Long distance running and Type 1

[Ad Infinitum]

Hi

I'm looking for some advice on long distance running and BS management.

I've been type 1 for just over six years and during this time have never felt restricted in exercise by being diabetic. I have cycled long distances regularly (100km+) and been a casual runner over short distances.

I decided earlier this year to test myself and run a marathon in August but 5 weeks into my training programme I'm having serious doubts.

I'm having major problems with my BS, no matter how much I reduce my Lantus the evening before a run of >1 hr or regardless of what I eat/drink before and during exercise I just can't keep my BS high enough to avoid hypo. An example of this is, yesterday I ran for 70 minutes (was supposed to run for 115 minutes), starting BS of 7.6 then BS readings of 3.2 at 40 minutes, 4.2 at 55 minutes and 2.6 at 70 minutes, at which point I called it a day.

Obviously this is not safe practice especially as I do a lot of my running alone and off road, I make sure to carry all the essentials for immediate survival but the constant worry is taking all the enjoyment out of running.

Any advice would be greatly appreciated.

Regards, Richard

 

[phoenix]

I have exactly the same problem. I have 'run' (I'm very slow) a marathon on MDI . The only thing was to drip feed dextrose, some people eat jelly babies, every 20 minutes or so, topped up by isotonic, energy drinks later on; but yes because I don't like to run my levels high, it was at times a bit of a yo/yo. Actually I found it less of a problem after the first couple of hours of running (I am very slow!) .
Some people start their runs with quite high levels and similarly, top up with small amounts of carbs .
I now have a pump and I was prescribed it because of my frequent exercise hypos (sorry I'm not it the UK although a reading of the guidelines suggests it could be possible) This enables me to cut my basal down diring running and after,... I run with a basal of 0.1u an hour.
It's better, its not a complete answer and I still have to eat carbs during a run(same thing happens on long hill walks), not quite as frequently as before. I still use small quantities at time to avoid big spikes. What I have been able to mostly avoid is the running on empty. With it I ran marathon at levels between 4 and 8, pre pump I would have been bouncing between 2 and 5.

 

[Snodger]

I have not tried long distance running so I'm not chipping in with advice, sorry, but I'm just very interested in the answers.
While phoenix's pump advice makes a lot of sense I'm interested to know if there is a way to manage on MDI (eg if you can't get prescribed a pump, or if it takes a while to get). Eg could you split your basal dose up into several jabs of tiny amounts? Would that work insulin-wise, if you could manage the hassle of having to stop to jab?

 

[Ad Infinitum]

Phoenix - Thanks for sharing your experiences, you raise some interesting points.

Maybe I should have provided a little more information on insulin doses and food consumption in my original post, so here goes ...

My usual dosage of Lantus is 24 units, I reduce this by 50% the evening before running for >1 hr. I will increase my carbohydrate intake the evening before running and continue to do so up until leaving the house.

I mentioned that my starting BS yesterday was 7.6, I ate a slice of multigrain bread with Nutella before leaving the house.

I have experimented with various forms of sugar during my runs, dextrose tablets, gels, jelly babies, energy bars and energy drinks amongst other forms. Currently none of these seem to be doing the trick.

Perhaps a pump which releases a basal dose throughout the day is the answer. I will speak with my consultant at my next appointment.

I guess in the mean time I'll just have to limit my runs to < 1hr and put the marathon plans on hold for the time being!

Regards, Richard

 

[Member34835]

I am sorry to hear that you are having problems like this. I am a type 1 who is running for 2 -2.5 hours without hypos but I can only do this by starting out on a level of 15-18 which then rapidly decreases to a 4-6 by my return. I then have to keep on reducing insulin to carb ratios due to the afterburn. Judging by some of the posts I have seen the idea of having such high blood sugars seems to be unacceptable but I don't seem to get ketotic and my blood sugars do not remain high for long.
The only things that occur to me other than the obvious that you can't start an hours run on 7 and not go hypo if you are running and not walking, is do you inject in your legs and might that make the insulin peak more quickly as you are moving your legs so intensively?

 

[copepod]

I also run distances of several km, usually in orienteering context, so not flat out. On a linear course, I never know how far or how long I will run, and on a score course, while I can be fairly sure how long I will run (typically 60 mins), I can't be sure how much distance I will cover. So, I have to ensure that I have my last short acting shot at least 3 hours before running, start with blood sugar of about 12.Xmmol/l, and usually have a handful of jelly babies after about 30mins, and more if still out at 60mins, plus have more jelly babies after finishing. If I know far enough in advance, I will reduce long acting dose(s) before running - I take Humalin I at morning and at bedtime, which gives more chance to fine tune. If my blood sugar is as low as 7mmol/l before starting, I'll need some jelly babies before starting - the beauty of low key orienteering is that starts happen when you stick your dibber in the SI box, so there's not problem having say a 15 min delay while the sugar gets into my system. In higher standard pre-entry events, start times are predetermined, so there's less flexibility.

