Thriving in Triathlon as a Diabetic

TDP 372 - Thriving in Triathlon as a Diabetic

Andrew Harley: Welcome to the TriDot Podcast. We are rolling through our series on how to thrive as different types of triathletes, and I'm really excited about today's topic, because I did not think of it. I cannot take credit for today's episode. An athlete in the TriDot audience sent a little comment in the I Am TriDot Facebook group and said, "Hey, I'm loving this thriving series. Can you do an episode about how to thrive as a diabetic triathlete?" And I was like, wow, I never would have thought about that. Let's freaking do it. So I've got two experts with us today to help us learn how to thrive if we are a diabetic triathlete or an insulin-resistant triathlete. Our coach joining us, for the very first time on the show, is Tony Hampton.

Tony Hampton: Hey, glad to be here, Andrew.

Andrew: Happy to have you, Tony. I've met Tony several times at the races and I'm finally getting him on the show. Also joining us is Taryn Richardson, the founder of the Triathlon Nutrition Academy. Taryn is an advanced sports dietitian who specializes in working with age-group and elite triathletes. She also hosts the excellent Triathlon Nutrition Academy podcast. Taryn, welcome back to the show.

Taryn Richardson: Thank you so much for having me. It's been a minute, but good to be back.

Andrew: It's been a minute. Taryn and I over the last couple of months have had several "let's talk about this, let's talk about that," and our schedules just didn't line up.

Taryn: We made it.

Andrew: Yeah, we made it. I'm Andrew, the average triathlete, voice of the people, captain of the middle of the pack. As always, we'll start with our fun warm-up question, settle into the main set conversation, and then wind things down by asking Taryn an audience question on the cooldown. Lots of good stuff, let's get to it. Okay, today's warm-up question is a selfish one from me, because I need to do some shopping and I want to see what TriDot Nation has to say. Across all of your training and racing, what is your go-to headwear? As we're recording, if you're watching the video, I'm rocking a TriDot hat. I don't train in these, because I have to wear these on the podcast. My favorite training hat has bitten the dust. It finally got too gross. I'd washed it a couple of times, it was fraying at the seams, and I threw it away. So I need to shop for a new training hat. What are people wearing on their head when they're training and racing? Coach Tony, what is this for you?

Tony: I'm a heavy sweater and a very salty sweater, so a headband is a must. It keeps the salt out of my eyes. As Taryn can attest, I lose a lot of sodium, like twenty-four hundred milligrams per hour on the run. So that headband saves me. Over the headband I wear a Zoot one, which is thin, so it goes on real nice. And I can wear my Ironman Florida finisher run hat that I got in November. If that one's wet, I've got another Ironman non-finisher hat, it's just an Ironman run hat. And sometimes on the treadmill I'll actually wear a trucker hat.

Andrew: I love it. So you're publicly endorsing Zoot's sweatbands and you threw a hat over it. I would not have thought of that. That's very smart. I'm also a heavy sweater, so I just might have to try that. Obviously we love our friends over at Zoot. Taryn, what's this answer for you? You've been CrossFitting a lot on Instagram. What do you wear when you're CrossFitting?

Taryn: Nothing on my head. But when I'm outside, I have a ponytail, right? I have lots of hair and it's really hot in Australia. So if I'm exercising, I'm wearing my TNA visor. Can't get it on over the headphones, though. Let's do this.

Andrew: Yeah, I was hoping you'd flash one of those. I had a feeling you would.

Taryn: I don't like wearing my hair down low on the back of my neck. I don't know if any other ladies feel that way. It just gets all hot and sweaty. So I love a ponytail, and I have to wear a visor so I can get it up there and off my neck.

Andrew: Taryn, I love the idea of a visor. I really, really do. I want to be a visor guy. With the receding hairline that I have, I look ridiculous in visors, so I personally just can't do it. But we have a lot of triathletes who are TNA alumni or are in the TNA actively right now, and on Instagram I see several TNA hats and visors in the training cycles. My answer here: I've had a Precision Fuel and Hydration trucker runner hat for a long time, and that's the one I mentioned earlier that's falling apart because I've worn it for every run for years. They were giving out these really fun PF&H bucket hats in Kona a couple of years ago. I tried wearing it on a workout one time, and I love it when I see somebody else do it, but when I try to wear it I'm too self-conscious and feel like I look ridiculous. So I never train in it, but I wanted to give them a shout because I like them. So I'm kind of a freelancer right now. A lot of the running hats, when you buy a nice running hat, don't have a snapback plastic clasp. They have a stretchy clasp, and I don't like that, I don't feel like it's secure on my head. I like wearing my hats backwards, so I exclusively have to seek out one with a snapback, like the TriDot hat I'm wearing. For people watching on YouTube, I've got to have this kind or else it gets real squirrely for me. Anyway, I'm complaining a lot about my hat problem right now.

