When Phil Southerland and his all-diabetes biking staff convened on the beginning line for the 2006 Race Throughout America, they carried small doses of insulin and have been met with heavy doses of skepticism.
“Good luck,” different riders would say. “We love what you’re doing for charity, and we hope you make it to the end line.” They made it to the end line alright — in second place.
In a three,000-mile tag-group race that lasted greater than 5 days, the eight-individual group — recognized on the time as Team Sort 1 — fell in need of the quickest general time by solely three minutes. A yr later, the temper was totally different.
“The second yr on the beginning line, everybody was frightened of the diabetic group,” Southerland stated. “They knew we have been going to win. And we did. We beat the second-place group of professional athletes by three hours.”
Within the decade since, Southerland’s squad — now often known as Team Novo Nordisk — has grown into a worldwide enterprise of almost one hundred athletes, all of whom have diabetes. The group is spearheaded by the lads’s skilled biking group, whose members regularly show that diabetes might be managed in even probably the most grueling circumstances. However none of it might have been attainable with out some assist.
“This group exists due to breakthroughs in know-how,” Southerland stated. “There’s no query about that.”
The know-how to which he’s referring is the steady glucose monitor, or CGM. Initially commercialized within the late Nineteen Nineties by the medical system firm MiniMed (which was later purchased by Medtronic), the CGM consists of two elements: a tiny glucose-sensing catheter that’s inserted into physique tissue and a radio transmitter that may repeatedly ship the glucose knowledge to a wi-fi receiver.
Monitoring glucose ranges is essential for individuals with diabetes as a result of their blood sugar, which takes the type of glucose, may be wildly unpredictable. All of Team Novo Nordisk’s professional cyclists have sort 1 diabetes, which signifies that their our bodies don’t produce sufficient insulin, the hormone that regulates blood sugar. In consequence, their blood glucose ranges might skyrocket or plummet throughout a race, which may trigger quite a lot of problems, a few of which could be life-threatening.
Due to this, the cyclists have to examine their glucose ranges continuously and regulate for the highs and lows, both by injecting insulin or by consuming food and drinks. However earlier than CGMs, frequent glucose monitoring wasn’t potential on the bike. Recalling the primary race through which he used a CGM, Southerland describes it with the fervor of a blind man who might see for the primary time.
“We discovered a lot,” he stated. “We discovered extra within the first two days of that race utilizing this know-how than I’d discovered within the earlier 24 years of life with diabetes. Simply getting access to this info was so empowering to our capacity to regulate diabetes and thus to carry out on the bike.”
Earlier than CGMs have been popularized within the mid-2000s, the one dependable check for blood sugar was the blood glucose meter, a tool that analyzes a drop of blood from a fingertip and shows a glucose degree studying. Whereas these “finger-stick” exams are nonetheless probably the most correct means for individuals with diabetes to examine their glucose ranges all through the day, they aren’t very sensible for athletes in the midst of competitors. Australian bike owner Chris Williams, a veteran on Team Novo Nordisk’s professional workforce, says it was a little bit of a guessing-recreation earlier than he used a CGM.
“I might race principally on feeling,” he stated. “Typically you get it proper, and typically you get it very fallacious. I keep in mind ending races the place my blood sugar was actually excessive, however you haven’t any concept when you’re racing. You don’t have time to cease and verify your blood sugar with a finger prick, so having a CGM is only a large profit. It makes it a lot simpler.”
Of course, nothing with diabetes is ever straightforward. Williams was recognized with sort 1 on the age of 27, a later analysis than most. Realizing that injections naturally invite suspicion within the sport of biking, he took his insulin photographs in secret, although he had a Therapeutic Use Exemption for the hormone.
“As quickly as somebody sees you having an injection, you get one million questions after which you must clarify it,” he stated. That was a problem he didn’t need to cope with. He additionally came upon that managing his diabetes was rather more complicated than he anticipated.
“It’s like a mass equation,” Williams stated. “You’re given the actually easy model of it, when the truth is it’s tremendous, tremendous difficult… It’s not simply insulin and carbs that have an effect on your blood sugar. It’s altitude, it’s train, it’s the kind of meals, it’s whenever you eat, it’s waking up, it’s illness — it’s all of this stuff.”
