"I Don't Live Like I Have Diabetes"

(Editor's Note: As you'll soon see why, San Antonio marketing director Ray Hoese is proud of his teenage daughter, Jordan. One evening, he e-mailed some questions to his daughter upstairs, and these were her responses.)

Ray and Jordan Hoese post-marathon, looking remarkably well after a grueling 26.2-mile run

Apr 22, 2008

A Question-and-Answer Session With Jordan Hoese, A 14-Year-Old Type 1 Marathon Runner.

You’re only 14 and have type 1. What made you think you could run a marathon?

Actually, neither my age nor diabetes crossed my mind after I decided it was something I wanted to do until my dad brought them up. I don’t live like I have diabetes, and it’s our joke in the family that I “don't really have it” because my control is so good. Honestly, I forget all about it when I'm not checking my blood sugar. So when I first got the idea that I wanted to do the marathon, the whole “I’m type 1” issue wasn’t even an issue in my mind, mainly because being type 1 is not an issue. As for being 14, it’s just a number. I’m told I don't act like I’m 14 or look like it, so it’s not even a number I really connect to, which is probably why I didn’t think of it.

Which marathon did you run?

We ran the AT&T Austin Marathon in Austin, Texas, on February 17, 2008.  It took us 4 hours and 15 minutes.

Was it your first?

No, actually, I did one when I was five. Just kidding. Of course it was my first!

How do you know you’re the youngest type 1 to ever run a full marathon?

It occurred to me that I might be the youngest about a month or so before the race. So I looked up the current record online for type 1 diabetic marathoning (age-wise), and it was a 24-year-old guy. I’m 10 years younger.

How did you train for it?

My dad and I were both in good shape because I ran a lot anyway and he’s a cyclist, so we only trained for three months. We’d run two or three times during the week, and then take a longer run on the weekends. The long run started out at six miles the first week, and then it was seven, and then 11, then 15, and then, finally, a month before the race, we went out and ran 24 miles around the neighborhood. Four hours of running in six-mile -circles!

Our neighbors probably thought we were crazy. But it was a lot of fun. We were going to go walk two miles afterwards to say that we covered marathon distance, but we got home and were like, “Wow, my legs hurt now.” So we didn’t. I sat on the couch and watched a movie. But after that peak, we started making our long runs shorter. A week before the marathon, we did a 10-mile run, and that Wednesday we ran four miles. That was a sad run. Training was over.

What was it like when the starting gun went off?

Loud, because it was a cannon. No, it was really amazing. There were so many people, and they were all running and people were cheering. It was still dark when we started, and as we crossed this bridge right off the start line, all these fireworks got set off. It looked like the Fourth of July. But there was so much adrenaline in the crowd that it was contagious! I mean the crowd of runners, not the huge crowd of bystanders, although they had a lot of excitement and spirit.

Were you ever nervous or scared about trying the marathon?

Like two weeks before the marathon, we hadn’t been running as much and my dad got the flu, and neither of us really ran for a week. That made me really nervous about being able to finish the marathon, even if it was just an irrational fear. I knew that, but I was still worried. My dad pointed out to me, though, that we had run almost a marathon distance three weeks before and that was no problem, and, if anything, we were fitter now. So I cooled down a little. I was still nervous up until the night before the race, though. I was sitting there and I said to my dad, “Dude. This isn't going to be hard at all!” He said something to the extent of, “Duh.”

What do you think when you hear people talk about their child's diabetes as a handicap?

I remember the day I got diagnosed, my family already knew about diabetes, so from the second I heard the doctor say that I had it, I was crying. We went to get blood work done (my blood sugar was only 233, so no hospital for me), and the receptionist looked at me and said, “When I was your age, I had cancer.” Yeah. So I think that people who think diabetes is a handicap are wrong, obviously, because there are much worse things out there.

Diabetes is not hard to deal with, it is not something that has to affect your life, it is not something that you even have to think about. Seriously! It doesn’t take that much thinking capacity to check and bolus! And once you do that, you’re done. There may not be a cure for diabetes, but there’s a 100-percent guaranteed effective treatment, which is more than a blind person or someone with cancer or AIDS can say. Anybody who says diabetes is a handicap just doesn't know that all they have to do is check (a lot) and bolus (or eat) accordingly.  

