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Type1. Long distance running

Charlotte.beadling

Member
Messages
6
Type of diabetes
Type 1
Hi all,
I have just signed up to do the Great North Run in aid of Diabetes UK (obviously) and was wondering if anybody had some training tips. I have type 1 diabetes and only usually run around 5k at a push. The only thing I worry about is falling ill whilst doing a long run and not being able to do anything about it. I try not to go out when my sugars are high because my muscles feel very lethargic so this wouldn't really be an option. Does anybody have any experience with this? I have never been very athletic so actually running 13 miles will be a massive challenge without the diabetes element being thrown in
 
Hi @Charlotte.beadling - wow, what a fantastic challenge!

Thanks for the introduction, @therower !

Charlotte I'm in foot rehab at the moment, having mildly wrecked it running (I broke my rule about not running on consecutive days and massively overdid it on frozen ground two days in a row) which has been very frustrating!

My distance is generally only 5km (parkrun and local running club) but I've done a couple of 5-milers and a 10km, and other bits in between.

I'm pretty new to this running lark, and have been out of action for a few weeks now - but I'm swimming 5 times a week to keep up my cardiovascular fitness, and I'm powerwalking 'hilly terrain' on the treadmill in the gym. Today my osteopath has passed me fit to RUN again, but only on the treadmill, not outside yet.

Being high makes me very lethargic too. I like to run in the morning, after breakfast. I have my normal bolus insulin and 2 boiled eggs, then about 20 minutes before my run I turn my pump's basal rate down to 50%, which means I'm around about the 7mmol/l mark while I'm running.

That works well for 5km. Exercise makes me go high immediately afterwards, so I turn the basal tap up to 150% for an hour or two. And I LOWER my basal 6-8 hours after a run, as otherwise I have afternoon hypos.

If I'm running in the evening I'll have a snack before I go out, and have a late tea when I get in.

My pre and post run snacks tend to be eggs, cheese, pate or Peperami, unless I'm below 5mmol/l before running, in which case I'll have a bite or two of a banana. I generally fuel myself with fat and protein rather than carbs, and because I have a pump I am able to keep my levels steady with that. (Just to clarify this, I find my blood glucose much easier to control using the LCHF eating style, so I eat probably around 60g carbohydrate in a day, keeping my 'get up and go' going with gorgeous stuff like avocado, cheese, bacon and other such yummy fatty things.)

For the 5-milers and the 10km I've done, I've erred on the side of caution and reduced my basal to a mere 20% from halfway through the run. So 50% to start with, then down to 20%, to ward off hypos. If I didn't have a pump I would probably want to take on some pre-emptive glucose at this point.

I'm doing a 10k event in April (foot-permitting!) and am in huge awe of your fabulous Great North Run plans! I'm not an expert by any means, but I think if I were training for 13 miles I would try to get some predictability to my patterns by testing before, during and after training runs in the run-up to the event, so as to get to know how my body behaves, and then going for it, ensuring I had test kit and glucose to hand.

I've recently bought (to spur me on to get back out there training) a tiny little running rucksack so I can be certain I have everything on me on my longer runs. For parkrun I have my Libre sensor on my arm and the reader shoved in my bra, and some glucose tablets in my pocket.

The rucksack is for running on my own, in which case it will contain my full test kit, Libre reader, glucose tablets, phone and a Peperami. Or maybe even two....

Keep us posted with how it's going! I'm really missing my running and am getting parkrun withdrawal symptoms. And I was aiming to do a challenging 10km trail run on Sunday - waaaaaaaaah, not a chance!

Love Snapsy


PS 'Legend' @therower ? You do make me laugh........!
 

I can't run when high, my legs feel like lead and it completely wipes my motivation! So I tend to do long runs first thing in the morning, when I've got no insulin on board and I've eaten some uncovered carbs, set off when I'm 6+ and rising and the run levels off the rise. Take test kit and hypo treatment with you (phone and an alert bracelet if youre running on your own). I'm up to 11 miles at the moment, bath half on 12/3. I try to test at mile 7 or 8, and might need to have some haribo then. But most of the ladies I'm running with are taking on gels or drinks of some kind, so it's really not much different.

I use a CGM and that helps with telling me if I need to stop and test and eat. I've been trying to experiment with HIIT sprints to bump up blood sugars during a run. But realistically my legs are too knackered for me to manage anything approaching anaerobic exercise at mile 7! But all of my running gear has got haribo or jelly tots floating around and I can eat them while running (at a sedate aerobic pace).
 

