Ryan Smith – The Grateful Diabetic is a runner, certified running coach, and fitness and wellness advocate who uses endurance sports as a way to take control of his Type 1 diabetes and inspire others to do the same. Rather than running from his diagnosis, Ryan chose to embrace it, turning marathons into a platform for resilience, awareness, and personal growth.
As a BreakthroughT1D Outreach Ambassador, Ryan has raised over $13,000 for Type 1 diabetes research by running major marathons for charity. He is passionate about connecting with newly diagnosed individuals and families, showing them through action that life with Type 1diabetes is not a limitation, but a challenge that can be met with discipline, mindset, and self-belief.
Beyond running, Ryan speaks openly about the mental and emotional realities of living with Type 1 diabetes, including burnout, perseverance, and recovery. A guitar player, lifelong Deadhead, and seeker at heart, he believes true growth comes from showing up on the hardest days and choosing to move forward — embracing the journey rather than letting it define you.
In short, I realized that my running could also do something positive for the T1D community. And although I’ve been running for a significant amount of time, it started to feel like something was changing in my life late in 2019. I say that because that is around the time I started to volunteer with BreakthroughT1D and I could see how running was showing people, especially Type 1 Diabetics, that they could overcome anything, push themselves to new heights and limits, and take control of their diagnosis by embracing it. Not by running away from it. I then figured out I could enter marathons by running for charity and raising money. Obviously, I picked BreakthroughT1D as I already had a relationship with them. To date I have personally raised over $13,000 for Type 1 Diabetes research just through running marathons. This is just the start and certainly not the end.
It’s extremely draining psychologically and can put you in a rut if you are not careful. That can then lead to emotional distress. There can be many pitfalls even when you are doing everything right. It’s not something that you ever get a break from. It’s truly 24/7 and 365 days a year. Type 1 diabetics often make an extra 180-200 more decisions per day than a person not living with it. You can legitimately do the same thing two days in a row with what you eat, your insulin dosage and then get two completely different results. There are also many factors that impact your blood glucose levels, such as diet, physical activity, stress, illness, sleep, medications (like steroids), hormones, dehydration, alcohol, and even time of day just to name a few.
From managing your blood glucose to counting carbs, taking the proper amount of insulin, etc. It can often result in burnout or diabetic fatigue. It’s very common amongst people living with T1D. I think a common misconception is that insulin is a cure, it’s not, it’s simply just keeping us alive. I can’t think of many diseases where the patient is also in many ways, the doctor. When you are dealing with insulin you are dealing with a drug that can very well kill you.
Here are some examples of things that can cause fatigue that I referenced earlier. Endless doctor appointments, blood draws, insulin pump and CGM (Continuous Glucose Monitoring) site changes, pump and CGM malfunctions, pump and CGM alarms, multiple daily injections (MDI), treating low blood glucoses and correcting high blood glucoses (high and lows can be deadly and result in hospitalization or worse), over-corrections of blood glucoses, countless finger pricks, countless prescription refills, monitoring your inventory, time spent dealing w/insurance and the pharmacy, lack of sleep, fueling properly, increase in chance of mental disorders, increase in chance of eating disorders and mental and emotional struggles.
As you can see that’s quite a lot to deal with and I’m probably only covering about 40%-50% of it all. The turning point for me was I realized how much time I was spending complaining about it and hating it. At one point I finally decided I would take that same energy and lean into the madness. When I took on that mindset, everything changed. And that’s what I mean by embracing it. There is no current cure, so embrace it or it will control you.
I think my favorite would have to be the New York City marathon or the London marathon (so far). The energy at both of those races was insane, off the charts and unmatched. I often refer to the New York City Marathon as the best day of my life. I still feel that way almost 3 years later and that wasn’t even my “best” race by time standards. However, it was the first time I had a time goal for myself in a race, and I would hit that goal by nearly 4 full minutes. I was also horribly sick with an awful sinus infection the day I ran New York; 26.2 miles feeling like absolute garbage but still finding a way to persevere and see my way through it. The time goal was 3.5 hours, and I would come in at 3:26:07. Unbelievable day. One that I will never forget.
All that being said, it’s exceptionally hard to narrow it to just one. They are all special. I feel like every marathon that I’ve run there’s always been something else going on where not only did I have to run the race but also overcome challenges in my life. One example that immediately comes to mind is the Chicago Marathon in 2022.
Just 5 weeks prior to that race I attempted to take my own life by way of using something that keeps me alive, insulin. I over-dosed by using my insulin pump and administering an amount that should have left me dead. To be clear, insulin is to be taken either to correct a high blood glucose, or when you are consuming carbohydrates. My blood glucose was not high and nor was I eating or planning on eating.
To articulate a little further, let’s say I was consuming 20g of carbohydrates, for that I would typically take around 1 unit of insulin. When I laid down to go to bed that night I took 25 units of insulin. I was found unresponsive and highly incoherent the next morning when my mom stopped by my house. I was rushed to the hospital in an ambulance and spent 5 days in the wing of a psychiatric ward. When I was released, I had a decision to make. Run Chicago or don’t. I wasn’t even sure from an emotional standpoint that I was ready. Running would be what would get me through the next days, weeks, months, and even years. I then ran the Chicago Marathon 5 weeks after being released.
In one word, everything. Newly diagnosed T1D’s will often think that it’s the end of their life in many ways. That could not be further from the truth. Being able to run as a T1D and show others that you are capable of so much more is what it’s all about for me. Giving hope, inspiration, raising awareness, raising money for a cure, and helping others. I have my own personal reasons for running but to be able to help in that type of way while doing something I love meant the world to me. I was literally getting to do something that I love for something that I love. You can’t ask for much more.
