Diabetes Forecast

A Fourth Olympics for Skier Kris Freeman

Cross-country star fine-tunes his diabetes management for Sochi

By Tracey Neithercott , , ,

Kris Freeman during training in St. Ulrich am Pillersee, Austria.

Photographs by Sebastian Stiphout

I feel as confident as I ever have in my diabetes management.
Kris Freeman, Olympic skier

It’s a crisp October afternoon in Putney, Vt., and Olympic cross-country skier Kris Freeman has already completed the first of his two daily workouts. He’s staying at the home of ski technician and coach Zach Caldwell, pushing his body to get faster, stronger, better before the winter ski season kicks into gear. This morning, Freeman beat Noah Hoffman, another Olympian, by a minute in a 9-mile roller-ski race. When we’re done talking, he’ll be ready to sweat for 7 or 8 more miles.

And that’s an easy day. Yesterday morning, Freeman spent two hours running up New Hampshire’s Mount Moosilauke, then strapped on roller skis (short skis with Rollerblade-type wheels) for a 24-mile afternoon workout. His usual routine is no less taxing: Freeman’s summer training schedule has him working out practically every day with feats such as 20 (and often more) miles of running over mountains, followed by sprints in a kayak; 60 or more miles of roller skiing; shorter roller-ski jaunts followed by swimming; and 30-mile runs that cross six mountains. That adds up to about 900 hours of aerobic exercise each year.

Freeman’s not a masochist but an athlete with one, globe-sized goal in mind: competing in this month’s 2014 Winter Olympics in Sochi, Russia. He was among 14 men and women picked on January 22 for the U.S. cross-country ski team—and one of three four-time Olympians on the squad.

Watershed Moments

Freeman grew up with both feet in the snow. His parents, cross-country skiers themselves, involved him in the sport before he could say the word “ski.” “I was pulled behind them in a sled when I was a baby,” Freeman says. “I started [skiing] when I could stand up.” By age 5, Freeman was competing in his first race and working with a private ski coach. By 19, he’d won junior national races and competed at the junior world championships three times.

That year marked two major milestones for Freeman, now 33: He was invited by the U.S. Ski Team to train full-time in Park City, Utah. And he was diagnosed with type 1 diabetes.

“Did my dreams falter?” Freeman asks. “No. But I was very confused about what it all meant.” Straddling the line between adolescence and adulthood, on his own for the first time, and finally realizing his lifelong dream, Freeman was suddenly saddled with an unfamiliar body—one he wasn’t positive could compete at the Olympic level in an endurance event. He was supposed to be at the top of his game, training for the biggest sporting event in the world, but he was forced to learn blood glucose management—at 7,000 feet and while maintaining a rigorous training schedule.

“The way to not be terrified was to learn as much as I could about [diabetes],” says Freeman, who studied the way food and insulin affect blood glucose. After the exertion of a 9-mile race jacked up his blood glucose to 300 mg/dl, Freeman realized he needed to scrutinize his body like a scientist conducting research. “That was the first of many trips to the U.S. Ski Team treadmill to see how my body reacts.”

Freeman’s hours of self-evaluation paid off: He’s won 15 national championships and twice placed fourth during world championships. Last fall, he placed 13th out of 110 participants in a 10-kilometer (6.2-mile) freestyle race in St. Ulrich am Pillersee, Austria.

Exercising the Mind

Talking to Kris Freeman about his training plans is like listening to a passionate professor. He explains how aerobic exercise (when oxygen fuels the muscles) lowers his blood glucose while anaerobic exercise (intense movement in which the body doesn’t use oxygen to produce energy) sends it soaring. He talks about the connection between his blood glucose levels and lactate buildup from the breakdown of glucose in his muscles, and what happens when the body goes into oxygen debt. He uses phrases such as “[I] eradicated my body’s adrenaline.”

 The skier spent the summer and fall applying his know-how to a grueling training program aimed at whipping his body into Olympic shape, fine-tuning not only the physical aspects of his workouts to build strength and endurance but his diabetes management, too. Freeman wears a continuous glucose monitor (CGM), tests his blood glucose three to four times a day, and wears an insulin pump.

Freeman’s learned, for instance, that when competing at altitudes higher than 5,000 feet, he requires 20 percent more insulin than at sea level. Training and competitions have taught him to adjust his insulin based on the racecourse. When skiing for 30 kilometers (almost 19 miles), he reduces how much insulin he uses, cutting his basal (background insulin) rate by 20 percent. For 50-kilometer (31-mile) events, he drops his basal rate by 30 to 40 percent. But for short races (9 miles), in which he skies at a high intensity, he triples his basal rate to combat the spike in his blood glucose caused by stress hormones and the glucose release by his liver. (We’re fascinated by the detail of Freeman’s regimen, but don’t try to duplicate it—it’s special, personalized therapy for this full-time athlete.)