Taryn: Have you got a solution now? Do you know what you're gonna buy?

Andrew: I've got some ideas. I'm really digging Tony's headband and hat combo, because that might solve my problem of hats feeling like they're slipping.

Tony: I do like wearing a visor. My problem is I get hot, and I can't put ice in the visor, it won't stay. Pfft, off it goes. I have that very visor that she's talking about, and I've got the PF&H run hat that you're talking about, but I go with the Ironman finisher hat. If I'm out running, somebody's gotta see, right? If you're an Ironman, you have to tell everybody.

Andrew: I've been playing tennis a lot lately, and for a while I had an Ironman finisher hat that I wore when I played tennis. It finally got too gross, I washed it a few times and threw it away. But I was playing tennis against a guy one time, and my style in tennis is I'm just a short, fast guy, I'm going to get to everything and get it back over. I was beating him pretty good, midway through the second set, and he goes, "I really want to know what I can do. You're an Ironman. Of course you're just gonna keep running." And I was like, that's interesting, that's sending a message right now in my favor. Hey, we're gonna throw this question out, because again, today is selfish. I had an espresso before we hopped on, so I'm just talking.

Taryn: We're answering the hard questions here on the TriDot Podcast. It's the really important things we need.

Andrew: We're gonna get to today's topic, I promise. I wanna hear from you guys: what brand and headwear are you enjoying in your training right now? Let us know in the YouTube comments, in the Spotify comments, in the I Am TriDot Facebook group, and tell me personally so I can give your favorite hat, visor, or headband combo a shot. Thanks so much, love y'all.

Andrew: Tony, very fortuitously, you and Taryn know each other very well, because you are a graduate of the Triathlon Nutrition Academy. Tell us about your experience working with Taryn.

Tony: I was on the fence for a while. I had messaged Taryn about my condition, and I didn't know if she'd be able to help me or not. Of course she said, "Of course I can help you, I can help everybody." So I joined the program in July of '23, went through the three phases, and now I'm in the alumni squad, the Supercharged Squad, that's what it is. I've just enjoyed it. I've learned a lot, even though I thought I knew a lot, there's so much more to learn, and I'm still on that journey three and a half years later. It's been great.

Andrew: Taryn, how is Coach Tony as a student?

Taryn: Do you want the real answer or do you want my PC answer?

Andrew: You can give me the middle ground, a little flash of both.

Tony: Give the real answer.

Taryn: The great part about the Triathlon Nutrition Academy is how well I get to know athletes, and we also get to know the other athletes in the cohort you're going through with. When Tony joined, straight up, he said, "Look, I'm type two diabetic. I know you're going to tell me I need to eat more carbs and I'm afraid of carbs. I don't know if you can help me or not, but I'm going to do this anyway." So it took me a while to figure Tony out. He is very stubborn, but in nine months he'd become quite humble. He has come a long way. He has lost like 30 pounds of body fat, and for him it was mostly visceral fat, which is the fat that sits around your organs, which is really not good, so you want to get that within a healthy range. His HbA1c, which is your long-standing measure of your blood glucose levels, improved dramatically, from 6.5% down to 5.4%. Recently we've been working on his sleep. Again, he's very stubborn. It probably took me two-plus years to get him to actually get a sleep study done, because he was sleeping three or four hours a night and calling that a night of sleep, which is terrible. We literally bullied him to make an appointment. It's still not quite finished, but he's improved his sleep to six to seven and a half hours a night. He may not feel great yet, but there are so many things that can happen when you work with somebody for a longer period of time. I always talk about how compliant triathletes are. I love working with triathletes because when I suggest something, they're very receptive. They want to do everything right, dot all the i's, cross all the t's, except Tony.

Tony: I gotta make her work for it.

Andrew: Tony's not arguing against any of that, I can tell.

Tony: No, I'm not arguing. It's a known fact.

Andrew: So Taryn, you're talking about the cohorts, and that's one thing I think is really interesting and unique about TNA. You open the doors twice a year for new athletes to join. It's not something you can jump into at any given moment, because you walk through it together. It reminds me of a professor in a college course, with the kids all in the course at the same time. You just came out of a round of adding new athletes to the TNA. You survived, they're in, they're rolling. How's it going, and what do our athletes listening who maybe haven't heard about the TNA need to know about how to get involved in the future?

