A recently retired power industry exec who swims, runs and cycles at a really high level despite having type one diabetes.
Valerie Wencis (Co-Host)
But we’re also introducing the challenges Diane and others face while exercising with diabetes, not only in swimming, cycling or running but in a seemingly safe environment like a predictable yoga class.
Robert Pease (Co-Host)
There are many millions of Americans with diabetes. One in 10 have it already, another 30% are at risk of developing the Type Two variety. And it’s our most expensive disease. One out of every four dollars in US healthcare is spent on diabetes.
Valerie Wencis (Co-Host)
Let's start where we first met Diane -- as well as some other people with diabetes who are committed to using exercise to help manage this condition. We were at the finish line of the New England Tour De Cure cycling ride, which is put on by the American Diabetes Association.
Robert Pease (Co-Host)
We’re in a college dorm entry way; riders stowing bikes while making dinner plans way back in the pre-Covidien era of 2019.
Diane
I have type one diabetes, which means I'm insulin dependent. So I wear an insulin pump. Can't live without insulin.
Robert Pease (Co-Host)
And at what age did you learn that?
Diane
I was diagnosed when I was 28.
Robert Pease (Co-Host)
And so were you a cyclist already at that time?
Diane
No, I didn't start biking until I was 40, so it was like almost 10 years later when I started biking.
Robert Pease (Co-Host)
I see.
Diane
It definitely makes it harder. It's just really can impact your blood sugars, when you're active.And I started doing triathlons when I was 40.
Robert Pease (Co-Host)
Isn't that particularly difficult managing… ?
Diane
Crazy difficult. Yeah.
Valerie Wencis (Co-Host)
We also met Howie at that same Tour de Cure New England event. He’s an avid cyclist battling both cancer and diabetes.
Howie
Type two diabetic. I was diagnosed shortly after my last of six rounds of a non Hodgkin's lymphoma.
Robert Pease (Co-Host)
Despite those huge challenges, or maybe because of them, cycling has remained a central part of Howie’s life and his treatment..
Howie
I just, you know, because of all the riding I do, they're able to hit me harder with chemo, with radiation when they have to do it.
Valerie Wencis (Co-Host)
This point was echoed by Diane as well. She told us exercise has made her a better diabetes patient by reducing the amount of daily insulin she needs to survive.
Diane
My doctor described it as a three legged stool who said to really have good control, I needed to have exercise, insulin, in my case, you know, the medication and then diet. And so exercise has always been part of how I've managed the disease.
Robert Pease (Co-Host)
But Then COVID hit. We all remember that.
[ARCHIVAL– A SARS like virus, which has infected hundreds in China, has now reached the United States]
[ARCHIVAL–DR. FAUCI- Elderly people, and those with underlying conditions: kidney disease, diabetes.]
Robert Pease (Co-Host)
And as with many My Body Odyssey protagonists, we didn’t speak with Diane for two and a half years until this year, 2022. We had been wondering how she’d been doing, physically, mentally, and emotionally, without the events she so loves and looks forward to.
Diane
It's been really hard. COVID resulted in a number of events like the New England classic, really just shutting down. And I understand the need for that. A lot of the people that participate in those events, especially when it comes to diabetes are more at risk from, you know, COVID infections, complications arising from that. And so I understand they had to go virtual.
Valerie Wencis (Co-Host)
During the COVID years, Diane also lost her qualification for that most revered of all marathons, the Boston Marathon.
Diane
So I qualified for Boston in 2020, and I was actually training for that when COVID hit
[ARCHIVAL– For the first time in its 120 year history, the Boston Marathon is canceled.]
Diane
So, I ran a virtual marathon.
[ARCHIVAL– The marathon is moving online]
Diane
One of the hardest things I've ever done. But I finished it and I then tried to get back into Boston for 2021, but they had a much smaller field. And as a result, the qualifying time was, was much more difficult and I didn't get in, so that was a let down.
Valerie Wencis (Co-Host)
Diane, you said it was one of the hardest things you've ever done, is that because you, there weren't like crowds cheering on or you didn't have people you normally race with? What's that head space, like when you're having to do it on your own?
Diane
It was very different. I get a lot of energy from the crowds at races and when I pick races I typically pick ones where there's a lot of, you know, big crowds and I'm just in a fun atmosphere cuz you know, it's very mentally, it's hard. I will say that a lot of my teammates, quite a few of them who were on the New England ride with me, came out and some of them ran sections of the virtual marathon with me. Some of them rode their bikes.
Robert Pease (Co-Host)
With so many options closed down during COVID, Diane and her friends had also been doing a lot of online yoga.
