Diabetes Forecast

Skier Kris Freeman Preps for the Vancouver 2010 Olympics

By Katie Bunker ,

Cross-country skier Kris Freeman is heading to his third consecutive Winter Olympics and may offer America's best shot in more than 30 years to bring home a medal. Freeman, 29, of Andover, N.H., is believed to be the first athlete with type 1 diabetes to compete at a world-class level in an endurance sport.

Diabetes Forecast caught up with Freeman, who has won 13 national championships in cross-country events, to talk about everything from his race for the gold in Vancouver next month to finding the right basal rate for his insulin pump.

Is it true that when you were diagnosed, you were told that the disease would keep you from ever competing in the Olympics? How did you move past that?

I was told that I could continue to cross-country ski race but that my Olympic aspirations were not realistic. No one [with diabetes] had competed at the Olympic level before in an endurance event. I found that crushing. I wasn't interested in competing at a recreational level; I always aspired to be an Olympic medalist. So I looked for as much research as I could and learned as much as I could about research and treatments. What really made me believe it was possible was the innovations in the last five to 10 years. Take fast-acting Humalog, and how much faster [blood glucose meters] were getting. I thought, how could anyone know what's possible with all this new stuff?

How long had you been skiing when you were diagnosed with diabetes, and how did diabetes change the sport for you?

My dad pulled me in a sled behind him skiing when I was a baby, and as soon as I could walk, I was on skis. I did my first race when I was 5. I'm a lifetimer. I was diagnosed when I was 19, and it took a long time [to get used to]. First of all, when I was first diagnosed [after a routine blood test], I was in the "honeymoon phase" and I stayed there almost three years, which was both a blessing and also not. When I was diagnosed, my blood sugar was only 240. I was constantly losing my natural ability to make insulin, and the doses I was using a couple months prior wouldn't always work anymore. But it made for an easier transition off the bat, and I'm thankful that I didn't end up with the type of high, damaging blood sugar that some people have [when they're first diagnosed].

In Vancouver, what events will you compete in? Which one is your favorite?

There are two distinctive types of techniques: the classical style, which is a walking or running motion; and freestyle, or skating, which looks like speed skating with poles.

The freestyle technique is faster. I'll be competing in the [15-kilometer] freestyle event; the 30K pursuit race—which starts out in classical style, then you go through a triathalon transition halfway through the race and change your skis and poles, then ski another 15K—and I'll also be competing in the 50K classic event at the end of the week. All three of those events are about the same for me. Unfortunately, the 15K classic, which is always my best, isn't in the Olympics this year. But I did win the 15K freestyle at U.S. Nationals. And I've put a lot of emphasis on these events this year.

The United States hasn't won an Olympic medal in cross-country skiing since Bill Koch took the silver in 1976. What are your chances? What are your goals for yourself and for the U.S. Ski Team?

To end the medal drought! I think my chances are fairly good. Last year at [the] World [Cup], I took fourth in the 15K, and that was the second time I've been fourth in the 15K at World. A 15K race is 9.3 miles, and I was 1.3 seconds from a medal. The same guys at World are at the Olympics, so there's the same level of competition, just a bigger stage. I know it's very possible for me.

I get a lot out of going to kids' [summer diabetes camps] and showing them there are no limits to what they can do. A medal would mean a lot to the sport of cross-country skiing, but for me it's more important to get my message that much further out there for kids with diabetes. And I'm not the only one with a chance [at a medal]: Kikkan Randall and Andy Newell both have a great chance. Both focus on a sprint event that's 1 1/2K long, and they've had a lot of success. We're all rooting for each other.

You have 13 national championship wins and the two fourths in World Cups, and you're the only American to make the Red Group, the top 30 athletes on the World Cup circuit. Which has meant the most to you so far? What are you aiming for next?

The fourth place at World Cup was the best distance result we've had since 1982! I've been in the Red Group before; it always feels good. It's prestigious, but it's also about the money: It frees our budget up better! The Olympic medal is the ultimate dream. I used to have posters of Bill Koch in my room growing up, and that's the ultimate dream. I won the U23 [under age 23] World Championships in 2003, and that's probably my best memory as a ski racer. It certainly showed me that I'd be able to win when I reached my prime, which is where I am now.

You use an OmniPod insulin pump, right?

I had not used another pump before the OmniPod [which has no tubing] because my doctor and I were concerned about insulin freezing in the exposed tubing. It's legal in the Olympics to race in temperatures of minus 4 degrees, and I'm racing in a Lycra suit and underwear. With the OmniPod, it's right on the skin and stays at body temperature. Once I learned of this device, I switched to it.

Before that, I was using Lantus and Humalog injections. The problem I was having with injections is that I have to run such high basal rates in my races that I'd have to take a huge basal dose and then be running low for a 24-hour period in preparation for that race.

Do you wear your pump during races?

I absolutely have to wear it during the race. I switched to OmniPod in spring 2008, and I raced all last season with it. With the OmniPod I use just Humalog, which is a much better system for me because I can change rates much more quickly. I can be very fine-tuned with it.