Taryn: This one was a big one. I was knocked for six for about a week afterwards, because I ran what's called Fuel Camp. It was three sessions of live online training with me where we covered essential triathlon fueling, periodization, and race nutrition strategies. I'm running that again at the start of 2027. If you want to come, you can go to dietitianapproved.com/fuelcamp to register. Register now if you want to save your seat. It was a lot of fun. The Triathlon Nutrition Academy, which I also have a podcast of that name, is my online education program that teaches you everything you need to know about the fourth leg. My philosophy, after working with triathletes for two decades now, is that if I give you a fish, you eat for a day, but if I teach you how to fish, you eat for a life. So over nine months you learn the science behind what we're trying to achieve with triathlon nutrition, as well as the why behind why we do things, rather than me just handing you a meal plan you don't understand. We build your meal plans together. We build your recovery, your pre-training, how you periodize your food, and all of your race nutrition plans together, so that when you understand them, you can adjust, tweak, and adapt them at any time, no matter what life throws at you. It really sets you up for life. I call it education plus the application of what you need to know for your physiology, your body, your training, and your lifestyle, no matter what stage you're in. Athletes get me live every week in Power Hour, which is how I know Tony so well, because for nine months, most weeks, we turn up together and talk about you and your unique situation. I always say the word "N equals one." It's a research term for "you are the one person in this experiment." So it's understanding how to do your nutrition for yourself. Plus, because I've been working with triathletes for two decades, I've built lots of tools and resources to make eating for three sports easy, instead of it just being another thing on your to-do list where you get home from training, open up the fridge, and think, crap, what's for dinner? We're not gonna do that anymore. It runs in cohorts because when I open the doors, we all work on this together at the same time, and I spend 110% of my attention on that group while we're going through. Then we open it again at another time. If you're interested, go and learn more or get on the list for the next one at dietitianapproved.com/academy.

Andrew: We'll drop that in the description for today's show for sure. Guys, Taryn doesn't ask me to let her talk about it when she comes on the show, I just want to make sure she gets the chance. I think it's a great resource, a great program. Highly recommend it. All of our TriDot athletes who have gone through it will not shut up about it and will not stop posting on social media about it. Getting us into today's topic: my opening question is not for our diabetic triathletes, who are very well versed in the difference between type one and type two diabetes. This is more for me and for the other athletes listening who are curious and want to learn more. What is diabetes, and what is the difference between type one and type two? Tony, jump in.

Tony: It's a chronic health condition where your body doesn't create enough insulin to clear glucose from your blood. Glucose is basically what turns into the energy in the cells, and insulin is how it gets into the cells. If you're a type one diabetic, you don't have any insulin, or very little insulin, in your body. It usually develops when you're a kid, a young child. Some illness attacks the pancreas where the insulin is created, and then the insulin stops being made.

Type two diabetics are usually older adults, although it's getting earlier and earlier that they're detecting it. It's not necessarily an old person's disease. I was diagnosed at thirty-two, and people are getting diagnosed in their twenties now. That's insulin resistance, where your body makes insulin, but your cells just don't accept the insulin your body makes. That's the big difference.

Andrew: That's super helpful. I knew there was a difference. I still remember my first encounter with diabetes in first grade. It was halfway through the semester and a new kid was joining our class. They did this whole thing about this kid named Eric: "Tomorrow this kid named Eric is gonna join the class. He's a type one diabetic." They explained to all the first graders what that means, and they wanted us to be on the lookout for if Eric was having an episode or was low, so we could flag it and get the teacher to help him, because he's a first grader who was finding out he has diabetes and learning how to handle it. Literally the first day this kid walks in, it's "This is the kid, this is diabetic Eric." After a week or two he was just another kid in the class, but that was my first memory of this, our teachers making a big deal about this kid joining. So, very helpful distinction there, Tony. Taryn, anything to add?

Taryn: Tony did a great job there. I like to think of insulin as the key that helps you move glucose into the cells, that unlocks the door. With type one, the key is missing altogether, or there's very little, so there's nothing to unlock that cell door and let the glucose in. Type two diabetes is like using the wrong key in the lock, and it gets stuck in the lock for whatever reason. That's a good differentiator for people who don't understand diabetes.

Andrew: Very helpful. So Tony, you mentioned you were diagnosed at age thirty-two. What was your experience working through that journey of discovering you were diabetic? What problems were you having, and what changed after your diagnosis?

Tony: It's funny. We were having a birthday party at our house, and one of the parents brought over a sheet that said the same kind of thing you were talking about in first grade. One of the kids was a diabetic, so: don't let my kid have this, not this, not this, watch for this. At the bottom of the sheet there was a bunch of symptoms, and I was going through them and thinking, that's me, that's me, that's me. All of these. So I took it to the doctor and said, "I think this could be me." But all these symptoms with diabetes are like regular symptoms you would see on a regular basis, and a lot of them don't happen all at the same time, so you don't realize you have it until you're much older in life. That's why they say it's older people. One of the signs is you're always thirsty, and I'm constantly thirsty, but my doctor said, "Well, you're always working out and you're a heavy sweater, so of course you're gonna drink a lot of water." Well, I go to the bathroom a lot because I drink a lot of water. I can't go all night without having to get up and go to the bathroom. He said, "No, no, no," but he did a blood test, and it came back, and it was, "Yeah, you're a diabetic." When I was diagnosed in '99, it was a lot different than it is now. I went to a diet school where they basically told me not to eat more than thirty carbs at any meal. Every meal was the same, and it didn't matter if I was working out, watching TV, or whatever I was doing. Thirty carbs was all I could have per meal. Taryn's probably shaking her head, but that was the rule I learned back then, and some of that has stuck, and it's taken years to get past it. That's where, when I told her I was afraid of carbs, a lot of that came from. I had to learn how to eat and what to eat. They didn't care so much about whether it was a complex carb or a simple carb, and there was no talk of protein or fats or anything. It was nothing but carbs, and it was like three days long, so it was ridiculous. But you do learn a lot, and you learn how to manage it. You're doing all these finger sticks to check your blood and see what your sugar level is, and that's come a long way too. So yeah, it's been a challenge.

