Master's Capstone Project

By Logan Reardon

Fiona Wylde was laser-focused for her first professional race as a standup paddleboarder. She just signed her first professional contract, and the 17-year-old was as confident as ever. Wylde looked around at the world’s best paddlers. Years of paddling the 1,243-mile Columbia River that separates northwestern Oregon from Washington were about to pay off.

Wylde dominated that race, but her body gave up right before the finish line. Losing her footing and stumbling over, she fell to a sixth-place finish.

“I just absolutely bombed.”

That day was the beginning of a troubling trend. Her body continued to fail her, and it left her puzzled. 

“I lost 10 pounds of muscle with no explanation.”

“I [was] constantly drinking water and going to the bathroom.”

“I just [felt] super weak.” 

Where were these symptoms coming from? The last four years of training prepared her for this moment. Her body was supposed to thrive, but instead, it crumbled. She couldn’t maintain her speed and grew weaker with every workout. 

After finishing her final day of high school, she visited the doctor.

She had Type 1 diabetes.

Rather than dwell, Wylde hopped on a plane to Europe to paddle in her next competition. She just had a disease to carry on with her.

*** 

What does the perfect life entail? 

Usually, the answer is a “good career” or “lots of money.” Something that’s mentioned far less? A clean bill of health. It’s a quality that’s often overlooked in life. 

But when an athlete is diagnosed with a potentially career-threatening autoimmune disease, health is no longer taken for granted. 

“I'm a professional athlete and I rely on my body to work,” said Wylde, the 2016 Standup Paddleboard (SUP) Race World Champion.“When you're told that part of your body is broken, that doesn't sit well.”

“I remember seeing my dad cry,” said Mark Andrews, the Baltimore Ravens tight end who was diagnosed at 9. “I knew that something in my life was going to change forever."

“When the first doctor that I saw told me that I may never race again – I was very worried,” said Ryan Reed, a 26-year-old NASCAR driver who was diagnosed at 17.“(The doctor said), ‘Look, you’re never going to race again. You have to focus on living.’”

A Type 1 diagnosis isn’t a death sentence, but it certainly makes life more difficult. With Type 1, the pancreas can’t produce insulin – the hormone that helps sugar enter the body’s cells to be used for energy. Without insulin, blood sugar levels spike to obscene numbers, eventually leading to a diabetic coma. There is no known cause or cure for Type 1.

Daily insulin injections. Constant finger pricks. Frequent high or low blood sugars. That’s life for the 1.6 million Type 1 diabetics in America. Being a professional athlete becomes a secondary issue when your life is on the line.

Meeting the athletes

Ryan Reed strapped in for his first NASCAR debut in Richmond, Va., ready to fulfill a lifelong dream. Multiple former champions were lined up next to him as he rolled on to the track. 

His body began to bake in desert-like heat inside the car. The roaring engine blared relentlessly, leaving his ears ringing for hours afterward. Throughout the night, there were instructions from his team over the radio.

Check your mirror. Check your surroundings. And check your blood sugar.

Reed began racing at 4 years old in California, and moved to North Carolina to pursue it professionally when he was 17.

But shortly after his high school graduation and subsequent move across the country, Reed felt ill. Not the kind of ill where you lay in bed, eat soup and are fine after a few days. He lost weight. He couldn’t quench his constant thirst. With the thirst, frequent bathroom trips followed. On a 36-hour, cross-country drive home from North Carolina to California, Reed said he stopped almost every hour to urinate and “couldn’t stop drinking.” 

Reed’s parents noticed the symptoms when he got home, and a trip to the doctor confirmed he had Type 1 diabetes.

That first doctor’s visit nearly shattered his racing dreams when he was told to focus on life, not racing. The doctor didn’t realize that not racing wasn’t an option for Reed. His grandfather was a racer. His dad was a racer. He moved across the country to pursue racing – and he wasn’t going to go down that easy.

“I had nowhere to turn,” Reed said. “I didn’t know anything about it and I’d never even really known of any athletes or anybody that was living with the disease. So, I just kind of took the doctor’s word for it and ‘Man, I guess I’m done racing.’ I say it kind of nonchalant, but it was devastating to me and my family.”

