Each year, in September, we celebrate the European Week of Sport. This year, the week takes place on September 23-30 with a focus on the power of sport to make societies more inclusive as well as its contribution to education, equality, sustainability, solidarity and democracy. The 2024 European Week of Sport promotes three main values: Inclusion, Well-being and Belonging.
Physical activity is an essential component of diabetes management and overall well-being – it helps improve blood glucose control, it has a positive impact on both physical and mental health and contributes to fighting stigma.
We recently interviewed Alessio Fresco, Type 1 diabetes (T1D) advocate and member of ANIAD, the Italian Association of Athletes Living with Diabetes, who is involved in several sport initiatives.
Could you introduce yourself and your journey with T1D? How did you become involved in the diabetes community?
My name is Alessio Fresco, and I am a multi-sport athlete and personal trainer. I was diagnosed with diabetes at 14 in 2000. Back then, a diagnosis meant being advised to stop sport, which was traumatic for me. Despite my doctor’s recommendations, I began running and engaging in various physical activities, but very often I experienced hypoglycaemia.
My life changed in 2016 when I discovered ANIAD, the Italian Association of Athletes Living with Diabetes. Until then, I struggled with managing nutrition, insulin injections and blood glucose monitoring, as there were few technologies available. At a sports event in 2016, I found ANIAD’s booth, which was exactly what I needed. They helped me understand how to manage my blood glucose levels during physical activity. Since then, I have participated in numerous initiatives, gaining experience that led me to become a spokesperson for extreme endurance sports. Intense physical activity requires a deep understanding of diabetes management, and this transformation inspired me to share my journey to motivate others with diabetes on both national and international levels.
How does training for endurance sports affect your daily diabetes management, and what unique challenges do you face in balancing both? How do you overcome these obstacles?
In life, we typically learn to regulate our routines, but over the years, I have completely transformed mine. I now train almost daily and have adapted to managing my blood glucose levels during active days. The challenge comes during pre-race tapering periods, where I need to rest and consume a high-carb diet while adjusting my insulin doses. This is tricky because my body’s sensitivity and sugar perception are different from my usual routine.
In your role as diabetes advocate, how do you inspire others to participate in sport?
I share my experience to show that we can overcome our limits. Through social media, I communicate that breaking down barriers helps us achieve our goals. My journey demonstrates that knowledge and experience can help in managing diabetes even in extreme conditions. I hope to have a strong social impact and motivate and inspire many young PwD. It took me several years from my diagnosis to finding information on how to do sports while managing diabetes well, and I want that process to be quicker for others. I would also like to reach the families of PwD. When I was diagnosed, I did not suffer much, but I saw the concern in my family and those who cared about me. My goal is to help them understand that anything is possible with diabetes. I often participate in educational camps for children and adults with diabetes and assist others in preparing for marathons, cycling tours and races. Additionally, I attend conferences where I can learn more about sports and diabetes.
Can you tell us more about your involvement with ANIAD and how the organisation promotes inclusion and participation in sports for PwD?
ANIAD is a unique association dedicated to supporting and improving the lives of athletes with diabetes. Thanks to ANIAD, I completed my first marathon. For example, during the Milan Marathon, we ran with glucose sensors connected to doctors for real-time advice on diabetes management. On another occasion, during a cycling tour, the association brought together groups of people with and without diabetes, and it was interesting to see how everyone needed to manage their sugar intake to maintain the right physical strength. ANIAD also assists with administrative challenges, like obtaining medical certificates for sports in Italy. One of our current goals is to change the laws that prevent PwD from competing at professional levels and pursuing a career in sports.
In your experience, what are some of the main barriers PwD face in participating in sports, and how can we address these?
Children with diabetes often struggle with spontaneous activities like running while playing with they friends. It is important that they learn to check their blood glucose levels and understand they may need a snack before physical activity. We have a long way to go in improving technologies that integrate insulin pumps with heart rate monitors to support diabetes management, especially for kids. Knowledge and training are very important in overcoming these barriers, and sharing experiences among PwD can strengthen our community.
What role do you believe sports play in improving not just the physical, but also the mental, well-being of PwD?
Everybody knows that sport can help lead a long and healthy life. It positively affects physical health, and when our bodies function well, we also feel good. Physical activity strengthens the immune system, prevents other health issues, supports blood glucose management and releases hormones that improve our mood.
In my experience, sport also helps release tension and regulate emotions. During long races, one can enter into a meditative state and focus. This can be a real medicine when diabetes makes us experience emotional distress linked to hypo- and hyperglycaemia.
You recently completed an Ironman Triathlon! Could you tell us about the experience? How does the competition work and how did you mentally and physically prepare for the event?
Hearing “Alessio, you are an Ironman!” at the finish line was very exciting. It took a lot of mental and physical preparation. The Ironman is one of the longest races in the world. A triathlon consists of three sports in sequence: swimming, cycling, and running. For an Ironman, the distances are 3.8 km for swimming, 180 km for cycling, and a full marathon (42.2 km) at the end—making a total distance of 226 km.
Technology was a big help during the race, allowing me to check my blood glucose levels from time to time. As athletes, we plan our sugar intake throughout the race because if we do not have the right amount of sugar, our performance drops immediately. Swimming is especially challenging because I need to disconnect my insulin pump for at least three hours to avoid water damage. This is a big challenge because I also cannot monitor my glucose levels while swimming in open water.
After the swim, we transitioned to cycling. I completed the swim in one hour and 26 minutes, then cycled for five hours and 30 minutes, managing my blood glucose levels by sticking to my scheduled eating and drinking plan. After cycling, we moved onto the marathon. I finished the Ironman in 11 hours and 22 minutes, which is a long time, but a strong performance. The fastest athletes finish in around eight hours and 30 minutes.
I find many parallels between managing diabetes and competing in a triathlon. With diabetes, you need to balance what you eat, your insulin doses and your activities in harmony. Similarly, in a triathlon, you move from swimming to cycling to running and everything must flow smoothly. Both in life and in outdoor sports like triathlon, things can change quickly because of external factors, and we must be ready to adapt.
What has been your most exciting and memorable experience with sports so far?
Cycling is my favourite sport. I find triathlons exciting because changing sports is like a new beginning each time. I really enjoy my experiences in ultra-cycling events. One memorable adventure was biking alone from San Francisco to Salt Lake City, in the United States, covering over 1200 km.
What advice would you give to other PwD who might be hesitant about getting involved in sports?
Many associate sports with fatigue and suffering, but this is only true when people push themselves beyond their limits. You do not need to be an Ironman to consider yourself an athlete. The right sport is one you enjoy and can incorporate into your daily routine. It should be consistent and enjoyable. I often tell those I train to think of exercise as a daily hygiene practice – if you skip it, you are missing out on something vital.
What’s next for you in terms of both sports and your advocacy work for the diabetes community?
I want to continue to explore the world of sports and diabetes. It is already part of my daily life and I want to continue helping as many people as possible to find their balance in managing their diabetes with physical activity. I am very active in my local association and with ANIAD nationally, and I hope now to expand beyond Italy with organisations like IDF Europe to demonstrate that anything is possible. You just have to try.