WHISTLER, British Columbia -- Nearly halfway through Saturday's 30-kilometer race at the 2010 Winter Olympics here, Kris Freeman was trailing the front-runner by only six seconds and dreaming of making history. Not since 1976 had an American won a medal in cross-country skiing.
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U.S. Olympic skier Kris Freeman manages his insulin while competing.
Suddenly, though, his energy faltered, and he collapsed. Lying in the snow, having hit a wall that doesn't exist for his competitors, Mr. Freeman cried out for a very particular kind of help. "Sugar," he said.
As a 29-year-old athlete with diabetes, Mr. Freeman may seem unusual. Inactivity and a poor diet, after all, are the well-publicized twin culprits behind an epidemic of diabetes in America.
But Mr. Freeman actually suffers from Type 1, or "juvenile," diabetes, a disease typically triggered early in life by an auto-immune disorder rather than by lifestyle. Even as rates of Type 2, or "adult onset," diabetes skyrocket in the U.S. because of obesity and physical sluggishness, a culture of extreme exercise is taking hold among Type 1 diabetics, replete with specialized coaches and training camps.
"The crazy perception out there is that if you have diabetes, you must have weighed 300 pounds," says Michelle Adams, a Chicago-area exercise physiologist, Type 1 diabetic and coach for an organization called Diabetes Training Camp, which supports and promotes athletics among people with diabetes. "In fact, there are thousands of Type 1 diabetics who were always active and who are now competing in half-marathons and marathons, all the way up to Ironman-distance triathlons."
Type 1 diabetics produce little or no insulin, a hormone that regulates blood sugar, requiring them to inject themselves with the substance while constantly gauging the appropriate amount. They have been rushing into endurance exercise because it can dramatically help manage their disease. But winning events—in fact, sometimes even crossing the finish line—can be difficult for competitors struggling to control their blood sugar.
For diabetic athletes, Mr. Freeman is a hero, all the more so for what happened after his blood sugar crashed on Saturday. Never mind that this setback shattered his dreams of winning an Olympic medal that day. After downing a sports drink and sugar-rich "goo pack"—rushed to him by a German coach who happened to be nearby—Mr. Freeman clambered to his skis and completed the race, finishing in 45th place. "I wasn't going to have a 'Did Not Finish' beside my name in the Olympics," Mr. Freeman said in an interview on Sunday.
Yet finishing wasn't only a matter of pride. As a Type 1 diabetic competing in an Olympics endurance event, Mr. Freeman is a pioneer—which is to say that little guidance exists on how to control a diabetic's blood sugar during such races.
In fact, when Mr. Freeman was diagnosed with diabetes nearly a decade ago, his doctors told him he almost certainly would need to stop competing. But he refused, and since then medical science has moved his way. Doctors increasingly are advising diabetics of every kind to exercise, the more the better, provided the athlete keeps a sharp eye on blood sugar and consults regularly with his or her physician.
Ms. Adams says she has heard professional endurance coaches describe diabetics as better attuned to their bodies than other athletes. "Being an athlete with Type 1 diabetes requires a level of discipline that can actually give you an edge over nondiabetics," she says.
Matthew Corcoran, a founder of Diabetes Training Camp, said in an email that athletes such as Mr. Freeman have proven that diabetics can compete at the highest level—and are now shedding light on exactly how to do so, and on how much exercise might be advisable for less-gifted diabetics.
Mr. Freeman is not the first U.S. Olympian with diabetes. The gold medalist Gary Hall Jr. is a Type 1 diabetic. He swims sprint distances that often last less than a minute. A cross-country skiing race, by contrast, can last hours, and Mr. Freeman must decide beforehand what level of insulin to supply himself at every kilometer. The appropriate amount can vary according to factors as knowable as altitude and as unknowable as the pace set by the front-running pack of skiers.
On Saturday, Mr. Freeman had anticipated a faster pace. Stopping mid-race to reprogram his insulin-delivery system is out of the question, as it would take too much time. "I'm not out here to cross the finish line," Mr. Freeman said on Sunday. "I'm out here to win a medal."
One purpose of finishing Saturday was to gather information. Had he, as he suspected, set his insulin-dosage at too high a level before the race? To test that theory, he consumed large amounts of sugar throughout the second half of the race and yet found upon finishing that his blood-sugar level was normal—an indication of excess insulin.
With this information, Mr. Freeman will dial down the amount of insulin he delivers to himself during his final event, next Sunday's 50-kilometer race. At that distance, Mr. Freeman once finished 12th in an international race, leading him to view a podium finish as possible on Sunday.
A three-time Olympian, Mr. Freeman is described by the U.S. ski team as its best distance cross-country performer since Bill Koch, whose second-place finish at the 1976 Games earned America its only medal in the sport, which is dominated by Europeans.
A New Hampshire native, Mr. Freeman joined the U.S. cross-country team in 2000, leaving the University of Vermont after his freshman year.
Cross-country skiers—widely regarded as the world's fittest athletes—often peak in their 30s, so Mr. Freeman doesn't regard Vancouver as the end of his Olympic road. Whenever he does finish, however, he intends to analyze and publicize the diabetic lessons of his career. On behalf of pharmaceutical giant Eli Lilly & Co., maker of the insulin he uses, he already promotes the value of exercise for diabetics. Mr. Freeman says that about half his sponsorship income is related to diabetes products.
Any insight he could offer into how to control blood sugar during long bouts of exercise would be invaluable, says Ms. Adams, the diabetes exercise coach.
Too much insulin during exercise will rob the blood of sugar, causing collapses of the sort Mr. Freeman experienced Saturday. Too little insulin will leave the blood flooded with sugar, causing incapacitating muscle cramps and dehydration. "The idea is to mimic the blood-sugar levels of the nondiabetic person," she says. "It isn't easy, but we're learning that it's doable."
Write to Kevin Helliker at kevin.helliker@wsj.com.
adult onset diabetes, whistler british columbia, auto immune disorder, 2010 winter olympics, olympic skier, exercise physiologist, half marathons, endurance exercise, kris freeman, image getty, mr freeman, cross country skiing, extreme exercise, lying in the snow, michelle adams, winter olympics, juvenile diabetes, kilometer race, poor diet, sluggishness
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