COMMENTARY

Can an IndyCar Driver With Type 1 Diabetes Still Race?

Anne L. Peters, MD, CDE

Disclosures

April 25, 2011

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Hi. I'm Dr. Anne Peters, and today I'm speaking to you from the Long Beach Grand Prix racetrack. I'm going to talk about how to manage an athlete with type 1 diabetes, but in a way it's really about how to manage any patient with diabetes who likes to exercise.

This is the true story of Charlie Kimball. Charlie developed type 1 diabetes when he was 23 years old. He was already a racecar driver, and he was racing over in Europe. When he developed diabetes he came home. His parents happened to live near Los Angeles, and he came to see me. He wanted to know if he could safely race with type 1 diabetes. I wasn't entirely sure that he could because I was worried about him developing hypoglycemia or hyperglycemia when racing to a degree that he might have trouble maneuvering the car. It gets up to 130° F in the cockpit of a racecar. It's not exactly a pleasant environment, particularly not for somebody who has type 1 diabetes.

However, I never say "no" at first because I want to get to know someone. Not only did Charlie strike me as a really responsible person who would work with me, which is very important, but I also began to learn about racecar driving. When you help your patients who are athletes or doing any kind of sport, you must first learn about the sport. I had Charlie bring his racing suit so that I could see it and figure out if he could give himself insulin or if he could wear a pump -- what were we really dealing with? Then, I started going to some of the races so I could see what racecar driving entailed.

I also developed a rapport with Charlie, and we really began to work on both nutrition, which was vital here, as well as on his insulin requirements. We were able to connect a continuous glucose sensor to his steering wheel so he would be able to continuously monitor his blood glucose readings, which made all of this much safer because if Charlie knew what was happening with his blood sugar levels, I knew that I could manage him.

I met with the mechanics (the engineers of his racing car) and figured out a system that has glucose water on one side and plain water on the other side. A pipe goes between them, and Charlie can flip a lever and get glucose water or plain water. He can treat a low blood sugar reaction with glucose solution or a high blood sugar level with hydration, which helps bring his blood sugars down.

It turns out that commercially available electrolyte solutions don't have a high enough concentration of carbohydrate to treat a low blood sugar effectively, so now we mix up our own concoction, so that in 4 oz he gets enough glucose and a little bit of protein to help treat a hypoglycemic blood sugar. In truth, what we treat is a falling blood sugar rather than an absolute low blood sugar, because the goal is to never let him get low when he's in the racecar.

So we worked out a combination of fluids, both glucose solution and water. We worked out the dextrose concentration, and then we had to work out the training around the races. It turns out that many athletes do a fair amount of carbohydrate loading. We tell athletes to ingest enough carbohydrates, putting enough glucose in their muscles to sustain them when they are exercising. A lot of my patients with type 1 diabetes who are athletes don't want to take in a lot of extra glucose because then their blood sugars climb too high. Then, they must take more insulin and their levels are going up and down. It gets very frustrating.

Someone like Charlie needs to eat between 300 and 500 g of carbohydrates a day for several days prior to his really intense races, so we have worked on his carbohydrate intake. We have learned how to balance his insulin doses. We have precautions in place not only in the car, where we have the monitor, the glucose, and the water, but I have an insulated bag in which I have dilute glucagon and dilute insulin if I ever needed to use those.

Now, obviously if Charlie really got into trouble with his glucose control and his blood sugars went too high or too low he'd pull over and stop, but for all of the events in between, we are well prepared to help Charlie manage his diabetes. It has been quite a challenge, and it has also taught me a great deal about managing patients with type 1 diabetes in very unusual circumstances. This is Dr. Anne Peters for Medscape. Thank you.

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