Andrew: So Tony, that's your personal experience with type two diabetes. What is the difference, to your knowledge, when you're working with athletes, between what you go through as a type two diabetic versus an athlete who comes to you for help and is a type one diabetic?

Tony: One of my daughters is a type one diabetic, so I've learned a lot through her too. Her big thing is she's not restricted by diet at all. Most type one athletes can eat anything they want. They just have to inject the proper amount of insulin based on their current blood sugar level and how many carbs they're consuming. I, on the other hand, have to plan and know where my blood sugar is, what I'm getting ready to do, and how many carbs I'm gonna need to eat. Sometimes it's more, sometimes it's less, depending on what I'm doing. But type ones can eat whatever they want. They just have to inject the proper amount of insulin for their situation.

Andrew: I didn't realize that, that's really interesting. As a sports fan, there's only one professional athlete I can think of who I know is diabetic, in the tennis world: Alexander Zverev, one of the top-ranked players in the world all the time, who won two majors this year. He's a type one diabetic. An interesting thing about his career is that for a long time he tried to hide it. He thought it might give his opponents a competitive advantage if they knew, and he felt there was a stigma around admitting it. So he's playing three-, four-, five-hour tennis matches, managing his blood glucose levels and hiding it along the way. At some point he became very public about it. Now on camera you'll see him on a changeover, just like the other guys, drinking an electrolyte beverage, munching on a banana, injecting himself, and walking to the other side of the court. Over the course of a five-set tennis match he's constantly managing it, which is super fascinating. That's the only one I can think of. As you're encountering athletes you work with, is being diabetic a pretty rare thing, or is there a pretty solid population here? Taryn, what do you think?

Taryn: Well, if you're looking for professional athletes, you've got an entire pro cycling team, Team Novo Nordisk. Every rider on that team has type one diabetes. They're about educating and evolving this stigma that seems to be associated with diabetes, which is really cool. It's a great example of high-level athletes managing diabetes and doing the same courses and the same fueling as somebody who doesn't have diabetes. We also have quite a lot of athletes inside the Triathlon Nutrition Academy program who either have type one or type two diabetes or are managing insulin resistance and rising fasting glucose levels, that pre-diabetes stage where we're starting to monitor. Maybe it's because Tony is so vocal about having diabetes and how much he's been helped by educating himself around nutrition. But you're right, there was this stigma, and that's definitely evolving and changing. Now it's time for athletes to really understand how to manage this, not only for general health but for longevity in this sport of triathlon.

Andrew: Tony, how often are you having athletes come to you with this background, wanting to work with you?

Tony: I get quite a few inquiries, mostly questions. I think that same team also has a type two diabetic cycling team now, or they're working on getting one, one of the two, I'm not exactly sure where they are. Most of the athletes are gonna be type one, because one thing about pro athletes in general is that they maintain a pretty healthy lifestyle, so type two diabetes is rare in pro athletes. I think more people get diabetes and then decide to get into endurance sports, as opposed to developing it over time as an endurance athlete. I've been an athlete my whole life, but I got out of the military and was out for a few years and not nearly as active, and during that time is when I developed diabetes. I probably would have developed it later in life, but since I was so active and then pretty much went non-active for quite a few years, that's when everything showed up. But yeah, I get a lot of questions: how do you do this, how do you do that, what do you eat, what are your numbers, how do you train without eating carbs. That's probably my biggest question.

Andrew: We're gonna answer some of those, or guide people in the right direction, in just a minute. But I wanna ask you both a question that's not on our run sheet that I just thought of. My brother, hopefully he's okay with me saying this, went in for a routine physical at his general practitioner, and just in the screening, they said, "Hey, you're showing a lot of signs of being pre-diabetic. You really need to think about this, this, this, and this." They had a good conversation, and now he's eating healthier and he's fitter. At the time we're recording this, he's about to do his very first Hyrox event in Tampa, Florida. He works out with some of the guys at the company he works for.

But for someone out there listening to this who thinks, I don't even know what the symptoms are, am I diabetic? What would an athlete be looking for? Taryn, when you're talking to athletes in the TNA and discovering they have insulin resistance of some kind, how are you finding that out? How are you learning that that's a problem for somebody who right now might be sitting here listening to this, not knowing they have a problem?

