# Marathon Running



## bluepotter81 (Oct 26, 2009)

Hi

I am looking for advice on running a marathon next year. Basically, I recently ran a half marathon and my blood sugars went really low after about 10miles and I had to quickly eat 2 energy bars.

Now, this happened despite me not taking my morning insuling (Novorapid); eating a substantial breakfast and relying on my night time insuling (Lantus), taken the night before, to see me through the race.

I am sure by the time the race started my sugars were running between 25mml and 30mml as all the usual symptons were there.

Therefore, I'd like to understand if anyone has a better way of managing their insulin regime for a race such as a marathon. I'm pretty clear that I shouldn't be taking any Novorapid in the morning, but does this also mean that I should reduce my night time insulin (Lantus) from the night before aswell. I am conscious of not having enough insulin in my body to convert the sugars and feeling awful throughout the race.

My blood sugars seems to be highly sensitive to endurance exercise. Any guidance would be appreciated.


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## Copepod (Oct 26, 2009)

*www.runsweet.com*

First of all, welcome to this forum.
Best source of information about physical activities / sports with type 1 diabetes I've found is www.runsweet.com - not just running, and it's a UK site, good for both background physiology, biochemistry etc and case studies of athletes in many different sports, which I've found useful in adapting to my sports (orienteering, canoe touring, adventure racing, mountain marathons etc). Sorry, I can't help directly, as I'm not a road runner, but Northerner has just done Great South Run, Aymes does several 10km runs etc, so there should be some personal experience.


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## aymes (Oct 26, 2009)

Hi and welcome!

As Copepod said, I do a fair amount of running, mainly 10ks at the moment although I have done a couple of half marathons also. My ultimate aim is the London Marathon, although I reckon I'm a couple of years off that at the moment.

How do you get on with your training? I found the way I got to grips with it was to build up slowly so now I'm at the stage where I know how many 'free carbs' I need per mile of exercise. Of course this will be very different in different people.

One thing to bear in mind is that in race conditions adrenaline will come into play so the level of carbs you need will most likely be different than in training. 

Personally, I reduce my lantus the night before a race, usually dropping from 24 to 20 for a 10k and a little more for a half marathon (this is just what I do not advice!). I wouldn't totally cut out the novorapid for my breakfast (assuming morning race) but reduce it significantly. I wouldn't cut it out totally as I would spike massively and there needs to be some active insulin. I then take on carbs during the race, jelly babies are usually the carbs of choice, to keep me going. The last couple of races I've finished between 5 and 6 so I seem to have it down to a fine art, it has taken a lot of trial and error to get there though! 

The thing that really helped me was taking on carbs during the race so that I had enough for the whole race but not making myself go too high before. It's not always easy eating while running but jelly babies, juice or glucose gel are manageable.

I'm sure Northerner will be around soon with the 'science' bit as well as his experiences.


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## Pigeon (Oct 26, 2009)

Hi BluePotter, 

I've done a couple of half marathons too, I wouldn't say I'd got it down to a fine art yet though! I take about one third less Lantus the night before (6 units instead of 9 for me) and had a about 25% less Novorapid with breakfast. I've found if I go running without any Novorapid in the morning then my levels just go up.

Last year I had a hypo towards the end of the Great North Run, gobbled a few glucotabs (try not to inhale them when you're short of breath - Aymes' jelly babies are far more sensible!) then finished at 7.6mmol/ml. This year I drank more Powerade en route and finished at 11.7mmol/ml, which I felt was a bit safer.

I definitely recommend Runsweet, it's the advice on there that I used to start long distance running.

Best of luck, let us know how you get on!


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## rossi_mac (Oct 27, 2009)

Hi all,

I used to run a few years ago, and am hoping to start up again at somepoint soonish (well I've been saying soon for a while, but I hope it is soon now!) So I am really interested in hearing all of your tips and tricks But I guess as some of you have siad a lot of it will be trial and error, hopefully the errors won't be too catastrophic!!

Best of luck.

Rossi


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## Northerner (Oct 27, 2009)

bluepotter81 said:


> Hi
> 
> I am looking for advice on running a marathon next year. Basically, I recently ran a half marathon and my blood sugars went really low after about 10miles and I had to quickly eat 2 energy bars.
> 
> ...



Hi, welcome to the forum! As you've probably gathered from the others, there's a lot of trial and error involved, and we are often quite different in how we are affected. Before a run I take my normal novorapid as it is the period AFTER the event that affects me, so that is when I will reduce my insulin, both slow and fast acting. I haven't done any really long runs since diagnosis so it's still a process of discovery for me. As you get used to a certain level of exercise you may find that your levels don't drop as much. I ran the Great South Run last weekend and my levels were 9.7 at the start, 5.7 at 7 miles - had 2 jelly babies and finished on 4.8. You should not be starting a run with levels above around 13 mmol/l as this can be dangerous, and you do need to make sure you have sufficient circulating insulin to help get the glucose into your cells, so I wouldn't recommend relying on your background insulin for this over 26 miles.

