An Intro to Running with Diabetes

Chris

This is a guest post from my dear friend and adventure seeker, Chris Scully who blogs at CanadianD-Gal.  I read an old post of hers recently where I realized that she didn’t always run half and full marathons and it hit me that everyone has to start somewhere.  Many of her posts detail her diabetes management prior, during, and post run (or bike) and she is a world of knowledge when it comes to handling intense and long duration exercise and diabetes.  For all of you wondering if you too, could become a runner, check this out for some seriously valuable advice.  Take it away Scully!

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I am not a professional.  Not even close.  I have learned everything through experience and trial and error.  Please consult your physician/CDE/Endo on how to start running while managing diabetes.

30 seconds into it and I feel like I’m going to cough up a lung.  I’ve never breathed so hard in my life.  I feel dizzy and nauseated.  I have no idea how some people do it for 26.2 miles at a time.

I’ve taken my first steps into running.

I think it happens to everybody who decides to pick up running.  That is the best thing one can try to remember.  Pretty much EVERYBODY goes through that.  The trick is not letting that feeling make you want to throw out your running shoes.  The trick is getting PAST that feeling.  It’s going to hurt no matter what you do.  The other trick is learning to harness that discomfort and find a way to level it out.

The best piece of advice I can give from someone who tried many times to become a runner is “SLOW DOWN”.  I think most of the time new runners bound out the door sprinting rather than running.  It’s hard to tell that you’re probably going too fast when you’ve never run before.  Take it slow and steady.  Walking does not make you a failed runner.  Some people learn very well with the walk/run approach.  At the beginning, walk more than you run while eventually increasing the run time and decreasing the walk time.  Slow down and ease into it.  It’s going to hurt at first and it’s going to hurt a lot.  Let your body recover between runs.  With time and patience the pain will subside.

Learning to run takes a long time.  Especially if you have very little athletic foundation to begin with.

One of the things that helped me more than anything else is an article I read on breathing while running.  This was over 10 years ago so I can’t quote it and have no clue where I read it but it goes like this:  2:3 ratio.  2 in, 3 out.  Breathing, it’s that simple.  2 steps of inhaling, 3 steps of exhaling.  The day I put that to practice is the day I learned to love running.  I remember reading that your exhale should be longer because you want to really empty your lungs. Focus on long deep breaths from the belly, not the diaphragm because then you end up shallow breathing.

To this day I let my breath guide my body and it has become second nature that I am always counting the breaths in my head.

Running with breath allows control I find.  There’s two ways to look at it, let the body guide the breathing or the breathing guide the body.  If you force one, the other will follow.  This breathing technique is similar to the “conversation” marker.  Can you feel like you can carry on a conversation with a running partner? If the answer is no, then you’re running too fast.

That’s how I learned to run.  That’s what worked for me.  Paying close attention to my breath made it so it stopped feeling like my lungs were going to explode out of my chest.  It taught me a comfortable pace that I could eventually maintain for longer periods of time.

As for the diabetes aspect? I haven’t always had an insulin pump and I wasn’t always the most responsible diabetic.

When I began running (post diagnosis) I didn’t have an insulin pump.  I was on shots of Novorapid and Lantus.  The timing of the runs were what was most important.  I was an evening runner so hopefully there wouldn’t be any weirdness from leftover insulin and food by the time I got home from work.  I probably took a bad approach to it because I wouldn’t leave the house if my BG was under 10.0mmol/l (180mg/dl).  I would normally eat a granola bar or something that my stomach wouldn’t try and regurgitate half-way into the run.  There was a lot of waiting.  I would still carry my glucose meter and some sort of fast acting sugar just in case and would really only use it if I was low.

I don’t remember very much from the running and pre-pumping days.

Blood sugar management while running really depends on a lot of factors.  Doesn’t it always though? But seriously, I’m going to stick strictly to running for now.    The key to my success (when I have it) is the temp basal option on my pump.

What effects the BG while running?

