Ironman Arizona with Type 1 Diabetes: An Interview with Blair Ryan

Blair Ryan, Director of Media and Publications at Insulindependence, has had type 1 diabetes since 2000. She is an accomplished collegiate distance runner, triathlete and cyclist.  After a long time of hearing lovely things about Blair, I had the chance to met her in person last month.  She’s even better than rumor says.  A striking redhead with a tall, athletic build, Blair immediately catches your eye.  She’s not looking for attention, though.  Only when prodded by a friend did she shyly mention that she’d just completed her first Ironman triathlon ( 2.4 miles of swimming, 112 miles of cycling, and 26.2 mile run).  “That’s amazing,” I said.  “I want to know more.”  Blair was kind enough to share her story with us.  If you want proof that diabetes doesn’t have slow you down, keep on reading.

Can you tell us about your diabetes diagnosis?  How old were you? 

In 2000 I was a freshman in high school and running cross-country. My performance in races worsened over the duration of the fall season and I experienced muscle stiffness, much like the way muscles feel at the end of tough anaerobic exercise, even during the easiest workouts. I raced 2-3 minutes slower on 5k courses that I’d run at the beginning of the season. I blamed my extreme thirst and muscle stiffness on overtraining. My mum, a family physician, recognized those symptoms, and combined with the fact that I was waking up at night to pee, she knew to take me to pee in a cup at her office. She diagnosed me the moment she saw how clear the urine was.

Anyone else with diabetes in your family?  How did your family react?

There is nobody else in my family with diabetes, so it was a shock. We all went through a short period asking “Why me?” and finger pricks and injections were very difficult for me at the beginning.

Despite all this, I only missed two days of cross-country practice. This reflects the support I received from my parents and coach — three people who understood that continuing to run was not only possible, but was the best thing for my health.

Just months after my diagnosis we found Dr. Anne Peters, a diabetologist who cares for many athletes with diabetes, including Olympians and professionals. Dr. Peters assured me that not only would I be able to race with diabetes, but that I would get faster. She worked tirelessly with me to fine tune my diabetes management to help my athletic performance.

I am lucky that I was an athlete before I had diabetes. Running and racing were my motivation for good control. In order to perform well as an athlete I had to manage my diabetes well. I had very defined goals.

When did you become involved with Insulindependence?

My first Insulindependence (IN) experience was at Ironman Wisconsin in 2008 where the first cohort of Triabetes Club Captains was competing. IN’s Founder and President Peter Nerothin asked me to travel to Madison to help facilitate the youth program during the race because he knew I was familiar with diabetes and triathlon. We’d been introduced a year earlier after I attended an internship meeting hosted by Insulindependence on campus at the University of California, San Diego (UCSD) where I was an undergraduate student. The internship wasn’t for me, but triathlon was. I flew out to Madison, spent the race day spectating with the Junior Captains and their families, took photos, and experienced Ironman magic for the first time.

Please tell us about your first Ironman. How did you train? 

I raced Ironman Arizona in November, 2012. I took a very simple approach to my training and simply swam, rode, and ran whenever I could fit it in. I can’t tell you how many miles or yards I completed leading up to the race because I never logged it. The longest run I did leading up to the race was 13 miles, and I’d never run more than 15 in my life. This was not how I planned to train at the time I registered for the race.

Needless to say I arrived in Arizona under-trained. Despite this, I had two things going for me: most of the training I did do, I did with my good friends, colleagues at Insulindependence, Peter, and Brennan Cassidy. Both have diabetes and were racing Ironman Arizona. My diabetes management plan for Ironman was a blend of strategies from our 37 combined years of diabetes experience and shared trial and error. I stepped on the line feeling under-trained, but had confidence that I could adaptively manage my way out of any scenario Ironman might throw at me.

I discovered that a lifetime of endurance athletics and a solid insulin and nutrition strategy go a long way. I had a ton of fun out on the course, I raced faster than the goal time that I’d set. Great things happen when you have the best support system in the world.

How often did you think about your blood glucose during the race? Were you worried about it? Were there any surprises? What did you eat/drink during the race?

I raced on injections for both basal and bolus insulin. I wore an insulin pump, but set the basal rate to zero and didn’t need to bolus during the bike or run portion of the race. I wore a CGM for the first time, which was extremely helpful for me to monitor my blood glucose trends, and I plan to contribute all of my race data to a new diabetes and exercise research project that is being planned by Dr. Nate Heintzman at UCSD.

During the race, I regretted just one unit of insulin that I’d taken because after that, I was teetering on the low end of blood sugars most of the day and eating to prevent dropping too low. However, it worked in my favor; it is very hard to force yourself to eat during races when your heart rate is up and you are breathing hard. If I had not been conscious of carb intake (as I might not have been if my blood sugar had been higher or if I didn’t have diabetes) I may not have forced myself to eat and drink the calories that even people without diabetes need for energy during a race that long. My muscles have always felt best with insulin on board and the consistent nutrition helped prevent any cramping. It turned out to be an ideal scenario.

What did you eat?

I ate Snickers, PR*Bar nutrition bars, 2,700 mg of salt by tablet, and drank Coca-Cola and water.

What does your endocrinologist think about the Ironman?

Dr. Peters wasn’t surprised at all when I told her I’d be racing. She had no doubts that I could race it and race it well. She made it clear that she was available to help if I needed anything.

Were there many women participating?

816 of the 2,974 finishers at Ironman Arizona were women.

How many people with diabetes (that you know of) participated?

I know of at least 11.

How long until your next race?

I’m going back to my running roots. I’ve been enjoying long trail runs and am exploring racing opportunities within ultra running. I will also be participating in various events with Insulindependence, including the Carlsbad Race Weekend and the Ragnar Relay series.

Any advice to people who have a hard time fitting exercise into their lives?

At Insulindependence we feel that it is socially responsible for people with diabetes to stay fit and healthy and recognize that an important resource for healthy living is the diabetes community itself. I wouldn’t have signed up for Ironman without Peter’s introduction to, and appreciation for, the Ironman distance, and I wouldn’t have made it to the starting line without Brennan’s consistent company during training. I strongly encourage anyone who is struggling to fit exercise into his/her life, to find someone with similar goals, and work together to achieve them. Any form of exercise makes a difference.  It doesn’t have to be Ironman!

 About Insulindependence:

Insulindependence (IN) is a San Diego-based 501(c)3 nonprofit public benefit corporation. IN’s mission is to inspire people with diabetes to set personal fitness goals, educate them on adaptive management strategies through hands-on-experience, and equip them to explore their individual capacities. IN’s staff and volunteers serve thousands of U.S. program participants annually in an effort to revolutionize diabetes management through experiential diabetes education.

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

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Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)