Diabetes Forecast

Team Type 1: Serious Competition

As members of Team Type 1, elite athletes with diabetes race in the upper echelons of cycling

By Andrew Curry ,

It's 11 a.m. on a hazy California Sunday, and the team is getting ready for the Manhattan Beach Grand Prix. The old blue Volvo they're sitting in is a far cry from the fancy buses and fleets of team cars that follow bicycle racers in the Tour de France. Still, Manhattan Beach, a small town just south of Los Angeles, hosts one of the biggest races on the West Coast, and the four guys set to start—two Americans, a Slovenian, and an Australian—are in serious prep mode.

As the team's mechanic pumps tires and adjusts brakes, the racers test their radios and pull on jerseys emblazoned with sponsor brands. The rituals are familiar. These guys compete dozens of times every year across the country and around the world. Today's race isn't particularly long, but preparing carefully is a way to quiet any jangly nerves.

Team cofounder Joe Eldridge has one extra ritual, something that's as much a part of his race day as pulling on his socks. Sitting in the passenger seat, Eldridge pulls out a black neoprene case and begins a series of blood glucose checks, 15 minutes apart. "I just need to make sure it's stable and trending up, not going down. A little bit high is OK. I just don't want a low," he says. "With 150 guys out there going 30 miles an hour, there won't be time to check."

Eldridge, 27, has type 1 diabetes. He is also a professional bike racer, and he is devoted to showing the world that there is no conflict between the two. He and his friend Phil Southerland started this team—Team Type 1—in 2005, and they want to see the riders invited to race at the Tour de France one day soon. "Five or 10 years ago, doctors were telling people [with diabetes], 'You can't compete in sporting events,' " says Southerland, also 27. "We want to show people that with good control, diabetes isn't your crutch—it's your strength."

Team Type 1 traces its history back to a bet—a burrito bet, to be precise.

When Eldridge first saw Southerland checking his glucose levels in the stands after a collegiate race in Georgia, he struck up a conversation. It turned out the young athletes shared more than a Southern accent; they both had type 1, too. Eldridge, then racing for Auburn University's cycling team, had never met another athlete with diabetes, and neither had Southerland, who raced for the Univer­sity of Georgia. The two hit it off quickly. "We had everything in common that two kids could have in common," says Southerland. Yet when it came to dealing with their diabetes, the two were far apart.

Southerland had been diagnosed at 7 months old. Doctors told his mother that he'd be lucky to live to the age of 25, and would probably lose his sight long before that. Determined not to let that happen, Joanna Southerland became obsessed with controlling her son's glucose levels, wringing out his diapers to get urine to test, the only option in the time before blood glucose meters.

As he grew, Phil sometimes resisted taking his insulin. At 6, he threw a temper tantrum at a friend's birthday party, refusing to take his shot before eating cake. His mother told him the alternative was going blind. "She said, 'It's insulin that keeps you alive,' " he recalls. "Since then, I've been extremely grateful every time I take a shot, because I get to keep my sight." Indeed, that was the last time his mom had to fight with him over his insulin. She encouraged him to be active as a kid, because sports helped him keep his blood glucose down. But as soon as she told team coaches about his diabetes, she could see them get nervous. "Coaches would never play him," Joanna Southerland says now. "I saw him gravitate towards athletic endeavors where he was in charge."

At 12, Phil started cycling seriously and soon discovered that long bike rides came with a bonus: "If I rode a bike, I could eat Snickers bars," he says. "Riding turned into racing, and racing became an addiction." Bike racing was a good fit in another way. It turned out that a lifetime of attention to his body and diet paid off when he started competing. In a sport where riders may burn upwards of 8,000 calories a day, eating right becomes a critical part of getting enough energy to the muscles to keep going. Every racer knows what it feels like when the body runs out of sugar to fuel the muscles: Cyclists call that empty, dizzy feeling "bonking," and it usually means the end of the ride. For someone with diabetes, however, bonking was potentially deadly. "Everyone has to worry about what to put in their body during a bike race," says Southerland. "But because I was always focused on making sure I didn't bonk, I had an edge."

Eldridge's story is not quite the same. An active kid who played soccer and football and rode his bike, at 10 Eldridge found himself stuck on the couch, too exhausted to do anything but suck down orange juice and water and Coke. When doctors told him he had diabetes, it was almost a relief. "You feel so much better when they diagnose you and you get the medicine you need," he says. "I realized I'd have to do two things for the rest of my life: check my blood sugar and take insulin."

Yet despite playing on a competitive soccer team as a teen, by the time Eldridge got to college, managing his diabetes had slipped low on his list of priorities. Recruited as a place kicker for Auburn, he quit football and took up bike racing. By the time he met Southerland, Eldridge's blood glucose was out of control more often than not. "It became evident that Joe didn't care about taking care of himself. He was just motivated to get through till tomorrow," Southerland says. Eldridge freely admits he had a lot to learn. "I wasn't doing things the way I needed to," he recalls now. "Phil picked up on the fact that I wasn't checking my blood sugar."

