A 331-pound barbell resting on her shoulders, Rosalind Sutch stands ready. When the judge gives the signal, Sutch expels a sharp breath, dips into a squat and then, exertion crossing her face, pushes the load up.

“The rep is good!” the announcer booms.

Sutch, 38, sets down the weight and walks from the platform. As impressively muscled and fit as she is, there is still evidence of her type 1 diabetes: two small squares — one, a Dexcom G6 continuous blood glucose monitor and the other an Omnipod tubeless insulin pump — pasted to her upper arms. As one of eight women with type 1 in the Philadelphia Love USA Powerlifting competition, she must stay attuned to both her sport and her chronic disease.

“I’m always thinking: What was my last meal? How much insulin do I have on board? Do I have to adjust it?” said Sutch. “It’s almost like you’re a human science experiment.”

While aerobic exercise can cause the body to burn through sugar, making blood glucose levels drop, anaerobic exercise such as power lifting can lead to higher sugars. Because people with type 1 don’t produce insulin, they must inject external insulin – or bolus – to keep blood sugars balanced.

Continuous glucose monitors and insulin pumps have made control easier for athletes with type 1 diabetes. Sutch does even more, regularly tracking her workouts, nutrition, blood sugars and insulin requirements, analyzing the data to see whether her regimen needs tweaking.

“Blood glucose control is an issue with any form of exercise,” said Gary Scheiner, a certified diabetes educator and exercise physiologist who advises Sutch. “But we don’t believe in limiting anyone – if they are interested in any type of activity, we’ll make it doable.”

Scheiner noted that in activities such as high-intensity strength training, “there’s such an increase in adrenaline that blood sugars may not respond as we expect.”

“Usually, when someone exercises, we expect glucose to come down. With strength training or power lifting it may rise temporarily but maybe drop later on. We have to learn the patterns for each individual and configure their insulin around that.”

An additional factor is muscle mass: The more muscle you have, the more effectively the body can handle glucose.

“Muscle is metabolically active tissue that’s burning fuel [glucose] continuously even when we’re at rest,” said Scheiner. “A person with more muscle who’s taking insulin won’t need to take as much.”

“The key is having the right set of adjustments. With cardio, you might need to cut insulin dramatically while with regular weightlifting sugars might hold steady. But if you do powerlifting, blood sugar may jump, and you’ll need extra insulin on those days.”

A combination of cardiovascular and strength training works best for insulin control, he said.

“Exercise is the most powerful tool we have to make insulin work better,” said Scheiner. “You can take a whole medicine cabinet full of diabetes drugs, but they won’t improve insulin sensitivity the way exercise can.”

The other important consideration in powerlifting and type 1 is nutrition, both when and what you eat.

“You have to enjoy eating,” said Stephen Cornely, Sutch’s powerlifting coach. “Your body needs to refuel, and powerlifting requires a lot of fuel, so you need to eat a lot.”

Since August, Sutch has worked on moving from an 84 kilo (184 pounds) weight class to a 72 kilo (159 pounds) weight class, eating a high-protein, moderate-carbohydrate diet to build muscle and lose fat. On competition day, she weighed 157 pounds.

Following her parents’ deaths in 2008 and 2009, Sutch went through two years of not taking care of herself and her type 1 diabetes as well as she had earlier. Although she still took her insulin and monitored her blood sugar, she ate whatever she wanted and abandoned exercise. But when she found herself shopping in the plus-size department, she decided to join a gym and work on her nutrition.

In 2013, after dropping 40 pounds and feeling “too thin” she began working with Cornely.

“We did mud runs, Olympic lifting, and finally powerlifting, which she fell in love with,” he said.

Searching for a community of powerlifters with type 1, Sutch went online and discovered a group called Bolus and Barbells. Founded in 2016 by Rodney Miller, a power lifter who has had type 1 since he was 4 years old, the nonprofit was formed to provide education around glucose control and intense exercise for people with type 1 diabetes and their families.

Intrigued, Sutch flew to Austin, Texas, for a Bolus and Barbells event. It proved life-changing. There, she met other type-1 women and men devoted to the sport, many of whom also competed in the USA Powerlifting meet.

“Everyone understood me at a level that no one can unless they are a type 1,” Sutch said. “They understood what it’s like to be up at night with a low blood sugar or have your blood sugar do something that makes no sense.”

Upon her return to Philadelphia, Sutch began training for her first powerlifting event. Competitions included squat lifts, bench presses, and dead lifts. At a meet in 2016, she lifted a combined weight of 766 pounds. Within two years she was hoisting a hundred pounds more.

By the competition’s end, Sutch had met her personal goal of lifting a combined 837.76 pounds, which qualified her for an elite meet in Illinois next October.

Although Sutch loves being stronger, what she loves more is the community formed through her association with Bolus and Barbells.

“The magic of Bolus and Barbells is being surrounded by people who understand you in ways even your family doesn’t because they don’t have type 1,” she said.

“Type 1 diabetes can be a very lonely disease,” Sutch said. “But there is nothing like the feeling of being surrounded by people who understand you and are passionate about lifting.”