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?
I’m discouraged, but I’m certainly not giving up.
I’m planning to go for another Olympics. I love to ski, and I’ve skied with the best in world. I’ve beaten every skier in world if you count all the race days — but just not all at once.
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:
What about drug testing for competitive athletes? Isn’t insulin considered a performance-enhancing substance?
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!
He is simply amazing. He should be proud of all he has accomplished. Wishing him continued success!
Great interview, great story! Found both very inspiring and hopeful. Thank you!
i have so much admiration for kris! amy, thanks for this interview. it’s great.
“I kinda wish I could be more of a role model for (athletes who have diabetes.)”
I don’t think Kris could be a better role model. He couldn’t win the race because of his blood sugar…instead of saying he just can’t do it…he is learning, and planning to do it again.
Is there a better role model? I think not.
He has given my boys inspiration that I could never give. I tell them all the time they can do anything…Kris has shown them that it is so.
Thank you for sharing your story Kris. You ARE an inspiration for my boys who see through you that all things are possible.
If you talk to him again, let him know that he has inspired a 46 year old recently diagnosed (May of 09) T1 to do what he can to get back in shape again. He’s awesome – and I’m pulling for him as much as I can.
Kris, you are most certainly an inspiration! If you can do what you do, then I can certainly make it through my day at the library! I used to have a big issue with control and anxiety about lows, but people like you help me to get over myself.
Jana, T1 16+ years
my goodness!! i know Kris feels disappointed in his runs at the Olympics, but honestly…i am amazed that he IS AT THE OLYMPICS!!! what a great role model for all of us…and for sure my t1 daughter.
Talking with guys like Kris and talking through the numbers and what effects certain things have is probably the most useful information out there — since guys like Kris keep phenomenal records (and I don’t mean logging every BG), I mean exactly what went in the body and what went out the body and adjusting.
I’m wondering how Kris actually feels about BG accuracy on his meters — reading his comments about not correcting anything over 180. I have had the same opinion for the past decade — mainly because of the inaccuracy of the meters. In his example: 180 could actually be 140, and if you correct to 110 — you’re dropping down to 70 (add exercise on top of that and you end up bonking hard).
The tighter control you have the harder it will become to have tighter control without bouncing around (is a 65 actually a 90?) — from what I see as poor accuracy from the meters.
Kris is such a role model, and he’s so modest. What a person to have as an example of what high heights you can reach, even as a Type 1. Stellar job, Amy. Thanks for this.
Kris, you are definitely an inspiration to everyone who has Type I diabetes. I agree with Cary above, though, who warns Kris that a 180 reading on a meter could actually be as low as 140. In the almost 38 years since I was diagnosed with Type I, I have had the worst control – yo-yo-ing all over the place, BG-wise, when I tried to keep my numbers TOO close to normal. Also, Kris, watch out … hypoglycemia unawareness set in, in my case, after 10 years of Type I diabetes. CGMS is helpful, and I wear one myself, but I think CGMS systems have trouble tracking PRECIPITOUS drops in BG more than they do slower BG drops, and of course one’s BG drops quickly during intensive exercise. I’m rooting for you for the 50 K!
Wonderful interview! Kris is such a breath of fresh air… I saw him on the today show and the picture of his ABBS!! WOW!!
Kris congrats on the great A1C’s and for sharing your numbers!
God Bless!
Seems like Kris could use some coaching from the folks at Team Type 1 – they’ve made huge strides in managing BGs while doing long distance/duration races. It is simply amazing to be able to compete at the olympic level as a type 1, but its great that there are a few teams out there figuring it out for the rest of us.
Kris’s approach certainly seem counter intuitive – especially boosting his basal rates way up during heavy activity. We definitely need a good deal of insulin to allow our cells to process sugar while exercising, but… well, its surprising. I’m no olympian, but I’m also surprised that he’ll do “200 jumping jacks” to push down his BG… it simply doesn’t work that way for most of us. If he needs to boost his basal rate for heavy exercise, doing aerobic activity to correct a high BG should do the opposite. Not something I’d do myself.
It’d be great to have some collaboration between Team Type 1 (or similar) and some other diabetic athletes. That’d be one way to get some great publicity for our cause, not to mention add to the body of knowledge about managing diabetes for athletes.
