Managing Diabetes at the World’s Longest One-day Pro Cycling Race

02 April 2019

See how Team Novo Nordisk rider Charles Planet managed his type 1 diabetes over 6 hours and 250 kilometers in the breakaway at Milan-San Remo, the longest one-day professional cycling race in the world.

Charles Planet:

It’s a really long race. In total, 7 hours and 40 minutes. My only goal this year was to be in the breakaway. Your sugar can go like this,
like a wave, you know. The main challenges really are keeping glucose in the goal range.

In the race, it’s always different than at home. Your body experiences a lot of different kinds of feelings. You have stress, panic. You have happy moments and sad moments.

Day Before the Race

The evening before, you need to load a lot of carbohydrates – because carbohydrates mean power.

At home you don’t eat much carbohydrates – because your goal is to lose weight and to not use a lot of insulin.

And carbohydrates need more insulin. But before the race, of course, you need to have a lot of fuel in your body – and then just go to bed and digest and sleep.

Race Day

I wake up and I check my sugar, my phone. I just take it easy – put my clothes on and go to breakfast with my teammates.

And just have breakfast, easy, with a nice coffee and enjoy it. I had a plate of rice and an omelette.

But you really need to focus on the amount of insulin you have in the morning.

Charlotte Hayes:

The idea is to get the insulin dialed in as well as possible before the race – to minimize lows and to try to minimize highs.

Charles Planet:

And then after breakfast, it’s time to be focused, little by little – when you get close to the start of the race.

You just go to your room, get ready, prepare your clothes, everything – and then we leave pretty early.

And then your sugar must be okay before the race.

You have to eat something before the race to make sure everything is okay. But actually, personally, when I have some stress – my sugar always goes high at the beginning of the race – so I don’t have to eat anything.

The most terrifying minutes… you are checking that everything is all right. You know how important it is, so you really watch the sugar level.

There is a lot of nervousness, as many of the guys want to go in the breakaway. So it’s really hard. There are always many crashes.

Usually my sugar goes high at this…when I feel pressure. So the first two hours, I couldn’t eat – because my sugar was really…
was not so good at this point. And yeah, I just had to take some insulin – and then my sugar went a bit down, and it was all okay again.

Making the Breakaway

I knew at this moment, if I can pass the first guy – and go full gas after this roundabout, I can win the breakaway.

You make the first gap by a few meters. But you just need to keep full gas for a few kilometers – to make sure it’s the right breakaway.

Blood Glucose Management

Federico Fontana:

All riders are fortunate to be on continuous glucose monitors. Thanks to this technology, the rider is
able to keep monitoring his glucose level.

Charles Planet:

It’s just in my pocket all the time, so every five minutes, you have new data.

Charlotte Hayes:

And they can also see if it’s rising or falling – and the rate of change of their glucose. It also helps them to know what to do.

Federico Fontana:

They carry an insulin pen. So if they are spiking up a lot, they usually prefer to wait.

Because exercise is going to reduce the glucose – but sometimes this doesn’t happen. So they might decide to inject, but this is a very rare event.

Charlotte Hayes:

For all of our riders – being skilled with that insulin management is critical.

Fueling Strategy

Charles Planet:

Then when you know your sugar is back in the target range – it’s just about eating constantly every half an hour.Our athletes may have to fuel a little bit more frequently.

Charlotte Hayes:

They may have to delay fueling a little bit – based on what they’re seeing on their CGM data.

Charles Planet:

Even if you feel good, even if you think you eat enough – sometimes you can have a really bad day and the race is over.

Staying Hydrated

Drinking is super important. Sometimes it’s raining – and you don’t feel like you need to drink. But that’s the biggest mistake you can make.

“It’s raining. I don’t need to drink.” But your body is losing water.

Charlotte Hayes:

Keeping glucose in range can be somewhat affected – if someone’s dehydrated.

Every 15 minutes at least, you need to drink.

Consuming anywhere from two to four bottles an hour might be necessary.

Charles Planet:

Personally, I like to drink a lot of water – and eat something instead of drinking something – when I need to get some sugar in my body.

Charles was in the breakaway for 6 hours and 250km

When you get caught, you have nothing much in your legs.

So you just try to find the gruppetto. You know you did your job for the day – so you just enjoy the last “easy” kilometers.

Recovery

After a normal race, my sugar usually goes high again.

Because there’s so much stress. It’s the final of the race.

So there’s a lot of stress in the peloton, a lot of panic – a lot of fight, a lot of action in the peloton.

I need insulin after this stage. Otherwise I go really high.

Charlotte Hayes:

After exercise, everyone has a really heightened sensitivity to insulin.

Being aware and kind of learning about how your body responds – in that post-exercise recovery period can help you learn – how much to back down on your usual dose of insulin.

…exceptions ARE allowed.