Diabetes Forecast

Pro-Cyclist Mandy Marquardt Talks Diabetes Management on the Track

By Andrew Curry , ,

Mandy Marquardt

It’s just after 10 a.m. on a gray day in February. Mandy Marquardt is in her element: circling an oval track with sides sloping at a 45-degree angle on a $15,000 carbon-fiber bicycle with no brakes.

Marquardt has come to Berlin, Germany, to compete in the track cycling world championships. She has just a few hours to practice ahead of an event that could define her career: Her results over the next few days could decide her chances of competing in the Summer Olympic Games in Tokyo, now rescheduled for 2021.

All around her, her teammates and other racers familiarize themselves with the Berlin track. The whir of wheels and the rumble of riders on wooden boards fill the cavernous hall. Marquardt and the other U.S. riders, in their red, white, and blue skinsuits, are easy to pick out. Look closely and you’ll see a slight bulge on Marquardt’s left arm. It’s where she keeps her continuous glucose monitor (CGM).

Marquardt, 28, was diagnosed with type 1 diabetes 12 years ago.

Riding With Diabetes

Growing up in southern Florida, Marquardt spent her childhood running and swimming, often accompanying her father, an avid runner, on morning jogs before school. At age 10, she decided to give triathlons a try. To help her practice on a bike, her father took her to a nearby velodrome. Such circular tracks, built for bike racing, are rare in the United States, which has only 22 of them.

“I started to learn to compete there because it was safer than on the road,” Marquardt says. But she soon fell in love with the sport and the tight-knit community of cyclists. “Being on a steep track without brakes when you’re only 10? That’s exciting,” she says.

When Marquardt was a teenager, her parents divorced and her father moved to Germany, where the sport is more widespread. The budding cyclist followed and joined a team. In 2008, at the age of 16, she competed in Germany’s national championships and placed third in her age category.

During some routine fitness testing a few weeks later, Marquardt was tired—unusually so. A diagnosis of type 1 diabetes followed within hours. Marquardt spent the next two weeks in a hospital in Mannheim, Germany.

Then came a crushing blow. While explaining the ins and outs of managing her diabetes, one of the hospital’s senior doctors told her she’d never compete at a high level again. “It was really hard to accept,” she says. “But I did believe him. He was a doctor. I was 16, and I figured he knew what he was talking about.”

Marquardt’s enthusiasm and passion for cycling soon bubbled back. “I thought, ‘exercise is good, and I’ll keep riding and competing,’ ” she says. “The bike gave me a lot of joy.” As she learned to manage her blood glucose levels, she found that workouts helped bring them down.

Returning to competition was another matter. The stigma of diabetes followed Marquardt. When they found out about her diabetes diagnosis, coaches who had been grooming her for the national team lost interest. “It felt like I was almost a burden,” she says.

Her local team was still willing to give her a chance and sent Marquardt back to the German national championships less than a year after her diagnosis. Once again, she won bronze. “I did the same event with and without type 1, and had the same result,” she says. “I thought that was pretty cool.”

Marquardt returned to the United States, where she felt doctors were more open to the idea of someone with type 1 diabetes competing as an elite athlete and coaches were more supportive. In 2009, she joined Team Type 1, then an organization of over 100 riders and runners with diabetes. In the decade since, the professional team changed—it’s now part of Team Novo Nordisk—but never stopped providing her with financial and moral support. It’s a community and a constant reminder that sports are possible with type 1 diabetes. “I felt so alone at the time,” she says. “Connecting with other people with type 1 made a huge difference.”

Training Days

Marquardt is fiddling with a bottle of water in the lobby of a hotel, just a few days before her event at the world championships in Berlin. Her nails are painted blue to match her Team USA uniform. She’s got a “GRL PWR” tattoo on her left calf and a navy hoodie emblazoned with “Changing Diabetes,” the slogan of Team Novo Nordisk, her main sponsor. The outfit is a professional team made up of male riders with type 1 diabetes. Marquardt is the only woman the team sponsors.

These days, Marquardt typically trains alone at a velodrome near her home in Pennsylvania or with other members of the USA Cycling National Team (she’s the only one with diabetes). The goal: build up explosive power. Her event, track sprinting, typically lasts less than three minutes. Competitors circle the track slowly at first, often dueling for position at walking speed, then go full gas for the final few hundred yards to reach the finish line. Think 100-meter dash on wheels, complete with speeds that can reach a blistering 45 miles per hour.

In addition to training on her bike on the track and on the road, she lifts weights and uses a specially designed stationary bike or rowing machine. It’s a grueling, full-time job, all to prepare for a few crucial moments of all-out effort. “I train 30 hours a week for 30 seconds on the track,” Marquardt says.

