Team Novo Nordisk: educating, informing and inspiring
All-diabetic team starts maiden Tour of Britain with big ambitions and hopes of inspiring cyclists with diabetes worldwide
The crowds massed on The Tumble on stage three of the Tour of Britain, should they have waited long enough, would have seen a battered and bruised rider bringing up the rear as he became the 117th and final rider to complete the stage. For Charles Planet it was 'job done', and an inspiring feat, given that his courageous ride came just 24 hours after a dramatic, high-speed crash descending the Great Orme. But Planet and his Novo Nordisk team are all about inspiration.
Sponsored by a Danish pharmaceutical giant, this UCI Pro Continental squad is no ordinary team. Formed with the express purpose of changing public perception of diabetes, its entire roster consists of riders diagnosed with type one diabetes. For some, it means a second chance after being cast aside by their former employers when their condition became known. For others, it is a way into the sport where previously they may have encountered glass ceilings and locked doors.
Take Planet’s team-mate David Lozano, for example – the former Spanish mountain bike champion who burst onto the scene as a teenager and enjoyed phenomenal success on both the mountain bike and in cyclo-cross. His palmares, which includes 11 national titles in all, certainly makes for impressive reading. But when he was diagnosed with type one diabetes, his contract was annulled and his prospects in the sport changed from dazzling to bleak.
The second chance
Fast forward three years and the 25-year-old is one of the six riders pulling on the team’s all-white kit at their debut Tour of Britain. With ambitions, he told RCUK, of picking up the team’s first victory – preferably from a long breakaway – it certainly has the foundations of a Hollywood-style script.
“For me it’s very important to be here," Lozano, right, explained, when we spoke at the rider presentation in Liverpool. “To be part of this team is very special. We have an important message to all the people affected with diabetes or even those without, because everyone knows people affected by diabetes.
“You know you are carrying all these people on
your back and you are inspiring a lot of people
too. And you are showing you can do well in the races and perform as a normal guy
so it’s really important for me and all the team."Lozano is one rider who has undergone huge changes since his diagnosis three years ago. First among them is the switch from training for, and competing in, short, sharp mountain bike and cyclo-cross races, to building up his endurance and stamina for road racing – all while learning to control his diabetes for the first time.
The change has been profound as he readily admits, saying: “When I was riding my mountain bike I didn’t have to take care about anything – not the weather, food or anything. Because it is a one-and-a-half hour race, you just go full gas for that time and then that’s it.
“On the road, now, I need to watch out more for food and weather, keep warmer when it’s cold and check the way you eat and what you eat.
"Every rider on our team is different but all the riders know what they need to do to manage the diabetes better. We don’t have to do anything different to the other teams though.
"We just need to check our levels, our glucose, and then eat the kinds of food we like. This is the biggest difference, but we are ultimately the same as all the other riders."
Managing the levels
Normality and sameness are recurring themes when talking to people involved in the Team Novo Nordisk set-up. It is something team doctor Rafael Castol is certainly keen to impose, insisting the science behind type one diabetes is not a particularly complex subject to master. “Diabetes, itself, is a very straightforward condition," he explained as we met him ahead of the first stage of this year’s race in Liverpool. “Either you are high or you are low.
“If you are high, you need to keep your sugar in a range so whatever you are eating can be processed and used as fuel. If you are too high, you will not be able to eat because the body will start to become dehydrated. You create imbalances and then obviously your performance will be impeded. When you are low, your cells simply don’t function."
The key then, for Team Novo Nordisk – and the only significant difference from the 19 rival teams who rolled out in the shadow of the famous Royal Liver Building – is managing those levels to ensure their performance does not drop.
“For us, it is very important for the riders to keep their blood sugars within an ideal range for their performance to not be affected by the fluctuations," Castol explained. “The quantification and timing of their nutrition, specifically carbohydrates, is very important."
Race day, then, is when a scientific understanding of diabetes, and the management of its effects, is put into practice. Like all type one diabetes sufferers, the riders must monitor their blood sugar levels in order to ensure a healthy balance. Each person living with diabetes will react differently to it and so there is no hard and fast rule over medication – with strict medical guidance ensuring the specifics of managing one person’s condition are not taken to be the norm.Team Novo-Nordisk’s riders carry continuous glucose monitors (CGMs) to aid them in managing their levels both on and off the bike, while Castol and his team pay careful attention to nutrition throughout the day.
“As soon as the day starts, when they wake up, they will check their sugars," he said. “From there we will start making the adjustments for breakfast. As the race start approaches we will keep checking them at very specific checkpoints to make sure that before the start their blood sugars are within the right ranges.
“Half an hour before the race, we will look to have them at the optimal level with their blood sugars before they are ready to start." Castol continued: “Each rider individually knows, based on the race distance, the duration and intensity, more or less what their food requirements will be. Some carry their insulin in order to correct it. Then the race goes through as it would with every team. As soon as they finish we will control them again, check how their sugars are at the end, for them to also take advantage of their recovery block of carbohydrates and protein shakes, or whatever they have."
Post-race recovery, Castol added, is the most important part of ensuring the diabetes is not inhibitive to the riders’ performance. The two-hour period post-race, after a day of racing where tissue will have been damaged, is critical to ensuring the team are race ready for their next effort. If the recovery period is not properly taken advantage of, performance is affected as they enter a vicious circle of being unable to bring their blood-sugar levels into the optimum range.