And if you’re competing on the depth degree of knowledgeable bike owner, monitoring these variables is much more necessary. One of the irritating issues for individuals with diabetes is that once they get up, their blood glucose ranges could possibly be virtually anyplace. So whereas cyclists with out diabetes can eat the identical breakfast earlier than each race, Team Novo Nordisk’s riders have to rigorously tailor the meal in order that their blood sugar is regular by the point the gun goes off.
Then, in the course of the race, they want to concentrate on whether or not their glucose ranges are rising or falling. Usually talking, bodily exercise emphasizes the consequences of insulin and prompts muscle tissues to make use of glucose as power, which signifies that it has a glucose-decreasing impact. Nevertheless, intense bodily exercise can even produce hormones, like adrenaline, which have glucose-elevating results. That risky push-and-pull dynamic is what actually makes the CGM a useful device.
“The readings are very frequent, each jiffy all through each hour,” stated Charlotte Hayes, the Director of Analysis & Schooling for Team Novo Nordisk. “You see a bit dot for each glucose studying in a development sample that develops. So the riders can see what degree their glucose is at proper now, if it’s going up or taking place, and at what fee.”
This knowledge, which primarily seems as a graph, might be seen on a receiver that riders often maintain of their jersey pockets or mount on their handlebars. Because of the Dexcom G5 System, the CGM system that Team Novo Nordisk presently makes use of, this receiver may even be a smartphone or smartwatch. “It’s as straightforward as pulling out your telephone, opening up the app, and searching,” Hayes stated.
And what’s much more exceptional is that the riders can share their glucose knowledge with your complete medical staff, even when they’re on a unique continent. Utilizing Dexcom’s CLARITY software program, customers and medical professionals can view and analyze the info inside three hours of when it was collected, regardless of the place they’re.
Utilizing the “Share” function within the G5 Cellular App, riders also can share their knowledge in actual-time with as much as 5 individuals. Hayes — a Licensed Diabetes Educator, train physiologist, and nutritionist who spends numerous time taking a look at glucose developments and patterns on the group’s residence base in Atlanta — says the know-how has quickly improved.
“We will have riders half a world away and be capable of view their knowledge,” she stated. “As of just some years in the past, they might get the info of their units and ship it in an add, and that may permit us to see the info every week after the very fact. However now we will see it because it is available in. It’s fairly superb.”
However getting thus far was an extended street, for the science and for Southerland.
“I used to be recognized with sort-1 once I was seven months previous,” Southerland stated. “That was a time when know-how on the planet of diabetes was actually non-existent. My mother squeezed my diapers to get urine onto a strip to seek out out the place my blood sugar was two to 4 hours prior to now. That was what we had.”
Southerland, now in his mid-30s, wasn’t anticipated to reside previous the age of 25. With out superior know-how and even quick-appearing insulin on the time of his analysis, he beat the chances with what he considers the perfect drug of all: train.
Southerland’s mother and father discovered early on that when their son was lively, his insulin labored quicker and his blood sugar was higher. Southerland found this himself as child, when he developed a passion for Snickers bars. Missing the endurance to attend two hours for his insulin to kick in, he would eat the sweet bar after which experience his bike to metabolize the glucose.
“I didn’t need to verify my blood sugar. I didn’t should get insulin injections. All I did was experience. It was this actually huge liberation,” he stated.
By the point Southerland was racing for the College of Georgia, he had turn out to be a grasp of managing his personal situation via food regimen, train, and self-discipline. Nevertheless, he nonetheless wasn’t lively within the diabetes group, and he knew virtually no different athletes with diabetes. That modified when he met Joe Eldridge, a bike owner for Auburn College, after a race. The 2 turned quick associates, however Southerland quickly realized that Eldridge wasn’t taking the time to correctly handle his diabetes. So he made it his mission to assist him, and it labored.
“I noticed this monumental change in his character and the way he took management of diabetes,” Southerland stated. “His faculty was higher, his bike racing was higher, his confidence was greater. He was only a utterly totally different individual, and he was already a very good individual to start with. And he stated, ‘Thanks, you saved my life.’ So I assumed, ‘Wow, there’s one thing to this.’”
Impressed by the best way Lance Armstrong was capable of increase consciousness for most cancers on the time, Southerland realized that he might use biking as a platform to assist individuals with diabetes in the identical method he helped Eldridge. In a administration class throughout his final semester of school, he began toying with the thought of a non-revenue group.