Taryn: The first step is to get your bloods done and have that open discussion with your general practitioner. We're going to see a rising fasting glucose in the morning, and sometimes you can see an increase in the sugar that's in your urine. Pre-diabetes is a stage where you can act, and if you act quickly, sort out your nutrition, sort out your exercise, and generally lose a little bit of body fat, you can turn it around. If it's not a genetic autoimmune thing like type one, then it's usually too much fat sitting around our cells that's blocking insulin from getting put away into those cells. So driving some body fat loss, cleaning up your diet, and exercising will hopefully reverse that if you jump on it quickly.

Andrew: Tony, anything there?

Tony: No, I think that's pretty accurate. Stay active, eat a little bit better, do a little bit more cardio, cardio's good, and know what those numbers are. The blood test is usually what they do, a fasting blood test, and when the number comes back, it's pretty obvious where you fall on the scale.

Andrew: Got it. So when in doubt, a typical trip to your general practitioner to get some blood work done can help you find out if you have some work to do or if you're in the clear. I'm curious, because you both work with a wide spectrum of triathletes: when you start working with an athlete who you know is diabetic or insulin resistant in some way, what are the things you start talking with them about that maybe you don't discuss with other athletes? Tony?

Tony: If they're a type one, I wanna know what their blood sugar level is when they start a workout, what it is when they end a workout, and how many carbs they're taking. If it's a type two, I wanna know kind of the same things, but it's not quite as important, because it's a lot easier to work out as a type two than it is as a type one. Exercise lowers your glucose, which is the same thing insulin does. So if you're a type one diabetic and you start out with a low blood sugar, you're gonna crash. You need to be taking carbs probably before you start working out, so that when you start burning some of those carbs, you're not gonna pass out. Especially in a sport where we train a lot of times by ourselves, you've gotta have that covered.

Andrew: Or on two wheels, or in a body of water.

Tony: Yeah. When you're in a body of water, you don't have an insulin pump. If you're on an insulin pump, you can't wear that in the water, and you can't monitor necessarily what your blood sugar level is while you're out there swimming, because you need your phone or your pump and that's not gonna be on you. You've gotta know what the symptoms are, and this is one of the topics I make sure athletes cover: you always have to have some sort of fast-acting carb on you when you're working out, period.

Andrew: Really interesting. Taryn, same question over to you.

Taryn: I think it always comes back to N equals one. Every athlete is different, so I always work with the person in front of me rather than give generic advice. For diabetics, the same fundamentals and foundations are there, but there are more layers. The goals for a triathlete aren't going to change, but the way you go about it is likely going to be different for a diabetic. First things first: is it type one or type two? Insulin or no insulin, or any oral hypoglycemic agents like metformin? What type it is matters, because they all act differently. Is there any other medication somebody's taking, like a GLP-1? Then we look at bloods, and HbA1c is always the first thing I look at with a diabetic, because that tells me how good their control has been over a long period of time. The goal is to try to get that down within a healthy range. Hypo history is another one: is that happening all the time, or never? What's somebody's previous education level? Tony had general diabetic education, but that doesn't necessarily serve us when we're training for three sports. It required a lot of un-educating to get him to understand how to eat healthy as a diabetic and manage that side, while also still fueling for triathlon. He hasn't mentioned it yet, but he did a 70.3 on 60 grams of carbs total for the entire day, which is crazy. He absolutely bonked, and he didn't feel so good. Now he has at least that per hour. That hasn't happened overnight, it's about being comfortable with carbohydrate and knowing where to have them and how to manage your blood sugar levels around that. I think the other really important question for diabetics is: who else is on your care team? It can't just be you trying to go this alone. You're going to need a few people in your corner to help manage it until you've got enough education under your belt to make some of those decisions on the fly, like Tony can do now, and then be able to help other athletes through that as well.

Tony: You want a good endocrinologist along with a general practitioner. That'll be lifesaving, because the meds matter. One of the common drugs they're issuing now for diabetes is the GLP-1, and that brings a whole other level of issues along with it, because it's harder to eat, and all the other things the GLP-1 does. The type of GLP-1 matters too, because there's the GLP-1 and the GLP-1/GIP, and some of the others are just the GLP-1. There's a big difference, and if you don't know, you need to know those medicines and what they do and how they act. Taryn's right that N equals one applies especially for diabetes, because what works for me as a diabetic might not work for you. A lot of it is body type, your makeup, how much fat versus muscle you have, and the amount of muscle you truly have, because that's where you're burning all your stuff. There's a lot to consider for those athletes.

