Having diabetes should not necessarily be a deterrent for you to go out and run. That is not to say, that you should just ignore what your current health, physical and conditioning levels are. To me, it is just another variable/knob/area that will normally be in auto mode it is a switch to a manual setting and requires personal attention. As a runner one of the challenges, fear, and low points during training and events to me, is getting low sugars. Whether is just prior, during, and/or after is frustrating. 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 the recovery gets compromised with a series of low sugars the body will not be able to recover as quickly and as efficiently. It is frustrating, but it is fact of life that we have to proactively manage it but it should not be a show stopper.

In making decisions I, similar to the table above, make the call on when to run, how long, what to fuel when to fuel, and whether or not is safe to run. During my very early runs and especially long runs, I take extra equipment, fuel, and liquids with me. This in part made it harder to run due to the increased weight but makes it for better training effort. It was part of the learning process to understand how I was going to achieve my goals. Today, I will carry with me and extra gel during my training runs. Depending on the workout, I will normally check my sugars prior to leaving the house, check the trend using my CGMS, have a snack if necessary, and pay close attention to how I have been feeling that day.

The key is to gather and use the available data and pay close attention to your body. Some additional preparation might be needed because sometimes you do not know when or why a low or high might hit.  I am very fortunate to have the benefit of being in a Continuous Glucose Monitoring System (CGMS) that allows me to visually see trending and readings. But even with that in hand, I need to pay close attention to many other factors like if you are still digesting your last meal or snack before heading out and figure out if an adjustment is needed. I need to go over the training plan and set a plan of attack in advance.

Things to consider:   

1. When was the last time I ate carbs, type, and how many of them?
2. The type of workout and duration Do I need additional gels? Do I need to fuel now?
3. Insulin how much? And how long ago?
4. Hydration, do I need to drink more prior? Do I need to carry water or an energy drink?

In my case when I am on the low side of my range I consider the following options in preparation for my run:

1. Eat some amount of carbs if low: (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 <- One benefit of having a pump
3. Suspend mode (I prefer to do a temp basal with the minimal bolus setting) <- One benefit of having a pump
4. If high sugars depending how high I will do a bolus adjustment. Full if it is a short run, and start reducing the amount of the bolus the longer or the effort intensity of the training run.

During the runs 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 a couple of miles I will do my best to run carrying an emergency gel with me. It is also important to be aware of how your body is reacting and how it feels during the run. Even with having a CGMS, I have been in a situation in which my sugars are dropping rapidly but the CGMS has not reacted fast enough to warn. (For an example check my Marathon event in 2016)

1. I will do a very low temporary basal and continue to monitor after taking every 1/4 mile
2. Depending on the trending information 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 need it
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 a call for pick up. (Yes, I have done that)

For easy short runs, very minimal support: These runs are at a reasonable pace and effort. For me, these are 35-50 minute runs. In normal conditions, I will only carry my cell phone and one energy gel that I will use if feel sugars trending down. I take action quickly to make sure I do not drop too low if I am midpoint or early in my run. If I am close to home base I will look at the trend to determine how fast the sugars are dropping and if it is possible I can finish the run without using the gel. A tiny detail is that the home base, in 65% of the cases, is actually home.

For track work: I have the advantage of running by the home base (in this case the bench at the track) every 1/4 mile I can easily bring extra stuff to make my workout more enjoyable. Sugar-free energy drink, some caramels, an ice bag, and a couple of gels. My track workouts could total around 8-11 miles when including at least a 1 1/2 warm-up miles and a 1 1/2 cool down miles. Since the track workout is hard, I feel that it is necessary for me to bring liquids to hydrate well enough during and after the workout.

Long runs: I will have the extra gels, extra fluids, the glucose meter in the area or near me (Car, station), and protein snacks. I monitor the glucose once in a while and take a look at the trend information and make adjustments as I go. All runs are important, long, tempo, pace, easy run, and recreational runs. They offer you an opportunity to learn, adjust and enhance your approach to diabetes. Identify issues early and discern between normal pain, tiredness, weakness of an event or run versus glucose trending rapidly in either direction.

After a few years of trying a few different methods, I am coming to the conclusion that the training plan is very personal. Since we are all an experiment of one, it is very important to determine and find your personal plan that you will have faith in and believe increasing the chances that you will follow and like. It will all depend on your goals and limitations there are awesome resources like the ones in fellrnr.com which have nice details and a comparison of different approaches to training.

I was just concentrating on increasing my endurance when I was training for my 5k, Half, and 1st Full Marathon during the first few years. To me, the most important run was the Sunday runs, the main long run. Moving from 2, 3, 5, 8, 10, 12, 14, all the way up to 24 miles on that long run, provided me with the benefits of understanding how my body, including my glucose readings, reacted to fuel, effort, temperature, humidity, and more importantly the recovery aspect of the training. Knowing how much adjustment I needed for fuel intake was crucial for a successful run.

Once I started to dabble with Ultrarunning, the approach that worked best for me was the back to back to back approach. That approach helped me understand how to run on very tired legs. It also gave me the grit and endurance needed to keep pushing forward and the necessary knowledge to troubleshoot the different situations I have encountered for many hours on my feet.

Running Shoes:

1. Find the shoes that best fit your feet, running style, terrain, and training plan. Everyone is unique, and some trying and error will be necessary.
2. Just because you have always used the same style and brand does not mean there is not something better for you.
3. Shoe manufacturers update their shoes ever so slightly, and sometimes what worked for you before might not work in the updated version.
4. Log the miles of your running pair and note how they feel at the start and during the runs.
5. For those preferred shoes, keep an eye for sales even if you do not need them at the time. Buy one or two extra pairs at a good price.
6. Create a rotation plan for your running shoes to make the best and squeeze as many miles as possible.

Diabetes Information:

Running Useful Sites:

Podcast List:

Rating – Title
❸– DizRuns
❺– Science of Ultra
❹– StrengthRunning
❷– The Running Explained Podcast
<>– Trail Runnin Nation

<>– KoopCast

Running Books:

Rating – Title – Author

❺– Hal Koerner’s field guide to Ultrarunning – Hal Koerner
❸– Born to run – Christopher McDougall
❸– Ultra Marathon Man – Dean Karnazes
❹– The Rise of Ultra Runners – Adharanand Finn
❺– Training Essentials for Ultrarunning – Jason Koop, Jim Rutberg, Corrine Malcolm
❶– The Runner’s Literary Companion – Edited by Garth Battista
❺– Running for Mortals – John “The Penguin” Bingham and Jenny Hadfield
❺– Going Long: Legends, Oddballs, Comebacks & Adventures – David Willey
❸– Runner’s World Big Book of Marathon and Half – Jennifer Van Allen, Bart Yasso, Amby Burfoot, Pamela Nisevich Bede
❸– Daniels’ Running Formula – Jack Daniels
❹– 1:59* – Phillip Maffetone, Bill Katovsky
❷– What I talk when I talk about Running – Haruki Murakami

❸– North – Scott Jurek & Jenny Jurek