By mapping out how his heart rate affects his blood sugar levels, Zack Hawthorne makes sure his numbers stay steady.
Zack Hawthorne has been living with type 1 diabetes for about 15 years. The 28-year-old cyclist says it’s never stopped him from doing anything, except living off the grid. That’s because he uses fitness trackers—along with diet and exercise—to help control his blood sugar levels.
Instead of relying solely on medication, Hawthorne uses diet (he’s been a vegetarian for over two years), exercise, and a Fitbit Charge 2 HR to monitor his heart rate to help manage his diabetes.
Type 1 diabetes is a condition where your pancreas does not produce insulin, which allows your body to use glucose from carbs to produce energy. Patients often manage this with an insulin pump, which releases a continuous stream of insulin their body throughout the day and boosts of insulin around mealtime.
During the “honeymoon phase” when first diagnosed with type 1 diabetes, people’s bodies continue to make some insulin, but eventually they will need it, explains Akankasha Goyal, M.D., endocrinologist and instructor in the department of medicine at NYU Langone Health. However, some people can use their diet and exercise to help manage their condition.
That’s what Hawthorne does to cut down on his reliance on insulin: He tracks his heart rate and blood sugar while he rides to keep an eye on blood sugar fluctuations—and if he notices it spiking or dropping, he takes steps to normalize it, like eating a carb-heavy snack or drinking more water. He does use insulin on days that he does not exercise, either long-acting insulin at night or quick-acting insulin during the day.
Not all type 1 diabetics can use this technique—how your body responds to exercise can vary from person to person, and most will require regular insulin—but knowing how your blood sugar reacts to exercise and using food to manage it can work well for certain people, says Goyal. (If it’s something you’re interested in trying, you should work with a medical professional, like Hawthorne did, to come up with a plan that’s right for you.)
“During exercise, [managing blood sugar] without using insulin is a possibility, but it depends on how much insight the patient has,” Goyal says. “It involves a lot of math and calculations.”
Hawthorne has an intricate system that relies on food logging through an app, heart rate tracking, and blood-sugar monitoring to make sure all is well. And his previous job as a bike messenger in Pittsburgh provides the perfect way for him to do it.
At first, he relied on a Garmin and a heart rate monitor, but when he got tired of wearing the monitor on his chest, he decided to test out a Fitbit.
Hawthorne rides a minimum of 30 miles a day, though it usually climbs closer to 50 to 60 miles. He uses this time to gather heart rate data through various parts of his day—he found out he averages about 140 to 150 bpm—to help him know when he needs to refuel his blood sugar.
To best figure this out, he wore a continuous glucose monitor (CGM), which takes a measurement every five minutes, to track his blood sugar levels. Then, after a full day of riding, he printed out the readings and lay them over a heart rate graph to track how his blood sugars fluctuated with his heart rate.
“Now I know that, on an 8-hour day, I have some sort of standard of what I ate and how my blood sugar acted,” he says.
What he learned? If he sees that his heart rate is hovering around 170 bpm or so for anywhere from 10 to 30 minutes, he knows this means his blood sugar is dropping. Because his metabolism is burning off a lot of glycogen, or stored carbohydrates, he would take that as a sign to focus on getting sugar into his body. So he reaches for foods like homemade nut-free granola bars (he’s allergic to tree nuts) or Gatorade energy chews to keep his blood sugar stable.
Goyal agrees that keeping food and drink handy—and tracking blood sugar regularly, at least every 20 to 30 minutes—is key: Snacks such as gummy bears or high-quality carbs can help boost your blood sugars if they drop too low, she says. While carbs are not recommended to regulate blood sugar for everyone with diabetes, if you are an athlete, you still need them to fuel your workout.
“You always want to be close to food when you’re cycling,” Goyal says.
Using this fuelling and heart-rate tracking strategy, he even attempted the 400-mile Crush the Commonwealth ride from Pittsburgh to Philadelphia, completing 200 miles on a single-speed bicycle before running into a storm that caused him to stop, without taking any insulin—he just made sure he was refuelling to keep his blood sugar steady.
He also has started recording his rides on his YouTube channel, detailing his blood sugar levels and diet—everything from what he ate the night before through post-ride—along with a summary of the miles ridden and his bike metric data. He does this to show other people what is possible.
“It’s not about the stats or Strava; it is the experience and the journey,” he says. “It’s being in touch with yourself and crushing your own personal goals.”
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