-Types of runs, ie: Speed work, LSD (long slow distance), Hill repeats, short runs, etc… etc… etc.
-Time of day
-personal insulin requirements
-duration, intensity

LSD runs are usually anything over an hour.  They are meant to be run at a slower than usual pace and therefore won’t rid me of glucose as fast. However, because they are long (for me 2 or 3+hours) eventually I will run out of stores.  When preparing for my LSD runs I find it optimal to manage my blood sugars so that taking in a gel or the equivalent of 25-30g carbs per hour won’t ruin my BGs.  If I set my temp too low, I might have to take insulin with my gels.  I need the fuel during the long runs just like a non PWD and having to take any amount of insulin is sketchy.  I try not to have any IOB since I find even just a little bit of insulin can have a huge effect.  Though if I do need some insulin just to take the edge off or if I’m high when I really need a gel, I will take a bit.  maybe just a unit.

Early mornings for me are different.  I usually run about an hour but I am super insulin resistant at that time and don’t need to do anything for my BG.  I don’t need a temp basal even though at that time my basal rate is at the highest for the whole day.  I run on an empty stomach and my blood sugar still rises by the end of the run.  Unless I am low before the run, I don’t need any carbs.

My evenings are when my basal rates are the lowest and subsequently when I am the most insulin sensitive.  I need a very low temp basal and usually still need to eat something before I run.

I find when I run under 1/2hour it’s easier to do nothing than to suffer the consequences of post run high BGs.  It’s too short to effect my BGs.

Post run is touch and go.  I often need to set a high temp basal before the exercise finishes.  That would be to counter the effects of the extra glycogen that is released from the liver and is now running rampant through my body when I stop.  I will set a +50% temp basal about 20 minutes before I’m done running and leave it on for 2-3 hours depending on the time of day and how it relates to my insulin sensitivity factor.

About 4 hours after the run is when my BGs will start to go down and I might set a -15% basal.  More often than not this is when I’m ready to eat and I will just make adjustments with my bolus.

So the main factors to remember are:

-Your personal insulin sensitivity at that time of the day
-The intensity of the run – high intensity often means higher glycogen being released (depending on the duration of course)
-The duration of the run – the longer the run, the more glucose stores you use up

ON THE RUN!

I carry at LEAST 1 gel at all times.  The longer runs I will have 2 on my person as well as the bananas and dates that I stash ahead of time with water.  I never run without my glucose meter.  EVER.  I used to carry it in my hand the entire time.  That was before I discovered Tallygear.  I used to test nearly every 15 minutes for learning purposes.  Now I test about once an hour unless I feel weird.  I always carry my phone on longer runs in case of emergencies, diabetes related or otherwise.  I don’t have a medical ID because I rely on my medic alert tattoo but that’s important too.

TIPS FOR STRIPS!

They don’t work in the cold or when they are wet.  My meter acts up at about 5C (41F).  The strips will sustain a bit colder but not the meter.  I put hand warmers in my meter case all winter long.  If they are wet, they won’t work.  Even just a little bit of sweat.  Mini Zip lock bags work but I find they still get wet inside after awhile.  I have been using the strip container but the rattling of the strips drives me bonkers.

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The best thing I can say is, start slow and always carry a glucose meter and sugar no matter what.

If there is something about running and diabetes that I might have some experience on, feel free to contact me.  I’m always willing to share, even the embarrassing problems.   I know what I know because I put myself through the “learn through experience” program.  Available everywhere.

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Thank you, Chris!  I am so eager to put this advice to work and I’m sure many others have appreciated an insider scoop.  I urge everyone to check out this post on Chris’ blog where she talks about her love of running and how far she has come (and potentially, where you and I could one day be because frankly I’m still in the huff and puff stages).  Just knowing it takes time and practice and knowing what to look out for blood sugar wise makes me very hopeful.

2 thoughts on “An Intro to Running with Diabetes

  1. Ana Morales

    This is such useful information! I’ve hated running for at least the past 8 years and this gives me hope that maybe I could learn to enjoy it or at least come to not hate it :P Thanks for sharing!

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