I was so excited to be with Ryan Reed at the Texas Motor Speedway, where he was getting ready to race in the XFinity NASCAR series in Fort Worth, Texas. He was kind enough to talk with me about the process of testing his blood sugar, what he eats before a race, how he monitors his blood sugar and what his protocol is.

For National Diabetes Awareness month, please consider donating to Ryan Reed’s DriveToStopDiabetes.

Ryan Reed preparing to race!

From Ryan’s website:

Reed began his first full NASCAR Xfinity Season at the start of 2014.  He finished 9^th in overall standings, with 1 top 5 finish and 14 top 15 finishes.  His season best took place at Daytona International Speedway, where he finished 4^th.  He will start his 2^nd Season in the NASCAR XFinity Series with the No 16 team in 2015

Reed’s racing career began at a young age, capturing the Kid’s Kart Track Championship at the age of four.  The Bakersfield, California native followed that up by becoming the Junior 1 Comer and HPV Karting Track Champion at age eight.

Read the rest of his bio at DriveToStopDiabetes

Alissa:   Can you tell me a little bit about your schedule, diet and what you typically eat before a race?

Ryan:     Like many athletes, you need to develop an eating plan – which is really about consistency and making things simple enough so that it becomes routine. I usually have a turkey sandwich with mustard on whole wheat bread as a pre-race meal. I might change it up here and there, but not too much. It makes my blood sugar more consistent.

Alissa:   Racing can cause a lot of anxiety. Does this stress impact your blood sugar?

Ryan:     Yes, from time to time.

Alissa:   What is your routine checking your blood sugar and how do you self manage?

Ryan:     I check my blood sugar frequently. Even though I’m on Dexcom, I always like to start right around 100. The lowest I want to be is 90. The highest I'd want to be is about 120. I usually end a race right around 200. That seems to be a comfortable zone for me where I feel good the entire race.  (Ryan’s blood sugar pre-race was 107 and post-race 154).

Alissa:   How are you able to monitor and control your blood sugar during a race?

Ryan:     I have Dexcom in the car so I can watch my blood sugar throughout the entire race.  I keep a drink that is high in carbohydrate and sugar nearby in order to prevent or treat low blood sugar. It is important to replenish carbohydrates throughout the race.

Dexcom and high carbohydrate drink in Ryan’s No 16 Ford Mustang

Alissa:   Do you change your insulin to carbohydrate ratio or your 24 hour basal?

Ryan:     I am on long-acting insulin.  Knowing that adrenalin and stress on a race day can be hard, I reduce my insulin across the board. The worst case scenario is having low blood sugar inside the race car. Reducing the insulin is a safeguard that errs on the on the side of caution. Reality is that the race burns so many calories; a person doesn’t need as much insulin.

Alissa:   While you're racing, because it's so hot in the car, what do your blood sugars tend to run? What do they usually run after the race?

Ryan:     Dehydration during a race can result in the loss of up to five pounds due to perfuse sweating. Couple that with adrenaline, my blood sugar does gradually climb.  Since it is cool today, I'll probably end around 160-170. However, it can reach between as high as 200-210 on a hot day.  It really depends on the weather. After the race, my blood sugar drops pretty quickly.

Alissa: How does Dexcom work to your advantage when you're racing? How do you treat your blood sugar using Dexcom as recourse?

Ryan:     Dexcom tracks your blood sugar is at all times, including inside and outside of the race car. It IS the device that allowed me to get back on the track with NASCAR! This is my safety net for informing my crew of my blood sugar levels. I have a target on my fire suit that permits my crew to administer insulin, if I am too high. I also have a drink blend in my car in case it is too low. I try to monitor it the best I can during the race, but I may not check for 40 or 50 laps.

Alissa:   When you started racing again, were you on Dexcom from the start?

Ryan:     Yes, I was on Dexcom the first time I sat back in a race car.

Alissa:   How would it impact you if you were not on Dexcom while racing?

Ryan:     I wouldn’t be allowed to race professionally at my current level.

Alissa:   We're both athletes, and I try to really advocate showing fitness, diabetes and living a healthy lifestyle as a positive, not a negative. What advice would you give to a non-athlete with diabetes?

Ryan:   For me, the biggest thing was being able to find a doctor who works closely with me on managing my diabetes, both inside and outside the race car. You're the one who has to manage your diabetes. You have to take responsibility for it, but your doctor still plays a huge role by managing diabetes around the rigorous schedule of training and how an athlete eats. It can be frustrating. There can be times where you feel like it's defeating almost, but if you keep pushing through and persevere, it's definitely worth it.

Alissa :  This is National Diabetes Awareness Month and you're doing some fabulous things with Lilly Diabetes and the American Diabetes Association on the No 16 Ford Mustang. Do you want to share a little bit about what your charitable organization Drive to Stop Diabetes has done for National Diabetes Awareness Month?

Ryan:     One of the cool things is we have a special paint scheme here in Texas. You'll see a bunch of stars all over our car. The stars represent the entire population of Texas. You'll see red stars mixed in amongst those, and those are the fourteen percent of Texans living with diabetes. We also have a My Diabetes Pit Crew Sweepstakes going on this weekend. People, who sign up and get selected as the Pit Crew Champions, are going to have their names featured on my pit crew's fire suits. Just a really cool way to give back to people in the diabetes community that are living with this disease day in and day out, just gives them a way to be a part of the race team. We hope that they enjoy it.

Alissa:   Thank you so much for this opportunity - I'm excited to be here, especially during National Diabetes Awareness Month. I'm looking forward to seeing you race and do great.

