One of the first things Granville Christian Academy cross country runner Malinda Hall does at the end of a race is check her "number."

One of the first things Granville Christian Academy cross country runner Malinda Hall does at the end of a race is check her "number."

That isn't to say she's consumed by the time she just posted or her placement among peers. Those aren't even the digits she's seeking. Instead, the measurement she's looking for relates to her blood-glucose level.

Hall, a senior, suffers from Type 1 diabetes, which once was known as either juvenile or insulin-dependent diabetes. It's a chronic condition, usually diagnosed in childhood or early-adult years, that develops when the pancreas produces little or no insulin. A natural hormone, insulin regulates the amount of sugar in the bloodstream and helps body cells effectively absorb it for the production of energy.

Data from the American Diabetes Association estimates that as many as three million Americans suffer from the more severe of two forms of diabetes. Citing statistics from 2007, the latest year in which they're available, the ADA said that 23.6 million (about 7.8 percent of the nation's population) children and adults have been diagnosed with diabetes, including the more common Type 2. A recent study conducted at the University of Chicago suggests that number could double in the next 25 years.

Still, Hall's life isn't defined by the disease, which requires her to monitor her glucose level several times a day. A reading of 120 milligrams per deciliter is considered normal. She wears an insulin pump, a modern advancement that for some has eliminated the need to take multiple injections daily. The device feeds continuously to keep her glucose level as close to that number as possible.

"Right after a race, I check my blood sugar and put my insulin pump back on. If it's high I'll correct (by adjusting the insulin flow) and if it's low I'll grab something to drink like a Gatorade (for quick sugar intake)," Hall said. "But other than that I'm just like any other runner, I think."

Perhaps, but few put their bodies through what Hall does in preparing for a meet.

Covering a 3.1-mile course usually takes her more than 30 minutes, long enough for her glucose level to rise or fall dramatically. As is the case with many diabetics, extreme heat can cause her glucose level to raise so Hall said the early-season races are the toughest. Exercise burns sugar naturally, however, so she has to make sure her reading is high enough at the starting line to maintain a healthy level for the duration of the race. Stress, which most competition perpetuates, also can lead to inflated glucose levels and further complicates the balancing act.

"I try to keep it about 180-240 before I run," Hall said even as she acknowledged that intentional high readings are never recommended. "If it's in that range when I go out, I don't seem to have any problems."

Left unchecked, high glucose levels can lead to complications such as heart and kidney disease and blindness. Coma, amputations of the lower extremities and even death can follow in severe cases. Low glucose levels have a more immediate effect and the symptoms include sweating, trembling and confusion. Glucose levels that dip dangerously low can throw a person into shock.

"Low is the worst, definitely," Hall said.

Diagnosed 10 years ago, Hall is managing her diabetes as best she can and otherwise is living the life of any ordinary teen. She's a basketball cheerleader in the winter, lists math and art as her favorite subjects and is weighing her college options as a 4.0 student.

She took up cross country in the seventh grade when varsity coach Terry Wagner founded the program, and Hall will conclude her career next month when the district meets are held at Watkins Memorial. She will be among the first runners at the school to take part now that Granville Christian has joined the Ohio High School Athletic Association.

"She's my last original kid so I told her this year was going to be tough on me," said Wagner, who has known Hall since she was in elementary school and attended his daughter's birthday party. "She's certainly the toughest kid I've ever had. Even on her worst day, I don't recall her ever not finishing a race."

Hall, who is in her fourth season running with the varsity, said a friendly joke between the two resulted in her joining the middle-school team.

"I told him one day that if he ever started a team I'd do it," she said with a laugh. "But I remember thinking at our first practice that I'd never run more than maybe a quarter-mile at one time. I stuck with it, though, and I'm sure now I'll probably keep it up for the rest of my life."

Hall said she knows of a few classmates who have diabetes. Others usually pose the same questions about her disease, which has a lengthy list of myths.

One is that it's caused by eating too much sugar. In truth, genetics often times is the culprit in Type 1 diabetes although neither of Hall's parents is afflicted. Generally, doctors prescribe a diet and exercise regimen that are not unlike the ones they suggest for anyone looking to live a healthier lifestyle.

"My friends will ask if I can have a candy bar or something like that," Hall said. "I always tell them it's not so much what I eat as it is how much and how often I eat. Everybody has to have sugar."

Living with diabetes is about routine and moderation as much as anything else. Hall said one of the things she dislikes most is maintaining some semblance of a school schedule even on the weekend, when she still has to get up about 8 a.m. for her first glucose check. There are very few times when diabetes management is an afterthought although she once jumped into a swimming pool and forgot she was wearing her insulin pump, which was ruined.

Hall said her latest hemoglobin A1C test, which provides a three-month glucose average and is a strong indicator of how well overall management is going, was higher than 8. Doctors urge patients to maintain levels below 7.

"That one came after I was gone this summer for six weeks with Operation Barnabas," she said referring to a Christian ministry experience offered through CE National that had teams of youths visiting missions throughout Pennsylvania, New York, New Jersey, Maryland and Indiana. "Traveling like that and being off my normal schedule, it's just harder to control."

Perhaps surprisingly, Hall said she's yet to come across any other runners at a meet with her disease. With no breaks start to finish, cross country can be a sport in which diabetes management is more difficult compared with others where athletes frequently return to the bench and thus can obtain a quick glucose reading.

When she was younger, Hall said she enjoyed meeting other diabetics through various camps offered by the Central Ohio Diabetes Association or local chapter of the Juvenile Diabetes Research Foundation.

"There are too many (time) conflicts now, but I used to have a lot of fun at those," she said. "It was always neat being around other kids who knew what 'going low' and 'checking your number' meant."