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:
- When was the last time I ate carbs, type, and how many of them?
- The type of workout and duration Do I need additional gels? Do I need to fuel now?
- Insulin how much? And how long ago?
- 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:
- Eat some amount of carbs if low: (Granola bar or oatmeal cookie) or (Some fruit juice or piece of candy)
- Temporary basal 30%-70% or normal. For about 30min up to 1:30 <- One benefit of having a pump
- Suspend mode (I prefer to do a temp basal with the minimal bolus setting) <- One benefit of having a pump
- 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)
- I will do a very low temporary basal and continue to monitor after taking every 1/4 mile
- Depending on the trending information and how I feel, I will take the extra gel
- I will slow down a bit to give some time for the sugars to come back up
- Will take a second gel if I have it and need it
- Will start to walk, but I try to keep moving even if it is a very slow pace
- 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.