Andrew: I'm glad we're talking about it now. This was a question I had further down the run sheet, but we'll talk about it now. For a diabetic athlete, is this something they can read up on, research, self-assess, and learn themselves and have success on their own as an educated athlete? Or does it truly take having a coach, your general practitioner on board, an endocrinologist, Tony, like you're mentioning, and Taryn, a wonderful registered dietitian helping people like Tony have success through diabetes? Do you have to have the team to truly find success in something as wild as triathlon, or can somebody do the learning, figure it out, and get by all right on their own? What do you guys think?

Tony: Obviously, being a coach, I say you need a coach.

Taryn: Am I biased?

Tony: But truly, you can figure it out on your own, it's just really difficult. There's not a whole lot of knowledge, and it's a lot of trial and error, and some of these trials and errors could end very, very badly. You have to do a lot of research. It definitely can be done, but it takes a village, and if you get the right village, you cut that timeline way down. So I say it takes a village.

Taryn: Just like parenting, it takes a village. People with diabetes have to manage it for themselves 24/7, so they're usually going to know their body way better than anyone else. But endurance training is going to shift insulin needs a lot, and getting it wrong is going to cost you way more. So you'd be silly to try to go it alone without at least getting yourself some education first. The dream team for a diabetic would be your doctor or the endocrinologist, like Tony said, whether you've got a general practitioner and an endo or either/or. Some sort of diabetes educator, if you're on insulin, who's going to help you with dosing and adjusting your insulin if you're a type one. I think you need a sports dietitian who is specific to triathlon, somebody who understands our sport, because you can't go see a sports dietitian who works with boxing athletes or people who go to the gym and expect them to really understand the intricacies of swimming, cycling, and running in one sport. Bonus if they've got some experience with diabetics, because that's the fuel, helping you understand how to fuel yourself for triathlon and also manage medication, insulin levels, and blood sugar levels with that. Then a coach. You're obviously going to get to your goals faster with a coach, and somebody with some experience with diabetes is a definite added bonus, because they're going to know what it's like. They're going to know what it feels like to go hypo, what it feels like to be high, and they can talk you off the ledge sometimes when you're wondering whether carbs are good or bad. And then, in your dream team, you need your training buddies and your family, people like you two who have been educated already, who can spot a hypo for somebody in the classroom or in your training group so they can help you if you need it. So you can do it on your own, but you're going to get there way faster and way safer if you have a team around you.

Tony: Yeah, safety is the key.

Andrew: Tony, I like where you said you can get there, you can make it happen, but the learning curve is way better with the team around you. As a non-diabetic triathlete, I wish I had started my triathlon journey with better training and more knowledgeable people in my corner. There was already trial and error in figuring out this sport without having to manage diabetes, so I absolutely hear that message. What are the signs of an athlete who is becoming hypo and needs some help, Tony?

Tony: You'll really start sweating a lot. You'll turn really red, you'll get kind of scatterbrained. Heat stroke and a diabetic crash are very similar. You get lethargic, you suddenly forget where you live or whatever, and everything is just a little bit off. You might not even realize it. One of the symptoms I get is my legs get really, really tingly. It's weird, because I just wanna move them, even though I'm running, but they're not moving in the right direction. Everybody's gonna be a little bit different, so what happens for me when I'm low might be different than what happens for you. If I'm not working out and I start to go low, I will start sweating, I'll start shaking, and my pattern of speech might be a little off. Stuff like that. Hopefully you got all that, I'm having a bad day.

Andrew: Yeah, super helpful. Two last questions in our main set. I want to make sure we leave by hitting our diabetic triathletes with your go-to most important training tips and racing tips. For a triathlete who is diabetic or insulin resistant, somewhere on the spectrum, what would you say are the keys to good, solid day-to-day swim, bike, and run training? Coach Tony.

Tony: Definitely always have fast-acting carbs with you, whether it's a gel or a carb drink or whatever, because you never know when you're gonna go low. If you train with a CGM, it's different than without, and that matters. If you don't use a CGM, you have to know how to use your blood glucose meter to get effective data, because it is literally a point-in-time reading. If you just take it at noon every day, what does that tell you? Nothing. If you take it before a meal and after a meal, then you know what that meal did. Same thing goes for working out: you take it before a workout and after a workout, and you're gonna know what your body does. I wear a CGM, so I can tell you that twenty minutes into my run my blood sugar went up, because I had a gel right when I started, and then I dropped off hard, and then I just kind of flattened. You get that kind of data from a CGM, you don't get it from a blood glucose meter. But you need to know what's going on at all times, not just while working out.

Taryn: CGMs have been really valuable for all sorts of things, particularly overnight blood glucose levels, which we didn't really have any idea of before unless you woke up to test. If you are a diabetic, you need to be wearing a CGM overnight to see what happens. From my perspective, if you're going hypo overnight, that tells me you haven't done enough fueling during the day. So it's more than just before and after exercise: what is happening after you eat a meal, and what is happening overnight, and then we can manipulate fueling to make sure that doesn't happen.