Ryan:     Awesome.

Alissa:   Thanks so much.

Congratulations to Ryan for finishing the race in 15^th place.Ryan is currently 10th in the NASCAR XFINITY series championship standings after one win and 17 top-15 finishes.  His next race is at Phoenix International Raceway(PIR)

I interviewed Dr Ponder on his book "Sugar Surfing" . I asked him about the 6 key concepts and 3 virtues associated with sugar surfing, shots vs pumps, CGM, Texas Lion's Camp and much more!

I hope you all had a great summer – I had a busy summer , but I’m looking forward to posting more blogs and interviews with leading figures in diabetes and athletics – stay tuned because I’ve got some good ones coming up!

I recently was interviewed by Daniel Hargenrader, aka the DiabetesDominator.  Here’s the interview. 

Matt Allen with his family

Matt Allen is a 15 year old stock car racer, snowboarder, football player, straight A student and diabetic. He was diagnosed with type 1 diabetes in July 2006, but he hasn’t let that slow him down.

Alissa:           Tell me about your early years, before you were diagnosed with diabetes at the age of six?

Matt:             I was snowboarding at age five and right before I was diagnosed I started racing. I was actually diagnosed while on vacation with my family. The doctors told me that having diabetes would not stop me from doing anything I wanted to do. I totally believed them!

Alissa:           What kind of sports do you enjoy? How did you decide which ones to pursue?

Matt:              I snowboard, competing at a National level, as well as race stock cars and play football for my high school. My dad tried to introduce me to skiing when I was young, but it was not exciting enough for me. So, we learned to snowboard together instead. Now my whole family snowboards, often going on vacation together. As for football, all my friends started to play and I wanted to be a part of a team sport.

Alissa:           I admire you for being able to involve yourself and your family in snowboarding. Once you were diagnosed, how did you feel about continuing in sports?

Matt:              I was so young that I didn’t grasp that it could change anything about me. I never really thought about changing my lifestyle. My parents also helped me deal with my diabetes.

Alissa:           How did you manage your diabetes at the same time handling sports and school?

Matt:              I had a lot of help in the early years from the nurses at school. As I've grown older, I manage it myself. While participating in sports I’m very diligent, checking my blood sugar, making sure I'm in range - not too low, not too high.  My CGM monitor actually makes it a lot easier.

Alissa:           I also noticed that you're a straight A student and you have a very high GPA. How are you able to pursue you academic studies and such an advanced level in addition to managing your sports and school with your diabetes?

Matt:              My dad has always assured that school was a priority. I wasn’t allowed to do anything unless I did well academically.

Alissa:           Is it hard to manage school and sports all at once? What would you say your biggest challenges are?

Matt:              Sometimes assignments are missed when I travel around the country to race or snowboard. That is the most difficult part. However, I always catch up by the end of the semester.

Alissa:           You mentioned that you were diagnosed at six years old. Because I'm trying to provide helpful advice to other diabetics, can you tell me more about your symptoms and how were you diagnosed?

Matt:              I was very thirsty and had to go to the bathroom often. I was easily aggravated and tired all the time plus I lost a lot of weight. At one point, I drank a whole gallon of orange juice in less than one hour – and then went to the bathroom three or four times after. While we are on vacation in Cape Code my symptoms worsened. My parents took me to a doctor who advised that I was probably diabetic. From there we went to the Cape Cod Hospital, where my diagnosis was confirmed. Unfortunately, that hospital couldn’t treat me so I was transferred and admitted to another for two or three nights.

Alissa:           How did your parents and family handle it emotionally? Did you have any emotional struggles at that young age?

Matt:              It was definitely hard on my mom. My dad didn't struggle visibly, but I'm sure it was hard for him. I was so young that I didn't really know what diabetes meant. I just knew that I felt sick and that I felt better when I went to the hospital.

Alissa:           Does diabetes run in your family?      "

Matt:              Not on my mom's side. I am not sure of the medical history on my dad's side, but I don't think so.

Alissa:           How often do you see your endocrinologist and what kind of diabetic regimen are you currently on?

Matt:              I am on the pump, which helps a lot. I see my doctor every three months to go over my A1C levels – the graph of where my blood sugar and the changes required for my pump settings.

Alissa:           Who is your endocrinologist, where is he/she located and does he/she have experience working with other athletes?

Matt:              My endocrinologist is Dr. Criego in St. Louis Park , Minnesota. She has definitely helped us manage my diabetes and my sports.

Alissa:           How did you find an endocrinologist that you felt comfortable seeing?

Matt:              My mom’s friend whose son is also diabetic recommended Dr. Criego. The doctor helps me so much so I can manage my diabetes while being active in sports and traveling.

Alissa:           You mentioned that you were on a CGM. Are you also on a pump? How long have you been on a CGM and which one do you use?

Matt:              I'm on the electronic pump and the Dexcom CGM, which I started to use about four months ago. I need to know what my blood sugar is every 20 minutes so the CGM is very helpful.  Ryan (Reed) used it in his racecars so he could know his blood sugar at all times as well.

Alissa:           As a fitness competitor, I agree. I’ve ordered the Dexcom, am going through training and will be starting it soon. Every athlete I've spoken with has said how beneficial a CGM is for managing diabetes while doing a sport. Even my doctors have been encouraging me to go on it, so it’s great to hear about your experience with it. My next question is, how did you adjust your diet? What is your diet like?

Matt:              I've never really changed my diet or thought I needed to stay away from something because I am diabetic. I've tried to eat the way I always have, but I admit that diabetes definitely brings awareness to what you're eating.