In the tight-knit collegiate racing scene, the guys could count on seeing each other at a race pretty much every weekend. Southerland proposed a friendly competition: Whoever had the higher blood glucose at the end of a day of racing had to buy the other guy dinner. "For about three months, I bought a lot of burritos, and he ate for free," Eldridge says. That got old fast. "I threw out my bad habits and started checking more. The next time the burrito bet came along, I won," Eldridge says. As he got his blood glucose under control, his performance on the bike got better, too.

Meeting Eldridge got Southerland thinking about how he might be able to help other athletes with diabetes. After graduating from college in 2004, he took a 300-mile ride from Athens, Ga., to his home in Tallahassee, Fla. Along the way, he hatched a plan. "I wanted to use the bike as a platform for diabetes the same way Lance [Armstrong] did for cancer," he says. He called Eldridge with an ambitious proposal: They would enter—and win—Race Across America (RAAM), a legendary nonstop ride from California to Maryland.

The next year, the two friends organized an eight-man relay team they dubbed Team Type 1. In 2006, using insulin pumps to maintain their blood glucose levels, the team rode the 3,000-mile RAAM in alternating shifts. After nearly six days, they won the eight-person division but missed having the overall fastest time by three minutes. But the next year, Team Type 1 won both prizes and set a record, riding across the country in five days, 15 hours, and 43 minutes.

It was just the beginning. Team Type 1 has expanded to include Team Type 2, an eight-man team of Type 2 athletes, and it still fields a RAAM team. But Southerland and Eldridge soon came up with an idea that would make RAAM look like a ride around the block: getting Team Type 1—and, specifically, a racer with type 1 diabetes—into cycling's premier event, the Tour de France, by 2012.

It is a tremendous goal. Riding in professional cycling's most famous race is the equivalent of playing in baseball's major leagues. Only the fastest and toughest cyclists on the planet compete, riding for deep-pocketed teams capable of fielding small armies of mechanics, coaches, masseurs, and cooks. The 2,500-mile race may be the most challenging endurance event in the world. It has been compared to running back-to-back marathons for three weeks straight. For an athlete with diabetes, the grueling nature of the event would present even more hurdles.

Southerland's plan was to start the team small, competing in the cycling "minors" while building awareness and experience. Young riders were recruited from all over the world, though only four of the 15 on the team have diabetes. With sponsorship from the pharmaceutical firm Sanofi-Aventis, which produces the Lantus and Apidra insulins the team's diabetic racers use, Team Type 1 started competing on the American professional circuit last year and earned invitations to race in Ireland, Malaysia, Mexico, and Taiwan.

The team got a taste of the big leagues in February, starting its season at the Tour of California, racing against the world's best. It was a rough ride: Five of the eight cyclists didn't finish the five-day race because of injury or illness, and the fledgling team placed only one rider in the top 50. Southerland, who had to withdraw partway through, says it was an important learning experience: "[Getting to the Tour] is going to take development. It means getting into harder races and getting our butt kicked in harder races, and learning from that."

Southerland himself has had to take a step back from racing. In 2008, he was diagnosed with iliac endofibrosis, a rare circulation problem caused by years of pedaling that affects elite cyclists and is unrelated to diabetes. It has kept him off the bike for most of 2009. "I'm definitely frustrated with this condition," he says. "Diabetes I like because I can manage it." (Not one to sit around, however, he's entered to run the New York Marathon.)

Still, with Eldridge and two other type 1 riders, Australian Fabio Calabria and New Zealander Timothy Hargrave, the professional team—only in its second year—has racked up several high-profile wins and even more top-three finishes in races across the country. "We started out slow, but since late April the guys have done really well," says team codirector Gord Fraser. "The way they're racing, the results are going to follow eventually."

And when they're not racing, the team's diabetic athletes travel to diabetes camps to encourage kids to get into sports. Part of their message is that thanks to technology, diabetes is no reason to avoid competition. "When I was 10, I had to arrange my lifestyle around treatment," Eldridge says. Today, he wears a matchbox-sized OmniPod insulin pump on the back of his upper arm, even during a high-speed bike race. Fast-acting insulins can be used to help smooth out highs despite the chaotic schedules riders keep as they travel from race to race. "Now I feel like I have the latest and greatest in tools out there," he says, "and that levels the playing field a lot."

For the nondiabetic racers on the team, racing with diabetic teammates has meant learning some basics, like how to recognize the signs of hypoglycemia and how to give a glucagon injection. The lessons go both ways. Fraser, a three-time Olympian who has competed in the Tour de France, says the discipline it takes to be a diabetic athlete is an inspiration. "The guys without diabetes have learned so much from the attention to detail and diet," he says. At training camp, everyone on the team was outfitted with a continuous glucose monitor, which turned out to be a useful training tool to see what types of food had the most immediate payoff in terms of energy during a ride and recovering afterward. And, of course, "it let them live a few days in the shoes of an athlete with diabetes," Fraser says.

Back at Manhattan Beach, Eldridge checked his blood glucose one last time before lining up for the race start: 178 and falling. Crossing the finish line after 90 minutes of full-tilt racing, Eldridge placed in the middle of the pack; Team Type 1 teammate Ken Hanson, who does not have diabetes, took third place. "I have people tell me all the time, 'People can't do this with diabetes,' " Eldridge says. "I've been doing this the last 15 years, and I'm successful at it."

Learn about Team Type 2 here.



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