Whereas conducting surveys on the Mall of Georgia for market analysis, Southerland acquired an unprompted $four hundred funding from a person outdoors a Starbucks. Southerland refused to take the cash, however the man put the money on the desk and insisted.
“He stated, ‘Child, go begin what you are promoting. In any other case, somebody’s going to have an excellent day at Starbucks,’” Southerland recollects. “And so I took these 4 Ben Franklin payments to the checking account on February 22, 2005, and Team Sort 1 started.”
Quickly after, Southerland and Eldridge have been at a charity journey for the Juvenile Diabetes Analysis Basis (now merely often known as JDRF), when somebody steered that they journey their bikes throughout the nation to boost consciousness. Regardless of having restricted time and a variety of scholar debt, the duo favored the thought, in order that they set their sights on the Race Throughout America.
“That was actually the primary time there had been a workforce of a number of individuals with diabetes taking over a problem like this,” Southerland stated. “And I needed to win — the staff needed to win — however nobody believed in us.”
First, nobody thought they might increase the cash, however they raised $250,000 within the first yr. Then, nobody thought they might discover a group, however they have been capable of recruit six different cyclists who had diabetes. And even after that, nobody thought they might compete. However after coming in second in 2006, Team Sort 1 would go on to win the Race Throughout America in 2007, 2009 and 2010. That’s when the group started to garner media consideration, and Southerland acknowledged the impression it was having.
“I’ve been to diabetes conferences, I’ve been to diabetes camps, and these youngsters had heroes for the primary time of their lives,” he stated. “That they had individuals dwelling with diabetes who have been taking satisfaction in having diabetes, have been embracing it on a public stage and saying, ‘When you management it, you possibly can dream. For those who management it, you are able to do it.’ And I knew we needed to convey that to the world.”
With the assistance of Novo Nordisk, a Danish pharmaceutical firm that focuses on diabetes care merchandise, he did convey it to the world. In 2012, Southerland started a partnership with Novo Nordisk, which allowed him to hold out a worldwide recruiting mission. Though Southerland himself hasn’t raced professionally since 2009, Team Novo Nordisk’s professional staff now has 18 cyclists from eight totally different nations, together with a improvement group and a junior group that type their expertise pipeline. That mannequin has bred success, out and in of racing.
“We’re the only most improved biking workforce on the earth during the last 5 years,” Southerland stated. “And in the event you take a look at our improvement group and our junior staff, I’ve obtained a hero manufacturing unit. I’ve obtained athletes from sixteen totally different nations on my professional and devo groups who’re bona fide heroes for the individuals of their communities. However it’s solely attainable to do what we’re doing today due to the diabetes know-how that now exists.”
And the know-how is just getting higher. Earlier than final yr, CGMs weren’t thought-about correct sufficient to be the idea for insulin-dosing selections as a result of, in contrast to finger-stick testing, they measure interstitial glucose relatively than blood glucose. Nevertheless, final December, the FDA accredited Dexcom’s G5 System for these forms of selections. Whereas CGMs nonetheless must be calibrated with blood glucose meters each day, CGM-customers can now base their insulin-dose calculations immediately on the values from the system.
Researchers are additionally now trying to combine CGMs into a bigger absolutely automated system, generally known as an synthetic pancreas. A man-made pancreas would primarily mix a CGM with an insulin-supply system, like an insulin pump, utilizing a pc program that may mechanically monitor glucose ranges and regulate the insulin dosage. As a result of the physique’s immune system destroys the insulin-producing cells of the pancreas in Sort 1, researchers hope that a man-made pancreas can act instead and make life simpler for individuals with diabetes.
However regardless of how good the know-how will get, dwelling with diabetes will all the time be a problem. “When you get recognized, every little thing you do from that time ahead has a consequence on glucose in a single type or trend,” Southerland stated. “It’s a heavy burden to hold for lots of people.”
His aim is to ease that burden. By way of his Team Sort 1 Basis, he gave ninety one scholarships to NCAA athletes with sort 1 diabetes this yr. And thru Team Novo Nordisk — which now consists of runners, triathletes, and a kind 2 biking staff — he’s displaying that folks with diabetes can accomplish something once they handle the situation correctly.
“Diabetes can by no means be an excuse,” he stated. “You gained’t hear it from any of our athletes, and we take satisfaction in that.”