Type 1 diabetes is a chronic autoimmune disease. The exact cause isn’t fully understood, but it’s believed to involve a combination of genetic predisposition and environmental triggers. In people with Type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas, meaning the body can no longer produce insulin on its own.

Because of this, people with Type 1 diabetes require insulin therapy to survive. It’s most commonly diagnosed in childhood or adolescence, but it can be diagnosed at any age. In my case, my pancreas threw in the towel four months before my 20th birthday.

Type 1 and Type 2 diabetes are different conditions. Type 1 diabetes is an autoimmune disease in which the body stops producing insulin. Type 2 diabetes is not autoimmune; instead, the body still produces insulin, but doesn’t use it effectively—a condition known as insulin resistance.

Type 2 diabetes is often diagnosed later in adulthood and is commonly managed with a combination of medication, lifestyle changes, and sometimes insulin. While insulin therapy is required for people with Type 1 diabetes, some people with Type 2 diabetes also use insulin as part of their treatment.

Put simply: Type 1 is about insulin dependence; Type 2 is about insulin resistance.

Glucose is a simple sugar and the primary form of energy our bodies use. While carbohydrates aren’t just glucose, our bodies ultimately break most carbohydrates down into glucose, which then enters the bloodstream.

This is why “zero sugar” on a nutrition label doesn’t always mean zero impact on blood sugar—at least not for me. Foods can still contain carbohydrates that convert to glucose even if no added sugar is listed.

To be clear: carbs are not the enemy. They’re essential—especially for endurance athletes. This isn’t a carb-bashing or low-carb advice page; it’s simply an explanation of how glucose fits into my experience of living and riding with Type 1 diabetes.

Insulin is a hormone that helps regulate blood sugar. In people without diabetes, the pancreas constantly balances blood sugar behind the scenes. When blood sugar rises after eating carbohydrates, the beta cells of the pancreas release insulin, which allows glucose to move out of the bloodstream and into cells to be used or stored for later.

When blood sugar drops—or when the body needs more energy, like during exercise—the pancreas releases another hormone called glucagon. Glucagon signals the body to release stored glucose back into the bloodstream, bringing blood sugar back up.

With Type 1 diabetes, my beta cells no longer function, so my pancreas can’t produce insulin or perform this balancing act on its own. While glucagon-producing cells may still be present, their response is often inconsistent and poorly coordinated. That means I have to manually do what a healthy pancreas would normally handle automatically: manage insulin, anticipate needs, and constantly adjust to keep my blood sugar in range.

Hypoglycemia = blood sugar that’s too low
Common symptoms: shakiness, sweating, rapid heartbeat, sudden fatigue, light-headedness, dizziness, irritability.

Low blood sugar → reduce or pause insulin and/or consume fast-acting carbs or sugar

Hyperglycemia = blood sugar that’s too high
Common symptoms: thirst, frequent urination, brain fog, headache, heavy or sluggish feeling.

High blood sugar → insulin brings it down (exercise can help for some people, in some situations)
Symptoms vary from person to person, and many diabetics learn to recognize their own patterns over time.

Bolus (/ˈbōləs/)(v): to take insulin (usually before a meal). 

Type 1 diabetics can administer insulin in a few different ways, including insulin pens, insulin pumps, or syringes.

People who use insulin pens typically use two types of insulin:

• Rapid-acting (bolus) insulin, taken before meals to cover carbohydrates.

• Long-acting (basal) insulin, taken once daily or less frequently (depending on the type), to keep blood sugar stable outside of meals.

As an insulin pump user, I use one type of rapid-acting insulin. Instead of taking a separate long-acting insulin, my pump delivers a small, continuous amount of insulin throughout the day (called a basal rate), with additional doses given before meals or to correct high blood sugar.

In short: pens rely on scheduled manual doses, while pumps deliver insulin continuously to more closely mimic how a pancreas works.

Shortly after my diagnosis, I switched from insulin pens to a tubeless, waterproof insulin pump called Omnipod that I control with my phone via Bluetooth. A pod is a small, wearable device that sticks directly to the body with strong medical adhesive and holds both the insulin and the mechanism that delivers it—there are no external tubes. Each pod is filled with insulin, adhered to the skin, and activated with my phone through the Omnipod app. When activated, a small cannula is inserted just under the skin to deliver insulin into fat tissue, where it’s absorbed into the bloodstream. Each pod lasts about three days.