 

[wetmoose1960]

I'm American, so I don't know your glucose measurement system, but I've run about 25 marathons with Type 1 and have worked out a simple but effective method. I suspend my pump before starting . I get my sugar fairly high, but not excessive(250 by my system), then I drink a swallow of some sort of sugar drink every mile. I carry one of those little plastic flasks. As simple as this sounds, it has worked very well so far over the past 10 years. My sugars are ususally very good at the finish, I seldom get lows(but I have had some), and I get to finish line. I think it just keeps the sugars level over the course of a long workout. I would suggest trying this drink per mile method on short runs, and work up. I have done a couple of 50 mile races using this system, and don't see a limit besides the sore feet.
Also, before I got the pump about two years ago, this same method worked just fine.

 

[phoenix]

Maybe a cup of black coffee may help!

Caffeine May Ward Off Exercise-Related Hypoglycemia in Type 1 Diabetes

http://www.medscape.com/viewarticle/724488

 

[Fallenstar]

Hi
I do long distance and fell running, 90 miles a week on average with type 1. Whatever length run I go on I will not take any insulin with my last meal before the run. This was on my own findings and the advice of my Endo.
I will only set off on a run when my sugars are between 14/17 . I will check about 6 miles into the run and usually they will be down about to 10 this should then give me another 6 miles in the tank if it is not too hilly. I will have a Lucozade Gel if I am going further and will have three os these with me incase of hypo's.
My sugars will be down to 4 by the time I get back when usually I have another meal with a lower dose of insulin than if I had not exercised ,to just take care of the afterburn.

Sometimes if my sugars have not budged at the 6 mile stage ,or even occasionally gone up, I will take 8 units of my Lantus as my Apidra works too quickly when my circulation is going big time.

Hope some of this may help
I

 

[scni]

get your bloods above 9 before setting out. i usually aim for between 10-12. if i go running for 30 minutes i'll take 5 glucose tablets. maybe be an idea to keep an eye on your heart rate too. dont forget and reduce your insulin at meal before run and wait at least an hour and half after meal to let the food and insulin do its thing

 

[TamsinB]

I've found having a pump gives me much more flexibility when it comes to exercise, when I run I can reduce my basal rate so I don't have too much insulin on board. Of course getting your mits on a pump is pretty hard and even if you wanted one you could be waiting years.

In your case I'd recommend you investigate switching from Lanuts to Levemir - you do have to take it twice a day but that means you can knock back your background for 12hrs rather than a whole day. I used to take Lantus before switching to the pump and from personal experience found that it took a good 48hrs for any changes to take effect.

When I started running I carried jelly babies but now I use gels which are easier to carry. You can get different types - from very quick acting to slow release. I also like to carry flapjack for long distances.

If you can, try to track your sugars over a few runs to see how they trend. Does you clinic have a CGM system you can borrow? I find I drop about 6mmol every 4 miles (40-45mins) so I try to start around 11 and then top up with gels as I go.

Good luck with your running!

 

[Fallenstar]

Hi Tamsin
That is interesting what you have said about the switching from Lantus to Levmir, I do a lot of long distance running and am waiting for a pump, but I may speak to my Diabetic team about switching to Levimir if it is more flexible.
Thanks for the info

 

[Eddy01]

I do cardio exercise daily, i do running in the morning in the park,
i think running is good exercise, its helps to be fit and healthy.

 

[spideog]

Just did another marathon the weekend just gone, but my first since I got fitted with the insulin pump. Biggest difference was that I didn't need to carry anywhere near as many gels on me in order to last the distance as before. With the previous marathon last October I got through 9 gels I think it was and that gets quite sickly by the end, quite apart from it being a pain to be carrying that many of them from the start. This time I made it round only needing to take 3 gels and the BG levels were 7.0 at the finish which is about as good as you can get.

With the pump and therefore taking the amount of insulin appropriate to what you are doing, by changing the basal levels on the fly, makes things much better for exercise. On injections it's much more difficult as you have to take sugar to deal with the amount of insulin that you may have taken 24+ hours before the exercise which is completely back to front way of doing things.

Now to get some decent training in before London next year and go for a properly decent time.