Ahh no! When I started running I went full pelt and ended up injuring my achilles tendon. Its so frustrating because your mind wants to do it, it just takes a while for my body to catch up.

I am glad everyone else feels the same when high!! My legs just won't turn properly- my consultant said its probably to do with the energy not getting through to the muscles which sounds logical. I think my best time to go is around the 8 mark because anything lower I freak out about hypos. You sound like you're all clued up on what your body needs! Unfortunately I don't have a pump and they have been saying no to me for the past 2 years. It sounds like it would be really helpful though especially for this! I am back to the hospital next week and am going armed with 3 months of readings. I find it really difficult to stay stable because I finally crack it then the next week my hormones change and Im back to square one!

I like youe idea about the libre! I didn't even think of that. I do have one but I can't afford to replace it all the time but even if I just wear it on the day of the run that will probably put my mind at ease.

I like the park runs too! It took me a while to get the confidence to go though and then when the Great North Run came up I thought stuff it I will give it a go even if it kills me. If it contributes towards a cure it will all be worth it
 

Thanks for the advice that's really useful!! I really will have to get myself a little bag. I am going to try running home from work (around 7 miles) to start me off so I will need to take all of my diabetes kit home with me anyway.

You sound like you are well on your way so good luck with the bath half!
 
Charlotte.beadling said:
o with the energy not getting through to the muscles which sounds logical. I think my best time to go is around the 8 mark because anything lower I freak out about hypos.
Click to expand...
Hi Charlotte, fear of hypos is a valid reason for being considered for pump therapy - might be worth a push?

I didn't fit the NICE criteria for a pump, or so I thought. But it's not just the NICE criteria which can be taken into account - sorry to be a pest @noblehead but could you post that fab link to the ABCD criteria? Thanks!

I'm sure running training is all very very achievable on MDI, but I didn't start to run until I had my pump. In fact, it was having the pump that actually gave me the confidence. I think that testing and jelly babies would be the two key factors required for any runner with type 1 diabetes, pump or no pump!

The legs not working when high thing - I view this as the 'syrup effect'. If my blood's too sticky, it ain't going to flow - and that's EXACTLY what it feels like. Plus being high gives me cramp - not conducive to a comfortable run!



PS Halfway down page 3 of the thread below is an essay I wrote to myself, really, to clarify my thoughts about pumping, which I showed to my DSN. For the record my HbA1c was 42, but even though this was in the desired ('no pump') range I qualified for the pump because of quality of life issues. Sorry if I'm derailing the running-related thread, but it sounded from your post that you feel you would benefit from a pump!
http://www.diabetes.co.uk/forum/thr...really-like-to-live-with-type-1.103794/page-3
 
Snapsy said:
sorry to be a pest @noblehead but could you post that fab link to the ABCD criteria? Thanks!
Click to expand...

No problem @Snapsy , this one from INPUT gives a brief summery of the ABCD recommendations:

If you don’t meet the NICE criteria but you do fall under recommendations from the Association of British Clinical Diabetologists (ABCD), your clinic will need to make a strong case for you to be granted funding

ABCD recommends that insulin pump therapy is also considered in the following situations:
• Pregnancy
• Acute painful neuropathy or symptomatic autonomic neuropathy if
conventional treatment fails to enable adequate blood glucose control
• Hypoglycaemia unawareness
• Extreme insulin sensitivity
• Needle phobia
• Severe insulin resistance with poor blood glucose control
(especially if type 2)
• Specific quality of life issues:
– Pathological fear of hypoglycaemia
– Marked glycaemic excursions/dawn phenomenon
– Excessive number of injections for optimised control
– Impaired exercise capacity, abnormal eating behaviour or an unacceptable number of sick days
– Shift work or frequent travel across time zones
– In children: sub-optimal school performance, exclusion from aspects of a full school life; behavioural problems (for example, mealtimes); adverse impact on family dynamics

Consultant’s recommendation
Your consultant agrees you have a clinical need for an insulin pump and have the necessary commitment and skills to use the technology safely and effectively

http://www.inputdiabetes.org.uk/alt-insulin-pumps/is-it-provided-by-the-nhs/
 
Ahh awesome!! I am going to go in to my meeting next week armed with all of my readings and a fighting attitude! I always kinda get fobbed off. My HBA1C at the minute is at 8 but I just get told this doesn't constitute as 'bad' enough. Your letter probably resides a lot with most diabetics - just because mine isn't as bad as it could be doesn't mean it's not bad enough for that individual.
It sounds like I would benefit a lot from a pump particularly with my training! I really like the sound of what you do, at the moment I just kind of have to guess how my body is going to react to exercise/if I still have insulin working in the background/ if I am going to have a dramatic drop/ if I need to eat something first (pointless if you're actually doing the exercise to stay in shape) argh!!
 