Competition can be unforgiving when it comes to managing blood glucose. Even though exercise is known to lower blood glucose, the adrenaline Marquardt’s body produces during a race—and the nerves that lead up to each start—can cause her numbers to spike. Sometimes, she says, her blood glucose can stay stubbornly high, making her feel sluggish and slow.

And at any given event, she might have to race eight or nine times. Whether she’ll have a few hours or a few minutes to rest, recover, and respond to her blood glucose readings with insulin boluses before the next race is mostly out of her control. “They’re not going to stop the race just for me,” she says. “That’s why managing my blood glucose is so important.”

Over the years, she’s learned that breakfast is key to keeping her blood glucose in her target range. She often starts her day with overnight oats mixed with protein powder, along with fruit. Her diet includes lots of protein, from whey shakes to steak tacos, but she treats herself, too. “I love ice cream and pizza,” she says. “But when I order a cone, I go for the kid size.”

Another lesson Marquardt has learned over the years, one echoed by researchers working with her male counterparts on Team Novo Nordisk (see “Ride and Research,” below), is to pay close attention to her own body. “Keeping a log really helped me. I tracked the foods I ate, my training, my insulin levels,” she says. “I got to learn more about my diabetes and what affected it.”

Finally, Marquardt says, she’s learned to be patient, especially with the daily ups and downs of diabetes management. That’s not always easy when her blood glucose stays stubbornly high in the minutes before a crucial race. “You can’t blame yourself for elevated blood sugar,” she says. “Sometimes the body just does what it wants. You just have to take it as it comes.”

Eye on the Prize

The sprint is an elimination event. Before the racers are paired up, they’re timed to see how fast they can cover a distance of 200 meters—a little more than two football fields. At the world championships in Berlin, only the top 28 women go on to the next round. Marquardt is 29th, missing the qualifying time by mere hundredths of a second, less time than it takes to blink your eye.

Speaking from her home in Pennsylvania a few months later, Marquardt says the race result was crushing. In 2019, she had three top-10 finishes against the same international field of racers. She spent months away from home, training for the Berlin event and letting her body adjust to the different time zone. Then she was out of contention almost before it began. “I was pretty defeated by it,” she says. “But I have to keep moving forward. One race doesn’t define my career.”

A few fractions of a second in Berlin means Marquardt may have to wait months or more before she knows whether a trip to Tokyo in 2021 is in her future. According to the complicated points system international cycling officials use to distribute Olympic spots, a good result at world championships would have practically guaranteed a trip to the Olympic Games. But even though the games have since been postponed, Berlin was Marquardt’s last chance to earn enough qualifying points. While there’s still a slim chance she might be selected, she might not know for sure until next year.

At a time when so much of the world is in limbo, Marquardt likens the uncertain situation to her diabetes diagnosis: an obstacle to overcome. She’s back to training, riding near her home and working out on her stationary bike. She orders her groceries to be picked up curbside, conscious that her diabetes puts her in an at-risk group for the new coronavirus (COVID-19) despite her youth and athletic accomplishments. “There are still so many unknowns,” she says. “But I’m going to keep training. I want to be ready.”

And if Tokyo doesn’t happen, Marquardt’s already setting herself another goal: Paris in 2024.

Ride Research

Team Novo Nordisk is a professional bike team, but it’s also a research initiative. A few years ago, the team realized it was a unique resource for researchers: a tightly knit group of elite athletes, all with type 1 diabetes. Thanks to data-collection tools including continuous glucose monitors (CGMs), heart rate monitors, and special power sensors built into their bikes, the team is a rich source of data.

Its athletes have participated in studies of everything from how intense physical activity affects blood glucose levels to sleep patterns and overnight glycemic control. “Combining all that data, we can start to look for patterns,” says Sam Scott, PhD, a research fellow at the University of Bern in Switzerland and head of research at Team Novo Nordisk. “What are they doing well, and what are they struggling with?”

The team works with researchers around the world. One of the first efforts is a look at how the different riders on the team reach out for help with their diabetes, using a detailed questionnaire to quiz the riders in depth.

The range of experience varies a lot: Some of the riders were diagnosed as children and have been dealing with diabetes for more than a decade; the team’s oldest rider, 33-year-old Hungarian Peter Kusztor, was diagnosed with type 1 just a year and a half ago. “When we find something that works, we’re looking to share that so it becomes more accessible,” says Scott. “We’re looking to redesign the questionnaire so health care professionals can get information about what their patients are finding most challenging.”

One of the big takeaways: There is no one-size-fits-all strategy on the team. Specific methods that work for elite cyclists may not apply to other athletes with type 1 diabetes, whether they’re competing at an elite level or just trying to get in 150 minutes of jogging a week. Says Scott, “We want to use the experience of each of these riders to give other people with diabetes education and confidence.”

 

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