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I am Type 1 diabetic runner. Which means that I am insulin dependent which I receive in specific doses via an insulin pump. I am not going to cover what diabetes is or the difference between the types and other general stuff here. There are plenty of really good information available, you can take a look in sites like The American Diabetes Association, JDRF (Juvenile Diabetes Research Foundation), WebMD, TuDiabetes, DLife and others. Diabetes management is a personal and very individual. What works for one might not work for others, but it is in the learning about others and experiences from which all can improve. Here I will like talk about how I manage and deal with managing my sugars and diabetes while training, running and racing.  

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As a diabetic runner one of the challenging and low points during running is getting low sugar. Whether is just prior, during and after is frustrating. There are several reasons why a low is not fun to experience, but for a runner in training or in an event there are additional setbacks that can snowball further into higher impact the performance. For example, having a low sugar prior you training run, especially on a key workout means that you might have to skip the workout, delay the workout and/or not being able to perform during workout hence not getting the necessary outcome of the workout. Similar is when it happens during a run or workout set. All runners know that recovery is as important as the workout and events. Because it will determine how quickly you will be able to perform the next activity. If recovery gets compromise with a series of low sugars the body will not be able to recover as quickly and as efficient. It is frustrating, but it is fact of life that we have to proactively manage it.

Now with all that said, it is not necessary a road block or an insuperable impediment. The key as mentioned in the past is to gather, use the available data and pay close attention to your body and how it reacts to the different circumstances. Some preparation will be needed, because sometimes you do not know when or why a low might hit. For pre-runs checking your BGs is key at least 30min to an hour prior. I have the benefit of being in a Continuous Glucose Monitoring System (CGMS) that allows me to visually see trending and readings. Determine if you are still digesting your last meal or snack and go over your training plan and set your mind on your plan of attack (Visualize doing the workout)  

In a nutshell these are things to consider in addition to the reading:

1. When was the last time to ate carbs, type and how many of them
2. The type of workout and duration Do I need additional gels? Do I need fuel now?
3. Insulin how much? And how long ago?

In my case when I am in the low side of my range I consider the following actions in preparation to my run:

1. Eat some amount of carbs: (Granola bar or oatmeal cookie) or (Some fruit juice or piece of candy)
2. Temporary basal 30%-70% or normal. For about 30min up to 1:30
3. Suspend mode (I prefer to do temp basal with the minimal bolus setting)

For during the run I carry an extra gel or two in addition to the normal fueling plan, depending on the distance I am going to cover. Even if it is just couple miles I will do my best to run with an emergency gel. It is also important to be aware about how your body is reacting and how it feels during the run. Even with having a CGMS I have been in a situations in which my sugars are dropping rapidly but the CGMS has not reacted fast enough to warn. In both cases, in which I get a CGMS alarm or my body tells me is getting into a low sugar state, this is what I normally do to address these kinds of situations. 

1. I will do a very low temporary basal and continue to monitor after taking each step
2. Depending of the trend and how I feel I will take the extra gel
3. I will slow down a bit to give some time for the sugars to come back up
4. Will take a second gel if I have it and needed
5. Will start to walk, but I try to keep moving even if it is a very slow pace
6. If no more sources for fuel/carbs area available I will then consider call for pick up.

For after runs/events I consume some carbs with protein. I keep a close look of my sugars especially after couple hours after the run. In my case, it is around that time when my sugars start to drop with the longer mile runs. For me recovery is very important when I run 5-6 days of the week during training season.

I have several stories about when things did not worked out the way I want it them to go. Some of those came from my own stupidity of not carrying that extra gel or no adjusting the basal in time. Yes, there have been occasions in which I had to call my wife to pick me up and to bring me some carbs. Also not carrying my cell phone and having to flag others in the trail to be able to make that call. But in all, there are not that many compare to all the runs that I have completed. The key is not to panic, concentrate in making good decisions and take action early. Know that you might be able to rescue

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