Before I started running and before I started pumping I started swimming. I worked so, so hard to be safe with it, and with a lot of trial and error I nailed it.

I would have porridge either 20, 15 or 10 minutes before leaving the house, with either 1 or 2 units of Novorapid depending on what my blood sugar was on waking - and it would be different every single day! The timing and/or the dose would vary enormously! I would swim 'through' the porridge spike, hoping to time it perfectly..... it did work for me, and I was felt all the trial and error was really worth it.

Then when I started pumping I had to work it all out again.

Then I started running and had to figure that out (still a work in progress - I'm only confident with exercise either first thing or pre-tea!), plus now I eat low carb etc etc etc - sooooooo many factors!

I'm thrilled to hear you're going to be making more enquiries about pumping! I find my control is more predictable, and my confidence has soared!

 
Update?

In the context of mature onset IDDM, middle and long distance running, science based nutrition and sports coaching and the real world, if I had known years ago what I know think I know, I would have gone keto, trained much more, enjoyed more effective running, possibly been only on CGM not also a pump for years longer, had fewer other health complications and better cognitive management for longer.

We rarely get a direct path to the best outcome.
If you do not get a pump, then there are other pathways foward.

All the trial and error is actually desirable. As an athlete of any ability you ought to be trialling and accepting there will be more errors than successes.
Once you find a success it becomes your norm so it only counts as one success! On the other hand, lots of trials and errors is one big, successful approach.

Keeping a record of your training and biomarkers relevant to you will help. This could be too much for most but the concept is a logical consequence of training, trialling and accepting "errors".

It reflects that you are in charge, you are the expert on you and it also helps refute the speculative bad advice of others.

So, keep any record at whatever level suits you. Maybe it is just a few words in a diary ("tried 3kms am felt **** kicked cat") or go overboard in detail if it suits you (and your coach).
I have a template that could capture far too many daily biomarkers before during and after training and competition / race but it is deliberately too much for anyone - the point is to enable coached athletes in running to choose over time what to track. Anything recorded is better than nothing.

The above is just to emphasise the benefits of trial and error, accepting it is all work in progress, no one else but you can best advise you (only support you) and you will better manage IDDM and running long distance if you keep some track of your progress, trials and errors.
And successes.

The elephant in the room is fear of hypoglycaemia especially overnight after the kind of training and competing typical for long distance runners with IDDM.
My gratuitous advice, as good or as bad as any other's advice, is that becoming keto adapted almost entirely removed the real risk to me when coupled with CGM.
It is a totally different world of running training, living a life and managing all health issues.
Most advice in research papers and so also in blogs etc assumes carb adapted athletes. Even researchers whom I respect and who directly advise international level athletes with IDDM seem to to be totally limited to carb based athletes - presumably there's too much risk and too much career effort to get off the runaway train that is the "carbs remain best substrata for athletes" hypothesis masquerading as fact.
(Regrettably, the USA aproach to gurus on keto athletes gives me headaches and white knuckles of despair. You can live a much happier IDDM sporting life keto adapted without ever once reading hearing or buying from the zealots)


Off my hobby horses and onto the envelopes. The winners are:
1. Whatever you decide.
2. CGM.
3. regular physical exercise.
4. 1, 2 & 3
5. Becoming and staying keto adapted.
6. 4 & 5.
7. Pump.
8. 6 & 7.
9. 8 & deliberate trialling (safely, of course).
10. 9 & recording biomarkers relevant to you as much as you wish and only to the extent you will actually use the record to learn from it.
11. 10 & running to compete.

Special encouragement awards also to participating in orienteering, trail running, fell running, mountain running, triathlon and refereeing team sports (they have to be fit!).
 
Hi guys, thanks for all of your advice a few months ago I completed my half marathon last weekend and I just thought I'd give you an update on how it went! It all went well for the first 9 miles then my blood dropped like a stone! I was so determined though I kept running and was fighting the hypo for 2 miles. 2 dextrose gels and copious amounts of jelly babies from spectators and I finally got going again and managed to finish bang on my target time of 2hours 15. It was strange because it never happened on my training runs, I think I was so anxious on the day (my heart was nearly beating out of my chest at the start line) that that's what probably affected my bloods. Anyway thats all over now and I managed to raise £750 for diabetes UK in the process A hypo was probably meant to be!
 
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