I have read an interview with one of the top-level strongman competitor (I would rather not name him, cause I do not want to be toxic in any way to anyone). However, that athlete claims that he suffers from diabetes. Also according to how he describes his diet, it seems he is really doing everything to have diabetes. So my question(s):

  1. is it possible to have diabetes (even some easier type) and compete on the world level in strongman (or similar) competitions? (Especially with a diabetes unfriendly diet.)

  2. if is it legal to use/abuse insulin with an official diagnosis of diabetes - if so, why all athletes do not have diabetes formally?

  • Did this strongman state which type of diabetes he has? Type 2 diabetes can be caused by an unhealthy diet, and is the one people mean when they say that eating too much sugar can give you diabetes. Type 1 diabetes is genetic and cannot be caused by diet. (Source: my sister is type 1 diabetic.) – F1Krazy Feb 27 at 18:25
  • @F1Krazy Thanks for comment. I would like the answers related to both types. I did not exactly remember if he mention that. However, his specific case is not that much important for my questions. – matousc Feb 27 at 22:01
  • Maybe the same reason why there are so many professional cyclists with asthma. – E. Sommer Feb 28 at 8:16

I think it's best to start by explaining, for any users who may not know, what diabetes is and what insulin does.

Insulin is a hormone, produced in the pancreas, that allows the body to regulate its blood sugar levels. In type 1 diabetes, the pancreas stops producing insulin; type 1 diabetics thus have to inject themselves with insulin at regular intervals, or else their blood sugar will climb to dangerous levels. In type 2 diabetes, the body becomes resistant to insulin, often - but not always - as a result of obesity or lack of exercise. Type 2 diabetes can be managed by exercising, eating healthily, and if necessary, medication.

With that out of the way:

  1. is it possible to have diabetes (even some easier type) and compete on the world level in strongman (or similar) competitions? (Especially with a diabetes unfriendly diet.)

Absolutely. Sir Steve Redgrave was diagnosed with type 2 diabetes in 1997, and it didn't stop him from winning his fifth Olympic gold medal at the Sydney Games three years later. Spanish footballer Nacho was diagnosed with type 1 diabetes at age 12, but has still carved out a successful career with Real Madrid. Wikipedia has an entire list of diabetic athletes, though it also includes athletes who developed type 2 after they retired.

As for "diabetes unfriendly diet" - bear in mind that athletes, especially strongmen, have different dietary requirements to most people. They perform more exercise, and more strenuous exercise, than most people, therefore they require more calories - and since exercise uses up your blood sugar, they need more blood sugar too. So while that strongman's diet may well be unhealthy for an ordinary person, it almost certainly fulfils their own personal requirements.

Additionally, type 1 diabetics can simply adjust their insulin dosage to account for any sugary foods they may eat. With careful management, there is no such thing as an "unhealthy diet" for a type 1 diabetic, and they can basically eat whatever they want as long as they account for it. (I don't think this is the case for type 2 diabetes, though.)

  1. is it legal to use/abuse insulin with an official diagnosis of diabetes - if so, why all athletes do not have diabetes formally?

I initially wasn't sure how one could "abuse" insulin. Certainly it would be a dangerous game: injecting too much insulin results in hypoglycemia, which at best makes you lethargic and clumsy (not desirable traits for an athlete), and at worst is fatal (see the film Memento).

In the comments, you linked to this paper, which describes how insulin is in fact abused as an anabolic steroid. However, the same paper notes:

[T]here is a paucity of data on the use of insulin as a PED [...] there is no evidence of improved muscle mass after insulin administration in healthy adults at this time.

So while some people do abuse insulin to try and gain an advantage, there doesn't seem to be any evidence that it actually works. (In any case, the paper also states that the IOC have banned non-diabetic athletes from using insulin since 1998.)

Even if there were an advantage to be gained from having diabetes, its two main causes are genetics (which are something you have no control over) and obesity/lack of exercise (which, again, are not desirable traits for an athlete). So an athlete trying to give themselves diabetes on purpose would find it very difficult - and would probably become uncompetitive through lack of fitness long before any benefits of type 2 diabetes kicked in.

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  • Great answer, thanks. I am really close to accept it. I miss only one thing - Your statement: "I fail to see how one could "abuse" insulin". See for example ncbi.nlm.nih.gov/pubmed/28606865 (or any other article/post on this topic, you can found houndres of them). Can you please disclaim/support/relate to this to make your answer complete? Really good job so far. – matousc Feb 28 at 9:35
  • @matousc I wasn't aware people actually did abuse insulin. Thanks for bringing that up, I'm busy at the moment but I'll come back to this and address that when I have time. – F1Krazy Feb 28 at 10:11
  • Thanks a lot. I am looking forward to reading it. – matousc Feb 28 at 10:16
  • Most cases of insulin abuse are a result of Type 1 patients not using insulin in the prescribed manner. They maintain high blood sugar as a way to lose weight. Their bodies are not able to use the calories they are ingesting. This is still called insulin abuse, though the abuse is by not taking enough. It's very dangerous and leads to serious and irreversible co-morbidities. – Val Mar 3 at 16:33

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