How do you control your blood sugars?  Do you have any issues, problems or complications?

I check my blood sugar, and then I give insulin for the carbs I eat! That’s as in depth as I’m going to go, because that's all there is! I check about six or seven times a day, which really only takes a total of, like, 30 seconds, and when I eat carbs, I give insulin. Oh! When I run, I burn blood sugar like nobody’s business, so I have to eat about 30 carbs for about every 40 minutes I’m running. That's kind of a pain. Especially because if I so much as think about insulin while running, I will drop faster and need to eat more Gu or drink more Gatorade.

If I actually have insulin (even leftovers from the insulin I bolused at lunch two hours ago!), I can’t run. Because of all that, we’d have to stop and check every three miles during training. But during the marathon, we used a Dexcom continuous meter so we didn’t have to stop at all. It made everything a lot easier. And it probably made our time faster by at least 20 minutes. It was fun to run like I wasn’t diabetic for once! All I had to do was glance at the Dexcom and drink the Gatorade the people at the aid stations hand to you!     

Anyway, I check my blood sugar, and then my pump tells me how much insulin I need for how many carbs I eat – a 30:1 carb ratio, a consequence of running – and then I adjust (or don't) based on blood sugar. My A1c is always somewhere between 5 and 6.5% and I have never had a severe high or low, or been hospitalized, or had an issue or problem or complication with diabetes, and I don’t plan to!

Tell me about your pump therapy – how/who adjusts your basal rates, ratios, and all that stuff. How often do you adjust things, running a marathon and otherwise?

First of all, I do everything myself. Aside from the process of figuring them out, as I’ve gotten increasingly fitter over the last year and a half, I don’t adjust my basal rates or ratios very often. My basal stays at.25 units an hour, except at night, when it’s .2u/h because my dad is paranoid about nighttime lows and I have to keep him happy, and my ratio is one unit for every 30 carbs. That’s not a lot of insulin. I’m really insulin sensitive because of all the running I do, so a little insulin goes a long way. A tenth of a unit drops me between 30-50 points. A whole unit is only something I would want to do if I were above 300.

I’m on a Medtronic MiniMed pump that I put NovoLog in, and I also have NovoLog in my insulin pen. I avoid the pen at all costs, though, because I’m a total needlephobic. As far as blood sugar, because of my insulin sensitivity and fitness, I go low if I so much as walk half a mile with my pump on. So my pump is quite frequently suspended, usually because I’m walking around or it’s a while until dinner. I don’t wear my pump or bolus for at least an hour and a half before running, if I can help it. Running, plus residual insulin, equals a big drop really fast.

About doctor visits…. I feel like a rebel now – I don’t keep a logbook. My meter has a feature that tells you your averages, and I read that to my doctor. They’re all in range, so my doctor visits – which are with a great endocrinologist who realizes that my dad and I know what we’re doing diabetes-wise – are basically just casual discussions about stuff after all the paperwork gets done because we don’t really have any treatment questions. Last visit, we just talked about non-insulin-mediated glucose uptake in skeletal muscle, and proteins, like Glut 4, that facilitate glucose diffusion. So I look forward to doctor’s visits, ‘cause I’m a nerd like that. And because they’re usually during school hours.

What advice do you have for other type 1s?

Take care of yourself. I know so many diabetics who just don’t realize or care that staying alive is so easy. You don’t have to be a runner or a biker or an athlete to be healthy with diabetes – although it’s cooler if you are, in my opinion! You just have to check and then bolus. Diabetics are seen as handicapped because people just don’t check their blood sugar or give the right amount of insulin.

I know I sound repetitive, but it’s as simple as that. I know so many people who make the fact that they have diabetes their life, and they still have really bad blood sugars! But you guys should know that type 1 doesn’t have to be your life, because it’s not that complicated. And in the words of my favorite runner of all time, Forrest Gump, “That’s all I have to say about that.”

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Categories: A1c Test, Blood Sugar, CGMs, Diabetes, Diabetes, Exercise, Insulin, Insulin Pumps, Kids & Teens, Pens, Type 1 Issues

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Apr 22, 2008

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