Andrew: So the key to success in our day-to-day training is to just be aware of our levels, have the best way possible to monitor, so you can fuel accordingly. Really helpful. When it comes to race day, is it the same thing, Coach Tony, or are there some other tricks to ensuring we have a good race day?

Tony: Nerves do play a factor in your blood glucose readings. Your numbers are gonna be different just because your heart rate's elevated and you're nervous, standing on the start line thinking, what the heck did I just do? The same kind of stuff applies. You've gotta know what your number is. You've gotta have something to get you through if you do go low. Like I said, a lot of the exercise you do lowers your blood sugar, so if you start out medium to low already and you don't have a carb source, you'll crash. There's just no way around it, and it doesn't matter if you're a type one or a type two. If you're a type one and you're getting ready to swim and you're not gonna be able to know exactly what your blood sugar is, you need to know what it is going into the water. Depending upon how long the swim is, it might need to be really high, especially if you burn a lot of glucose. If you've got an hour and a half swim for a full Ironman, you might need to be above 250 before you even get in the water, and if you're not above 250, you might not get out of the water. That's just how much glucose you're gonna burn out there. So there's a lot that's the same but different, just because you can't just feel what your number is. I can't tell you right now what my number is without looking at my CGM. I can see that I'm at 125, which is not bad, but I don't feel any different than when I'm at 160, and there's a big difference between 125 and 160.

Andrew: For a type one diabetic, how often are they needing to supplement on course, and take insulin on course?

Tony: Insulin does the same thing as working out, so they could possibly need to take insulin, but more than likely they're gonna need more carbs as they start to go low, especially if they're working hard. They may have to take carbs on the swim, so they have to know how to eat carbs on the swim, like a gel stuffed in your wetsuit that hopefully is waterproof, or you're gonna have a mess.

Andrew: Stuff it in your swim cap.

Tony: Yeah, that'll work too, until you have to pull it out of your hair.

Taryn: There are lots of videos on YouTube of open water swimmers showing you how you can feed in the water if you need some hot tips in that arena.

Andrew: The first time I ever saw that, Taryn, was a couple of Olympic cycles ago, watching the open water marathon, which I think is a ten-kilometer swim. It's almost like a NASCAR or Formula One pit lane. There's a dock in the water that all the swimmers swim by, with a pole with their number on it, holding whatever they want, gels, whatever they need. They just grab it, kind of backstroke, take it. It was fascinating, I had never seen that before.

Taryn: Yep, it's amazing.

Andrew: Taryn, what would you say to a diabetic triathlete heading into race day?

Taryn: Okay, there are lots of things to cover. I just want to say again, this is very general advice, so don't confuse it with individual prescription. My number one tip really is, don't be afraid of carbs. You need to educate yourself around what's going on in your body, understand physiologically what is happening, so that you can learn how to fuel yourself properly, because the type of training session is going to change the response of your blood glucose levels. Aerobic exercise is generally really great for lowering glucose, which is why type two diabetics are almost prescribed more aerobic exercise. Whereas anaerobic exercise, the short, sharp, hard stuff, is going to temporarily raise your blood glucose levels, because your cells are releasing glucose into the bloodstream to be used for energy before it gets sent to the working muscle. So if you understand some basic physiology, then you'll understand how to fuel for the work required and build your fueling plan around it. I think the fuel comes first and the insulin wraps around that, not the other way around. If you're out racing an Ironman or any sort of triathlon, you understand how to fuel properly, and then we manage your insulin levels or other medication around it. For a type one, they may or may not need to give themselves insulin during something like a full-distance event, but they may be adjusting their long-acting, their basal insulin, for that day. It depends, and you need to have a great team behind you so you can understand that and adjust your meds for the day. Like Tony mentioned, what your blood sugar level reads before training is really important, and you might want to start sessions higher than outside of training. Again, that's very individual. If it's below a certain level, you might have a fast-acting carbohydrate you need to take before a session to get through it. I definitely think with CGMs being so accessible, you would be silly not to use one as a diabetic, because it's empowering us with so much more information that we can then educate on and adjust your fueling around. Don't be afraid of blood sugar levels that seem high, because when we're exercising, that's a good thing. We want that glucose in our bloodstream so it can be transported to the working muscles to use for energy. You more want to be watching the trend line on your CGM, and if things are going down, we want to be acting early, because once you're too low, it's going to take twenty minutes to rectify that, and you're gonna feel pretty shit in that process. Sorry, I'm Australian, it's just part of our language.

Andrew: Just keeping it real, keeping it honest.

Taryn: Carbs are not the enemy. Make sure you rehearse everything in training, in your brick sessions, even in B races, to understand what your body does in response to that extra stress of racing. Your blood sugar levels are likely to be higher on race morning because of the adrenaline and the stress. You're in that fight-or-flight response where the body naturally releases glucose into the bloodstream so you can run away from a lion. If you give yourself more insulin to adjust for that, or change your oral meds, you're likely to go hypo in the race. So really it's about practice, understanding your own body, and working with a team to build your plan, so you can have confidence on race day that you're not going to go hypo, or that your blood sugar levels aren't going to go so high because you sucked back sixty gels in an hour or something like that.