Diane
There's a YouTube instructor that we really like that does yoga, Yoga with Tim.
[ARCHIVAL–TIM: Hi and welcome to the yoga with Tim 30 day challenge. I’m Tim and this is my dog Ollie.]
Diane
And we did the 30 day challenge and we formed a text group just to motivate each other, to stick with it, and for some of my friends, it was their first time doing yoga. For others, they've been doing it for a while, but they hadn't done this particular instructor's classes. And so I think it has stuck with a lot of them.
Robert Pease (Co-Host)
Yeah. Well tell us what you like about Tim's classes
Diane
I like his classes because he describes them as yoga for longevity. His classes, he really focuses on form and doing things correctly so that you're gonna be able to do yoga for years and not hurt yourself.
[ARCHIVAL–TIM: Spending a little bit more time in the poses, and relaxing into them, you'll feel more open and you can flow with more ease in and out of those poses].
Robert Pease (Co-Host)
But all of which makes that yoga episode, where Diane ended up in an ambulance, even more puzzling. Diane’s no stranger to yoga; she’s been doing it for years.
Valerie Wencis (Co-Host)
She’s no stranger to diabetes either, having been diagnosed three decades ago and managing that disease via that two-page spreadsheet for three ironman triathlons and a bunch of marathons as well.
Robert Pease (Co-Host)
But she did have a relatively new pump for that not so restorative yoga session. Could that have been a factor?
Valerie Wencis (Co-Host)
We reached out to one of the world’s authorities on the management of diabetes through exercise, Dr. Michael Riddell of York University in Toronto, who has Type 1 diabetes himself.
Dr. Michael Riddell
I was diagnosed in around 1983 or 84. The notes are a bit unclear for me on that, because it's been almost 40 years. I was diagnosed at a time when, you know, insulin came in a vial and you took one or two shots a day and did your best to keep your blood sugar in a reasonable range. But, at the time we didn't even know if blood sugar control really mattered for longevity and diabetes.
Robert Pease (Co-Host)
That diagnosis helped set Michael Riddell on a research odyssey to better understand and control diabetes. His team at York University has published more than 180 scientific articles and are currently helping develop an “exercise-smart” artificial pancreas for people with type 1 diabetes.
Valerie Wencis (Co-Host)
Dr Riddell has helped a number of professional athletes manage their diabetes. Such as the elite NHL player Max Domi.
[Archival footage of NHL game]
Valerie Wencis (Co-Host)
In this TV interview Max Domi recalls his own diagnosis some years ago, and the first question that came to mind.
Max Domi <archival>
So I went and got my bloodwork done. It came back positive and the first question I asked when the doctors came over and said "Oh Max it looks, it looks like you're a Type 1 diabetic and you're gonna have to head down to sick kids today." I'm like "Okay, but can I still play hockey?"
Valerie Wencis (Co-Host)
Dr. Riddell remembers that diagnosis as well.
Dr. Riddell
Max and I have become pretty close over the years. I knew him the summer that he was diagnosed with type one diabetes. I've learned so much about that type of intense competition that Max faces, including, you know, short shifts, two minute, two minute shifts or less, skating as hard as you possibly can.
Robert Pease (Co-Host)
By comparison to an NHL hockey shift, Diane’s yoga class seems way less intense and not even the most challenging activity she undertakes.
Valerie Wencis (Co-Host)
So we asked Dr. Riddell what might have caused that trip from yoga mat to ambulance stretcher? His explanation includes the medical term for the dose that Diane’s pump provides – its a bolus of insulin, which then lowers her blood sugar level.
Dr. Michael Riddell
She did exactly what she's supposed to do to get her blood sugar up for the yoga class, but the pump didn't know she was going to do exercise. And so it saw the blood sugar rise a bit and it gave a bolus of insulin. And when it gives a bolus of insulin, and then all of a sudden she does some exercise, that exercise working in combination with the insulin drives the blood sugar down. And so this is the real frustration that we all have with this emerging technology. It's wonderful, and it works most of the time, but in some situations, typically spontaneous exercise, it can let us down.
Robert Pease (Co-Host)
Was there anything she could do with her pump? Does she have any adjustments that she can make going forward?
Dr. Michael Riddell
We're now recommending that if you're on these artificial pancreas pumps or closed loop insulin pumps that you delay your carbohydrate feeding until you start exercising. But you also know that she did much better, I think, when she did her Ironman, because she was so much more organized and, and had planned out what she needed to do, what settings needed to be on her pump, what she needed to do with her insulin and her nutrition. And it's those types of planned exercises where these pumps do better, quite frankly.
Valerie Wencis (Co-Host)
We asked Diane what she had learned from that anything-but-zen yoga experience.