Alissa:           My daughter is a diabetic in middle school and I know there must be many challenges as a high school student who has diabetes. There are so many parties, events and holidays revolving around food. Do you follow a strict regimen or do pretty much eat what any non-diabetic eats? If so, what would be a typical meal for you at a party?

Matt:              I don't follow a strict regimen and tend to eat like a non-diabetic. However, at parties and events I try to not eat sweets because even if I give my correct insulin dosage, my blood sugar can still be high. When my blood sugar is high, I don’t enjoy the party. I usually eat pizza and drink diet soda, but not much else.

Alissa:           I know when my daughter goes to parties, she is used to, like you, not having sweets and has been really good about it. But any time we have a party or take her some place, we always know what she is going to eat and carb count in advance. Do you do that also?

Matt:              I have an app on my phone that tells me carbs for pizza and different types of food. For the most part, I have a very good idea of how many carbs are in a pizza per say.

Alissa:           Which carb-counting app do you use?

Matt:              It's called Carb Control or Carb Count. It works really well.

Alissa:           What do you do when you have low blood sugar while racing? How can you prevent low blood sugar? Do you have a special racecar that is equipped for it? I know with your CGM it's helpful, but how is your racecar equipped?

Matt:              I carry a sports drink, like a Gatorade or something sugary in my car with a long tube, which I can drink if I go low. Fortunately, I've been very careful about watching it and have never gone low in a race.

Alissa:           Was Ryan (Reed) helpful with the design of your race car?

Matt:              I feel like I wouldn't be on CGM right now if it weren’t for Ryan. He also told me about carrying a sports drink.

Alissa:           Has he been a good mentor to you?

Matt:              Yes!, Absolutely!

Alissa:           I’ve heard that you're fundraising for Ryan Reed’s charity ‘Drive to Stop Diabetes’.   How did you get involved?

Matt:              My dad and I were watching a race and we saw Ryan Reed in a car that said ‘Drive to Stop Diabetes’. We couldn’t get over how awesome that was. My dad reached out to Ryan’s charity offering to help fundraise at a local level where I race. Now my car looks just like Ryan's – Number 16. . It is red and everything!

Alissa:           When you are racing, who do you work with medically to care for your diabetes?

Matt:              For the most part, it is just my parents, my brother and my family. There are other people in the picture who know I'm diabetic and know what to do, but my main support is my family.

Alissa:           How many races do you do a year?

Matt:              I'll do a little over 20 at the local track and then go south and do some races in the winter. I did winter nationals last year in Las Vegas and Florida, so that equals about six races in the off season. In total, I would say about 30 races per year.

Alissa:           Are you also a part of NASCAR racing?

Matt:              I am not a part of NASCAR racing but Legends cars have a division, which is supposed to be a size down, cost effective model. That was the idea behind Legends.

Alissa:           Do you plan on competing in the Olympics or becoming a professional racer? Which is your favorite sport?

Matt:              Being in the Olympics would be very cool, but I don't think it is likely. It's hard being from Minnesota where we have hills and it’s hard to compete against states like Colorado where you can live on a mountain and snowboard and train every day. I definitely love snowboarding – it’s like racing in a lot of aspects. But I would probably say that racing is my favorite. I would love to become a professional racecar driver. I'm going to go as far as I can in racing, but if I don't make it to a professional level, that's okay too.

Alissa:           Do you have different types of athletic plans in your future?

Matt:              I want to keep pursuing racing and do both sports as much as possible. At the same time, I plan on going to college and getting an education. That definitely plays a factor in it as well.

Alissa:           What advice would you give people with diabetes who want to compete in racing or any other kind of sport?

Matt:              You can really do anything you want with diabetes, as long as you’re willing to take the time to manage your blood sugar. It's not always easy to do that; especially while snowboarding when it's cold out. You don't want to take your gloves off and do your tests on a hill, but that's what you have to do with these types of sports when you’re diabetic.

Matt Allen with car race car

You can keep up with Matt at http://www.greatnorthlegends.com

Please consider donating to Ryan Reed's charity DriveToStopDiabetes

This is the second and final part of Alissa's interview with NASCAR racer Ryan Reed.  Please consider donating to Ryan's charity DriveToStopDiabetes

From Ryan’s website:

Ryan Reed began his first full NASCAR Xfinity Season at the start of 2014. He finished 9th in overall standings, with 1 top 5 finish and 14 top 15 finishes. His season best took place at Daytona Intentional Speedway, where he finished 4th. He will start his 2nd Season in the NASCAR Xfinity Series with the No 16 team in 2015.

Reed's racing career began at a young age, capturing the Kid's Kart Track Championship at the age of four. The Bakersfield, California native followed that up by becoming the Junior 1 Comer and HPV Karting Track Champion at age eight.

You can read the rest of Ryan’s bio on his site DriveToStopDiabetes

Alissa:       What team of people do you work with who medically care and support you in your diabetes while you're racing?

Ryan:        I’m mostly managing it myself with the help of my doctor. At the racetrack, one of my pit crew is trained to give me an insulin injection at a pit stop if necessary.  NASCAR has a medical team at every race.

Alissa:       I have looked at some of your videos and I saw that you have some kind of bulls-eye that gives you insulin?

Ryan:        That's a patch on my suit that’s a little bit thinner than the rest of the material. It’s to indicate where to give me the insulin injection if I need it.

Alissa:       What do you do if you're racing and have low blood sugar? What do you do to prevent low blood sugar while you're racing?

Ryan:        I have a drink inside of my car that's timed glucose. It's like a sports drink base that we add dextrose to for more glucose.