Andrew: Sixty gels in an hour, wow. Last question for the main set before we move on to the cooldown. If a diabetic triathlete manages everything correctly, they've done the learning and the training, they keep their levels up and their numbers up during race day, is there any reason to be concerned about how they could perform versus an athlete who doesn't struggle with diabetes? What's the ceiling for performance for a diabetic triathlete? No ceiling? The same?

Taryn: Same. No ceiling.

Tony: I don't think so. It's all your training, right? If you put the time in and you get fast, it's not gonna hold you back. Does it make it a little bit more difficult to manage, yeah, especially mid-workout or mid-race, but it doesn't mean you're not going to have a record performance. You can go out there and rub elbows with everybody and just keep up.

Taryn: Just make sure you tell people that you are diabetic if you're going to race. I think that's really important. Carry medical information on you, or wear a medical ID, whatever you need to do to make sure the race people are aware that you've got diabetes. If you're collapsed on the side of the road, they might think it's overheating or hyponatremia or something, and they really need to check your blood sugar levels before they do something to treat you. If it's a hyper, so your blood sugar levels are high, giving you a fast-acting sugar is the opposite of what they need to do, whereas if you're hypo, that's perfect. So make sure you've got that medical information in your race, and that your crew knows how to spot a hypo and how to fix it. Maybe even check the race rules to see if you can carry some sort of phone with you to call somebody in an emergency or check your blood sugar levels. Technology's evolving so rapidly in this space, it's soon going to be on our Garmins. I think we're going to have a screen for blood sugar levels right there in front of our face all the time.

Tony: One other thing to consider: insulin is on the banned substance list, so you need to report that. You'll get an exemption, it's not hard to get, but you need to get that exemption before you go to a race and they find out. Another thing is they make Road IDs that go on your Garmin now, so you can put "type one diabetes" or "type two diabetes" on your Garmin. If you're a type one diabetic, you should have a bracelet you wear all the time that says you're type one. You're more likely to go hypo than a type two diabetic. Usually most type twos, if they stop working out, their blood sugar rises, but type one won't do that, so without carbs you have to have something to raise your blood sugar. Everybody needs to know, and make sure it's in your race registration when you sign up. There's a medical section there, so put your type one or type two diabetes. I know some people don't, like, "I don't want to be labeled." It's not about labeling, it's about safety if something bad happens on the race course.

Andrew: Moving on to our cooldown, where we'll ask our coaches one question from the audience. Taryn, no lie, nutrition is probably the most asked-about topic from our athletes, so while you're here I was like, let me throw a fun nutrition question Taryn's way. This one comes from Katherine from Alabama. Tony, you're welcome to jump in as well. Katherine says: "I've heard on the podcast plenty about the benefits of fueling properly for our workouts, both for energy during the workout and to practice taking fuel during effort. But I do wonder, on the shorter, easier workouts, do I really need fuel? Do I need to take in nutrition on every workout, or just the medium-to-longer stuff?" Taryn, what do you think?

Taryn: Great question, Katherine. The short answer is no, you don't need to fuel every session, but you need to ask yourself probably five questions. How long is the session? How hard is it? When was the last time you ate? What is the goal of your session: are you trying to perform and get ready for a race, or are you just going out for recovery? And are you in race-prep mode or in the off season? If you can answer those questions, it helps us decide whether you fuel that session or not. As a rough guide, anything under an hour that's super chill, easy, aerobic, where you're not getting very huffy-puffy, then water is probably okay. If it's under an hour but really hard, like intervals or FTP testing, then you're probably better off having some fuel available, because you're going to train harder when you have fuel on board than if you don't. So you might need to top up beforehand or during or both. And another general guideline: if it's greater than about 90 minutes, whether it's hard or easy, you're at the tipping point of probably needing to have some fuel. How much you have is really individual and depends on the answers to those five questions. So sorry, there's no clear magic ball, Katherine, it depends, but that's some general guidelines to get you started. For a type one, the answer flips. I don't know if you want to answer that, Tony.

Tony: This doesn't specifically call out diabetes, but if you are a diabetic, and it doesn't matter if you're a type one or a type two, you need to know your blood glucose level before you work out, especially if you're going to work out fasted. Like we've been saying, if you start low and then go out even for a twenty-minute hard run, "I'm just gonna do a 5K or whatever," you could tank right down and maybe not make it to the mile marker, who knows. You've gotta know what that blood glucose level is before you start working out. That's the only other thing I would add. The purpose of the workout does matter a lot, and all the things Taryn said are great, but if you're a diabetic, you need to know what that number is when you start.