My MIL has diabetes. Whenever we go to visit her, we always have to be careful to plan what we do with her, so that she can have her regular meal times. She also has to be very careful with her diet. Wow. I can't imagine doing something as challenging as this race with diabetes. I wish this pair well.
As for forced smile, that may not be necessarily bad. She may simply be shy and not like having to pose for photos.