It's a ritual Bill King has done for most of his 54 years - get ready for a daily run.
"My dad was an American marathon champion," says Bill. "My mother was a runner. We'd go to a race every other weekend."
At 24, while training for his 4th marathon, working 2 jobs, and going to school, King collapsed one day.
The diagnosis - Type 1 Diabetes.
"943 blood sugar... I was entered into the ICU and spent a week in the hospital," he recalls.
He notes that Type 1 Diabetes is an auto-immune disorder, and thinks his workload plus running 80-100 miles a week overtaxed his immune system, allowing a virus or other infection to trigger the diabetes.
He was told his running days were over - in fact, in the 1980s, diabetics were discouraged from exercising.
"They thought it would increase insulin sensitivity, complicating controlling blood sugar," he says.
But King wasn't about to let the disease control him.
"The first step in achieving control of your diabetes is education," he says.
He learned about his disease down to the cellular level, in addition to basics, such as managing blood sugar, even during races.
For years that was hard to do with insulin injections. But in the 1990s he became one of the earlier users of an insulin pump. And these days, he has more technological help - a wireless electronic glucose monitor checks blood sugar levels every 5 minutes and alerts him when it's going too high or low. Then he has an insulin pump to adjust them.
"It delivers small quantities of insulin every few minutes," King says.
29 years after his diagnosis, King is so knowledgeable he has become a diabetes educator, working with Achieving Better Control, ABC. It works with hospitals and more than 1500 doctors, teaching patients how to manage their diabetes. He is also inspiring others even as he racks up more miles.
"I've run 20 marathons, this will be my 21st," he says proudly.
It's the 6th time King will run the Philadelphia race. He's also run in Boston 3 times.
His best time before diabetes was 2 hours 51 minutes, which he ran twice. Since his diagnosis in the 1980s, his best time was only a little slower, 3 hours and 8 minutes. It came in a Boston Marathon.
King calls his running a mission of doing the best he can do.
He revels in the range of emotions during a marathon.
"Initially, you're so excited and confident. And you think, I can go faster," he beams.
"As reality starts to set in, you start to struggle with the pain," he continues. Once you hit "the wall" around 19 or 20 miles, "You're really starting to question your sanity."
"But in the end, it's always such a reward," he says.
King doesn't expect every diabetic to become a long-distance runner, but he does urge them to be active and get exercise into their daily lives, because it eases blood sugar control.
He is quick to say patients shouldn't go it alone - find a medical team you trust and can have a good relationship with.
For more information on ABC, call toll-free 1-866-339-4222.