I like Kris’ attitude to life. Sometimes you have to deal with obstacles and challenges life throws at you. Kris sure knows how to do just that. Competing at olympic level with diabetes certaily exemplifies a “can do” steely attitude. Being a diabetic as well, Kris has got a good grip on his calorific requirements on a daily basis which is very important as far as good diabetic control is concerned.
Matching insulin requirements with that level of physical activity such as running a 30k race can be pretty tricky but I’m sure as time goes on, Kris will get the margin of BG control right for his races.
Good luck, Kris and keep it up.
I admire Kris’ attitude. Sometimes in life. you have to learn to deal with challenges and obstacles. Kris has done this pretty well. He has zest with a “can-do” steely mentality which goes a long way when dealing with a medical problem like diabetes.
He has a very good grasp of his daily calorific requirements and knows how to adjust for his extreme level of physical activity. Getting the margin of BG control with Insulin for a strenous activity like a 30K run can be tricky but I’m sure with time, he will get it right.
Good luck, Kris and keep it up.
Just the fact that Kris never gives up is reason enough to be a great role model. As a parent, it’s not always about winning with in what we want to teach our kids – in fact, there sometimes are better lessons in getting back up in finishing the race even though you know you aren’t going to win. Kris, you’re awesome. Thank you for being exactly who you are! You represent our diabetes community so well.
This is so wonderful. My grandson is 10 with JDRF and just wants to know he can be as normal as everyone else. Good luck and luck for all who have this disease. We need a cure!
Kris, whether you get a medal or not YOU are in inspiration to ALL Kids and ADULTS with Type 1 diabetes. My daughter is almost 7, she’s had diabetes for over 4 years. You are a hero to her. Having a low during that race shows our kids that diabetes can throw you a punch, it can pop up at any time, anyplace and TRY to knock you down, but you don’t have to let it. by getting up after you got glucose and finishing that race you showed our kids what a HERO you are! I’m PROUD to say my child looks up to you! I’m proud to say Kris Freeman is from NH.. I hope one day my little girl can meet you! You are MOST DEFINITELY A ROLE MODEL FOR KIDS AND ADULTS WITH TYPE 1 DIABETES!!
I agree. To be in the Olympics is such an accomplishment that while Kris didn’t lead the pack there, he is leading the pack for Type I’s everywhere!
I hope Kris reads these comments and knows that we are in awe of his efforts! 45th in the WORLD is one heck of an achievement!
Great interview and congratulations Kris on what you have done and accomplished.
[...] “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.” -Kris Freeman, on Diabetes Mine [...]
You are awesome Kris!!!My son is inspired by you and your
determination.I have taught him to be the same way.NEVER
give up,NEVER let go of your dreams!!!NEVER let anyone tell
you it can’t be done because there is always a way!!Excellent
race,and lots courage to finish when you knew you wouldn’t win!!
Just know that there are so many kids with T1 that are watching
you!!
Amy, I am loving these interviews. And Kris, you are TOTALLY a role model and inspiration to so many of us.
I love the line about “the enemy of good control is great control”.
Kris I want to tell you that you are a role model already…..I am a 15 year old boy living with diabetes. At the age of 11 I started running triathlons to show others that “I could do it”. I have since competed in two National Youth Elite Triathlons Championships along with 30+ adult sprint triathlons. I am running my first Olympic Distance Triathlon this year in May at the Honolulu Triathlon. I am traveling to Boston this summer to help Gary Hall work with children who also have this disease. I am running the Cohasset triathlon with a diabetic team and I am going to give it my all to make them proud of me! It is people like you that give me inspiration and keep me going and believing in myself. Aloha, Devin
Kris I want to tell you that you are a role model already…..I am a 15 year old boy living with diabetes. At the age of 11 I started running triathlons to show others that “I could do it”. I have since competed in two National Youth Elite Triathlons Championships along with 30+ adult sprint triathlons. I am running my first Olympic Distance Triathlon this year in May at the Honolulu Triathlon. I am traveling to Boston this summer to help Gary Hall work with children who also have this disease. I am running the Cohasset triathlon with a diabetic team and I am going to give it my all to make them proud of me! It is people like you that give me inspiration and keep me going and believing in myself.
Aloha, Devin
I like Kris’ attitude to life. He knows how to deal with obstacles and challenges that are thrown at him. Competing at the Olympic level with diabetes certaily exemplifies a “can do” steely attitude.
He has given my me and my friends inspiration to do things I would never think me or my friends can do.