Showing the Parallels of Sport and Disease ManagementFriday, February 01, 2013
Mountain biker and diabetes advocate Tony Cervati serves as a role model sharing his diabetes and sporting experiences publicly and showing how doing both are about overcoming the fear and uncertainty associated with any challenges that arise and getting back on the bike when you fall.
By John Parkinson, Clinical Content Coordinator, DiabetesCare.net
It was the first day of the cross-country biking event the Tour Divide back in 2011, and Tony Cervati estimates he was about 30 feet away from the grizzly bear. He was alone on a bridge that spanned over the Spray River in Northwestern Canada—just him, his bike, and the bear.
Cervati was participating in an event that was supposed to take him over 2,700 miles along the Continental Divide that runs from Banff, Canada in the province of Alberta, through the western U.S. and finishing in New Mexico at the Mexican border. And on the first day of the event that he had trained and prepared for years, he was dealing with a life or death scenario.
For the uninitiated, the Tour Divide is truly off-road and the trail contains vast isolated areas with limited cell service for most of the course and long stretches along the trail where other people may not be seen for days. The event is self-supported, so that meant Cervati didn’t have a group of people helping him to make the trek; there was no support car he could retreat to away from the bear.
Cervati, in a precarious and extremely dangerous situation, slowly moved away from the grizzly but in the ensuing escape he fell down a ravine and into the frigid Spray River. He suffered multiple contusions, bruised and fractured ribs, and hypothermia. Cervati couldn`t continue the event.
For most people this harrowing experience would have been enough to say never again; however, this isn`t how Cervati operates.
Cervati is a longtime type 1 veteran who was diagnosed over 36 years ago when he was 8. Back then, Cervati points out, people with diabetes often lived in isolation, not knowing other people with the disease and not talking about it.
The advent of social media combined with the evolution of the diabetes online community (DOC)—in which Cervati is an active member of—have made it easier for people to communicate about the disease.
And Cervati has certainly embraced living openly with diabetes.
In 2005, he started the Type 1 Rider organization. Type 1 Rider was created to lend support and guidance to other athletes who have diabetes and are looking for ways to train for sporting and endurance events. The organization also brings its message of diabetes awareness to the forefront as well.
On his Type 1 Rider site, Cervati posts logs of his mountain biking training, including how long he trains for and his glucose levels. The site has an active blog and supporting social media to blast out events and initiatives going on in the DOC.
Through his blog, he shows that it is ok to literally fall off the bike and overcome the adversity of bad experiences to come back and not let it defeat him. Cervati also serves as a role model for his fiancée, Diane, and her son who has type 1. And so whether it is his own family or with complete strangers, Cervati leads by example to help others see that they can work through their fears and distinctive challenges.
As proof, Cervati went back to Banff for the Tour Divide last year and went through the same area of the course where he had encountered the bear the year before. He overcame his fear and got through that section of the course. Cervati equated his fear and apprehension he felt in going back to Canada to anyone with diabetes when they are initially diagnosed or have their first bad hypoglycemic episode.
DiabetesCare.net recently sat down to talk to Cervati about his disease management, how he got into mountain biking, the Tour Divide, and how he takes things he has learned from diabetes and his sport and shares his lessons with everyone.
DiabetesCare.net: Can you talk about your personal experience with diabetes including when you were diagnosed and what your management is like today?
Cervati: It was a different time in terms of diabetes care as well as the social aspects of the disease.
When I was diagnosed, we used syringes; insulin pumps and blood glucose monitors weren’t around yet.
Before I was able to get my hands on a blood glucose monitor, which happened when I was in high school, I once calculated I had tested my blood sugar 85,000 times. And before I switched to pump therapy, I figured I had taken between 50,000 to 55,000 insulin injections. I also estimated how many units of insulin I have used throughout my lifetime—620,000.
When I was first diagnosed we used to use the gluca sticks that required using urine samples and would change color and you would compare them on a chart.
I have gone from that extreme to now I’m currently on the Omnipod and I use a glucose monitor. I have quite a bit of experience in terms of living with diabetes. I have seen the whole gamut.
DiabetesCare.net: How has your control been through the years?
Cervati: When I first got out of the hospital when I was diagnosed, my parents were hands off in my disease management. It was mine right out of the gate.
My control in the beginning was unknown, and if I had to guess, I bet it wasn’t very good.
As the technology has gotten better, it created a path for me to get better control. And once I started to play sports in high school, control became much more important because there was a direct correlation between my diabetes care and being at my best on the field as an athlete.The only way to truly judge my control has been in the last fifteen years. My highest A1c I have ever had was 6.3 percent. Most of the time my A1c runs between 5.9 to 6.0. I think a lot of that has to do with the training and exercise that I do to be able to race my bike.
Cervati and his fiancée, Diane
DiabetesCare.net: How would you characterize the importance of sports to you growing up?
Cervati: Sports have always been an important part of my life. When I was very young, I played pop warner football and little league baseball. I had a very normal childhood, diabetes not withstanding. And that last part is due to the fact I never thought of diabetes being in the front of my mind for anything.
Back then, you didn’t have Facebook and social support groups. You were pretty much on an island and you dealt with the good and bad by yourself. In fact, the first type 1 person I met was my high school track coach, Ken Mazur. It was super comforting to me to know someone else who had diabetes and was my coach.
You also didn’t think about diabetes back then the way that people do today. I don’t remember carrying fast-acting insulin with me anywhere, or carrying a candy bar or having a juice box. Of course, glucagon was not around either.
DiabetesCare.net: Can you talk about how you got into mountain biking?
Cervati: All through high school I played football and ran track. When I got to college, my fitness started to go by the wayside.
