BALTIMORE — Charlie Kimball has spoken often about how he learned at age 22 to manage the disease that threatened to end his career. Less has been said, however, about the technology and trial-and-error engineering that enabled him to race at the highest level of motorsports.

Charles H. Weiss

“The IndyCar series doctors have said that without the modern technology, the monitors, the modern insulin, the delivery methodology, it wouldn’t have been possible,” Kimball said in an interview here before the inaugural Baltimore Grand Prix over Labor Day weekend, in his team’s pit. Kimball would go on to finish 21st.

The racer, now 26, first became aware of a problem while racing in the 2007 World Series by Renault. “I was making a lot of mistakes, and spinning off and crashing, which is atypical of me as a driver,” he said. “In my first race I had a top-10 finish; when I was diagnosed it was more in the 15 to 20 range.”

When an endocrinologist told him he had diabetes, his first thoughts turned to his career, and he asked the doctor if he could still race, with the years of preparation behind him and his future hanging on the answer.

“It felt like someone has pushed pause on my life,” Kimball said. Everything went into super slow motion. It seemed like eons before he answered, but it was probably a second or two.”

The doctor saw no reason why Kimball should be limited by his illness, but there was the matter of how to manage the diabetes. As far as anyone knew, no top tier race driver had dealt with the problem before. If Kimball’s blood sugar level had been good before a 45 minute Indy Lights race, there was little chance it would get critical before the checkered flag. However, full-fledged IndyCar races that lasted two and a half hours were a different matter.

In a sense, he faced the same problem as any diabetic: how to manage blood sugar. But to his and his doctors’ knowledge, no other diabetics had tried to monitor and manage the disease at speeds in excess of 200 m.p.h. Compounding the challenge were the sport’s high g forces and draining heat.

To his team of mechanics and engineers, he added a health team led by three practitioners from the University of Southern California Center for Diabetes: Dr. Anne L. Peters, a diabetologist; Donna Miller, a certified diabetes educator; and the nutritionist Meg Moreta. “I call them Charlie’s Angels, because they keep me safe on the track,” said Kimball.

He worked with his doctors, mechanics and engineers to design a diabetes management system that could be integrated into his racecar. And to that team, he added his father, Gordon Kimball, a mechanical engineer who worked for a number of notable race teams, including Dan Gurney’s All American Racers, McLaren and Ferrari. “Most of the brainstorming was done standing around the car,” Kimball said. “They would have ideas based on what they had done before.”

In theory all they needed was to find a way to make a sugary drink available to Mr. Kimball while driving. Getting water to drivers is a well-established practice. A 50-ounce plastic bladder is generally stowed beside the driver under the bodywork. A tube is threaded into the helmet with a valve that opens when the driver bites on it.

To save time, Kimball’s decided to forgo the bite valve. “The idea was it would be easier for me to get the drink without having to manipulate the bite tube,” said Kimball. That idea didn’t survive the first hard turn. “The g-loading pumped a lot of water into my face, so to the pit crew listening on the radio, it sounded like I was underwater.” The bite valve was reinstated.

Diabetics commonly drink orange juice to replenish sugar, but Kimball required more volume than could be conveniently sipped while snaking his car through a chicane. The answer was a mix of orange juice and dextrose, “so I don’t have to drink a pint glass to get the effect,” said Mr. Kimball.

The dextrose cocktail does have its drawbacks, one being that it is an outstanding medium for mold, which can blacken the drinking tubes if they aren’t cleaned immediately after use. The other drawback is the flavor. “A crew member tried it and said it tasted like Kool-Aid gone bad,” said Kimball. “I see it as a necessary evil,” he added with a shrug.

Installed in Kimball’s cockpit is a three-way valve his father ordered from a scientific supply store. Kimball would turn the valve in one direction for water, the other for his dextrose drink. “It had to be at a placement where it was easy to get to it, but it doesn’t restrict his movement,” said his father.

Again easier than it appeared. The first set-up seemed fine until Mr. Kimball made a post-race discovery, a deep bruise on his arm where the valve was mounted. “It was circles of purple and yellow and green,” he said, rubbing his arm at the thought of it. The next effort put the valve in a place where it interfered with his harness. It was finally lowered and moved back toward Kimball’s shoulder, which worked.

He cannot, of course, afford to wait until he feels woozy to attend to his blood sugar. To head off a problem, he has a meter, a Dexcom Seven Plus, that reads his blood sugar from a wireless sensor with a lead inserted under his skin.

“The monitor is prescribed for use on the abdomen on only, but because of the harness, that doesn’t work for me,” he said. Tests with his doctor determined that he got an accurate reading for the back of his arm.

The palm-size monitor is stuck to the center of Kimball’s steering wheel using “the high-tech miracle of Velcro,” Mr. Kimball said. “It’s just one more gauge to check.”

The last detail to work out was what to do if the monitor shows he is headed for a blood sugar emergency, which would require a hypodermic of insulin for high blood sugar, or Glucagon for low blood sugar.

One thought was to use a common diabetes tool called an insulin pump. About the size of a deck of cards, the pump holds a reservoir of insulin, which feeds though a tube into a cannula placed under the skin. Insulin would be available at the push of a button. The problems with that were manifold. For one, the heat of the cockpit could cause the insulin in the reservoir to crystalize or denature, rendering it useless. A second was it would be hard to have the pump handily available and still secured, especially an issue in a crash.

The decision was made in favor of a Flexpen, a sort of emergency syringe filled with insulin or Glucagon. If Kimball needs a shot, it becomes part of a regular pit stop. “If I pull in, I’ve lost those seconds, so we want to change the tires and fuel up so I can stay out longer,” he said. The crew member Jerry Bouchard is tasked with changing the front tire, which he can do in about four seconds, then jabbing Mr. Kimball with a insulin dose.

A doctor trained Mr. Bouchard to administer the shot using the time-honored method of practicing on an orange. After a few hours of practice, Mr. Bouchard hailed Kimball and shouted, “Good news Charlie, the orange survived.”

Because Kimball’s custom-molded safety seat and elaborate harness makes it impossible for Mr. Bouchard to deliver the injection to Kimball’s abdomen, he jams the pen into Kimball’s thigh. “It’s the easiest place to get to,” said Kimball.

Easy to reach maybe, but not pleasant. “We’ve only practiced it once, with saline,” said Kimball. “It’s painful enough that I didn’t need to repeat it.”