Diane
Every time I do yoga, I now know I need to take my pump off to prevent something like that from happening again.
Valerie Wencis (Co-Host)
Wow. And I'm sure nobody, I certainly would never think, oh, if she's gonna have an issue, it's gonna be during a yoga class versus, you know, one of your really, really intense events. But what great knowledge, you know, for people to know about and good thing you were with other people in a safe environment.
Diane
It was a great educational opportunity. The YMCA, they now have, you know, juice boxes that all their teachers, all the instructors know where they are. I know I'm not the only diabetic there, obviously. And I said, this is what you need to do. So I think, you know, sometimes those things happen and try to make lemonade outta those lemons.
Robert Pease (Co-Host)
Turns out that crashing blood sugar isn’t the only challenge people like Diane who have Type 1 diabetes face in group classes like yoga. There’s also the problem of the dreaded pump alarm.
Diane
Recently, I had an issue. I don't know if any of you are yogis, but you know, it's a pretty calm, quiet, atmosphere typically. I went into a class and my blood sugar was starting to drop and my pump alarms. I walked in and it's just this horrible, loud beeping noise. And I'm trying to drink my juice box and I'm having to get the straw in. And it was just, it was awful. I ended up having to leave the class, you know, the whole thing and, you know, things like that happen and you're embarrassed.
Robert Pease (Co-Host)
That might cause some of us to roll up the yoga mat and position it in closet pose.
Diane
And there was a part of me that was like, I don't want to go back. That was so embarrassing. And I'm like, you know what? Nope, I'm going back. And I let the instructor know, I'm really sorry for disrupting the class. And she was great.
Valerie Wencis (Co-Host)
And that does seem to be that ironwoman Diane mentality at work there in the yoga studio. Just one more mile, just one more posture.
Robert Pease (Co-Host)
But can that mentality go too far? Diane told us her blood sugar had gone low once during the swimming leg of a triathlon. But she didn’t waive her arms for help; she kept on going.
Valerie Wencis (Co-Host)
How much is too much dedication to exercise for those with diabetes? Should others strive for that level of Ironwoman Diane dedication or take a more measured approach? We asked Dr. Riddell.
Dr. Michael Riddell
Oh, I celebrate what she's done and what she's doing. These are the people who I think are champions in the area that I study. I think we learn so much from them and sure, it's not risk free, but the right kind of person with the right type of technology and equipment can tackle an Ironman. They can be on a pro cycling team. They can play in the NHL. And I just find that so inspirational. And sure, from time to time, they're gonna stumble a bit with their blood sugar management, but we, but we know that it's not insurmountable. They can accomplish their goals.
Robert Pease (Co-Host)
And Ironwoman Diane has a lot of goals ahead of her. Such as running along on her daughter’s first half marathon this year.
Diane
<laugh> Well, she's given me many lectures about, you know, if you're gonna run with me, we're gonna run at this pace and I am fine with that. Not every race needs to be a race race. And so I have decided to take that opportunity to just really enjoy it and to be there for her.
Valerie Wencis (Co-Host)
And, having just retired, she’ll be doing more trail runs and paddleboarding with her dog.
Robert Pease (Co-Host)
Is there a look that your dog has to give you to say, I'm really tired. Can we go home now?
Diane
<laugh> Yeah. I was kind of worried about her when I decided to retire. I thought, oh my gosh, I'm gonna have to take it easy on her.
Valerie Wencis (Co-Host)
Let’s hope daughter and dog are up to the Diane challenge. We’ll find out on the next leg of her odyssey. Many thanks to Diane for sharing her story with us.
Robert Pease (Co-Host)
Next episode on My Body Odyssey, we’re going to hear from a protagonist who is also a medical expert. Dr. Sarah, an avid runner and occasional triathlete who faced quite a challenge diagnosing her own chronic condition.
Dr. Sarah
I had gone for 30 years with no injuries and then all of a sudden I've gotten an IT band. I got plantar fasciitis. I'm tearing my hamstrings, I had back pain and just, and it was just – looking back on it, once I got that diagnosis, it all started to make sense.
Robert Pease (Co-Host)
Meantime, what about your body odyssey? What obstacles do you face in living a more active lifestyle?
Valerie Wencis (Co-Host)
We all know we should be more active. But life can get in the way in so many ways. Especially for people with chronic conditions, recurrent injuries, behavioral issues.
Robert Pease (Co-Host)
We’d love to hear about your odyssey, the rewards and the challenges. Go to our website at mybodyodyssey.com or social media. My Body Odyssey is a Fluent Knowledge production. Original music by Ryan Adair Rooney.