Racing the Iditarod with Type 1 Diabetes
Meet Bruce Linton, PWD Type 1
Bruce Linton has completed 12 marathons, three Ironman triathlons, and six Iditarod races covering more than 1,000 miles across the tundra with his team of sled dogs. Plus, he lives with type 1 diabetes, which presents its own set of challenges in The Last Great Race that stretches from Anchorage to Nome, Alaska.
Photo caption: Annie Holt, CEO of Alaska Regional Hospital and PWD type 1, rides with Bruce Linton and dog handler Emily Theim (far right) during the ceremonial start of the 2012 Iditarod in Anchorage.
Bruce's Harrowing Iditarod Story
Exhausted and alone in the dark, Bruce Linton faced a musher's worst nightmare during the 40th Iditarod Trail Sled Dog Race in March. He'd lost his dog team.
While his dogs' safety was the immediate concern for the 49-year-old musher, he recognized that he was at risk, too. Bruce, who has had type 1 diabetes for nearly 20 years, was alone in the cold Alaska wilderness with just a pocketful of cookies and some insulin vials tucked deep beneath his layers of clothes.
After negotiating an infamously tough patch of trail known as the Dalzell Gorge, Bruce was traveling an old burn area of scrub spruce, snow-covered tussocks, and ice patches. Fraught with obstacles, the twisting trail was challenging but not impossible, and his 14 dogs ran fast, unfazed. Then, in an instant, that changed.
"I hit this little loop-de-loop the wrong way, and I went to the left and smashed into a tree," Bruce says. "I hit my head and cheek and shoulder. When I hit my shoulder, that's when I lost the sled."
Photo caption: Bruce's team includes Gizmo, Kiwi, Granola, Beans, Ruby -- these are a few of Bruce's dogs, all Alaskan husky mixes bred for the Iditarod. Teams average 15 dogs, and more than 1,000 dogs started the 2012 race. Also on hand were 52 veterinarians.
A Musher & His Dogs
Battered but OK, Bruce brushed himself off and ran after his dogs as quickly as he could. An unattended dog team can quickly lead to disaster. Without their driver to maintain tension on the lines, a loose team can get tangled, lost, or even strangled in the maze of lines, harnesses, and snaps that connect them to the sled.
"I was immediately in this land of quietness," Bruce says. "It was just me."
A fellow musher did arrive 45 minutes later. He and Bruce caught up with the runaway dogs, and Bruce continued on the race, bruised but relieved that the incident hadn't turned out worse.
The crash proved to be one of many challenges during the 2012 race, in which Bruce crossed the finish line in 35th place in a field of 66 mushers. While not his best race -- he placed 23rd in 2011 -- the experience solidified a resolve that began to form when he was diagnosed with diabetes at age 30.
"I was a type A personality, and I had a lot of problems with people telling me all of a sudden I can't do things because of diabetes," Bruce says. In addition to the 1,000-mile Iditarod -- dubbed the toughest race on Earth by the Discovery Channel -- he has completed 12 marathons and three Ironman triathlons.
Photo caption: An emotional Bruce says good-bye to Maya, who led the way in his previous five Iditarod races. She didn't go this year because of her age (she's 10). "I owe my life to her," he says.
A Changing Lifestyle with Diabetes
Where diabetes presents obstacles, Bruce sees opportunities.
"He's not just a type A; he's a type AAA," says Melissa Linton, Bruce's wife and mother of their children, Shea, 2, and Brody, 4. "He doesn't do anything halfway. He goes from 6:30 a.m. to 10:30 at night. He never stops."
In reality, living with diabetes has changed Bruce's life. He must monitor his blood sugar three to five times a day and pay attention to what and how often he eats. He always has insulin at the ready, and he needs the right amount of sleep or he suffers.
"I can look at anything, any food, and immediately know how many carbs are in it," Bruce says. "I don't even think about it anymore."
Bruce has adjusted the way he eats to manage his diabetes, but he doesn't let it rule his life. He pushes his limits physically and mentally. "I'm convinced it was a good thing that I got diabetes," he says. "If I didn't have it, I don't think I would have ever started running and doing marathons."
Photo caption: Bruce and dog handler Gus Guenther (in orange) organize everything that must get packed on the sled.
Managing Diabetes in Extreme Conditions
The Iditarod runs from Anchorage to Nome, Alaska, and takes nine to 14 days to complete, racing 24 hours a day. Mushers must carry tools such as axes, snowshoes, sleeping bags, and dog booties. Bruce, who wears an insulin pump, has a more extensive list: insulin, blood glucose meters, test strips, and his continuous glucose monitoring system.
