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Bearing the Olympic Torch for Diabetes Awareness Posted 08/12/2004

Anne Peters Harmel, MD

Figure 1
Our patients often teach us more than we could ever teach them. Gary Hall, Jr, an 8-time Olympic medal winner, is one such patient (Figure 1). I was with him when he won 4 of those medals, and I am heading to Athens to see if he can win more. This is the first in a series of reports as I start my journey to the birthplace of the modern Olympics; in this report I will recount my past 6 years as the physician on the team of an elite athlete.

The Olympics are in Gary's blood. His father, Gary Hall, Sr, is a 3-time Olympian, and an uncle on his mother's side was on an Olympic team. All swimmers are built with long, lean muscles, but Gary also has some extra fast-twitch muscle mass that makes him a fantastic sprinter. His best race, the 50-meter freestyle sprint, is, as he puts it, the classic race that every kid who leaps into the water with his best friend and challenges "race you to the other side" is talking about. The event is a lightning-fast flash of 8 men springing into graceful action, leaping from the starting blocks, and churning through the water, hearts beating, lungs breaking, racing until they hit the wall. The difference between winning and losing is measured in hundredths of a second. It is hard to tell who wins from watching; only the electronic scoreboard knows for sure.

Gary won 2 gold medals and 2 silver medals in the 1996 Atlanta Olympics. But he came in second in his 2 individual events, the 50- and 100-meter freestyle, with Russian swimmer Alexander Popov going home with the gold medals. Gary was absolutely determined to beat him in 2000. But in 1998, as he'd tapered off training a bit, he developed symptoms of polyuria, polydipsia, and blurred vision. His father, an ophthalmologist, found nothing wrong with his eyes but knew the symptoms of diabetes all too well. Gary's blood sugar was over 500, and at age 24 he was found to have type 1 diabetes.

He went to see his family doctor and then saw several more physicians. All said the same thing: "You can't compete at an Olympic level with type 1 realistic and give it up." Gary, dejected, left for a long vacation in Costa Rica with his fiancee Elizabeth Peterson (they are now married), a glucose meter, and a fistful of rapid-acting insulin pens. He learned, on his own, how to adjust his insulin for his exercise and diet; as an athlete he already understood the link between nutrition and performance and was quite in-tune with his body and its metabolic needs.

When he returned from Costa Rica, his father referred him to me for another opinion. Gary showed up late (his flight had been delayed) with Elizabeth. I had to race across town to give a noontime lecture at a local hospital and crammed them (both over 6 feet tall) into my bright-red Volkswagen Beetle and interviewed Gary as I drove. I felt a little lost discussing swimming (which I knew nothing about), but I did learn that Gary really wanted to swim and, even more important, that he wanted to help other people with diabetes by being a role model. I have never had a patient with new-onset diabetes who really cared about reaching out to others even as he was struggling himself. It was this fact, more than anything else, that made me say at the end of the day, "I don't see any reason why you can't train for the Olympics; let's see if we can work on this together."

In hindsight, I think his prior physicians said "no" to Gary because diabetes is a defect in providing normal fuel transport to muscle. It is more than glucose -- it involves fat and protein metabolism and it is very, very hard to find the right balance using exogenous insulin. Sure, people with diabetes can swim, and even compete, but at an Olympic level where fractions of seconds matter? That's a different realm entirely. And how could a physician guarantee that Gary's diabetes could be so well controlled that it wouldn't interfere with his racing performance? I think I was naive in saying "yes." I am very glad that I did.

Figure 2
I flew up to Berkeley, California, where Gary was training. I met with his coach, Mike Bottom, who is an amazing person and incredibly supportive of Gary. I taught Mike about diabetes, and how to watch for low blood sugar reactions. (I was worried that during intense training periods Gary might not be able to differentiate between the catecholamine surge of racing and the one that comes from hypoglycemia). I had Gary test his sugars before and after various intervals of training and types of nutritional supplementation (Figure 2). I wrote a list of ideal fuels for Gary to eat while training, and we found them in Platinum Bars (invented by a veterinarian to help racehorses heal after surgery). I got to know Gary, and he got to know and trust me.

Gary started to do well. Six months after his diagnosis, he'd rebuilt enough muscle mass to set a record at the Nationals. He was learning to compete with diabetes. I went with him to as many meets as I could, learning about swimming and the physiology of glucose metabolism and exercise. I went with him to Indianapolis, where the 2000 Olympic Trials were held, and (for the first time in my life) found myself screaming support from the stands as Gary blew away the competition and qualified for the Olympics. No one thought he had it in him to come back, but they didn't know Gary. What he was doing wasn't easy, but it was possible.

Next was the Olympics in Sydney. Although I had just changed jobs and was busy trying to start 2 diabetes centers, I agreed to travel with Gary, and brought my 9-year-old son Max. But before anyone starts looking to become a doctor for an Olympic athlete, realize that everything I did I paid for myself. All of the trips -- Berkeley, Indianapolis, Sydney -- and the time away from work were donated because I believed that Gary would help others live their dreams. It was my own odd contribution to help people with diabetes, and I've never regretted it. Gary has helped hundreds of children with diabetes believe in themselves and in their futures. He has given back the time and expenses I have donated a hundred times over.

Sydney was tough. Gary got sick from the flight and couldn't get his blood sugars below 400 in the days before the first race. He needed 3 days with normal blood sugar levels to store enough muscle glycogen to be in peak competitive form. It was only 12 hours before his first event, the 4 x 100 freestyle relay, that his diabetes became manageable. Unfortunately, this race had a lot of media attention because it pitted the home team, the Aussies (with superstar Ian Thorpe), against the US men. In recent times, the US team has nearly always won this race. Gary swam last, the final leg. The first 3 swimmers had let him down, and he dove into the pool with Ian Thorpe leading. Gary, with his amazing strength, pulled ahead of Ian in the first half of the race. He was ahead after the turn, and it looked as if he was going to win it for Team USA. But suddenly, in the last 25 meters, he began to slow; he looked like he had run out of gas. He struggled gallantly to maintain his speed, but Ian Thorpe pulled ahead, passed him, and won the race. I was crestfallen. It looked to me that his diabetes had gotten the best of him. The days of insulin resistance and hyperglycemia had made it impossible to prepare him adequately for Olympic competition. The other doctors had been right, after all...I felt awful.

Gary never once used his diabetes as an excuse. He accepted his silver medal graciously, and then, in true Gary form, went on to win the bronze medal in the 100-meter freestyle event (which no one thought he had a chance of winning a medal in at all). And he achieved his dream of winning the gold in the 50-meter freestyle race. I have never cheered so loudly or cried so much at an athletic event. It was absolutely fantastic to be there with him.

So here I am again. Gary has made it to his third Olympics. At 29, he is the oldest swimmer in decades to be competing, and he and his father are the only father/son pair to both compete in 3 Olympics. Gary is, in many ways, stronger than ever, but his diabetes is also tougher to manage than ever. I will be reporting back from the Athens Olympics as I, part of Team Gary, help work with him to bear the torch of hope for the millions of people with diabetes who need to know that, with a little work, they can live their dreams (Figure 3).

Figure 3

Olympics Dispatch I: August 15, 2004
Posted 08/17/2004

Medscape Diabetes & Endocrinology 6(2), 2004. 2004 Medscape