Living the Olympic dream with diabetes

Participating in the Olympic Games is the crowning achievement of an athlete’s career. Over 11,300 athletes from more than 200 countries are currently competing, across 50 disciplines, for a coveted gold, silver or bronze medal at the Tokyo 2020 Olympic Games.

Living with diabetes is no obstacle to competing at the highest level. The Croatian delegation in Tokyo features two athletes living with type 1 diabetes – Kristina Tomić and Ivan Marcelić. Kristina has been living with the condition since 2019 and represents Croatia in women’s Taekwondo (<49kg weight category), while Ivan was diagnosed in 2005 and is a member of the Croatian men’s water polo team.

Just before Tokyo 2020 got underway, Ines Jakopanec and Ana Špoljarić, from the Zagreb Diabetic Association, spoke with Kristina and Ivan about life with diabetes and how they manage their condition ahead of a big competition.

The content below has been adapted and reproduced with the kind permission of the Zagreb Diabetes Association

Tell us about your trip to Tokyo. Did the time difference affect your blood glucose levels?

Kristina Tomić: The trip went really well. I paid a lot of attention to my blood glucose. There were no major fluctuations. I didn’t eat much and slept a lot. I have to pay attention to my diet to make sure that I stay within the weight limit of my category, so I usually avoid airplane food. I only eat the salad portion and always have my nuts with me. The time difference affected my basal insulin as I wasn’t sure when it was night to give my injection.

Participating in the Olympics, Regional or World Championships is the pinnacle for all athletes. Do you find it challenging to keep your glucose levels within the target range ahead of a big competition?

KT: Anyone who knows about diabetes, particularly people living with the condition, knows how challenging it is to keep blood glucose levels in the target range at all times. Before a big competition, the training gets harder and more demanding. Everything has to be kept in balance – diet, weight, effort. The body is under great strain and is often calorie deficient. For the Olympics, I am coping well because I am very motivated.

Do you bring extra stock of medicines and supplies to competitions and have you ever experienced shortages in the middle of a competition?

Ivan Marcelić: For the Olympics, I brought two packs of short-acting insulin and 6 long-acting insulin pens. These are much more than I need but I always like to take more in case of unexpected events. Anything can go wrong when travelling so it’s better to have extra supplies.

How do your teammates react to your changes in blood glucose during a game or training session?

IM: All my teammates have known about my diabetes for a long time. They can recognise when my blood glucose drops and have juice or chocolates on hand to give me. During a game, our physiotherapist is always ready with electrolytes in case I need them.

When you compete, what do you like your blood glucose level to be at?

KT: 6 or 7 mmol/l (108-126 mg/dl).

IM: Between 8 and 10 mmol/l (144-180 mg/dl) when I enter the pool. The workouts and games are long and strenuous, so I try to avoid using supplements because it’s hard to know how much to take without my blood glucose going too high.

What do you like to eat to raise your blood glucose before a competition?

KT: A banana or protein bar.

IM: A good lunch followed by a rest break work best for me. This helps my blood glucose to be at an optimal level long before a game starts.

When you travel for a competition, what diabetes material do you most often forget to take with you?

KT: Lancets and strips in case something happens to my sensor.

IM: Everything more or less always fits in the same bag, so I always have it with me.

Ivan, you started playing water polo around the time that you were diagnosed with type 1 diabetes at the age of 10. Were you ever advised to stop?

IM: After I was diagnosed, I never doubted that I would have to stop playing water polo. One of the first things my doctor told me was that physical activity was not only recommended, but necessary to manage blood glucose levels. I went back to the pool to train soon after leaving the hospital.

What adjustments have you have had to make as an athlete as a result of your diabetes?

KT: I try to eat as healthy and varied as possible, limiting sweets and drinking a lot of water. I manage my insulin dosage to prevent hypoglycaemia during training and tournaments, since it can make the conditions more difficult than they already are.

IM: I have to monitor my blood glucose levels before, during and after training to avoid complications like hypoglycemia that can lead to loss of consciousness. Other things like looking after myself and my diet are more than welcome. Diabetes simply forces you to live healthier, which is what we should all strive for. In other respects, I am no different from my teammates and the condition has not affected my performance as an athlete.

How challenging is it to stick to your daily routine when travelling to competitions and how do you prepare for them?

IM: Travelling for me is the biggest challenge and the hardest to deal with. The body gets used to a certain rhythm of training, rest and diet, and that all changes when you travel. Each trip is a story in itself. Sometimes we travel by bus, others by plane, and this in itself carries its own challenges and requires preparation. In principle, when I travel I avoid fatty foods, pasta, potatoes and anything that could unnecessarily raise my blood glucose over an extended period.

Has diabetes ever prevented you from achieving your goals as an athlete?

KT: When I was diagnosed, people told me that I would no longer be able to compete at the highest level. I didn’t listen to them and quickly embraced my new way of life, never thinking that I would not be able to continue as a top-level athlete. As long as I feel that I can perform, I will never give up.

IM: Fortunately, never. From day one of my diagnosis, I have had the full support of my family, friends and teammates, coaches, teachers and doctors. I’ve never found myself in a situation where I had to miss out on something because of my condition. Everyone is aware that I have diabetes and it’s never stopped me from training, playing matches and going to competitions. I’ve achieved everything I wanted.

Have your teammates been supportive?

IM: All my teammates and coaches have been supportive and understanding. Most of them were actually interested in learning more about diabetes. It’s great that I’ve been able to inform them so that they know how to react if I, or any other person with diabetes, needs assistance. It’s very important to make your environment aware of your condition. There should be no stigma attached to diabetes. You’re just doing harm to yourself by hiding it.