Using an insulin pump gives me far more flexibility than injections, especially as an athlete. I can increase, reduce, or pause insulin delivery in real time in response to my blood sugar, rather than being locked into fixed doses.

To track my blood sugar, I use a continuous glucose monitor (CGM) called Dexcom, which I control via Bluetooth through my phone. It consists of a sensor and a transmitter, which last about ten days and three months, respectively. The transmitter is the “brain” of the CGM and sits inside the sensor, which inserts a very thin filament under the skin upon activation. Together, they measure glucose levels in the interstitial fluid (the fluid between cells) and send updates every five minutes to the Dexcom app on my phone. The app displays trends over time, which is often more useful than a single number.

The biggest recent upgrade is that my insulin pump and CGM now communicate with each other. This allows my pump to automatically adjust insulin delivery based on my glucose levels, helping keep me in range with less manual intervention.

Most of my insulin settings are determined by my endocrinologist, including things like my basal insulin rate and my carb-to-insulin ratio. Those settings act as a framework.

Day to day, I tell my insulin pump how many grams of carbohydrates I’m about to eat. The pump then checks my current blood sugar using data from my continuous glucose monitor, calculates how much insulin is needed based on my preset settings, and delivers that amount through the pod after I accept the dose.

Short answer: yes, sometimes. I’ve had needles or cannulas in my body continuously since 2019, and over time, finding comfortable injection sites has become harder. The most reliable spots tend to be areas with more fatty tissue, but I only have so many that don’t interfere with movement—mainly the backs of my arms and my lower stomach, which are now often bruised or sensitive. 

I’ve also developed scar tissue across my regular sites from repeated injections, which has been the most frustrating part of blood sugar management for the past two years. Scar tissue means a leaky pump site/unreliable insulin absorption, making it hard to stay in range and wasting insulin that’s already painfully expensive. 

On top of that, riding can make things worse. Rough terrain or sometimes even Seattle potholes can make a leaky injection site worse, and can cause my CGM needle to shift and scratch my nerves/muscles, which is unbearably painful. My gear adds another layer of challenge: tight jersey sleeves press on already-sensitive arm sites, and constant sweating under bibs or gym clothes makes stomach sites tricky. I do my best to rotate sites and adapt, but it’s an ongoing struggle of living and riding with diabetes.

Several factors influence my blood sugar and insulin needs while riding, including ride type (road vs. gravel), training intensity, stress, sleep (or lack of it), nutrition before and during the ride, and temperature or weather.

Because insulin is a hormone, other hormones can affect how well it works. For example, cortisol and adrenaline—which increase with stress or high intensity—can make me more insulin resistant, often leading to higher blood sugar. On the other hand, heat tends to increase insulin sensitivity, which can cause blood sugar to drop more easily. And all of these factors can interact in different ways from ride to ride.

While my insulin pump helps keep my blood sugar in range during everyday life, cycling is a completely different equation. On the bike, I’m managing my blood sugar in real time—reading physical cues, checking my numbers, and adjusting insulin up, down, or off entirely in response to what my body is doing. On familiar routes, patterns are easier to anticipate, but on any given ride, multiple adjustments are always happening at once. Even when I follow the same steps for the same ride, blood sugar outcomes are often different.

Before I even kit up or clip in, I have to create the energy my body can’t reliably access on its own. That often means eating and intentionally under-dosing insulin to build a glucose “reserve” for the ride ahead. How much insulin I take—and how far ahead of the ride—depends on distance, elevation, and intensity.

Tools like activity mode, which tells my pump to aim for a higher blood sugar than my typical range, can help, but they aren’t foolproof. For harder efforts, I often pause insulin altogether and rely heavily on gels to prevent lows. On rides longer than seventy miles, I may eat without bolusing—something I would never do off the bike, but is sometimes necessary to keep moving safely on it.

Even after staying in range during a high-intensity ride, my blood sugar can spike the moment I clip out. This is a protective response to stress hormones like adrenaline and cortisol, which raise blood sugar to ensure the brain and muscles have enough fuel. Non-diabetics experience this too, but their bodies automatically correct it—mine doesn’t. So even when everything goes perfectly, it doesn’t.

