I often get asked how I deal with running and Type 1 Diabetes. Particularly long runs. When training for marathons and ultras and the mileage starts creeping up, it becomes a split of concentrating on getting those miles in, whilst planning and executing perfect fuelling to ensure stable blood sugars and no crashes or harmful spikes in levels. I say perfect. It rarely is. When it is, boy does it feel good, but still now after a couple of years of running long, I am learning. Type 1 diabetes isn’t that beast that can be fully tamed. But I have found what works for me. Mostly.
Before I share my tips and how I fuel, please do take note. I am not medically qualified. this is just how I deal with it. My own opinion. You may find it helpful, you may not. Living with type 1 diabetes, isn’t a one size fits all condition. It’s extremely personal. Only you know your overall blood sugar control, and what works for some, doesn’t work for others. There’s different treatments to consider. I am still very much old school. I inject four times a day. 3 x Novarapid (short acting insulin) 1 x Lantus (long acting) so the advice and tips I have to give, wouldn’t necessarily apply to those on pumps. It is also very different to managing running with Type 2 Diabetes.
Before a Run
Unfortunately, when you are running with diabetes you do lose a little of the drop everything and just go for a run freedom. I do mostly try and plan when I am going to run. I certainly plan long runs.
pre run tips
- Try not to run within two hours of giving yourself a short acting injection. For something short like a parkrun or half hour run, I will wait until afterwards to eat. Short runs can be more unplanned, so long as your sugar levels are ok before heading out. But the two hour rule still applies. Unfortunately this also means that if you are planning an early long run on a Sunday, yes you do need to get up extra early to eat a decent breakfast. The plus side is you can go back to bed and snooze for a while.
- Try not to inject in the top of your legs. Stick to upper body. This can cause fluctuations in your sugar levels whilst running and working those leg muscles!
- I tend to try and run on a starting level between 10 – 14 mmol/l. The higher end for a long run. I’ve found these levels work for me. They might be slightly different for you.
- I always embrace the carbs before a long run, mostly just to keep something longer acting on board. It always helps me to keep more stable levels.
When I say short, I mean anything up to an hour. For a half hour run, I wont fuel. I don’t need to. I will just check my blood sugar is ok. I find around 10 mmol/l sits just fine. An hour run, I will have a few jelly babies or half a gel at 30 minutes. I have a few times, had a hypo around 45 minutes in if I haven’t taken anything, and particularly if I am working aerobically. Those easy runs drain my sugar levels. You would think it would be the other way around, but no. Hard efforts make them rise, easy makes them fall. Something to be aware of. It can also be helpful to add in some short hard bursts to kick up the levels again, but depending on what you want to get out of a session, it may not fit. So stick with fuelling properly.
If you are marathon training, these are your bread and butter, and the most important run to nail fuelling. How you fuel during a long run, can be applied on race day. The more you can get this right in training, the better a race will be. If I am running anything over 10 miles, preparation starts the night before, with reducing the number of units of Lantus I take. I’ve found this not only helps to keep levels more stable during the run, but also helps to reduce the risk of a hypo in the hours after finishing. Embrace the carbs beforehand, but don’t go overboard! After trial and error, I’ve found porridge or a bagel works well for me. it’s the right amount of carbs I need to start off with, and also the ones that I can actually stomach before long running without encountering GI issues. I tend to start long runs at 14 mmol/l or as close as possible.
During these runs, I aim to take on board a gel an hour. Which equates to roughly 30g of carbohydrates. My personal preference are torq gels, I’ve found these to work well for me. Plus there are some amazing flavours (Hello Rhubarb and Custard!) Most will need 30 – 60g per hour. I go to the lower end, based on reducing long acting insulin, the carbs I have beforehand, and the level I start off at. Again, it is trial and error as to what works for you.
I always, always carry something for treating a Hypo (low blood sugar) I’ve been caught out before, where I have been low in the middle of nowhere with nothing to treat the hypo. It is not a nice situation to find yourself in, is extremely dangerous and quite frankly terrifying. Again, plan on what works best to treat a hypo for you. For me, I take jelly babies. If I do start feeling a little low, I’ve found these work quickly to kick up the levels again. Sometimes some sporadic jelly babies are required on top of my gels. Particularly if I am doing a slower long run.
These are another thing altogether, although still the same principles of a long run. I can only stomach a certain number of gels, so for Ultras I have been using a mixture of Tailwind, flat coke and real food! Two double marathon ultras done, and still I’m learning. The second I did get it more right and although started going low, I didn’t have a hypo as I did in the first. I have a sachet of Tailwind per hour right from the start. The trick is to start early on and take little and often. Flapjacks worked well for me, along with peanut butter sandwiches. Finding what gives you energy but also sits well, again takes some playing around with. I spent some runs trying different foods. I also halved my Lantus the evening beforehand!
- I’ve mentioned a few times, trial and error. It really is. The best way to learn about what works for you is to experiment safely. Try different things, different gels, drinks, sweets. It can seem daunting, but it doesn’t have to be, just be prepared. Go on longer runs, take a ‘survival kit’ to ensure you can treat low blood sugar. If you are concerned, rope in a friend to come with you, on foot or by bike. If that’s not possible, find a public mile loop close to home. Yes it’s boring, but it serves a purpose! Spend time testing before, during and after a run to see how your body reacts.
- Always, always run with some form of easily accessible form of identification, your emergency numbers, and most importantly something that displays you are a type 1 diabetic. I run with my parkrun band on long runs, as this has medical condition and ICE details. You can also put this information in on your phone.
- It’s a pain carrying emergency hypo treatment or fuel. I wear a Spibelt on shorter runs, and don’t notice it there at all. Plenty enough room to stash Jelly babies, phone, and for marathons, gel loops which is perfect! I almost, always, wear a Camlebak for long training runs. I take my blood sugar monitor, just in case (sometimes if out for a few hours, its reassuring to pause and test to see where your levels are at) and probably go a little over board with hypo treatments. I’d rather be prepared. Plenty of water to stay hydrated, especially when taking on gels.
- Be kind to yourself. you can find what works, but there will always be times where curveballs are thrown in. Stress, lack of sleep, what you ate yesterday, misjudging the amount of insulin for your last meal, there’s a huge list of things that can throw a curveball in and mess with your blood sugars. Sometimes it may even seem like there is no real reason, it just happens. Don’t let it knock your confidence. It happens. So long as you are prepared, you’ll be fine. Try again, next time. You are a complete badass for doing what you do, whilst living with diabetes!
So that’s about all the little nuggets of useful information I have, whilst trying not to ramble too much! It can be scary, it can be a pain in the ass, it can be incredibly frustrating, but I promise you, it is worth it! Any other questions, please do feel free to leave a comment. Stay safe and happy running!