The continuous glucose monitor (CGM) tells Bruce if his blood glucose is trending high or low. It proved invaluable when fatigue set in during the Iditarod. Mushers face brutal winds, extreme cold, treacherous trails, and sleep deprivation -- and, as a result, poor judgment can occur. Bruce started using the CGM after his first race and found it helped him determine if he was going low or just exhausted.
Melissa worked hard to balance Bruce's protein and carbohydrate requirements by portioning out each of his meals for the race. She cooked and vacuum-packed macaroni and cheese, chicken Alfredo, prime rib, and beef stew, and Bruce thawed the meals by boiling the pouches.
"The quality of food on the trail is not as important as getting calories in my body and staying hydrated," Bruce says. Every few hours he would snack on cookies, beef jerky, or peanut butter granola bars. It's not all healthful, he says, but it's easy to eat while moving. "I also have to take into account how easy the stuff is to eat when frozen," he says. "When it's -30 degrees F, it-s hard to eat a rock-hard Snickers."
Photo caption: Bruce keeps in one bag the diabetic supplies that won't be damaged from freezing, such as empty infusion sets, cannulas, and reservoirs for his insulin pump.
Dealing with Frozen Insulin
With Bruce's improved monitoring equipment, Melissa says she doesn't worry about him out on the trail as much as she did in the beginning years. He keeps his insulin and meter in plastic bags next to his skin near his abdomen to prevent them from freezing, and he checks his blood glucose regularly, sometimes even doing it while moving. But problems still occasionally arise.
During the 2012 Iditarod, Bruce called Melissa from a race checkpoint in the town of Unalakleet. He told his wife that he didn't think he had kept his insulin close enough to his body when the temperature dipped to a bone-chilling -50 degrees F. He could not tell from looking at the insulin if the cold had compromised it, but he told Melissa not to worry.
From that point, Bruce headed into a ground blizzard, losing the trail during the night, but he finally made it to the tiny village of Shaktoolik, just 125 miles from the finish line.
"I was trying to walk into the checkpoint, and I couldn't even walk," Bruce says. "I knew something was wrong. I got in there and my meter read 600 -- and it doesn't even give you a reading over 600." It could have been higher.
Exhausted but afraid to sleep, Bruce began to care for his team. After her conversation with her husband, Melissa called race director Mark Nordman, who had a spare vial of insulin that Melissa had given him before the race began. A pilot flew the insulin from Nome to Shaktoolik. Bruce might not have been thinking clearly, but she was. "I thank God that Melissa did that," he says. "I was in bad shape."
Photo caption: A bag filled with extra insulin, pump supplies, a meter, and alcohol swabs was delivered to the race marshal before the Iditarod began. Bruce's insulin has frozen only once along the trail.
To protect his feet, Bruce wears three pairs of socks: one thin layer that wicks away moisture and two heavy wool-blend pairs.
Embracing a New Role
The 2012 race was Bruce's most challenging Iditarod yet. He says it underscores the importance of staying focused and positive in the face of diabetes; he feels fortunate that he has been able to manage so well.
And he's buoyed by the support he receives on an almost-daily basis from other people who have learned to live alongside diabetes. After his first Iditarod, Bruce received more than 400 e-mails from fans thanking him for being a positive role model. The messages continue to pour in.
"The last thing I could imagine is the attention you'd get just for having diabetes," Bruce says. He shied away from it at first but realized he could be a role model, a title he now embraces. "Talking to children and parents of diabetics has become as important to me as the race itself -- if not more."
Photo caption: Bruce and his team leave the starting gate in Willow, greeting well-wishers who line the route's first mile.
Mind Over Matter
You can imagine that being alone on the Alaskan tundra would give you a lot of time for thinking and reflecting. Here are some thoughts and fears Bruce shared about what has gotten him through the tough times:
"My biggest fear is that I wouldn't be able to tell the difference between being sleep-deprived and hypoglycemic. If I am tired, that is one thing. But if I am actually hypoglycemic, I could die out there all by myself in a few minutes."
The CGM he wore was a huge asset, helping Bruce track his blood glucose. "When I do get mad, I think about people who lived before insulin was invented and how they suffered. Then I see how the incredible medical and technological advances of today have allowed me to live a healthy, positive life, and that quickly takes any anger away."
Food is also always within reach. "My pockets are always full. I keep candy bars and other high-carb-containing snacks there. My overcoat has a large pouch in front for an entire bag of cookies."
In the end, it's about his family. "On the trail, I think about how my wife, son, and daughter have given me everything I've ever wanted in life. I feel extremely blessed."
Photo caption: Bruce on the snow with his team of dogs. "We are all one team out there, and you are only as strong as your weakest dog (or person)," says Bruce. "They depend on you to be their leader, and you depend on them to safely get you where you need to go."