What's been your worst experience with diabetes during competition?

In the World Cup [30K race] in December, I ran my basal at the same rate I would have for a 15K, and I had to drop out of that race with a blood sugar of 49. I knew that was a risk going into the race, but I had to find the bell curves of what I could and couldn't do. I didn't have an entire year [since going on the OmniPod] to figure it out.

Do you stop to check your blood glucose in the middle of a race?

I tried something else at U.S. Nationals. I'd never stopped and tested blood sugar before. So I made a plan to do that halfway through the 30K race to get a basal rate in mind for the Olympics. I ended up coming in second; it may have cost me the win. But I won U.S. Nationals 13 times, and I haven't won an Olympic medal. I wanted to know what my blood sugar was at the halfway point given the basal rate I had given myself. That's the first time I stopped in a real race. I really needed to get that with the Olympics coming up, especially with the unfortunate insulin reaction I had had in the previous 30K.

How do you manage your blood glucose before a race?

Leading up to the start of the race is the most important. There are days I've tested 15 times before a race. I need to have my blood sugar as close to 100 before I start as I can.

Sometimes it goes along very smoothly, and sometimes I get a reading I'm at 250 an hour before the race, and I crash through the basement and have to come back up. I put everything on hold until I get that blood sugar right.

Can you tell us about your training regimen? How does your diabetes management affect it?

I have a race every weekend in the winter, and spring is recovery from racing. The bulk of my training is in summer and fall, June through October. In those months I'll train six hours a day. I break it into two sessions: A typical day would be a 2 1/2-hour roller-ski in the morning—they're kind of like long rollerblades I attach to my feet like skis that work on pavement—then a 15- or 16-mile run. That would be a typical day. Depending on how heavy the training is, my basal rates are always fluctuating with my insulin needs. Just the amount of training could affect whether my basal rate is 15 to 16 or up to 45. If I take a few days off in a row, my sensitivity to insulin decreases.

When I'm actively working out, I generally use Powerbar products and have Energy Gel Blasts. They have about 4 grams of carbohydrate per chew, and I eat a steady stream of those as I'm working out. I also eat a very strict diet. I try to replace exactly what I've burned and no more. I eat whole grains, fruits, vegetables, a lot of lean protein, and foods in their natural form. I'd rather have an orange than a cup of orange juice. If you strip fiber away, it's more difficult to process the sugar.

How have you found the right basal rates for racing?

I've done some extensive testing during time trails with my coach and at the U.S. Ski Team's training facility in Park City, Utah, where there's a treadmill that you can ski on; they have a helmet and a tube you put in your mouth that measures oxygen and, with me, tests glucose as well. We've simulated races on that to see what basal rates are best for different events. I burn more and more sugar the harder I go until I go into an anaerobic state, and at that point my blood sugar starts to rise. … So, as a result, we've found that I have to race with a much higher basal rate in short races than in longer races. Right now it's 6 units per hour for a 15K event, and only 2 units per hour in a 30K event.

With nerves at the beginning of the race—when you get nervous before a race and have a fight-or-flight response, you're dropping sugar in your bloodstream—I have to up my basal rates as well, and have to try to stay relaxed and calm. Depending on how important the race is, I do have to adjust. For instance, I had two weekends of racing in Norway this past year; the next week was the World Cup. I ran the exact same basal rates leading up to the race and had no problem going to Norwegian Cup, but just lying in bed thinking about the [the World Cup], my blood sugar rose 80 [mg/dl] because I was more nervous. I practice all the time different relaxation techniques and try to preempt that.

You had surgery last spring. What was that for, and how did it affect your diabetes and your skiing?

I had compartment syndrome, which occurs when a muscle outgrows the fascia, a protective covering. If you repeat a motion over and over, sometimes the muscle grows so large that it's bigger than its covering. Then blood flows to that muscle and causes numbness and intense pain. What I had done on my shins and calves was to have 60 percent of that fascia removed from my muscles. … The injury cut my season short two months. Because of that, I only got one start in a race that was longer than 15K. I didn't have my basal doses nailed down as well as I wanted going into this season. So I did a few experiments in 30K events this year to make sure I had the basal rate where I wanted it for the Olympics.

You have traveled to children's diabetes camps across the country. What has that been like?

During the summer I go to a lot of camps for kids with diabetes and I tell them my story about how I was told I couldn't do something, and I point out the successes I've had since then. I tell them that if you treat your diabetes and you're diligent with your care, it won't get in the way of your life. The only way it will is if you don't treat it properly. A lot of kids want to know what kind of insulin I use, what kind of pump I use, if I've gone low in races. Sometimes they ask great questions I wish someone had answered for me off the bat. I've had to learn a lot on the fly.

What do you want those kids to learn from you?

As long as you are always on top of it, anything is possible with this disease. You just have to work harder.

Read Part 2 of Kris's interview and learn about how diabetes affected his performance in Vancouver. Now, he's headed to the 2014 Winter Olympics in Sochi, Russia!



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