Alissa:       What is that? Does your CGM tell you when your blood sugar's high or low? How do you get the drink into your body?

Ryan:        I have a tube that runs to the front of my helmet—it's a camelback system. I have a bite-valve that's right on the side of my helmet so I can actually drink while I'm racing.  I also have my CGM that I'm looking at throughout the race, so I know if my blood sugar is high or low.

Alissa:       Does the stress of racing affect your blood sugar?

Ryan:        Yes. More than the stress, the dehydration is probably the biggest factor. Adrenaline plays a factor as well.

Alissa:       That's interesting. So what do you do for dehydration?

Ryan:        I do the best I can leading into the race to stay as hydrated as possible because there's no way around it. On a hot day I will lose up to 4 or 5 pounds in a race. On the days that I feel I didn't do as good a job as I needed to in order to stay hydrated, I pay the price.

Alissa:       I was wondering if you could tell me a little bit more about your organization. It's “Drive to Stop Diabetes,” right?

Ryan:        Yes. My personal foundation is “Ryan's Mission” and then “Drive to Stop Diabetes” is an American Diabetes Association organization, which I also play a huge part in. “Drive to Stop Diabetes” came out in 2013 and was centered around our racing platform. For me the biggest part is working with younger kids and spreading the message that you can do whatever you want despite having diabetes—don’t let someone tell you that you can’t chase your dream.

                The American Diabetes Association does a lot of work to spread general information at the racetrack—whether its risk tests or awareness information. Lilly Diabetes got involved at the end of 2013, beginning of 2014, and became a title sponsor. They have played a huge part in helping it grow, reach more people and funding.

Alissa:       You mentioned “Ryan's Mission.” How did you come up with that idea and what exactly is it?

Ryan:        “Ryan's Mission” was my first way of getting involved. It was just a website we put up and it was a place to go to tell my story. There is a woman who works for “Ryan's Mission” who does a lot of the day-to-day work with ADA, Lilly Diabetes and “Drive to Stop Diabetes,” but we are more behind the scene. We don't have a lot of events or fundraisers, but we'll have charities donate to “Ryan’s Mission” and a lot of the funds go back to ADA or to help fund an auction or a fundraiser.

Alissa:       Have you raised a lot of money through your organization?

Ryan:        We do a little bit here and there to help stay afloat, but most of our efforts go into the Drive program. It’s hard managing two different programs and my focus is on the Drive program because they've done a lot for me to help me to continue to chase my dream.

Alissa:       What kind of advice do you give people who want to become athletes and compete? Do they need a team of people or is it doable to manage independently? I have interviewed my doctor, Dr. Blevins, and I did an interview with him on this topic and he actually said it is doable. So I'm curious to hear what you think and what your advice would be to people.

Ryan:        I feel it's different for everyone. Meeting and talking to people like you, everyone has a different situation. Each sport, or each person, has their own challenges—not only with their own diabetes, but with whatever their passion is. A lot of it I can listen to and understand, but there is also a lot of it I don't understand and so it’s hard for me to give too in-depth of advice. For me it’s just going through it and dealing with it. With others I just try and tell them, "Don't give up."

                I still struggle with my diabetes.  I have a great doctor and I understand it, but I still have my bad days—just like everyone else. I try and give a positive message of "Don't give up. Don't let the frustrations beat you. Just continue to overcome and give 100%." That's all you can do and, at the end of the day, it’s worth it being able to go out there and do whatever it is that you love to do.

Alissa:       That's so interesting, and that's why I wanted to interview you. Those are all my questions, so I really want to thank you so much!

Ryan:        No problem.

From Ryan’s website:

Ryan Reed began his first full NASCAR Xfinity Season at the start of 2014. He finished 9th in overall standings, with 1 top 5 finish and 14 top 15 finishes. His season best took place at Daytona Intentional Speedway, where he finished 4th. He will start his 2nd Season in the NASCAR Xfinity Series with the No 16 team in 2015.

Reed's racing career began at a young age, capturing the Kid's Kart Track Championship at the age of four. The Bakersfield, California native followed that up by becoming the Junior 1 Comer and HPV Karting Track Champion at age eight.

You can read the rest of Ryan’s bio on his site DriveToStopDiabetes

Alissa:       Can you tell me about your diabetes, how you were diagnosed and what were your symptoms?

Ryan:        In 2011, I was living and loving life. One morning I woke up and was incredibly thirsty. It was so severe! It felt as if I hadn't had water in days. I was continuously drinking water and using the restroom. This went on for two or three months.

I had lost ten to fifteen pounds and didn't feel well at all. When my parents saw me they were terribly concerned and insisted that I seek medical attention. The next day my doctor checked my blood sugar which was 350 fasting. I was diagnosed on the spot with diabetes.

Alissa:       How did you handle your diagnosis emotionally, and how did your parents and family handle it?

Ryan:        My main concern was how it was going to affect my racing. My doctor said I was never going to race again and I was emotionally destitute. I started racing at age four and I was 17 when I was diagnosed. Because I had just started having a lot of success in racing, when I was diagnosed I thought my career was over. My family was very supportive.

Alissa:       Does diabetes run in your family?

Ryan:        No.

Alissa:       What kind of treatment did you initially receive, and how did you find the right doctors and medical support?

Ryan:        I was immediately put on insulin. I started researching athletes with diabetes and I found a story on Charlie Kimball, the Indy car driver. The story spoke of his doctor, Anne Peters, so I researched her. She was in Southern California, only two hours away from my home, and I contacted her and became her patient. The first time I saw her, she was optimistic and confident that I would get back into a race car. That's when things turned around.

