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From Couch Potato to IRONMAN: How I Did it – With Type 1 Diabetes

Casey Boren by the ocean pre-race alt
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My First Tri

When I was growing up, my parents owned a running store, and I swore I’d never be a runner. Call it rebellion.

Instead, I grew up, got married and was running computer systems for Starbucks. Then, in September of 2003, when I was 33, my wife’s brother and sister and some friends came out to Seattle to do a fun little mini-triathlon. They weren’t extreme athletes by a longshot: This was just a half-mile swim, a 15-mile bike ride, and a 5K run, which is about 3.2 miles.

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Of course, at that point in life, my favorite activity was pretty much watching ESPN. But these guys were so enthusiastic about this race, and they kept encouraging me to do it with them. I actually don’t quite know how it all happened. They were like “Come on, man, you can do it!” And I was like, “I haven’t trained!” A few hours (and a few beers) later, they had me convinced.

When I say I was unprepared, I’m not kidding: I didn’t even own a bike. Well, strike that: I had a cute, little hipster-cruiser bike. I didn’t have running shoes – just cross-trainers. I had no idea what I was getting into.

Race day dawned, and I started strong. I beat them all in the swimming segment. Then it was time to get on the bikes, and suddenly I realized I hadn’t paced myself wisely. I actually threw up on my bike.

I might have stopped, but just then, after horking up my breakfast, my brother-in-law passed me and yelled, “Come on, man! Keep going!” So I did. I mean, I finished last in our group, but I did finish.

Becoming a True Triathlete

After that first race, I was hooked. I officially joined a triathlon training group, and the coach’s wife talked me and another guy in the group into anteing up for an IRONMAN competition: Mind you, that’s a 2.4-mile swim, a 112-mile bike ride and a marathon.

“Man,” I remember thinking. “This is out of your wheelhouse.” And it was a far cry from my former existence, but I began training in earnest.

At the same time, my wife and I were considering relocating from Seattle to her hometown of Boise, Idaho. “If you find a great job in Boise, I’ll move,” I told her. I never thought she would. But she did, and I’d given her my word, so it was off to Idaho for us.

That was scary for me. I was training for my first IRONMAN, and I wasn’t an endurance athlete. I needed guidance to understand what was happening to my body. But I was able to hook up with a community online and successfully trained for IRONMAN Coeur D’Alene. By now, I was 35 years old, and my body had changed completely: I’m 6’4”, and I’d gone from 197 to 150 pounds.

When I finished my first IRONMAN with a time of 13 hours, I was ecstatic.

Shortly after that, my body hit the wall. I lost more weight and felt totally lethargic, as if I couldn’t recover. I was so hooked, I wanted to start training for another race immediately, but my coach saw how run-down I was. “Take a month,” he said, “and don’t work out more than 30 minutes a day.”

With all that downtime, I Googled my symptoms, and everything was coming up cancer.

A Surprise Diagnosis

Finally, I went to a doctor, and after all the tests were in, he sat me down. “You have Type 1 Diabetes” he told me. That was the kind of diabetes, he explained, that they used to call juvenile diabetes. It’s not caused by lifestyle issues, but simply your body not producing enough insulin.

“Great,” I said. “That’s not cancer! Give me a pill and let’s get on with it.”

“It’s not that kind of diabetes,” he said, seriously.

“Well, I’m not really a ‘shot guy,’” I retorted.

And I’ll always remember his response: “You are now,” he said.

When people think of diabetes, they generally think of Type 2 diabetes, which can often be controlled by diet because the body does produce insulin, in limited amounts. In Type 1 diabetes, your body isn’t producing the insulin; basically, your beta cells are attacking the insulin that is produced, so you don’t get any. You have no option but to cover the carbs you eat with injected insulin. Typically, that means a shot three to five times a day.

If you don’t do that, your body will inevitably start to break down, and you’ll be hospitalized with complications: Damage to your cardiovascular system, painful nerve damage, kidney damage, blindness – it’s awful. You do not have the option to not manage this disease, and the better you manage it, the longer you can stay healthy.

So I met with an endocrinologist and told him I wanted to manage my disease, but I wasn’t about to change my lifestyle. “I’m going to do this IRONMAN,” I said. “So what are my options?”

Through him, I learned I had the option of using a pump. In other words, instead of giving myself several shots per day, I could hook this up to my body and set it to release small doses of insulin. There is a little needle that you put just under your skin with the help of a plastic spring-loaded inserter and attach with a round Band-Aid kind of thing. That attaches to a tube that goes into the pump, which slowly releases insulin into your system according to a schedule you set.

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I use the Animas® Vibe® pump. I call it “life-ready” – it’s waterproof, so I can wear it swimming, and it has a color screen, so I can easily read my blood-sugar levels and how much insulin is left in the pump. It also has a vibrating alarm that alerts me when my blood sugar has gone outside of the parameters I’ve set.

Meanwhile, on my upper glute, I also attach a sensor for continuous glucose monitoring – a Dexcom G4®. This tests my blood sugar continuously, just like it says, and sends that information wirelessly to the pump, so I can see the data in real time, how my body reacted to my activity and to the food I ate, confirm the reading with a fingerstick test, and adjust the pump if I need to.

But if I can tell diabetic athletes – or people with diabetes hoping to be athletes – one thing, it’s that you have to take charge of your management of this disease. When I started, I would check my blood-glucose levels, run a mile, check my blood again, write it down. I wanted to see how running affected that number: Did it push me into a dangerously low zone? You have to know what’s going on with your body.

And you can’t let this disease stop you. There’s just not a lot of research out there about diabetes and sports, and that’s scary for a lot of people. I wanted to lead by example and show the world that it’s possible to manage your body and achieve your dreams. And I wanted to help others do it, too.

The Diabetes Sports Project is Born

I began to train with other diabetic athletes through organizations that seemed to quickly fade away; none of them are around anymore, so I decided to found my own. I ended up with nine other athletes, and our vision was of an organization where we would run races and compete to provide inspiration.

But once people are inspired, what do they do with it? Next we started free training plans designed to get you off the couch and chasing your dreams – to help people take the practical steps they need to manage this disease and live a more active lifestyle.

The Diabetes Sports Project has just come together in recent months. In fact, the URL isn’t up yet – it’s launching October 10 (, but you can “like” the Facebook page for now.

The other athletes on the team work full-time and still work out and compete at a high level because they love it. This is when we get to unplug from work, talk to friends. People think that we’re these superhero, Greek-god kind of athletes – that’s just not true.
I love running, I love riding, and I have learned to love swimming. What the diabetes has taught me is that if you love something, you can make it happen regardless of your own personal obstacles.

Every year since that first IRONMAN, I’ve done one or two full IRONMANs and finally worked my way to getting a legacy spot for Hawaii, which is the world championship. There are two ways to get there: Win your age group – in 2009, I missed it by six spots – and the other is to do a dozen IRONMANs. I tried for that spot every year, and now I’ve qualified for this legacy spot, and I would not have traded this for any of those other years. This is the right year for me to do this IRONMAN.

Now I look at those pictures of the guy in 2003: He never would have thought he could run across America, complete 13 IRONMANs – he didn’t even know he had this dream. He just had that cruiser bike. Once you start living an active lifestyle, you have no idea where it’s going to take you. That’s what I want to get across to people: Whether you have this disease or not, you can live life to the fullest. And the only goal you should have is that: To experience your journey.

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