One day when I was on my way to class, I passed by this store that had been closed up for a while, and it had a sign for a grand opening of a bicycle shop that was going in the space. I’m not really sure what clicked in my head, but I was like, ‘yeah, that’s what I need to do.’ I was in there the next day and I picked up a mountain bike and I just started riding it all time. That was in the late 80s and I have been hooked ever since.
Shortly after college, I moved down here to Chapel Hill, North Carolina, and there is a huge cycling community here. And this where I found out about and got into competitive mountain biking. At that point, it became a matter of controlling my diabetes to get stronger, lighter, and build more endurance while racing.
DiabetesCare.net: Can you talk about why you decided to start Type 1 Rider?
Cervati: I had been doing some mountain bike racing for a while, and I had heard there were some mountain bike races that last for 24 hours. Most people do it in teams and it’s done on a closed course. The teams use chips or batons, and the team that completes the most laps in that 24 hour period wins. Somebody I know did this event solo, and to me it seemed like the ultimate challenge.
I tried doing one of these events with another person. Unfortunately, I ran hypo almost the entire time of the race. It was a complete failure and I think we finished dead last.
During the ride back to Chapel Hill, I was super frustrated with myself, but I also decided I was going to do one of these 24 hour races solo. I remember saying, ‘I don’t how I’m going to do it, but I’m going to figure it out.’
With that, the mission was set: become the first type 1 person to do a 24 hour bike event solo.
I started working with Joe Largay at the University of North Carolina Diabetes Care Center. Joe is a physician assistant and diabetes educator who is part of John Buse’s practice in Chapel Hill. Dr. Buse told me I needed to switch to a pump and I sought out Joe because I knew he was a cyclist who was type 1 himself.
When Joe and I sat down to talk he said that there was no real data showing a type 1 person doing a race that long before, so we started working together in figuring out how to do this.
We started looking at things like what types of basal rates we needed and how many carbohydrates do I need to take in? How does it change from hour 4 to hour 8?
We were working on that up until a couple of months prior to my first 24 hour solo race, and I was nominated for a Lifescan athletic achievement award for my work with Joe in trying to calculate for this event.
I went to the awards ceremony and while I didn’t win I listened to others who were nominated and how they were working out the challenges of their individual projects. Later that evening while I was thinking about everything, I said to myself, `I don’t have a plan but I ride bikes.` And at that point, Type 1 Rider popped into my head.
I began Type 1 Rider by simply putting my logs in about what I was eating, my basal rates, how long I was riding—that kind of data—and I was sending it to to Joe. In a couple of weeks, we must of got picked up in a search engine and I started getting emails from people who were trying to do the same thing.
Type 1 Rider grew from that.
DiabetesCare.net: Can you talk about your Tour Divide experiences?
Cervati: In 2011, I was the first person with diabetes to attempt that race, and I didn’t finish. Last year I attempted it again, but didn’t finish because of an injury.
I had trained with a handful of people, and we had done two years of preparation. There is a lot to doing a race of that length—completely isolated and self-supported for someone with diabetes.
You carry everything from your tent to your clothes to your diabetes supplies to your bike parts.
You can start the Tour Divide anytime you want; you wear a transponder that marks your position via satellite.
Only about 10 to 12 percent of the course is covered in cell phone service, so you are in some of the most remote regions of North America and at elevations of 12,000 feet.
And in addition, you ride through one of the most densely populated areas of grizzly bears in North America.
On the first day, I started by myself, and about 45 miles in and right over a bridge next to the Spray river up in Canada, I literally ran into a grizzly bear. I fell into the Spray River trying to walk away from the bear. The fall into the river was 12 to 14 feet and I was sucked down the river. The water temperature was approximately 41 degrees Fahrenheit/5 degrees Celsius.
Cervati at the start of the 2011 Tour Divide in Banff, Canada. Cervati`s broken foot he suffered in last year`s Divide.
My first year (2011), my goal was New Mexico or fail and it took a long time to get over not finishing. It almost ended Type 1 Rider right there, because I was so disgusted with myself and cycling.
Yet, I had a lot of support from the diabetes online community. And I had unwavering support from my fiancée, Diane, to go do it again.
The second year my goals changed. The big overall goal was to make it to New Mexico, but I also had other smaller, important goals. For one, I was terrified because I was in a life threatening situation in 2011 where I didn’t think I was coming back, so I wanted to get to Canada first.
Another one of my goals in 2012 was to cross the border in two days, and I did that. However, I broke my foot and had high and low ankle sprains on the end of day one. I rode for five days like that and got all the way down into Montana, but I could not get my foot in my cycling shoe and my ankle was so swollen. And that point I knew there was nothing I could do.
I never used the word failure to describe 2012 like I did for 2011. The 2012 Tour Divide was the greatest race of my life. I had a lot of personal victories on the ride. Just getting past the site of where I met the bear, I knew it could be done. I covered the mileage from Banff, Canada to the U.S. border in two days.
And in 2012, getting past that bridge over the Spray River, I had to go over that same area again. It’s like getting over your first hypoglycemic incident or when you are first diagnosed. That is how I looked at it, so all of those little victories were huge to me.
Crossing the U.S. border, I rode through customs on a bicycle fully loaded with my gear—not many people can say that. Only about 200 people have ever attempted this race. It really does parallel a lot of things you do with diabetes on a daily basis.
If you know anything about me, you know I do not back down from any challenge ever. And that is what living life with diabetes is all about—for everyone. Whether you are cycling across North America or trying to get your A1c below 9, it’s a challenge.
Tour Divide and myself—there is some unfinished business there.
Someday when the timing is right, everyone is back onboard, and we have the ability to train, I’ll go back and try it again.
I’m certainly not going to sit on my couch; I`ve got some bike racing to do this year!
This is the first installment of a two-part interview with Cervati. Look for the second portion of the interview to appear next Friday, February 8.