I was diagnosed with Type 1 Diabetes in the fall of 2002 at the age of 28. I wear a Minimed pump with the Minimed CGM. Since starting to run in September of 2009, I have participated in two 10Ks, two 10 mile races, a 200 mile relay with 11 other Type 1 Diabetics, the GO! St. Louis Half Marathon and will run the Chicago Marathon later this year. I am not a doctor and don’t have a medical background, but I like to share my experiences to help and inspire others with T1.
Tony asked me to write about my experiences with the before, during and after care that goes with extraneous physical activity, like running with T1 diabetes. What follows is what I *try* to do every time I run. I am far from perfect, but I have a good plan. Most days everything will go just fine , but others… well, let’s just say every day is a learning experience.
Preparation and planning is the key to a good run. Having T1, I can’t simply go out for a run at anytime. I need to be aware of what I have eaten and how much insulin I have on board (IOB). An hour before a run I will set my basal down to 10% of the normal level and depending on the distance I’m planning to run, I will leave it at 10% for another 30 minutes to an hour. I like to start my runs with my BG around 120-150 and trending upwards. To do this, I’ll eat 15-20 grams of carbs about 15 minutes before heading out. I’ve found that eating right before starting has little or no affect on my BG, so 15 minutes seems to be the right length of time for me. A lot of other Type 1 Diabetic runners that I know prefer to start with fairly high BG levels. I perform much better with a lower BG level, so I like to be in the normal range. If I am high before my run (220+) , I will do a correction that is equal to about 50% of a normal correction. Having too much IOB is a sure way to have a nasty low while running. If my BG is in the 200-220+ range, I would skip the 15-20 grams of carbs before the run and naturally let my BG levels come down
During runs I will eat 25 grams of carbs approximating every 30 minutes. I prefer GU Energy Gels, because they are easy to carry and easy swallow while running. I NEVER, repeat NEVER, go out for a run without at least 2 GUs. They literally keep me going and out of trouble. I’ll have a GU after my first 2 miles and if my BG is holding steady, as a result of BG testing or keeping an eye on my CGM, I will delay the second and subsequent GUs as long as I can. I like to keep my BG numbers between 120 and 150 during my runs. My CGM really helps me with this, but as soon as I see it start to trend down I will eat a GU. Since the CGM has a bit of a delay compared to a BG meter, a low can occur faster than the CGM will react to it, so keeping a close eye on the graph is critical.
In case of emergencies I wear a wrist Road ID with my contact information and the fact that I have T1. I also try to carry a cell phone. But the main thing is staying out of trouble in the first place. This can be done with proper preparation and just being smart about the situation.
If you have a the luxury of running with a friend, make sure they know what to do in the case of emergency. I have a friend that I run the majority of my long runs with. We talk a lot about T1 and he knows what to do in case of an emergency.
After running I have two scenarios to deal with. The first is going high soon after finishing. Right after a run, my body is low on insulin and potentially high on carbs. In some cases, I have had my basal set at 10% of my normal level for nearly 2 hours while also eating 50 – 75 grams of carbs. My practice is to bolus the amount of basal I have missed during my run. Typically, this would be about 2 units for an hour long run. I also try to eat at least 30 grams of carbs afterwards to help my body recover more quickly. I will simply bolus the normal amount to cover these carbs. The second issue is going low later in the day. About 5 hours after a run, I will set my basal down to 50% of the normal level for 3 hours and also try to remember to eat a carb/protein snack to prevent late afternoon lows.
Running a marathon has been a life-long goal of mine and I’m not going to let diabetes stand in my way. Sure, there are a lot of challenges that I have to deal with to be safe, but in the long run better overall health and improved control is worth it. So, get out there, have fun and enjoy life to its fullest!