Alissa:       How often do you see your endocrinologist and what kind of diabetic regimen are you currently on?

Ryan:        I see my doctor every three months. I used pens and I use a CGM (Dexcom).

Alissa:       You're not on a pump?

Ryan:        No. It gets very hot, about 150 degrees, inside the race car. We didn’t feel confident that the insulin would be effective at those temperatures. We decided the pen was the right treatment for me, and I’m really comfortable with it.

Alissa:       What benefits do you get from Dexcom that made you choose it?

Ryan:        I’m a huge advocate of Dexcom. I went on it very shortly after I was diagnosed. I sometimes go most of the day without checking my blood sugar, and it's always right on.

Alissa:       How did you educate your friends and family when you were younger in school about your diabetes? What kind of diabetic regimen did you follow when you were at school?

Ryan:        When I was diagnosed, I was already in the process of moving to North Carolina and my schoolwork was an independent studies program.  Although I was a senior in high school, I didn’t go to school.  My friends were not only supportive, but they wanted to understand diabetes and the changes that were being made in my life. If I needed anything, they were available. My parents were right there with me the whole time.  I had a really great support group around me!

Alissa:       What is the most common question that you're asked?

Ryan:        I get asked a lot about taking shots every day—does it hurt, or what’s it like?

Alissa:       How demanding is racing? What kind of shape do you need to be in?

Ryan:        There are guys in racing that are in great shape—they’re triathletes and world-class athletes—and then there are guys that aren't. I love being active, and I love being fit—whether racing or not. I do cycling, Crossfit and weight lifting to stay active. In doing so, it benefits for racing endurance.

Alissa:       How did you adjust your diet?

Ryan:        I was really concerned with training and diet limitations. My doctor and nutritionist made sure I could eat and train like an athlete and not have to sacrifice because of my diabetes. It actually motivated me to get in better shape and understand more about what I was putting in my body. I felt like I became healthier and a better athlete.

Alissa:       How did you persevere and become successful in this sport that you're so passionate about when you were told that you may not be able to race again?

Ryan:        It was horrible to be diagnosed and told I couldn’t race. At 17 years old, you take things for granted. My diagnosis motivated me and made me appreciate what I had.

Alissa:       Were you aware of any other colleagues of your race car drivers living with diabetes? If so, were they able to provide you with support or advice?

Ryan:        No one besides Charlie. He was always open to giving advice and I talked to him whenever I was first diagnosed. There really aren’t many people in racing with diabetes—some crew guys, but not any drivers. 

This concludes Part I of II, interview with Ryan Reed.  In the next(and final) part, Ryan talks about how he manages his diabetes while racing, whether or not he uses a CGM, what he does for dehydration and much more!  Register now to be notified when An Interview with Ryan Reed Part II is published!

I’ve been fortunate to have Nicole Brent as been my dietitian.  She has worked closely with me while training for my competitions to manage my diabetes through proper diet and exercise regimen.  Since I’ve known her, I’ve become much more knowledgeable and successful with regulating my blood sugars.  She has always been helpful with diabetic issues that have arisen.  It is such a treat that she has agreed to be interviewed on diabetes, her area of expertise.

Alissa:     Please tell me a little bit about your credentials and how you got involved consulting diabetic clients?

Nicole:   I'm a registered dietitian. I have a bachelor's degree then did an internship; Diabetes is very nutritional-related. Medication, exercise, and diabetes all go together and it's something that I was very interested in and felt that I could be helpful. You need 1000 hours working with patients to be able to become a certified diabetes educator. I attained that goal and became a Certified Diabetes Educator All of this education and experience has provided me with the skills needed to help my patients.

Alissa:     What would be the best way to find a dietitian who specializes in treating diabetics?

Nicole:   The National Certification Board for Diabetes Educators website is http://www.ncbde.org . Your zip code will give you a list of all the Certified Diabetes educators in your area.   Also, if you talk to your endocrinologist, then he/she may have a dietitian that they work closely with. We work very closely with Texas Diabetes and many other physicians and endocrinologists in Austin.

Alissa:     Cost is always a factor when making medical decision.  There are so many expenses that diabetics incur that create financial difficulties. If somebody needs to see a dietitian and they can't afford it for some reason, how do you advise somebody to be able to get that dietary care?

Nicole:   Usually, your insurance covers it if you have diabetes, but it just depends on your insurance.

Alissa:     Are there alternative methods of coverage if insurance doesn't pay for it?

Nicole:   I don't know about that. That would be up to your employer. 

Alissa:     Where can I find a dietitian who works with diabetic patients? Are there special certifications needed for this?

Nicole:   There is a certification, which is not just for dietitians, but for practitioners who works with diabetics. It is called a Certified Diabetes Educator or CDE. You can go to their website, http://www.ncbde.org, to find a CDE.  Practitioners working with diabetic clients, including nurse practitioners, physician's assistants, and dietitians should be a Certified Diabetes Educator or CDE.

Alissa:     Are there specializations or certifications for dietitians to work with children with diabetes?

Nicole:   There's not a certification for a diabetes educator to just work with children, however, there’s a Certified Specialist in Pediatrics or CSP.  You can find board certified specialists in pediatric nutrition at The Commission on Dietetic Registration website, www.cdrnet.org.

Alissa:     Craving sugar is a symptom of diabetics, but could something else cause this?