 

[borofergie]

Well done spideog! How are the legs? What time did you run?

Me and Fallenstar were tentatively thinking about forming a "Diabetic Running Team" (possibly a DUK one) for a Half Marathon next year (possibly the Great North Run, but I'm not sure how easy it is to get a place). It would be great for promoting the message that not only can lead a normal life with diabetes, but you can also do extraorinary things.

Do you think you might be up for something like that?

Stephen

 

[spideog]

Did 3:05 this weekend, but it was a pretty tough course around Rutland Water and there was a lot of cattle grids and the odd gate to negotiate on the way. In addition to the constant undulations of the course which meant you could never get into a good rhythm. Have my automatic place for London next year sorted already based on a sub 3 time I got in Dublin, and will be hoping for something around 2:50-2:55'ish in London now.

I think that Great North Run generally fits in a pretty good time of year for a half in the build up to a full marathon. My half marathon times are still about 13 minutes too slow to be getting an elite place though. :lol:

So it would either be luck of the draw in a lottery, or getting a charity place.

 

[Fallenstar]

wow spiedog that's a good time, I can relate to the amount of Glucose Gel, those things aren't for the faint hearted :sick: I have found that my change from Lantus and Apidra to Levemir and Novo has made a massive difference with the amount of Hypos I have now during runs..and my performance also.
I used to have to set off with my sugars so high and carbed up to the hilt to cope with Lantus, now I can have a meal with Bolus, set off with them at around 12 and I only have to have a couple of glucose sweets every 45 mins now...and my orange juice and water mix, very diluted ,in my Camel pack, will see me right for a full marathon now...before ,I was like you , I had to run my BG so high at first then I,d be chasing Hypos at the 16 mile mark :roll:
I'm glad you find the pump is working for you, you have some really good times going on , are you faster now on the pump?

 

[spideog]

If I'm faster because of the pump then it is because I can train better. It is far easier to run with the pump, well I don't mean the being attached to it as that is not better, but the having nearly instant control over how much basal insulin you want and when is 100% better than on injections for me. I will still try and have the BG level up a touch before going for a run or race, but nowhere near what I needed to keep it at before going for a run on injections.

I just reduce the basal setting about an hour before the run for a certain duration, test again just before going out the door. If it's about 9-10 then I'm happy to go running for an hour or so, if running for longer then I'll take a gel every 40 minutes. Previously I needed the BG to be up around 14 in order to last an hours run without going hypo, and if going further would have had to take a gel every 20 minutes to be able to remain upright.

It took some experimentation to figure out the settings that worked for me based on my pump profile settings, but there is no way I'd go back to injections. Just the not having to keep the sugars high to enable me to go running means that I can run better.

 

[Fallenstar]

Yes ,I can second that, the not having to have your BG so high to start with...it's like running through treacle for the first hour. I think I will go for the pump. As it does sound like it would be the logical thing for me to do...as good as the Levemir is for me...well improvement to the Lantus :crazy: Having a Basal in there working that you have to adjust to...can't be as good as having the pump which you can adjust to you...it just makes sense with training.

glad it's worked for you, it must be liberating

 

[Simon v]

I'm American, so I don't know your glucose measurement system, but I've run about 25 marathons with Type 1 and have worked out a simple but effective method. I suspend my pump before starting . I get my sugar fairly high, but not excessive(250 by my system), then I drink a swallow of some sort of sugar drink every mile. I carry one of those little plastic flasks. As simple as this sounds, it has worked very well so far over the past 10 years. My sugars are ususally very good at the finish, I seldom get lows(but I have had some), and I get to finish line. I think it just keeps the sugars level over the course of a long workout. I would suggest trying this drink per mile method on short runs, and work up. I have done a couple of 50 mile races using this system, and don't see a limit besides the sore feet.
Also, before I got the pump about two years ago, this same method worked just fine.

Hi there, thanks for the tips. Very helpful. I am new to t1d (18 months) and endurance running so am trying to learn a lot as I go. I am currently training for my first marathon and then a 60km ultra 3 weeks later and I am currently not using a pump. Training is coming along well but am getting lows. You mentioned that you suspend your pump prior to starting your run. At the risk of sounding dumb, does this mean that you are not using any insulin during the race at all? My confusion is that I feel like I’m not getting sugar/energy to my body without taking insulin but when I do I drop to fast? I’m running at 5.30am so waking up and eating porridge and banana prior. Will I get the benefits of this food if I don’t take any insulin prior to the run???? I would normally take 10 unit of lantus (long acting) in the morning so would be 24hrs since my last does if I missed it? If advise would be appreciated