Aaron: I believe you are an IndyCar racer, is that correct? Can you tell me about your sport?
Charlie: I race in the IndyCar series and have for 10 years. This will be my eleventh season trying to qualify for the Indianapolis 500. The Indy 500 is the single largest one-day attended sporting event in the world, historically. Obviously we had no fans last year. It traditionally runs memorial day Sunday, in Speedway, Indiana at the Indianapolis Motor Speedway. This year will be the 105th running, and the first Indianapolis 500 was in 1911.
Aaron: How old were you when you were diagnosed and what was that like for you?
Charlie: I was 22 when I was diagnosed, a little on the old side. Can I ask how old you were when you were diagnosed?
Aaron: I’m 15 now, and I was diagnosed when I was 6 years old.
Charlie: Okay so about 9 years ago. For me, I was 22 and I was diagnosed in October of 2007. So I’m 13 and a half years in. What I call a 13 and a half year member of the cool kids club. I was racing at the time, I had started racing go-karts when I was 9 years old, and got into cars when I was 16. I graduated high school, deferred entry to college, and moved to Europe to go race cars over there, and worked my way to being a professional at that point. It was while I was over there that I developed a skin rash that was unrelated to Diabetes. I went into the doctor, he had some cream that he said he thinks should clear some things up. “Is there anything else going on that you want to ask me about?” I said, “Nah”, I’m 22, being 22 meant nothing else could go wrong. So then I said, “Well I’ve been kind of thirsty lately, I’ve been drinking 8, 10, 12 bottles of water a night”. I mean quite a lot of water. I had been going to the bathroom a lot, and he asked me if I had lost any weight recently. And when he had me get on the scales, in just 5 days I had lost 25 pounds. As an athlete, you can imagine Aaron that I didn’t have 25 pounds to lose. When I saw that number, I said “Okay maybe something is wrong here”. He said he wanted to do some more tests, but he thought I had Diabetes. And I said “Great, what’s that?” I didn’t know what it was or what it meant, what it meant for my racing especially. That was October 17 of 2007, when I became a member of the cool kids club and got diagnosed with Type 1 Diabetes.
Aaron: Did you ever question whether you could ever race again?
Charlie: Absolutely. I wasn’t sure if I’d ever get the chance to put my helmet on again and I don’t know that anybody would have ever blamed me for hanging up my helmet, and for retiring based on that diagnosis. There were, at that point, no professional drivers that I had ever heard of that were sharing their story of having Diabetes. So I didn’t know how I was going to go about it. I think had I not been racing semi-professionally, and if I hadn’t loved racing so much, I might not have tried so hard to get back in the car. Thanks to my endocrinologist, and seeking out an endocrinologist that is very specialized in sports. She has treated people that have won gold medals at the Olympics, she’s treated people that have run ultramarathons, and done ultra-cycling events, as well as a lot of different fields. Once I talked to her, I had a better understanding of how to go about it. Racing is such a unique challenge, every sport with diabetes is a unique challenge. The challenge that I think is involved in racing, is that there are no timeouts. In baseball, while you’re in the dugout waiting for your turn to bat, you can check your blood sugar, you can get a snack, you can get some insulin. While in racing, once that green flag flies, you’ve got to be ready to go, green to check.
Aaron: Yeah, that brings up another question: How do you manage your blood sugar during a race? Obviously like you said, you can’t stop or lose focus, so I’m curious. How do you manage it?
Charlie: Do you mind if I start with how I manage my Diabetes on a day-to-day basis?
Aaron: That’s perfect.
Charlie: We’ll start there because that lays the groundwork for how I adjust that when I’m in the racecar. So I know a lot of people with Diabetes use an insulin pump, I don’t. I use insulin pens and have since the day I was diagnosed in 2007. I’m on a basal/bolus program. I use two Novo Nordisk Insulins in pen form so I still take injections, one long acting and one fast acting for meal time. I also use the Dexcom G6 Continuous Glucose Monitor so I’m able to keep an eye on what my blood sugar is doing everyday, all day long. Those are the tools that I use everyday. The thing I love about my CGM is that I don’t have to do fingersticks. My fingers haven’t been in this good of shape since I was diagnosed. That is a real benefit to me especially because my hands are so important to holding the steering wheel and what I feel in the car. In the car, I use those same tools. I adjust my mealtime insulin dose at around lunch before the race so that my blood sugar aims to be a little bit higher in the car than it would on a normal day.
Aaron: What time is the race usually?
