In 1998, two-time Olympic gold medal swimmer Gary Hall Jr. was preparing for the Goodwill Games when his hands suddenly began to shake in the middle of practice. He shrugged it off; after all, he was training up to eight hours a day, burning calories out of the pool as well as through running, weightlifting and boxing. He downed some PowerBars and Gatorade to boost his blood sugar and went back to work.

But then he began sucking liquids like a diesel truck, sometimes drinking four gallons of orange juice in one sitting. Soon he couldn’t make out the letters on a Pepsi can held at arm’s length. He had all the telltale signs of diabetes: extreme thirst, blurry vision and fatigue. When he was diagnosed, he was told that his swimming career was over.

“The doctors said exercise was good in moderation, but not at the level I was at,” says Hall. Yet he continued to dive into his sport, revamping his diet and closely monitoring his condition for warning signs. And when he climbed out of the pool in Sydney last year, four more Olympic medals hung around his neck, two of them gold.

Hall may be an exceptional case, but he shows that men can pursue active lifestyles, and even exceed their expectations, while managing diabetes.

What’s Your Type?

About 16 million Americans have diabetes, and about 2,200 new cases are diagnosed each day. There are two primary kinds of diabetes: Type 2, in which the body lacks sufficient insulin or the ability to use it properly, accounts for more than 85 percent of cases and is generally diagnosed in obese adults over 40. Type 1, in which the pancreas becomes unable to manufacture insulin, usually strikes those under 30 and is the more common condition among active males.

Insulin is a protein hormone that enables the body to use sugar and other carbohydrates; it also helps tissues to store nutrients. Because those with type 1 diabetes, such as Hall, cannot produce insulin, they require daily insulin injections, often two or more a day. (Pills are not effective because stomach acids destroy insulin before it can do its work.)

Unfortunately, there are times when the body doesn’t use insulin like it should. Insulin resistance, which fluctuates even within a single day, may be triggered by any type of physical stress, such as the flu or taking cortisone to treat inflammation. There are two ways to fight it: exercise and diet. Moderate to intense aerobic exercise for 20 minutes to an hour can break the resistance within 24 hours, while strength training works within 48 hours.

Studies published in Public Health Nutrition and other journals have shown that diets high in fat and refined sugar tend to boost insulin resistance, while monounsaturated and polyunsaturated fats do not; also, omega-3 fatty acids found in cold-water fish may offset resistance to a degree. “If you change your diet to include higher fiber, complex carbs, whole fruits, and vegetables, then the symptoms will often go away within a few days,” says Sheri Colberg-Ochs, Ph.D., assistant professor of exercise science at Old Dominion University in Norfolk, Va., and author of The Diabetic Athlete.

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Bad Sports

Exercise has always been encouraged for diabetics because it can help to transport glucose into cells, reducing blood-sugar buildup. However, there are certain activities in which blood-glucose imbalances could lead to inattention and result in serious injury. “These sports include scuba diving, rock climbing, mountaineering—anything where you are really out on the edge and don’t have a lot of backup,” says Martin B. Draznin, M.D., director of the Pediatric Endocrine Specialty Clinics at Michigan State University Kalamazoo Center for Medical Studies.

Hypoglycemia, marked by an abrupt decline in blood-sugar levels, is the No. 1 concern for type 1 diabetic athletes. Red flags include moodiness, shakiness, confusion, and numbness in the arms and hands. If you experience any of these symptoms, try consuming some rapidly absorbing carbohydrates, such as fruit juice, hard candy, soda, bagels, or glucose tablets and gels. For extended activities—long runs, cycling—diabetics have to balance insulin intake with carbohydrates.

Some diabetics can become “hypoglycemia unaware” and must learn the subtler signals that their bodies give out, says Colberg-Ochs. “One guy told me when he’s out running, his warning sign is when he begins kicking the back of his left shoe with his right foot.”

[pagebreak] Speaking of which, always take special care with your feet. “Over time, diabetics can develop neuropathy—nerve damage that causes a pins-and-needle discomfort followed by a loss of sensation—which means you can injure your feet or get a blister and not know it,” says Colberg-Ochs. She suggests inspecting your feet daily and wearing proper footwear and socks with padded soles, or “replacing running with something where your feet aren’t at risk, such as cycling.”

Diabetics also have to be wary of microvascular problems with the eyes, kidneys and nervous system. If you have such a condition, you should avoid any activity that involves excessive jumping or increased blood pressure, or causes your head to drop lower than your heart. Another danger: “silent ischemia,” a symptomless condition in which you don’t get enough blood flow to the heart because of insulin nerve damage. To be on the safe side, check with your physician before starting or altering any exercise program.

The Proactive Diabetic

Don’t let any of this scare you. Most diabetics can still work out by choosing activities that don’t exacerbate their conditions. A study published in Diabetes Care found that subjects were able to safely reduce cardiovascular risk factors, such as abdominal-fat content and hypertension, by exercising 2.25 hours per week. And a report in Diabetes Education was enthusiastic about the positive effects of resistance training, except when retinopathy is present.

Above all, diabetics must balance workouts with proper nutrition. Hall gives himself up to eight insulin shots daily during peak training. With that much insulin, his body constantly craves carbohydrates for fuel. “At first I didn’t know the carb content of a baked potato,” says Hall. “Then I compared it with the frozen kind, which turned out to have twice as much, so I had to give myself twice as much insulin. Basically, you have to have an idea of what every food you consume is going to do to you and how your body is going to react to it. In a lot of ways, you have to be your own doctor.”

If you eat right, you should be able to cut down the amount of insulin you need, says Colberg-Ochs. Adding fiber is usually recommended, as is substituting low-fat milk for whole milk and replacing saturated fat and tropical oils with “healthy fat,” such as nuts and peanut butter. “Balance is the key,” says Colberg-Ochs. “Not too many carbs or fats or protein.”

Each athlete must find his own formula. Diabetics should measure blood sugar before, during and after their activities. Technology has made frequent testing much simpler. Hall carries a glucose monitor the size of a watch; he can determine his sugar level in just five seconds. He also has an insulin kit that can fit in his back pocket.

“Whether it’s running a half-marathon or playing pickup basketball games with your college buddies, don’t let anyone tell you that you can’t do it,” says Hall. “It all comes down to you and how well you take care of yourself.”