All of this means there are countless variables to juggle, and no matter how much data I collect, there’s no clear algorithm. That unpredictability is the most exhausting part. Between constant monitoring, leaky injection sites, and factors I can’t control, the mental load of riding with diabetes is often harder than the ride itself. It can make training feel ten times harder and racing feel insurmountable—even when I’m deeply motivated to train, excited to get stronger, and genuinely thrilled about a race. Especially when shame creeps in around “bad” blood sugar management, how I feel after a ride becomes a complicated evaluation of both performance and blood sugar data.

That being said, I don’t see myself ever giving up riding. Beyond the joy it brings me, riding is how I remind myself that I’m more than the physical limitations of diabetes. At the same time, diabetes is the reason kitting up is only one of what feels like a hundred steps before I ever roll out. So riding has become a cyclical act: pushing past the mental limitations before the ride, so that I can ride and prove to myself that I can push past the physical. 

Think of the worst bonk you’ve ever had and multiply it by fifty. Depending on how low my blood sugar is, I become shaky, extremely hungry, lightheaded, sleepy, and completely depleted of energy. Processing the road and terrain becomes harder, decision-making slows, and my legs feel jelly-like—continuing to push can feel like riding on two flat tires.

Lows can be especially challenging on group rides, where managing my blood sugar can feel like it’s affecting everyone else. Sometimes it’s a quick fix without stopping; other times it requires a five-, ten-, or even fifteen-minute pause. Interestingly, some of my best blood sugar days on the bike have been hard solo rides or races, where I can respond immediately and effectively—my time is fully my own, and every decision can be made based on what works best for my blood sugar, not the needs of a group.

Some symptoms overlap with low blood sugar. When my blood sugar is too high, I feel sleepy, nauseous, heavy, fatigued, and often experience brain fog.

While high blood sugar is generally less immediately dangerous on the bike than low blood sugar—there’s no risk of a hypoglycemic seizure, for example—it’s still physically and mentally taxing. For that reason, I may let my blood sugar run above my typical range on certain rides to create a “reserve,” but there’s a ceiling to avoid both immediate symptoms and longer-term impact on my overall numbers.

A lot of things, but mostly Carbs Fuel gels, because no other gels have worked as well for my blood sugar. For me, “working well” means slowly raising my blood sugar enough to create the glucose reserve I need, without causing an immediate, stubborn spike that ultimately hurts more than it helps.

I usually take gels when my blood sugar dips below my typical range, or when I’m in range but know I have a harder effort coming up. Between gels, I eat whatever candy happens to be living in my frame bag. Sometimes it’s a sweet potato jelly block from a 7-Eleven in Japan; other times it’s a Trader Joe’s chocolate crêpe, Nerds clusters, or gummy bears. I almost never use carb mixes, mostly because after consuming so much sugar for blood sugar management, all I really want is water.

Unrelated to blood sugar (but very related to joy): I’m also a big fan of pickle juice shots and Trader Joe’s “A Handful of Olives.”

There’s a lot you can do as a non-diabetic to help make cycling spaces more inclusive. Don’t ask a diabetic, “Should you be eating that?” If they’re already eating it, they should be! And don’t fall for common misconceptions about diabetes, like the idea that eating sugar “causes” Type 1 diabetes or that carbs are off-limits for diabetics. Do offer to share your carbs if they need them—and if you know you’re riding with a diabetic, packing a little extra goes a long way. It’s basically the equivalent of buying us a diamond ring.

Don’t push the pace if someone has clearly communicated expectations for a ride based on a specific blood sugar management plan. While that’s annoying for anyone, it can be dangerous for a diabetic. Do help create a sense of collective responsibility—if someone needs a (blood sugar) break, it’s in everyone’s interest to take it.

Don’t make a diabetic feel like a burden for advocating for their needs or experiencing symptoms, even if it affects the ride. They likely already feel that way, and reassurance makes a world of difference here. Do ask questions if they’re open to it—like what a more inclusive space looks like for them and what support actually helps. 

Cycling spaces are already difficult to access for many people, and while cycling can be an individual sport, it becomes something special when it’s shared. There’s real power in marginalized riders creating inclusive spaces for ourselves, but there’s just as much power in stepping up if you don’t fall into those margins and choosing to be part of that effort.