Charlie: For the Indy 500, the green flag starts at noon. So I eat “lunch” at like 10:00. I usually eat my meal 2 hours before the start of the race. Now the races aren’t always the same time. There’s a night race, we’ll race under the lights at 7 or 8 o’clock at night. So my pre-race meal is about two hours before then. For me, my doctor, my health care team, exercise physiologist, and I narrowed that meal down to a carb, protein, and fat counted and measured meal. That includes plain grilled chicken breast (no sauce, no breading or anything like that), plain white pasta with just a little bit of oil on it, some salad with some oil and vinegar salad dressing, and some bread, fruit, and cookies if I need some extra carbs and extra fat. It’s that combination of fast acting carbs, long acting carbs, little bit of fat to delay that effect. It’s all measured because the less variables the better. By removing that variability in that meal, I can just adjust my dose based on what my blood sugar has been over the course of the weekend, how I’m feeling, if I’m sick, if it’s hot and if I’m dehydrated and things like that. So then when I get in the car my Continuous Glucose Monitor actually plugs into the car’s data system. So on my electronic dashboard I have speed, lap time, oil pressure, blood sugar, water temperature. My car and my body data, right there together.
Aaron: Wow, that’s amazing!
Charlie: For me, being able to see where I am blood sugar wise on my dash, is really key. It’s really important for me to know what’s going on. The other thing about that is once that information is into the car’s electronics, my engineers, mechanics, and my personal team including my wife, business manager, and personal manager can see that data and that information live on pit lane. If I’m racing wheel to wheel at let’s say Texas Motor Speedway around 220 MPH side-by-side for 10 laps and don’t get a chance to look at my dash, I know there are other people keeping an eye on my blood sugar as well.
Aaron: What would happen if you went low or high? How would you bolus or give yourself glucose without being distracted from the race?
Charlie: I’m going to give you a little racing background to explain what I’m conscious of when I’m in the car. An IndyCar itself, with me in it, weighs about 1500 pounds which is about the same or a little lighter than a Chevy Cruze. It’s a really small car with about 600 horsepower. The wings on it look like an airplane wing turned upside down to push the car into the track in order to go faster in the corners. The wings on an IndyCar at 200 MPH produce enough downforce to hold the car on the ceiling. The wings produce about 3,000 pounds of downforce, even though the car only weighs about 1600 pounds. We also have no power steering, and no power brakes. So it’s very physical, wrestling all that horsepower, all those aerodynamics, for up to 400 miles. The other thing is, the adrenaline. When you’re competing in racing at 225 MPH, you travel a football field (100 yards) every second. So when you think about going that far, that quickly, you have to look a long ways ahead and think very far ahead. So when you think that far ahead, and move that quickly, there is that adrenaline response. In the car, the physicality of driving the IndyCar tends to drive my blood sugar numbers down. Now the three layer fire-proof suit, fire-proof balaclava gloves, shoes, and carbon-fiber crash helmet that I’m wearing in a car that doesn’t have air conditioning, causes dehydration. That dehydration and adrenaline actually tend to bring my blood sugar up. So there’s this kind of fine balance, at least in my body for most of my career, that if I can start the race with my blood sugar stable, I stay pretty stable. Now, like I said, I can’t call timeout, I can’t ask the other drivers to slow down while I get a snack. So, I try to make sure that I have all the tools that I need to keep driving. For me the biggest concern is hypoglycemia (low blood sugar) because it’s not just my safety at risk, but the other drivers on the track as well. Most IndyCar drivers have a drink system in their car, so they can get some water or some sports drink during the course of those 3.5 hours. My system is unique in that I have two drink bottles. One full of water, and a second one full of orange juice that we add glucose too. So it’s about 30 grams of carbs, about the same as a can of Coca Cola, in 6 fluid ounces, about half the size. So it’s really really sweet. I don’t have to drink a huge amount of volume to get the carbs I need to bring my sugar up. Those two drink bottles come together at a valve that my dad who’s an engineer designed. We got it 3D printed, and it mounts on my seatbelt. From that valve, a tube runs into my helmet, kind of like a long straw. So depending on what my body needs, I can switch between water and orange juice. I’ve never needed the orange juice in the car to keep going. It’s there as a back up plan and to make sure it works. But the preparation I do, my insulin doses, my meals, all of the training in the off-season, and all of that prep-work, means that I’ve never needed that glucose-rich fluid to keep going.
Aaron: You must be doing something right if you’ve never needed the juice.
