Contributor: Dr. Rita Kalyani

The following is adapted from Winning with Diabetes: Inspiring Stories from Athletes to Help You Thrive by Dr. Mark Corriere, Dr. Rita Kalyani, and Patrick Smith.

WHEN PEOPLE WHO HAVE type 1 diabetes are diagnosed as children, often parents and other family members have an active role in helping them to take care of their disease. But what about people diagnosed during adulthood? Who helps them learn how to interpret their glucose numbers? Or inject themselves with insulin? Or cook the right meals? Even many health-conscious people report that they learned diabetes self-care largely on their own.

“I was diagnosed on a Friday,” recalls Monique Hanley, an Australian cyclist and an advocate for women’s sports in her country. She got the news from her doctor while she was a 19-year-old college student. “They showed me how to give myself injections and then they sent me home.”

She had just finished her rookie season in Australia’s women’s professional basketball league and was looking forward to a university semester abroad when she visited her doctor. The sophomore point guard was a few months from leaving for an exchange year at Ryerson University in Toronto, where she would study and play for the school’s basketball team.

“When the doctor sat me down and told me I had diabetes, the first thing that came into my head was ‘But I’m going to Canada. Are people with diabetes allowed to travel?’ ”

Her physician assured her that travel and athletics would be fine; but that’s where her diabetes education ended.

The day after learning she would live the rest of her life with diabetes and started treatment for diabetes, Hanley played a game of netball, a modified version of basketball popular in Commonwealth nations. In Australia, it’s common for teams from rural towns to play one another in informal weekend pickup netball games. After an especially productive first half, it was time for one of Hanley’s first-ever finger sticks to check her blood sugar.

“I hadn’t told anyone about my diagnosis,” she recalls. “I mean, I didn’t know what to tell them. I felt like a failure. Or like I was impure or something.”

“So, at halftime, I thought I’d check my sugar in my car, away from all the other players.”

She followed the directions she’d learned at her doctor’s office the day before. Hanley pricked her finger, got a blood sample, and tested her sugar. Her glucose level was 6.0 mmol/L, or 106 mg/dl. It’s one thing to have accurate data from blood glucose test. But it’s another thing to know what to do as a result.

“I remember looking at the number and thinking I have no idea what to do with that information,” she says. “The moment overwhelmed me.”

Disoriented and afraid, Hanley got out of her car and told her coach she couldn’t play the second half.

“The team was a bit flabbergasted because I’d been having a blinder of a game,” she says, using an expression that translates, roughly, to “on a roll.” She gave the coach her jersey, apologized, and returned to her car.

“I just sat there, in the car. I didn’t know what to do or who to talk to.”

Like many people whose type 1 diabetes develops during adulthood, Hanley’s early management of the disease was hit or miss. Her exchange student–athlete adventure in Canada presented some challenges far from home.

“I learned by process of failure,” she says with a laugh. “First, I lost my finger-pricker somewhere over there. I’d say that, in Canada, I learned a lot of life skills about how to survive diabetes when things go wrong.”

Hanley recalls a Caribbean island trip with her teammates that turned into a hunt for the type of insulin needed before meals. Her Ryerson University team had a week-long training camp in Barbados shortly before the season opened.

“And I didn’t pack enough insulin,” she says. “A few days into the trip, I was like, ‘I don’t have any short-acting insulin left.’ I ended up going to pharmacies and hospitals, looking all over for some,” in a country where she had no prescription.

Her search proved futile.

“I didn’t know what to do,” Hanley says. “The short answer, though, is I just didn’t eat much for the last few days and I just kept using my long-acting insulin until the trip back to Toronto.”

Hanley’s basketball talent carried her through the season in Canada. But a return to professional basketball proved trickier.

Managing the pressure of playing professionally, while still learning how diabetes affected her body and her performance, lessened much of Hanley’s enthusiasm for basketball.

Despite her role as starting point guard, Hanley’s fire for the sport was diminishing along with her energy. A few weeks before the start of the season, Hanley decided she was done with basketball. She says her team’s indifference toward her diabetes factored heavily in her decision to say goodbye to the sport she’d played since childhood.

“I didn’t get much support from coaches or teammates. I thought, ‘That’s it. I’m done,’ ” she says. “I just decided I didn’t want to do it anymore.”

Freed from the rigors and inflexibility of team sports, and because inactivity wasn’t part of her plans, Hanley searched for a new athletic pursuit. It turned out she didn’t need to look far.

Hanley had always loved riding a bicycle. But she’d never considered riding competitively, even though her hometown is a hotbed of competitive cycling.

Soon, Hanley became not only a competitive cyclist but also an advocate, both for women’s cycling in general and for athletes who have type 1 diabetes.

She founded and led an organization dedicated to making the sport of cycling more welcoming to women. And she founded and led another organization to encourage people with diabetes to stay active and pursue their own athletic dreams.

Hanley’s cycling achievements are astounding. She rode across Canada. She was the only woman on a team of racers that won a race across the United States, setting a new course record. And in 2003, she “chased” the Tour de France, following the famous race on her own bike, carrying with her only a tent, a sleeping bag, and her diabetes supplies.

Expert Commentary
With a new diagnosis of diabetes, it is not uncommon to feel overwhelmed. Not only are there lifestyle changes but adapting to daily finger sticks and taking medications regularly (particularly frequent insulin injections) can be daunting. For many individuals, it comes down to figuring out what works best through trial and error, such as determining which glucose level is optimal for them before starting exercise to prevent unexpected drops. At times, it may seem that even with the same daily routine the glucose levels fluctuate unexpectedly, and it is not uncommon to feel a lack of control. Good self-care in diabetes includes recognizing that some days will be better than others. The more educated an individual is about their disease, such as understanding what the numbers mean and setting realistic goals, the more empowered and motivated they may be to manage their disease at home. There are many diabetes self-management resources available. Difficulties are sure to arise but being able to effectively problem-solve and maintain a positive attitude are imperative.

---

Dr. Rita Kalyani is an Associate Professor of Medicine at Johns Hopkins University School of Medicine in the Division of Endocrinology, Diabetes & Metabolism and a nationally recognized thought leader, researcher, and clinician in diabetes who is actively involved in diabetes education and public awareness initiatives. She previously served as a member of the DiabetesSisters Board of Directors.

Adapted from “Winning with Diabetes: Inspiring Stories from Athletes to Help You Thrive” by Dr. Mark Corriere, Dr. Rita Kalyani, and Patrick Smith. Published by Johns Hopkins University Press © 2023 The Authors. Reprinted by permission of the publisher.