The key, therefore, is education – which is where Team Novo Nordisk come in. The cycling team is just one arm of a club which has more than 100 athletes in all. And it is a policy which is earning more and more exposure. The team, for example, will be familiar to some cycling fans for their exploits at the USA Pro Challenge. The educational aspect, however, is where the link with Novo Nordisk comes into its own.
Education, education, education
“Already the general concept is that all riders need to be educated on how to use their carbohydrates, and what they do," Castol said. “The most important thing is how they time the intake of the carbohydrate to take advantage, but it is very individual in how they time it. Each one is different. “The education is therefore a continuous process. It’s a long, long learning curve.
"Many of the riders were diagnosed many years ago and some were even cyclists before joining the team and already had diabetes.
"It’s a condition where you develop a lot of sense of responsibility. At the end of the day, it is something you have to be on top of every hour, every day.
“However, some are naïve when it comes to racing at this level and they just can’t gauge how their body will respond and that’s where you really need to advise them. It is very individual, and also depends on their roles in the team on race day."
That aside, however, is one of few big differences to life on any other professional team.
“You still do the same as you would do for any other team – you still look at performance, fatigue, recovery and keeping the riders as healthy as possible," Castol concluded.
“The biggest difference with diabetes is just making sure everyone is on track with their sugars and making sure it is not a factor impacting on their performance.
“Diabetes is something every physician knows how to handle. It’s just in sport, it is about how you can apply the science of the condition and avoid making it a factor in their performance."
Spreading the word
There is one major difference to the other teams, of course, in the message the team spreads – a hugely inspirational one at that, which is literally turning lives around.
And with the educational system in place, the next step will be spreading the word worldwide – something they are already well in the process of doing. Their 2014 programme has included trips to San Luis, Mallorca, Mexico, Turkey, California and Colorado alongside their British debut.
It is giving opportunities, on a personal level for the riders, they may not otherwise have had. Javier Megias is one rider to have experienced in full those benefits, from riding in the break with Jens Voigt in the German legend’s very last race in the professional peloton to a maiden trip to Britain.
The 30-year-old has been with Team Novo Nordisk since 2010, when it was called Team Type 1. Previously he rode for Saunier Duval alongside Joaquim Rodriguez and Chris Horner, having been diagnosed with type one diabetes when he was 14.
And he insists the set-up at Novo Nordisk is different only in terms of the riders on the team, with the diabetes, and the management of it, the only major factor separating the two.
“I don’t feel different being in this team," he said. “I like to race with my friends. We all have diabetes but that is the only difference.
“I need to manage my diabetes, but I am just the same as the others – I wake up, I eat, I ride. It doesn’t effect my diet or my training. I have had diabetes from 14 years old so I know my body, I know what I need to do during the race. I have my CGM as well, which is a big help for us.
“I don’t feel it has affected me in any way as a rider. I know I have diabetes, but I am in the same group and the same peloton so we have the same opportunities. My hopes for the race are just the same as the other racers.
"I will try to get the first victory for the team, to be in the breaks and to get top tens. I was really close to winning in Colorado in the break. I would like to race in the same way and I really wish it can be that gets the team’s first victory."Such an attitude is one Team Novo Nordisk hope to be able to impose on the rest of the peloton, and the team and sponsors certainly have the ambition to match.
A place at the Tour de France in 2021 – 100 years after insulin was discovered – is their long-term aim, while in the short term the team will target stage wins and exposure in the world’s biggest races.
In Britain, the effect they are having is clear from the fans stopping and talking at the team bus – a vehicle emblazoned with messages from fans across the globe. Two supporters in particular – Cheshire-based Matthew Jefferson, 42, and his son Noah, seven – are prime examples of how effective Novo Nordisk’s work has been.
Noah was diagnosed with type one diabetes at the age of two, but has grown up a keen cyclist. And dad Matthew believes the attitude change will help make huge strides in the management of diabetes.
“I think it’s very important," he told RCUK. “Especially to young people who have been diagnosed with type one diabetes. The healthcare profession in the UK is still very split on it, from our experience. Some guys are enlightened and they understand diabetes is just a condition you have to manage, but you get others who still seem to think it’s the end of your life as you know it.
“We found out one of the riders at Novo Nordisk was told he should only ride one mile a day, which is very archaic. So Novo Nordisk inspire people like Noah, who was diagnosed when he was two, that they can do whatever they want – just live a normal healthy life and with good exercise, good medication and good blood control you can achieve what you want to."
And Matthew – who believes cycling has a profound effect on Noah’s blood-sugar levels – hopes it will be more than just Novo Nordisk offering a high-profile base for cyclists with diabetes soon.
“The opportunities for professional cyclists that do get diagnosed, they basically get thrown aside by the teams which is obviously very wrong. What Team Novo Nordisk’s greatest legacy would be if, ten or 15 years down the line, all teams have diabetic cyclists.
“There’s no great science behind it. If you get a good athlete, they will know how to manage it, whether it’s rowing with Sir Steve Redgrave, winning gold when he has type two diabetes, or hopefully some of these guys getting on the podium."
Team Novo Nordisk may not be of the calibre of the five-time Olympic champion yet. But with grand ambitions, strong support behind the scenes and an unwavering bid to rewrite the public opinion of type one diabetes we will certainly be hearing plenty more of them in the future. For more information on the team, visit www.teamnovonordisk.com.