Triathlete Pushes Limits of What's Possible With Type 1 Diabetes

Evidence-Based Diabetes Management, Patient-Centered Diabetes Care: Putting Theory Into Practice 2014, Volume 20, Issue SP9

A former triathlete and a T1DM patient, Jay Hewitt, was the special guest speaker at the PCDC 2014 meeting.

With Jay Hewitt, appearances can be deceiving. He comes from South Carolina’s western hills, and looks and sounds like the Southern lawyer that he is. But there’s

much more to his story, and Hewitt shared it with the audience that gathered at the reception on the evening of April 10, 2014, at “Patient-Centered Diabetes: Putting Theory Into Practice.”

A former world-class athlete, Hewitt still looks the part, and he surprised the audience when he shared that he was hours away from turning 47. His additional biographical details amazed the audience even further: diagnosed with type 1 diabetes (T1DM) in 1991, at age 23, he took up triathlon after receiving the news. Eventually, he spent 3 years competing around the globe for the United States National Long Course Triathlon Team.

As T1DM patient advocate Amy Tenderich had noted earlier that day, the disease is always part of the picture. Hewitt agreed. A major part of living with diabetes, he said, “is getting the patient to stay with the regimen, because it’s a day-today condition that has to be managed.” Managing T1DM over the 140 miles of an Ironman triathlon, which involves a 2.5-mile swim, a 26.2-mile marathon, and more than 112 miles on a bicycle, is complicated for a person without a chronic condition. For a type 1 diabetic, it’s a dance of multiple blood sugar checks before the race even starts, carefully calibrated nutrition and hydration intake while on the bicycle, and a final push that can sometimes be nothing less than excruciating.

Because of T1DM, Hewitt cannot consume calories as quickly as his competitors, and he typically loses 7 to 8 pounds during a race. He has to balance his insulin intake precisely and says he is often “close to the edge of blowing up.” Sometimes the calculations are off and he cannot finish, Hewitt says, “but other days I get it right, and that is what makes the finish line all that much more exhilarating and satisfying for me.”

Hewitt was candid about his many failed attempts to perfect his routine before the day he finally crossed the finish line. At the 20-mile mark, he saw his coach’s head emerge from the crowd. “He just screamed because he knew how much I wanted it, and he knew how much I had gone through,” Hewitt recalled. “He just yelled out, ‘How bad do you want it?’“

That first finish, in 2002, took 9 hours and 47 minutes. Later, when he was being treated in the medical tent, hooked up to IVs, Hewitt found a connection to the day in 1991 he lay in a hospital bed in the emergency department, being told for the first time that he had diabetes, and that his life was about to change.

“I had nothing left in my body, and I wouldn’t have it any other way,” Hewitt said. “I remember at that point thinking how ironic and wonderful the circle of life is, that on the worst day of my life I was in a hospital bed with an IV in my arm, too weak to stand, with tears in my eyes, and here I was after this race with an IV to rehydrate me, with tears of joy, too weak to stand or lift my head. The circle was now complete.”

Hewitt has raced stand-alone marathons, 3000-mile bicycle races across the United States, and triathlons of shorter distances. Now married with 3 young children, he no longer races full-time, but still travels on behalf of Novo Nordisk to talk about what is possible for a T1DM patient with proper disease management. Some challenges are the same, whether racing or not.

“The questions that I get asked the most are, how do I stay motivated to do something like this, and how I manage my diabetes to do something like this?” Hewitt said. “Many of you are thinking, if I could just get my patients or the people that I am interested in with diabetes to just lead their normal life and manage it with diabetes…that would be a victory.

“You don’t have to do the Ironman in order to live healthy for 23 years with type 1 diabetes, but if I can do that, then people with type 1 or type 2 can do so much more. It doesn’t have to be a handicap. It really can be a source of motivation, because it’s the reason I race.”

Hewitt said he no longer remembers what life was like before his diagnosis, and he takes the accommodations he has to make for T1DM in stride. For example, when getting out of the water after a swim, he has to be careful during the rapid transition to the bicycle not to rip off his continuous glucose monitor. Most other competitors have no such worries.

“I respect my diabetes, but I’m not going to surrender to it. Respecting it means that I’m not going to try to forget it, or just deny it. I’m not living in denial,” he said. “I want to live like I don’t have diabetes, but that is not living in denial. That is living in determination…perhaps a little bit different than normal, but doing it with diabetes.”

Hewitt has figured out the right combination of speed, nutrition, hydration, and insulin to get himself to the finish line in 8.5 to 9 hours, which is a little behind the top finishers but still highly competitive. “I will use every last muscle, fiber, cell, calorie, and follicle in my body to get to the finish line,” he said. “But I always have just enough strength at that finish line to turn around and step on the neck of this disease that was chained to my ankle for 140 miles and say, ‘You are messing with the wrong guy.’"

EBDM

“If you can convey that to somebody who has diabetes, that it doesn’t have to stop you, that in fact it can be something that can help you, you can start eating more healthy, exercising more, and those around you should be doing the same thing.”