Nicole:   I don't know that craving sugar is necessarily a symptom of diabetes. It depends on the person. Sometimes, it will come from the fact that someone knows they shouldn't be eating a lot of sugar causing them to want it more.  That’s just human nature.  One thing that will cause craving more sugar is if we are getting inadequate carbohydrate in our diet.

Alissa:     What are the biggest differences between diets for diabetics verse non-diabetics?

Nicole:   If I’m working with a diabetic patient and their goal is weight loss, we would be focusing on carbohydrates, so the emphasis would be carbohydrate counting and making sure that their carbohydrates are under control. Not only does carbohydrate counting help with weight loss, but it also helps to reduce calories because the carbohydrates have the largest percentage of our calories. If diabetes is not a factor, I will still teach carbohydrate counting because it is extremely helpful in weight loss. For non-diabetics total calorie intake and getting adequate exercise are priorities.

Alissa:     What tips do you recommend for measuring carbohydrates?

Nicole:   There are many great apps available to help figure out the carbohydrate content of while eating out.  It is also helpful for foods that don't have labels on them like apples.

Alissa:     The size of apples can vary greatly.  How do you carbohydrate in an accurate way?  Do you need to weigh it with a scale?  Do you need to measure with cups?  What are your suggestions?

Nicole:   Either way.

Alissa:     Is there a rule of thumb, 15 carbs for certain vegetables or fruits?

Nicole:   No, because there are so many different amounts.  The best way to learn is to measure your foods for a little while. You will learn from practice and experience.  If you measure a cup of rice several times then you are able to eyeball it down the road. 

Alissa:     Are there any danger foods or unsafe foods for people with diabetes? What are good treats and desserts for diabetics?

Nicole:   There is no list of food that is off limits because you are diabetic.  Certainly there are foods that are better choices.  I know that there are certain triggers for me which can be danger foods if you are diabetic. Same thing with safe foods. 

               I teach my diabetics to try to keep their snack to around 15, and for sure less than 20 grams. 

Alissa:     What would you recommend if somebody with diabetes wanted to have a dessert?

Nicole:   Sugar-free Jell-O is carbohydrate free. Sugar-free pudding has only 15 grams. A granola bar that is high protein is a good choice. Desserts and snacks that range @ 15 grams of carbohydrates are wonderful options. 

Alissa:     What if somebody wanted to have a piece of cake or cookie - what would you recommend?

Nicole:   Keep it small, and then if you're on insulin, you have to cover it. You need to be mindful about checking your sugar and making adjustments with insulin. 

Alissa:     Is NutraSweet or saccharin?  Which would you recommend?

Nicole:   According to the Food and Drug Administration, they are all safe, so that's something that I leave to the client. Some people feel more comfortable with Splenda because it's made from sugar. Some people feel more comfortable with TruVia, green leaf, or SweetLeaf because they are from a leaf, so they feel it is more natural.  Be aware of the amount of these sugar substitutes that are being used, so they are not overused. 

Alissa:     Is there a limit on how much sweetener you can use per day? Do they have carbs?

Nicole:   They do not have carbohydrates in them.  Some of them are equivalent to 20 to 22 diet sodas a day, so be aware.

Alissa:     Do sweeteners have long term side effects?

Nicole:   Everything in life is about moderation. That's the key. If you're not comfortable with it, then don't use them.

Alissa:     I really, really appreciate you, Nicole, as my dietitian and how much you've helped me through my competition season.  I have learned so much from working with you.  I thank you so much for giving me your time and helping me so that I can help others.

Nicole:   You are very welcome, my pleasure Alissa. 

I’ve worked with Dr. Joe Klemczewski over the last year in preparation for my figure competitions.  He has helped me lose weight and regulate my diabetes. 

Alissa: Can you tell me a little bit about your background, credentials and how you
are able to help somebody diet in a healthy way to compete in a fitness
competition like myself?

Dr Joe Klemczewski:   I became interested in nutrition when I was about 12 years old. I changed schools in the fifth grade and new friends pulled me into sports, but I was a chubby inactive kid. I wanted to catch up to my peers—I was inspired by performance, athleticism, and the sheer fun of sport. That led to weight lifting and it was a very positive turn for me. By the time I graduated with a degree in physical therapy, I was on my way to becoming a professional bodybuilder. I pursued a masters in health and doctorate in nutrition to support my hobby, but it naturally pushed me into a career in the fitness industry. After owning a health club for 10 years, I created The Diet Doc, LLC, went back to school for another PhD in health education, started writing and publishing nutrition books, and licensing our program around the world.

Alissa:   Do you believe an athlete with diabetes can compete in a professional sport?
What are the pros and cons?

Dr Joe Klemczewski: It’s absolutely possible, but can be extremely dangerous if the athlete isn’t careful and responsible in monitoring the condition. It’s easy to get caught up in training or performing and end up in a compromised state. The pressure of achievement—especially if others depend on the athlete—can push the condition further away as a priority, symptoms can be ignored, and bad things can happen. The pros, of course, is that activity and exercise is a great benefit to a diabetic. It can prolong life, increase quality of life, and reduce complications.

Alissa: What kind of diet would you use that might be different from somebody who
doesn't have diabetes?

Dr Joe Klemczewski:      I’m a fan of healthy, balanced eating and dieting, so there’s no difference in the way I would treat a diabetic. I constantly emphasize that blood sugar and symptoms are more important than the objectives of a diet. If a diabetic is following a diet of any sort, and they ignore symptoms because the diet they’re following wouldn’t allow for a deviation, it’s more than wrong—it’s irresponsible and can be fatal.

Even though my nutrition practice is naturally diabetic-friendly, I would always be careful to not reduce carbohydrates to levels that would compromise the condition.

