Life with Diabetes — The Story of an Endurance Athlete

Diabetes is not uncommon among athletes, yet we don't talk about it enough. It is surrounded by a stigma, causing those affected to prefer staying in the background and avoiding public exposure.

Žiga Papež is different. He has been living with type 1 diabetes since birth, and in recent years, he has been raising awareness about it. He wants to prove that it is possible to live a normal life with diabetes, including taking on challenging endurance endeavors. This is why he set out and successfully completed the endurance challenge North Cape 4000.

In this blog, he helps us uncover the details of living with diabetes, what adjustments are necessary, and how to approach athletic challenges.

The Art of Controlling Blood Sugar in Every Situation

Diabetes is not something that limits you only occasionally. It requires constant monitoring — at home, at work, and during physical activities.

"People imagine that blood sugar levels change once or twice a day, but in reality, these changes happen very quickly," Žiga explains at the beginning of our conversation, clarifying that fluctuations in either direction — high or low — can be dangerous.

Regulating blood sugar is an art in itself. Unfortunately, there is no golden rule that all diabetics can follow to control their condition. There are guidelines, but it is up to each individual to find what works for them and under what conditions their body responds best.

"I kept a journal for a long time, tracked my body's reactions, and recorded everything. That’s how I learned how my body behaves under different types of exertion, and based on that, I adjusted both my training and diet," Žiga shares his approach to managing the disease.

Type 1 diabetes is an incurable autoimmune disease that requires insulin treatment due to the non-functioning of the pancreas. It is less common than type 2 diabetes, affecting around 10% of diabetics, and primarily occurs in children and adolescents.

It's hard for an average person to imagine the fluctuations in blood sugar levels and how little it takes for these to “jump” to one side or the other. The range within which diabetics can maintain their blood sugar levels is narrow, while spikes after food intake can be quite significant.

What does this mean in numbers?

Blood sugar levels are measured in mmol/L. In healthy individuals, values should stay between 4 and 7 mmol/L, while diabetics prefer to see a slightly higher level, around 9 mmol/L.

Physical activities raise the allowable upper limit, as exercise lowers blood sugar levels. "During exercise, we are most concerned about low blood sugar, which is more dangerous for athletes, as they could lose consciousness or fall into a hypoglycemic coma," Žiga explains, adding that during exercise, he is content if his blood sugar levels stay between 10 and 11 mmol/L.

Let’s put the numbers in context. For example, just half of 4Energy Bar, which contains 15 grams of carbohydrates, raises blood sugar by one unit. This happens quickly, within 20 minutes, or even faster if the activity is very intense. In such cases, a spike can occur in as little as 10 minutes.

As a result, diabetics constantly have devices with them to measure their blood sugar levels. Žiga also continuously uses an insulin pump, and during cycling, he has a phone mounted on his handlebars, which receives data every 5 minutes from a glucose monitor on his arm, providing him with real-time blood sugar readings.

"During physical activity, I have to monitor my blood sugar levels. I constantly track the amount of sugar in my blood via the monitor. It changes depending on the intensity of the activity and the energy reserves I’ve built up beforehand through nutrition. Even the food I ate 48 hours ago plays a role," he explains.

Everyday Nutritional Adjustments of Diabetics

For a diabetic to successfully manage their condition, dietary adjustments are essential. Certain nutrients must be significantly limited or even completely removed.

As a result, diets like LCHF (low-carb, high-fat) and keto are quite popular among diabetics since both limit the intake of carbohydrates, which have the most aggressive impact on blood sugar spikes.

However, Žiga, who follows a slightly modified version of the LCHF diet, emphasizes that what works for one person might not work for another. Individualization is key, and there’s a lot of trial and error involved in finding what suits you best.

"In the context of diabetes, the focus is on the LCHF diet, meaning 'low-carb, high fat.' I personally advocate for including more protein while definitely reducing carbohydrates. There are many approaches. We’ve learned that our bodies function differently. In the end, each person has to figure out what works for them and which diet makes them feel best."

Carbohydrates are still present in Žiga's diet, particularly around the time of exercise. It is important to fill up glycogen stores during this period, and higher blood sugar levels are less problematic since physical activity will soon bring them down.