Reed and his family set up a meeting with Los Angeles endocrinologist Dr. Anne Peters, who had worked with several high-profile athletes. She and the Reeds worked out a plan for Ryan to continue racing.

Two years later in 2013, Reed and Lilly Diabetes teamed for the beginning of a six-year partnership. Reed joined Roush-Fenway Racing for six races in the NASCAR Xfinity Series in 2013, then ran full-time (33 races) starting in 2014. Lilly Diabetes sponsored him in all 171 races from 2013 through 2018 – including his two wins at the famed Daytona International Speedway.

“My biggest thing that I like to tell people is just ‘Don’t let diabetes take away from your dreams,’” Reed said. “Don’t let diabetes emotionally defeat you, it’s amazing the technology we have nowadays to help manage your diabetes. If you want to, go out and chase your dreams, and don’t let diabetes stop you from doing that.”

***

Stand up paddleboard (SUP) is a sport that tests all muscles in the body.

It’s not just your average ride through a calm, blue ocean – it’s constant water splashing and winds whipping. It requires massive arm strength and incredible balance to navigate the water. The mind works overtime during a SUP event, as a paddler must keep an eye on the water, the board and the competition.

Fiona Wylde, a 23-year-old native of Hood River, Oreg., signed her first professional SUP contract in high school.

After the disappointment in her first race, Wylde began to worry.

“It took me forever to recover,” Wylde recalled. “I started losing weight, and I thought it was just a lack of preparation, or that I hadn't been competing as intensely or training as hard. I wasn't getting any faster, and I didn't feel like I was recovering fast enough. 

“It was an uphill struggle. I did a couple more races and I was getting slower, which, mentally, was really frustrating.”

After unsuccessful attempts to cure her symptoms, the doctor finally checked her blood sugar. 

“(The doctor) pulled out a meter and pricked my finger and the reading was 586 (mg/dL),” Wylde said. “I was like 'Great! What's that out of, 1,000?' It was pretty much right then and there that (we knew) I had Type 1 diabetes."

Non-diabetics have a blood sugar in the range of 80 to 120 mg/dL. At 586, it was impressive that Wylde was still coherent.

“In that specific moment, (I was worried about my career),” Wylde admitted. “I was completely overwhelmed with everything. Just thinking ‘What does this mean? What does it mean for my life?’”

After the initial shock passed, Wylde and her parents went to work. They took the entire next day and searched for athletes with Type 1. 

“We saw that people were out there pushing the limits of sports regardless of the fact that they had Type 1 diabetes,” Wylde said. “That was a sigh of relief, for the fact that not only did I see that I could keep going, but also that my parents saw that this is something that can be manageable.”

Wylde won the 2016 SUP Race World Championship, meaning she was the best at long and short-distance races. Against the world’s elite, Wylde proved that diabetes didn’t hinder her.

“I want people to be able to see that there are shitty days, but you just have to accept that that's part of it,” Wylde said. “That's the way I've chosen to look at it.” 

*** 

Baltimore Ravens tight end Mark Andrews grew up playing football, but not the football he plays as an adult. 

Under the scorching Arizona sun, Andrews and his three older siblings played soccer in their backyard every second they could. 

When Mark was 9, he started going inside a lot more. Not because he didn’t want to play, but because he always needed water and the bathroom.

“I was lucky enough to have a dad who was a doctor and (he) saw the signs at a very early stage of it,” Andrews said at the 2020 “Children with Diabetes” conference. “That's when we went to see the doctor and I was diagnosed.”

Being diagnosed at a young age shaped Andrews’ life. Before lunch in the cafeteria, he had to check his blood sugar and inject insulin. The same was true before eating cake at a birthday party or going out to dinner with his family.

“Initially, I was a little bit hesitant to share with people (about diabetes),” Andrews said. “I was a little bit shy about it. I would test (my blood sugar) in the corner of the classroom or off to the side of the field so that people wouldn't see me. 

“It wasn't until my teammates and classmates started to come over and ask me what my (blood sugar) was (that I became comfortable). They wanted to test theirs, and I became more open about it. It allowed me to grow and be more open and share.”

Being forced to mature before everyone else his age was a blessing – and by high school, he knew he could achieve anything he set out to do.