I’ve made countless mistakes as a T1D, not so much recently but early on. Including 3 hospital stays within my first 7 years of being diagnosed. I was hospitalized with DKA (Diabetic Ketoacidosis) which can be life threatening. On one of those occasions, I was in such severe condition I spent 2 days in the ICU on a constant insulin drip having my blood drawn every hour on the hour. I am living proof that you can find a way and make the changes needed to have a better quality of life.
Being in the position that I was in because of those mistakes, I absolutely felt like it was my responsibility to pay it forward. I wanted to do my best to make sure no one else would have to go through the hell that I went through. It’s my duty and responsibility and I would even say obligation and a major reason I volunteer with BreakthroughT1D as an Out-Reach Ambassador. This is where the real work happens. The marathons are fantastic, but I get an even greater chance to connect with other T1D’s through volunteer work. Essentially what I get to do is talk to newly diagnosed patients or in a lot of cases parents of children that are newly diagnosed. It can be difficult at times because it’s sad, but when you are able to help it makes the pain you went through worth it. If I can impact just one life, that means I’ve done my part. I’d obviously like to impact so many more. You can’t always reach everyone, but you can try.
Great question. I think a lot of my pain in many ways has been self-inflicted. One quote that comes to mind right now is “sometimes the only way around the fire is through it.” Once you find something you love so much it becomes more about discipline and something I reference often, which is showing up.
I’m extremely stubborn, and in almost all cases (except for one, mentioned above) I refuse to give-in or quit because I’m tired or feel like it’s too hard. That’s not who I am. In those moments it is where you will learn the most about yourself, what you can do, and I believe where true growth happens and occurs.
I do have to give credit where credit is due though –my parents. They’ve both always been extremely driven and showed me from a young age that if you want something you better be prepared to work for it. There are no shortcuts. That was instilled in me at a very young age, and I think subconsciously it always stayed with me.
Lastly, I don’t want to let myself down and in those “dark” times I try to think of the 6-year-old child that is living with T1D. Are they giving up? Are they complaining? The answer is no they are not. So, then why in the hell should I? Everyone out there living with T1D helps keep this motor running and keeps me reaching for more, every day. Every time I take on a race, I take the mindset that I’m carrying some weight for people struggling with their diagnosis. Put it on me, I’ll carry your weight for the day but all I ask is if I’m going to fight for you, please also fight for yourself.
This is still fresh. I was out on my morning run, slipped on some ice while heading downhill, fell and the rest is history. Fractured fibula, and a chipped and mildly fractured ankle. Honestly for a person like me who is extremely active, and enjoys movement, it’s been tough. I need to realize that each day that goes by is a day that I’m getting better. As painful as that day might be.
Also, by keeping in mind the big picture, having visions of that first run back, which makes me emotional just thinking about, and the belief that I will get better. I fully admit in the moment this has been extremely difficult and very intense for me to deal with. The very moment I fell, the first thing I thought of was the Houston Marathon which at the time was just 4.5 weeks away. I didn’t really think much about if was I o.k. I sort of already knew I wasn’t, so all I could think about was everything I had just lost.
What I understand though is that this is temporary and is certainly not permanent. Staying positive and not feeling sorry for myself is helping me see through this right now. No complaining is allowed, chin-up, head high, we don’t give up that easily. That’s sort of my daily approach. If you don’t want to do the work then don’t, but don’t complain about it. It’s going to take a lot more than a fractured fibula to break me and take me out. I simply will not allow it to define me, break me, or wear me down. Strong and sound mind, that’s the ticket. I look forward so much to my first run back, although I’m not quite sure when that will be.
With all the things I’ve done from an endurance standpoint, this might actually be my greatest challenge. In the words of the Grateful Dead, “We will get by, we will survive.”
They are there for me every step of the way, and I do mean every step. Even now, they know I’m sidelined but they are picking me up and taking me to and from the gym as I’m unable to drive currently. That’s just one very small example. Overall let’s just say my parents show up! They’ve been doing that for me my whole life even when I wasn’t maintaining the best relationship with them or my family to be quite honest. I haven’t always been great at nurturing my relationships. No matter what though, they’ve always had my best interests at heart and have shown that in so many ways. They both have shown me what commitment and hard work are all about. Not once did they miss an event I had going on as a kid, anytime I’ve been going through something, right or wrong, they’ve been there.
My mom travels with me all over the world, quite literally, as I run these marathons, and my dad, not much of a traveler, stays home to watch my dog. The level of support that I get from them is unmatched, and extremely valued. Without them I honestly don’t know where I would be in my life. And I don’t think I can ever thank them enough or repay them.
They are my rock and true support system. They know what I put myself through and support me the whole way through.
All people are going through something in some form or fashion. Therefore, everyone you come across during the holiday season might not be “merry” or have that hope that you speak of. That’s their right and that should be respected.
Now, for me, hope can mean a lot of things. If I had to choose just one, hope means there is a belief inside you that things can and will get better. No matter where you stand today, you are in charge and can change your circumstances. It can also mean renewal, fresh starts, enduring through difficult times and knowing that nothing is forever. Even in the worst of moments, good is still coming and will find you. Your job is to stay the course, remain positive, and to believe.
You never know how something that can feel extremely bad in the moment can lead to something incredibly positive. There is a Latin saying “Amor Fati” which is to say to love your fate is to love your life. I truly believe that. Hope can come in many different shapes and forms. Things may not always turn out the way that you want but when you need to hold onto something. Hope might be all that you have.
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