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’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. 

A diet and training change that resulted in 2% body fat loss and 2 pounds of weight loss in a week has created hyperglycemia for 5 days.  I have provided my logbook of what consistent high blood sugars look like and how I handled it.  I’m very independent with caring for my diabetes and am familiar with the ratios that have been working up to this point.  My endocrinologist Dr Blevins, says in times like this, that availability is important (Dr. Blevins interview). After my 5 day pattern of hyperglycemia, I followed this advice and made an appointment with my endocrinologist. The result - my insulin was increased to adjust to my new diet and rigorous exercise regimen.    Over the next week, I must closely monitor for a similar consistent pattern of high sugar levels accompanied with weight and body fat loss over the next week and continue the close contact with my endocrinologist.  This is what makes an athlete successful in a professional sport.  

I interviewed my endocrinologist, Dr Blevins, founder of Texas Diabetes and Endocrinology in Austin Texas on managing diabetes while training for athletic competitions.  Please leave your comments at the end, I'd love to know what you think!

Alissa:   What is your opinion on professional athletes competing in sports such as myself who live with Type1 Diabetes?

Dr Blevins:          Any athlete or is planning to be one can  pretty much do any sport that exists and it’s very important to do what you’ve done which is to get a team consisting of a nutritionist, a doctor-type and yourself.  You’re the most important part because you’re there every day and you get to observe what happens to your blood sugar with various activities.  You really have to define what’s best based on your own body’s responses.  You have to not only train but be super careful about carbohydrate intake and its effect on your blood sugar.  You’ve clearly had considerable success, which is very impressive.  I think it’s good to have a team.  And every athlete I know of ….has a team. 

Alissa:   I have learned how my body responds to exercise.  How can others learn their body’s response to exercise and managing diabetes?

Dr. Blevins:         You have to learn your own body’s response to exercise.  Some exercises will raise your blood sugar – especially exercises with rapid bursts, some will lower.   Every individual is a science in and of themselves.  Those are the two main concepts.  It’s very individual - there are certain rules, for example with the rapid burst exercises, your blood sugar will go up afterwards.  If it’s more of a distance running or aerobic exercise, where the glucose is dropping, you have to adjust your treatment to accommodate that so that you can compete successfully – You want your blood sugar in a reasonable range.

Alissa: How often do you feel that somebody who is competing like me should be seen by an endocrinologist and followed?

Dr Blevins:  I think close initial contact is reasonable.  If somebody has problems, availability is important, probably once every few weeks.  Once the formula is achieved that works best for you then you don’t have to do it that often.  The most common sport I see are people participating in is marathons, triathlons, things like that.  Make sure your feet are well taken care of, make sure your heart status is known and that you’re able to do that kind of intensive training safely.  It’s a big deal too that people not just jump into something without some degree of assessing whether their blood pressure, feet, heart are all ok.

Alissa:  So being that I’m you’re first fitness competitor athlete and having worked with me over the last year to get me through an accomplishment and learning what my regimen, diet and program, training is it encompasses a whole lot of areas to succeed.  So if somebody else like myself , being I have this fitness blog , were to go and want to compete in a figure or fitness or bikini competition – what would be the advice that you would give them , that I can also help them with .  And what are your thoughts on losing body fat quickly – how does that impact blood sugar.  Those are the key things that I was wondering. 

Dr. Blevins:   I really think the blog is a good idea, because I think when people talk to each other about what their experiences are it really helps.  You can find someone with type 1 diabetes and take their experiences, you know, everyone is going to be different.  You may also find someone’s advice you really don’t want to take – I think you have to be discriminating and careful about it because some things that are good for other people may not be good for you.  I think that comparing notes is really potentially very helpful.  I’ve had a lot of runners talk to each other.  I don’ think you want to go on a radically different diet quickly.  You want to do things gradually and moderately, remembering, after all, that you do have diabetes and you have concerns about your blood sugars and you don’t want to go on a crash diet, no more than you want to start exercising in a crash sort of way.  You want to work your way into it and be careful with yourself and your health. 

Alissa:  So like for me, working with the team of people I work with, I’ve been advised that about 2% body fat loss per week and maybe a pound at most a week is advised – for me within a 12 week period.  So really it depends on the person, but right now, my body is at 13% body fat and when I compete it needs to be between 6% and 8%.  I have to stay at 13% right now for the next 2 weeks to build muscle and to stay healthy.  And then after that my diet starts decreasing, reducing carbohydrates, and I’m sure my blood sugars are going to be changed again, so when that happens what  do you suggest to help me self manage?

Dr. Blevins: Your insulin sensitivity can change when you increase your muscle mass and even if you change your fat percent and you have to be very careful and aware that your requirements might change.

Alissa: So what do you do to compensate for that - do you suggest follow-up appointments?

Dr.Blevins:  I think a continuous glucose monitor (CGM) may be very helpful in letting you know.  But close monitoring, careful monitoring, eyes wide open – that’s the bottom line. 

Alissa:  Sounds good thank you very much!