“I feel like it's made me a more all-around person,” Andrews said. “It allowed me to mature at an early age. I had to learn what to put in my body and what not to put in my body, and what things worked better for me. At that age, other kids don't have to do that.

“Having diabetes is something extra, but if you do the things you need to do, you're just fine. I knew that and I worked hard. … I really do think it helps you grow as a person.”

Game day

Mark Andrews wakes up at the same time every Sunday morning. He checks his blood sugar, making sure it’s between his target range of 100 to 120 mg/dL and adjusting if it’s not. He has the same meal – eggs and a peanut butter and jelly sandwich with extra peanut butter. 

“I know how (peanut butter’s) going to make my body react,” Andrews said. “It allows me to sustain for hours at a time while going through all these different emotions. So many different things are being thrown at you with your emotions (before an NFL game) that can really fluctuate your blood sugar.”

Coaches update strategy at the last second. Teammates blast music through the locker room. Emotions run wild, so it’s important to maintain his routine and keep his blood sugar steady.

To devise a race day plan, Ryan Reed turned to the source who told him he could still race – Dr. Anne Peters.

“Dr. Peters was amazing at helping me with (my pre-race plan),” Reed said. “My pre-race meal actually had more carbs than normal.

“I do go in (with a higher blood sugar) than normal, not because I’m worried about a low, but because of the natural effects that adrenaline has on my body during the race.” 

Reed has learned to manage after a rocky start. In his first race after being diagnosed, he started the race at 115 mg/dL and finished fifth to last – the lower blood sugar severely affected his ability. It’s a balancing act that’s constantly changing.

Fiona Wylde also prefers her blood sugar to be higher before beginning competition.

"Whether it's training or racing, I like to start around 150 or 160 (mg/dL),” Wylde said. “That gives me a little bit of leeway. ... But also, if my blood sugar goes down, I have some time to catch it. I'm not a big fan of starting straight up at 100 to 120 (the recommended range), just because if I do go down a little bit my performance is going to change quite quickly.”

Before athletic competition, that so-called “perfect” blood sugar range varies.

“As always, everything comes with a ‘depending’ caution,” said Katherine Wentzell, a pediatric nurse practitioner at the Joslin Diabetes Center in Boston. “But generally, 150 (mg/dL) is a good place to start. The goal is to have a bit of a cushion (before falling too low), but you need to balance that.”

Physical activity usually lowers blood sugar. But there are instances where stress and adrenaline hormones can cause an upward spike in blood sugar, so it’s important to know your body.

Whether it’s blocking 300-pound monsters, racing at 200 mph or carving through ocean waves, each of these athletes only competes at high-level intensity. With a consistent level of intensity, the athletes really just focus on workout’s duration.

“High-intensity workouts come in two types – short duration and long duration,” Wentzell said. “Think of it like a sprinter versus a long-distance runner. For short duration, simpler carbs are fine. But for anything longer than a quick sprint, I would recommend a mix of carbs, fat and protein to help sustain blood sugar during the activity.”

The pre-competition meal is crucial to success. Wentzell and her colleague Sanjeev Mehta, a staff physician at Joslin Diabetes Center, recommend the meal be consumed between 15 and 30 minutes before competition.

During competition, diabetic athletes have found a common ally – continuous glucose monitors (CGMs).

Instead of pricking a finger, putting the blood on a strip and seeing your blood sugar on a meter, the CGMs use an app that automatically tells you your blood sugar every five minutes. All it takes is a patch on a fatty part of your body and a smart phone.

Andrews, Reed and Wylde all use CGMs.

When Andrews comes off the field, Ron Medlin – the Ravens’ head certified athletic trainer – tells the tight end his blood sugar and they adjust accordingly. Andrews’ blood sugar readings are shared through the CGM app that Medlin – and Andrews’ family members – downloaded, so everyone can stay connected. 

“(The CGM) has been such a huge life-changer for us,” Andrews said. “It was a huge relief on my family and myself, just knowing that they would be able to know my numbers all the time."

Unlike other sports, NASCAR doesn’t have any timeouts. There’s no moment where the driver can get out and take a break to talk to coaches. On the track, Reed has full responsibility of his diabetes. To see his numbers, Reed mounts a reader device – which does the same thing as the smart phone app – on his dashboard.