"When I’m not burning calories, I consume as few carbohydrates as possible. It's different around workouts — then they’re back on the menu. Otherwise, I try to avoid them or drastically limit their intake in everyday life. As a result, I increase my intake of protein and fats. This helps prevent sudden sugar spikes."

It’s precisely these sugar spikes and the resulting sudden drops that diabetics strive to avoid by regulating their diet. Large fluctuations can throw the body into an abnormal rhythm, leading to unwanted side effects, especially extreme energy swings.

"I constantly try to prevent sugar crashes because when they happen, I fall into a strange rhythm where my blood sugar drops, and I then have to overcompensate. This causes my blood sugar to rise quickly and then drop rapidly again. This is the worst-case scenario for diabetics, and even for a healthy person. It feels like you're constantly in a cycle of being in a good mood, then depressed, back in a good mood, and then depressed again."

The Impact of Diabetes on Athletes

For diabetics, nutrition during exercise is heavily adapted. While sports nutrition mostly focuses on carbohydrates, diabetics cannot consume them in such large quantities, even during physical activity.

The adjustment comes in the form of smaller but more consistent carbohydrate intake, aligned with data from the athlete’s glucose monitor.

"I add very little carbohydrates, but I add them constantly. For example, 10 grams every 15 to 20 minutes. Of course, it depends on blood sugar levels," explains Žiga, who prefers carbohydrates in liquid form, as it allows him the most precise dosing.

"I usually have water in one bottle and 60 grams of carbohydrates in the other. We're talking about a drink with sugar and electrolytes," says the 31-year-old, who primarily relies on Nrgy Unit Drink 90. "I drink it gradually, depending on the activity. If my blood sugar is high, it means I already have enough sugar in my body, and I don't need to take more. In that case, I drink only water. When the sugar levels are low, I start drinking the isotonic drink."

One of the key products for energy intake during exercise for healthy athletes are energy gels. For diabetics, however, these are primarily seen as a backup, as they contain too many carbohydrates to be used regularly.

"I know athletes often consume 30 or 45 grams of carbohydrates at once. I can't afford that because my sugar levels spike too much, which leads to issues like cramps, water retention, and overall poor feeling."

"I use gels only when my blood sugar starts to drop dramatically, and I need a quick energy source. For example, before climbs, I add 20, sometimes up to 25 grams of carbohydrates. If I didn’t add any, my sugar levels would drop by 2 to 3, sometimes even 4 units."

Gradually adding carbohydrates is key to successfully completing a physical activity. Any mistake or moment of carelessness, as Žiga calls them, can lead to problems. While these aren't critical at first, they can bring frustration, as they indicate that a mistake has been made.

He explains that the first symptoms of high blood sugar begin to appear at levels around 10 mmol/L, which is still within the previously mentioned allowable range. However, not all diabetic athletes detect these symptoms, whereas at 13 mmol/L, everyone feels them. These symptoms include cramps, blurred vision, increased fatigue, and a constant feeling of thirst.

Despite all the adjustments diabetes demands in combination with sports, Žiga is convinced that physical activity is beneficial for diabetics: "Sports are good for diabetics, but extreme sports not so much. Aerobic activities are great for sugar control, as they lower blood sugar levels and help regulate it better. You also end up using less insulin," he concludes.

Conclusion

Diabetes requires numerous adjustments, both in everyday life and in sports. Constant monitoring of blood sugar levels demands discipline from individuals, as they must always carry the necessary medical devices with them.

Blood sugar levels fluctuate continuously, and the allowable range is relatively narrow. For a healthy person, this range is between 4 and 7 mmol/L, while a diabetic can allow a rise up to 9 mmol/L. During exercise, the upper limit may be slightly higher, as physical activity will lower blood sugar levels.

Diabetics must significantly adapt their diet. Carbohydrate intake is much smaller, with LCHF and keto diets being particularly popular. While carbohydrates are allowed during physical activity, they must be consumed in small, regular amounts. For instance, even half of an energy bar can cause a significant and rapid change in blood sugar levels.

Nevertheless, physical activity is recommended for diabetics. It helps regulate blood sugar, minimizes fluctuations, and reduces the need for insulin.