Alissa:   What are the health advantages of following your diet regimen as opposed to
other diets commonly used?

Dr  Joe Klemczewski:   I’m always going to include an appropriate amount of protein, but not too much. Diabetes can cause the vascular system and fragile tissues to degenerate and excess protein exacerbates that process. I like to include enough dietary fat to allow for flexibility, but also so that healthy fats can be a consistent part of nutrition. That leaves, carbs, and since I’m not going to suggest a faddish or impractical diet (like very-low-carb diets), there is always room for a good, safe amount of quality carbohydrates.

Alissa: How do you advise competitors or athletes to have a healthy lifestyle
(whether or not they are diabetic)?

Dr Joe Klemczewski:   There’s a growing fascination in the general population diet industry and in physique sport with “flexible dieting.” What was once seen as simplistic—counting calories versus using a hyper-specific, restrictive diet—has become the new trend. I think the original problem with tracking calories was that it wasn’t specific enough. Twenty years ago, the programming I introduced into the industry used flexible dieting principles, but included guidance based on goals and circumstances. I created ranges for protein, carbs, and fat, and offered help in meal planning, but the client could select foods they liked. It took a generation, but now it’s becoming the norm, even with big-box diet chains.

Alissa: What type of foods do you recommend? Is it possible for diabetics to have a
variety in their diet?

Dr Joe Klemczewski:   Absolutely. Just like the premises I began with 20 years ago for non-diabetic clients, it’s important for anyone to enjoy flexibility. It just takes a little dedication to learning what is in food.

Alissa:  Are there any healthy splurge foods a diabetic can enjoy?

Dr Joe Klemczewski:   Even a diabetic can process high-glycemic, sugary carbs, but like anyone, it’s not healthy to make that the norm. Small indulgences are, I think, a normal, healthy part of life. If someone decides never to eat something that would be considered “bad”—ever—that’s their choice. I don’t think it’s possible, and it can lead to obsessive or compulsive issues like bingeing, so I prefer to include small, manageable amounts of decadent foods.

Alissa:  Are there any foods that a nondiabetic can eat differently than a diabetic?

Dr  Joe Klemczewski:   A non-diabetic can certainly get away with abusing food without the acute health consequences, but look at our society: there’s still a cost. That’s why type-II diabetes has become such a health crisis.

Alissa:  Can you can help explain what an athlete, or physique competitor, eats during in-season training and the differences off-season?

Dr  Joe Klemczewski:   Someone trying to accomplish body composition goals—getting leaner or gaining muscle—will need to be objective and consistent. They’re going to eat higher-quality food and avoid deviations as much as possible. But, the goal of anyone should be health regardless. Someone who is diabetic or non-diabetic shouldn’t let their weight deviate greatly, and I would hope their eating habits are healthy year-round. Again, someone not in the acute phase of a training need might enjoy more margin for error and not be quite as diligent, and that’s where flexible dieting comes into play, but I don’t consider there to be dramatic differences. 

My daughter Molly shares her experiences and gives some helpful advice

Today is my birthday.  I received the best birthday present I could have possibly wanted when I woke up to my 2 children’s love, hugs and kisses!  I’m blessed to have two beautiful children to celebrate my special day!

As diabetics, my daughter and I can’t share in the tradition of eating birthday cake; so instead of cake, Molly gave me the gift of working on this blog together.  I interviewed her on what it’s like to live with diabetes during her first year of middle school. 

Even though I sometimes feel sad or upset that Molly has diabetes and wish there was a cure, in a strange way I feel blessed to have a child with diabetes, because of the way Molly handles it.  Diabetic children face many limitations and adjustments. Molly’s challenges living with diabetes includes learning to independently care for herself and thrive emotionally. My daughter has embraced her diabetes with such a positive outlook.  She educates her peers in school about what diabetes is, advocates to groups of people by speaking publicly, and attends/fundraises for the JDRF Walk for a Cure each year with such pride.    She has demonstrated such self control by accepting that she can’t have the yummy treats and making good choices, including counting her carbs beautifully, and always making wise choices with her meals.  She handles other children eating food she can’t at holidays and birthday parties with such grace. She is such a special and loving child, and it makes me proud that I have a child who can be a positive example for others. 

Diabetes is hard for children, but it’s not easy for parents either. Parents have the responsibility of supporting and teaching our children positive, healthy choices, and always letting them know we are here for them. 

It gives me great pleasure to share with you this interview with Molly.

Living with Diabetes in School

Alissa:   What do you do if the teacher is talking and you feel your blood sugar is low or high?  How is your teacher educated handling your diabetic care in their class?

Molly:  I have a 504 medical care plan that Austin Independent School District requires for any student with special needs or accommodations that my teachers are required to follow in their class.  My teachers are all educated by the school nurse and are aware of the warning signs and symptoms of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar).   The teachers are provided with juice and snacks and have a phone in the classrooms for emergencies.  I am allowed a medical pass to go to the nurse even if I’m in the middle of a test or lesson.     I go up to the teacher and tell her, “my blood sugar feels low (or high) and I need to go see the nurse”.

Alissa:  What do you do for your lunch time routine?

Molly:   I leave class 2 minutes early, go to the nurse, hand her the paper with my carbs, test my blood sugar, and while I enter the carbs in my pump, the nurse calculates the math to check that my pump is right.

Alissa:  What do you do if your blood sugar is high (hyperglycemia)?