“I have a formulated (sugary) drink – something Dr. Peters put together – in my car in case I hit a low (blood sugar),” Reed explained. “I have water in my car to stay hydrated. Additionally, we have an extra man over the wall and a target on my fire suit.” 

Reed has a designated crew member trained to inject him with insulin during a pit stop if his blood sugar goes dangerously high. He has a visible bullseye target on his uniform to show where he needs the injection, but he still hasn’t needed assistance in any race to this point.

“CGMs have really helped athletes,” said Mehta, who is also an assistant professor of pediatrics at Harvard Medical School. “But that doesn’t mean you shouldn’t respect how you feel. Symptoms of highs and lows are still very helpful in guiding treatment.”

Wylde doesn’t have a dashboard or coach to help her check her numbers. Instead, she uses her Apple Watch – which has a widget to display blood sugars from the CGM app.

Using both hands to paddle on the water, there’s no room to carry drinks to raise blood sugar. Instead, Wylde stuffs her backpack with supplies.

“Any time I'm in the water I always take Clif Bar Shot Bloks with me,” Wylde explained. “They're just little squares and they're super easy for me to know exactly how many squares I need to eat to raise my blood sugar a certain amount.”

Wylde competes in all sorts of races, which makes timing key. If she’s competing in a 200-meter race, it only takes one minute. But if she’s competing in a 20-kilometer race, it takes up to two hours. Either way, CGMs have certainly made things easier for diabetic athletes.

Being a role model 

“Right after (I was told I could race), I knew I wanted to (form the organization),” Reed said. “I know other kids are being told that they won’t be able to do things and only some are lucky enough to find doctors that are as supportive as mine and able to still chase their dreams.”

“When I got to high school, that's when I made a goal for myself to be able to help kids and families that were going through the same things that I had gone through,” Andrews said. “That's where my passion is, for helping people and kids with diabetes.”

“To have the chance to speak to a lot of different people that have Type 1 and to be in the same room is really motivating for myself on a personal level,” Wylde said.

Reed, Andrews and Wylde are all dedicated to helping future generations of diabetic athletes.

Shortly after his diagnosis, Reed recognized his opportunity. At just 17 years old, he founded Ryan’s Mission, a nonprofit organization dedicated to “help build awareness and touch the lives of so many that have been affected.”

“I had a huge reality check when I was diagnosed,” Reed said. “To be able to inspire somebody while I do what I love? To do that is a huge blessing.”

Ryan’s Mission and the American Diabetes Association collaborated on the Drive to Stop Diabetes campaign. It included sponsorship for Reed’s car, awareness and educational efforts at NASCAR races and off-track wellness initiatives. 

Andrews and Wylde have also made themselves visible voices for young diabetics. They both constantly post on social media about daily ups and downs, and have partnered with diabetic organizations for speaking events. 

“I get to learn so much from other people,” Wylde said. “I’m in an interesting situation because I really haven’t had diabetes for that long. … Every time I go to an event I am constantly learning from other people.” 

Setting the stage

The common theme is clear: there’s no “perfect” way to manage diabetes.

All diabetics respond to things differently, and so much of what happens is out of anyone’s control.

While every diabetic has a different journey – diagnosis age, body tendencies, treatment methods – those differences mean they are all the same. The one constant in every diabetic’s life is that there is no constant.

In the past 20 years alone, things have changed drastically for diabetic athletes. CGMs were invented in 1999, but didn’t become popularized until the mid-2000s. Insulin pumps were invented in 1974, but they were the size of a microwave oven. The modern, phone-sized pumps didn’t arrive until the 1990s.

Now, it’s not a question of if a diabetic can compete.

“There are no limits to be able to excel as an athlete,” Wentzell said. “There are pro athletes in almost every sport with Type 1. It requires a lot of work and dedication, but it is possible. Think about the technology that will be able to support athletes in 10 to 20 years. … Type 1 diabetes should never hold someone back from their dreams of being an athlete.”

In 20 years, an 18-year-old won’t fear for her SUP career because she has diabetes. A 17-year-old won’t be told he can’t become a racecar driver because he has diabetes. A 9-year-old won’t be as scared to share with his friends that he has diabetes.  

Diabetic athletes today are paving the way for tomorrow’s stars to shine, and not wonder if a disease will stop them.