Charlie: It’s interesting because I think one of the challenges globally with having diabetes is that it’s not visible. You look at me and I look at you, we can’t see anything. There’s no outward appearance except maybe a medical alert bracelet, an insulin pump tubing, or in the summer when I have my shirt off at the beach, my CGM sensor. So for me I think one of the really big challenges that comes with having diabetes is that there’s kind of nothing to show for it. We’re always learning, we’re always thinking about blood sugar, we’re always thinking about what we’re putting in our body. We’re thinking about everything we’re doing whether it’s going to shoot hoops with friends, going to run errands, or going on a road trip. I think working really hard in the background, so that when I get in the racecar, things are just like every other driver, is part of what having diabetes means for me as a racecar driver.
Aaron: 100%. I forgot to mention, I play lacrosse and football, and I’ve found that adrenaline also is a crazy factor that shoots me way up. So I find myself usually doing a pretty big bolus (about 2 units) before a game even if I’m at a good number like 150 or so which seems crazy but it's really not.
Charlie: I’ve heard many people do that. In fact, I’ve heard from an Olympic swimmer that in practice, he could hardly keep his blood sugar high enough. In competition, he would get in the pool at 100, swim for 30 seconds, and be 250 when he got out just because of the adrenaline response. I think a lot of athletes find that adrenaline response and stress really drive blood sugar up. I notice it, maybe less so when I’m in the racecar because of the physicality but when I’m doing public speaking, when I’m nervous in front of a big audience, my blood sugar will climb through the whole presentation.
Aaron: Yeah that’s definitely interesting. Speaking of adrenaline, after the race, does your sugar tend to drop. I know mine does after games.
Charlie: Yes, this is one of the things that I’ve learned over the years. A lot of times when I get out of the car, I still have that adrenaline in the system, but I’m no longer driving the car anymore. When my heart rates come back down, my body’s initial response is to send my blood sugar up. But if I don’t eat something and take some insulin for it, it’ll crash because my body needs to refuel. Even before I had diabetes, I see that if I don’t grab something to eat right after the race, I’d almost end up sick to my stomach because that adrenaline would drain out and I’d end up lightheaded and woozy. That’s probably nothing to do with blood sugar and more to do with adrenaline.
Aaron: You obviously mentioned you use orange juice mixed with glucose in the car, but just wondering for myself and others, what other snacks and drinks do you use to treat your lows?
Charlie: I like chocolate milk. I know it’s not as fast-acting as orange juice or a regular soda, but I like the recovery side of chocolate milk. So if I’m trending down but it’s not an emergency hypoglycemic event, I’ll have some chocolate milk to try to buffer that. I also like these shot-blocks; the little Gu blocks that are carb measured per block. So I know exactly how many carbs I’m putting into my body based on how many blocks I take. I think each block is about 8 grams of carb, but it obviously depends on the different flavors and different brands. That way I can just eat two or three and not over react and not eat or drink too many carbs, but to get the right amount to change what my blood sugar is doing.
Aaron: Has there ever been a time where Diabetes has made it hard for you to race?
Charlie: It's harder, for sure. It's hard, it takes more effort and it takes more management, discipline, routine. But I actually think that I’m a better racing driver because of my diabetes because I am more routine oriented, I am more disciplined in my training and in my nutrition. I listen to my body better than I ever would have. I was 22 when I was diagnosed, and in my mid-20s when a lot of people think they’re ten feet tall and bulletproof, I had to really listen and focus on my body. For me, I think having diabetes is a challenge, and I will never diminish that. But I think it’s also an opportunity because it’s more rewarding when you overcome that challenge.
Aaron: I 100% agree and can relate when I say that diabetes has made me so much more cautious and aware of what I put into my body and what I’m doing in general. Off of that, I think it’s helped me mature. Is there any other advice you have for newly diagnosed athletes?
Charlie: I do, and I just want to let you know I got goosebumps when you told me that was the aim of this project. Between the Lines is a great concept to empower future athletes, and even current athletes who may be struggling a little bit with diabetes. My best advice is that having diabetes may change how you go about things in life, and it may change how you do things. You may have to grit-create it, you may have to come up with a drink valve so you can have two drink bottles in the racecar, you may have to figure out how to get your glucose monitor to Velcro to your steering wheel or integrate with the car’s electronics. Or you may have to figure out how to have a secret sign with your coach on the sideline when you need a snack or need some insulin. You may have to change some things, but when you overcome this challenge, and you go out there and succeed on the playing field, on the racetrack, in the pool, on the mountain, or whatever that looks like for you, as an athlete with diabetes, it will be that much sweeter. And I use sweeter intentionally, as the worst pun I’ve got, because it really is an incredible feeling to overcome that challenge and succeed, and know that diabetes didn’t get in the way of you living your dreams.
Aaron: Yeah, that was great. Thank you so much Charlie, I really appreciate it.
Charlie: My pleasure Aaron thanks for doing this project, this is really cool. It’s awesome, way to go.