Molly:  I go to the nurse and test my Blood sugar.  If it’s over 300, I correct for a high, test for ketones, then I drink a lot of water and retest 2 hours later.  Many people have never heard of ketones.  Ketones are substances that are made when the body breaks down fat for energy.  Normally, your body gets the energy it needs from carbohydrates in your diet.  But stored fat is broken down and ketones are made if your diet does not contain enough carbohydrates to supply the body with sugar (glucose) for energy or if your body can’t use blood sugar (glucose) properly.  I check my ketones with special strips called ketostrip from a local drugstore.  I urinate on a stick and use a color pattern located on the test strip bottle to measure my ketones from trace to high ketones. 

Alissa:  What do you do if your blood sugar is low (hypoglycemia)?

Molly:  I go to the nurse, check my blood Sugar, and then if it’s 70 or below, I get preferably a juice box or glucose tablets with 15 carbs, but sometimes a snack with 15 carbs and then recheck 15 minutes later.

Alissa:  Do other kids ever ask, “Can you have this?”, when you know you can’t?

Molly:  People do that all the time, like in the theater for Valentine’s day we got donuts and everyone asked, “Can’t you just have one?”  I explain briefly what diabetes is and although usually they don’t understand they support me or try to bring in something sugar free.

Alissa:  Have you ever been acknowledged by some mean diabetes name?  How do you handle any negative comments?

Molly:  From 1^st grade up until 4^th grade a mean boy called me diabetes girl.  I didn’t tell anyone, because I thought nothing would be done about the bullying.  I also thought he wouldn’t stop calling me names and telling someone would only make him do it more. 

Alissa:  Do you ever feel your friends are avoiding you because they’re scared of you (and your diabetes)?

Molly:  No I don’t, but it happens to a lot of other diabetics

Alissa:  Do your friends not invite you over secretly because they’re worried about your diabetes?

Molly:  Most likely, but I don’t know for sure.  It’s hard when I hear about the foods kids are having at birthday parties and all of my friends who attend, and I am usually the only friend left out.  I’m told that there was a limit on who they can invite.  It does hurt my feelings, but I’m use to it and accept it and know this isn’t a good friend but an acquaintance and just accept them for who they are. 

Alissa:  Do you ever feel left out in school activities, experiments, or holidays because of diabetes?

Molly:   A lot of the time, because people will get to eat things in class during parties or for fun, and I don’t.  I am accustomed to knowing I have to pass on the treats.  I feel upset, but I know I need to stay healthy and make the right choices.  I’m used to it, but it still is hard.

Alissa:  Do people ever go, “Is diabetes contagious?”

Molly:  Yes! All the time!  This is the worst comment out of all comments, it’s so annoying and I hate it! People get scared thinking they are going to get diabetes and step away from me. – almost every new person I meet asks” isn’t diabetes contagious” and I say, “only in genetics”. 

Alissa:  How do you handle ketones?

Molly:  I handle ketones by drinking water non-stop throughout those 2 hours and DON’T EXERCIZE IF THERE ARE SMALL OR ABOVE!

Molly you are an incredibly special girl and I’m always so proud of you.  You are a gift, and such a

good, well mannered daughter!  I couldn’t be more proud of you!

I found out today my insurance provider doesn't pay for insulin at full cost and that I'm responsible for 50% of it. If I had to pay out-of-pocket it would've cost me $193 a month each for Novolog and Lantus. My test strips were also covered at 50% and that would've cost me $100 a month.

It helps to have a good rapport with your local pharmacy as well as your insurance agent. I spent a good amount of time today working with the insurance company, the doctor, and the pharmacy to help me find a medication that will be covered. With patience and persistence, I was able to find out that Humalog, and Levemir, were covered at full cost. This insulin is the exact replacement but different manufacturer.  Although change is always difficult, I felt pleased that this is one less expense I have to carry.

If you find it's too hard to continuously pay for your diabetic medication, I'd like to suggest calling your insurance company and working with your local pharmacy to find ways to lower your cost of expenses.

There are many challenges that we face as a diabetic and even more so as a diabetic figure competitor. It has been a tremendous growing and learning process for me to continuously monitor my basal insulin, short-term insulin, carb counts, as well as changes throughout the process of competing. The closer you get to the competition, the lower the carbs and amount of basal insulin needed. Previously I had blogged that my sugars were continuously high. Now I have the opposite - hypoglycemia.

I could easily say forget about it, I don't care anymore, this is horrible, why me, why do I have to live like this. With diabetes, it's the choices we make that will help us grow and thrive. I am a fighter – strong, determined, motivated and driven.  This isn't a natural instinct – it’s learned behavior that you can control. You have to be at the point where you want to mentally make that change such as a diet/weight loss, or exercise and a healthy lifestyle. This has to come when you are ready. I enjoy blogging because I want other people to know they’re not alone – we’re all going through the same issues.

What most people don't know about me is that I'm like everybody else - I've struggled with eating, weight, and lack of energy to go to the gym. I've struggled as a single parent with children and as a person who's had to move from one lifestyle to another. Change has affected me as much as anyone. The last six years of my life has been a work in progress. Unfortunately, there have been more negatives than positives, but with a lot of hard work within myself and motivation, I have picked up the pieces to the point where I know where I’m going and I'm not stopping until I get there.

I’ve realized I need to see my endocrinologist regularly, listen to their advice, and keep clear notes of what I'm doing. I also see the dietitian weekly now - I give them my weekly diet, exercise routine, and log every single thing I do. I'm going to take a picture and show this - it might help you to learn what can be done to regulate and control diabetes by taking notes.  You’ll see in the log my hypoglycemia, and what my dietitian today has done to help me change and prevent low blood sugar from here on out.