Managing diabetes and intensive exercise: an interview with Dr Rafael Castol, Team Novo Nordisk

insights from industryDr Rafael CastolMedical Director,
Team Novo Nordisk

What is Team Novo Nordisk and why was the team created?

Team Novo Nordisk is a professional cycling team that races at UCI Pro Continental level. It's the first ever team to be made up of athletes diagnosed with Type 1 diabetes. The team was created three years ago, and is part of the Changing Diabetes initiative developed by Novo Nordisk.

Team Novo Nordisk

How difficult is it to manage type 1 diabetes whilst training and competing in one of the toughest endurance sports?

The greatest challenge is educating all the riders about the importance of regularly checking their glucose levels to ensure they stay in the optimum range and their performance is not affected by blood glucose variability.

We inform the riders of crucial moments in the day; checkpoints where they need to make sure they are on target. If necessary, they can then correct their glucose levels using insulin or correctly timed nutritional intake, so that their diabetes does not become a factor when racing at this level.

What impact do you hope the team will have on people with diabetes?

I think the impact has already been huge. The whole idea is to inspire, educate and empower people affected by diabetes, and to try and change the perception about what can be achieved with diabetes. There can be a belief in the diabetic community that engaging in endurance or high-intensity sports should be avoided due to the risk of having an increased variability in glucose control or suffering an adverse event, such as hypoglycaemia or hyperglycemia while engaging in sport.

By showing what our team is doing, we intend to erase that stigma and encourage people to seek the proper information, technology, and recommendations needed to enable them to properly manage their diabetes and stop it becoming a barrier to engaging in sport.

What are the main benefits of regular physical activity on managing diabetes?

The benefits of physical activity have been well established and are very well known, but you have to draw a line between Type 1 diabetes and Type 2 diabetes.

With Type 2 diabetes, you certainly can engage in physical activity. Eating a well-balanced diet allows you to decrease a lot of the risk factors and long-term complications of the disease.

In Type 1 diabetes, you also see the physiological benefits that physical activity provides such as increased endurance, increased aerobic capacity, improved cardiovascular and cardiopulmonary function and a more efficient metabolism. However, managing Type 1 diabetes through physical activity means you are adding many more variables that will need to be properly controlled.

This learning process can present a real challenge for people with Type 1 diabetes, who need to constantly check and understand how their body is responding to different intensities, frequencies, and durations of exercise.

They need to adopt a certain routine in terms of managing their nutritional intake and ensuring carbohydrate intake is well timed. This timing is essential to maintaining glucose levels within the optimum range while physical activity is performed.

Team Novo Nordisk

What considerations need to be taken into account when supporting patients to step up their exercise levels?

Before stepping up levels of exercise, people with diabetes should speak with their healthcare professional. For those wishing to partake in intensive exercise or endurance sports, each diabetes patient should undergo a full medical and physical examination, as well as a risk assessment for any cardiovascular risk factors. Ideally, physical and metabolic testing should be performed to determine their aerobic, anaerobic and cardiopulmonary capacities. An individualized training program can then be prescribed according to the person’s capacities.

They need to be educated about the importance of regularly checking their sugar levels (especially when engaging in physical activity) and maintaining a record of which type of activity they've been performing and all the variables of that activity. The duration, modality, intensity, and frequency should all be noted and then compared with information on nutritional and carbohydrate intake.

People usually get into the routine of doing this during the first few months of engaging in exercise. They then become more confident and empowered in terms of managing their diabetes and feel much more secure about engaging in exercise.

Please can you outline how Team Novo Nordisk fits into the wider Novo Nordisk Changing Diabetes® campaign?

Team Novo Nordisk is part of the Changing Diabetes® initiative, the Novo Nordisk global commitment to improve conditions for the 382 million people living with diabetes today, and those at risk of developing diabetes tomorrow. People will always be able to manage their diabetes with structured training and careful monitoring.

Team Novo Nordisk embodies all of this and is applying these medical and scientific concepts to change the perception people have that diabetes makes physical activity quite risky to engage in, especially Type 1 diabetes. Clearly, the team shows that with proper medical support and education, diabetic people are able to engage in physical activity with no problem.

Team Novo Nordisk

What are Team Novo Nordisk’s plans for the future?

Our plan for the future is not only to consistently improve the glucose management of athletes across all sports, but to nurture and educate the professional cycling team.

We are constantly building foundations, growing, and obtaining a higher level of expertise, as well as a higher and more consistent level of competition at the professional level. We are keen to improve from being a Pro Continental to a ProTour team so we can take part in the world tour.

Where can readers find more information?

I co-authored “Lessons from the Professionals: Diabetes and Pro Cycling,” a peer-reviewed article published in healthcare journal “Practical Diabetes.”

For more information on Team Novo Nordisk, please visit:

About Dr Rafael Castol

Castol graduated in Medicine and Surgery from Anahuac University, Mexico City before completing his medical internship at the Traumatology Center of Txagorritxu Hospital, Vitoria, Spain. Shortly after, Castol went on to gain a postgraduate degree in Sports Medicine and Exercise Science from The University of Sydney, Australia.

He specializes in elite athlete development, sports nutrition and pharmacology, elite athlete testing and training, exercise metabolism and physiology, hormonal response to exercise and sports biomechanics, among other sports-related areas.
During his three-year tenure in Australia, Castol gained postgraduate professional experience with the New South Wales Institute of Sport (NSWIS), Sydney Academy of Sport (SAS) and Sydney University Sports Clinic.

Upon completion of these studies, Castol determined he wasn’t suited for an exclusively hospital environment and preferred to work directly with athletes who were actively training and racing in major competitions. At this time, he learned of a new cycling team that would be composed exclusively with riders living with of type 1 diabetes and was immediately interested in the project. Castol signed on to be part of Team Novo Nordisk as Medical Director when the team launched in December 2012.

Currently, Castol is a member of the American College of Physicians, American College of Sports Medicine and a research associate at Anahuac University Institute of Public Health. He is also Medical Doctor for the Ironman Triathlon Mexico, Sports Doctor and Exercise Science Consultant at the Centre of Orthopaedic Specialities (COE) at Hospital Angeles Lomas in Mexico City and for the Mexican Triathlon National Team.

A born athlete, Castol raced triathlon competitively in his age group for 9 years, and attended numerous world championships in his age group. He still races triathlon recreationally and also enjoys mountain biking and mountaineering in his free time.

April Cashin-Garbutt

Written by

April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.


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