When training, Freeman’s insulin doses may differ daily. Today, for instance, thanks to his high-intensity race with Hoffman, he’ll need only 18 units of insulin, yet yesterday he required 21. Constantly tweaking his insulin helps Freeman account for the ups and downs in his training schedule: one easy day, three strenuous days, and one day off. “Training absolutely makes me more sensitive to insulin,” he says, but notes that it only takes a single day off for his insulin sensitivity to drop. “Thirty-six hours seems to be the magic hour.” That’s why, the morning after a full day’s rest, Freeman doses about 40 percent more insulin than usual.

Freeman’s views on nutrition are also based on thorough analysis: It’s fuel, plain and simple. He doesn’t eat more than he burns and packs in more carbohydrate during higher-intensity or longer workouts to compensate for the glucose he burns.

He eats most of his carbs during training, which may translate to between 40 and 60 grams of carb (he likes energy bars) over a two-hour span. On a typical training day, he might eat a couple of eggs with lunchmeat, veggies, and cottage cheese for breakfast; a turkey wrap with carrot sticks and hummus for lunch; and chicken breast with vegetables for dinner.

Freeman’s laser focus on his blood glucose may seem obsessive, but staying in peak condition is a requirement of his pro-skier career—and a necessity if he wants to medal at the Olympics. So he does all he can, now, to make sure he’s as prepared as possible for race day because then, in front of the crowds and competitors, all bets are off. “I can test and I have tested over and over again the physiological response of working as hard as I can for two hours,” he says. “The race stress? You can’t mimic that.”

Thrill of the Game

When the spectators are crowing with excitement and the stakes are high and your heart beats faster, stress and adrenaline can raise blood glucose and knock you off your game.

That’s why Freeman arrives at the course prepared. He checks his CGM often before the race—the trend arrows that indicate whether his glucose is rising or falling, and how fast, are useful—and does five or six finger-stick blood glucose tests to make sure his blood glucose is right where he wants it: slightly elevated to account for the exercise-induced drop he’ll usually experience as the race gets going. He wears his pump during the race, a patch pump that prevents insulin from freezing by sticking directly to warm skin. And he plots, meticulously so, the number of times he’ll need to “feed” (that is, grab a source of glucose, typically a sports drink, from a waiting coach) during long races and how the glucose he’ll consume will affect his pump basal rate. He says he’s been seriously hypoglycemic during a race only twice—the last time was in 2010, at the Vancouver Winter Olympics.

“The Olympics is unlike any other event. The scrutiny’s different,” he says. “I didn’t adapt well to the stress of the environment.” He’d started the 30-kilometer race with high blood glucose, most likely from adrenaline, and faced a choice: risk his performance by skiing with high glucose levels, hoping they would drop as he worked out, or dose more insulin. “I was all in. I was going for the medal, and I didn’t want to finish 12th,” Freeman says. “I wanted it all.”

Increasing his basal rate led to low blood glucose later in the race and cost him time during the competition, though he finished the race. He wasn’t so successful in the next event. Skiing at full throttle so taxed Freeman’s body that his coaches pulled him out of the 50-kilometer race at the 20-kilometer mark. The cost to his body was more than a night of exhaustion.

For two months after the Olympics, Freeman fought chronic fatigue. “I’d go out and try to train, and my body wouldn’t work,” he says. The experience hammered home the importance of understanding his body’s potential—and limits. Should he face the same quandary in another competition, Freeman says he now knows how he’ll adjust insulin. And, in an attempt to prevent future prerace blood glucose spikes caused by excitement, Freeman has added yoga to calm and de-stress.

For the Record

Get Kris Freeman talking about skiing and he buzzes with an energy you wouldn’t expect from a man who spent the morning sweating more than many Americans sweat in a week. The same passion laces his voice when he speaks about his work with children. He’s visited more than 100 diabetes camps in the nine years he’s been making the rounds on behalf of insulin maker Eli Lilly.

“The first messages I got when I got diagnosed were so negative: You’re not going to be an Olympian. Getting laughed at when [I said], ‘I want to be an Olympian,’ ” he says. “A lot of people are stuck in the past about what it means to have diabetes. [I’ll see] mothers in tears because they’d been getting the wrong message.”

During his time at camps, Freeman shares his ups and downs as a professional athlete with diabetes, urging kids to go for their goals and setting the record straight: “[Having diabetes is] certainly not anything to be ashamed of,” he says. “I try to get that message out when I can.”

Sochi Dreams

The United States doesn’t have the greatest history when it comes to Olympic gold in cross-country skiing events. The last time the country won a medal in the sport (in 1976, when Bill Koch took home the silver) was before Freeman was born. “In 2006, I was really the only realistic chance of getting a medal,” he says.

This year, the country boasts a strong roster of capable Olympians. Freeman has faith that his blood glucose control will be better this time around. “I feel pretty confident in my fitness,” he says. “I feel as confident as I ever have in my diabetes management.” And despite his underwhelming run at the 2010 Olympics, Freeman is still at the top of his game: He’s the current 50-kilometer national champion of cross-country skiing. 

With the 2014 games fast approaching, Freeman is keeping both his ski career and his unoffical role model status in the front of his mind. “I am honored and excited to represent the U.S. at my fourth Olympic games,” he says. “I hope to reach my full potential in my Olympic races and to represent the diabetic community and myself the best that I can.”



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