Here's a thread we discussed earlier on a similar topic:

http://www.diabetessupport.co.uk/boards/showthread.php?t=1170

I'd definitely recommend getting hold of a copy of The Diabetic Athlete's Handbook by Sheri Colberg which will give you a good understanding of all aspects of exercise in relation to diabetes.


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## Deano (Nov 9, 2009)

Hi and welcome,

As every one has said its what works for you so try making small changes but always test before and after your runs note it down and you will soon see a pattern emerge. I am training hard for the london marathon 2010 and have my local 1/2 marathon (Norwich) coming up in 3 weeks time. So far i havent messed about with my Lanctus. If going on a shorter run of less than an hour i will lower my novo slightly before the run and take on extra carbs my normal rule is 1 jelly baby every mile after 3 miles. If going on a longer run then i keep my novo the same and eat extra carbs before i go out, and again top up on the way round. I am now up to 18 miles in training and am finding when i run long or cycle long in the mornings my body does not have enougth insulin circulating so today i did 18 miles and tried something new i lowered my novo before breakfast but 2 hours before i went for my run i gave myself 2 units of lanctus this did the trick. It does meen you have to snack a little more on your return but when you have run that far thats not too much of a problem. Its just finding what works for you, But as a general rule with marathon training i would suggest take on extra carbs befor and after your run and top up on the way round  you soon get in to a routine.
Good luck, and if i can help anymore than please ask
Dean


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## Ron Brownlow (Nov 10, 2009)

I am like Deano here - 1 'thing' per mile. I choose a gulp of locozade sport per mile and i run up to 12 miles at the moment. 

Although like most other people I don't reduce or up insulin levels, the most I would do is eat about 20g of carbs over what I would normally eat for say breakfast and not take the insulin for that extra food. So, I would start maybe 7 plus dependant on race or training and distance. I would push myself higher for distance or race than a 7, maybe a 10/11 if it's a 10mile race for instance but 6/7 is fine for a 5 mile training session. I take 1 gulp of luco sport every mile and generally fininsh at 5/6.

I'm doning another half ironman next year so I need to try this out at much longer distances. 

I am also fortunate enough to be going to see Dr Ian Gallen next week so I might be able to pass on some of his knowledge!


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## Northerner (Nov 10, 2009)

Hi Ron, welcome to the forum 

I'm still getting used to running with diabetes after being diagnosed last year (I'd run 11 marathons previously and loads of halves). No triathlons for me - not a strong swimmer and can't ride a bike! Please do pass on any other tips you might pick up as you increase your training. I've read recently that shorter training runs can be attempted on just basal insulin, but I'm sceptical - have you ever tried that? I always used to run before eating, but now I'm finding I have to eat then wait 1-2 hours which is most frustrating!


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## Ron Brownlow (Nov 11, 2009)

Cheers good to find you all.

Sometimes I will get up in the morning and do a weights session and swim session lasting about an hour for both and have a few swigs of locozade sport. This is before food and any injection (strangely I do my Levemir/basal at 12 in the afternoon - there was method there when I started although I can't remember what it was)

I'll normally finish that session the same as I started. then come home and have breakfast and the right amount of Humalog for the amount of carbs.


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## Ron Brownlow (Nov 11, 2009)

And yes, I do the eat thing then wait two hours minimum before exercise although I save that for longer runs or races as I can't do that for morning training sessions. I have to if it's a race though so I'll get up extra early, eat then sit around or snooze or travel to the event in the spare 2 hours.

If I go out in the evening for a run up to say 8 miles I would've eaten lunch at 12pm then had a snack at 4ish then run at 7pm. Do a test at 6pm and eat a slice of bread or something if I'm lower than 6mmol. 

That isn't much differant to getting up in the morning and exercise before breakfast I suppose. 

Hope that helps


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## Northerner (Nov 11, 2009)

Thanks Ron - it seems it can be done then! I've been worried since I read that not having enough circulating insulin would cause levels to go high. I guess I need to stop being a wimp about it and start experimenting


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## Ron Brownlow (Nov 11, 2009)

yep, go for it. The only thing I would add is obviously you should test as much as possible until you get a pattern going. I found the treadmill the place to start. Test to start, then test after each mile. Then test an hour after then 2 hours after. Now, after establishing some kind of pattern, I only test before and after a session - much easier on the old fingers.

I also found a spead sheet a really good idea as you can see the patterns emmerging. When I started running whilst knowing I was T1 I just took TOO many carbs on board but now I'm getting more experience I take a LOT less and finish at 'normal levels'. Then, if you're sad like me you add a HRM to the mix and you can track effort/BG/carb intake all at the same time. Have 2 spread sheets though - 1 for racing and 1 for training. 

Running without enough insulin will eventually mean that your BG will rise but that's when you will need to eat and inject while on the go - I'm not at this stage yet! I've yet to test it out, but I think it will be after half marathon distance!


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## Northerner (Nov 11, 2009)

Thanks for that Ron. Not sure about all that testing, but I suppose it has to be done! Not on a treadmill though, can't abide them! Probably do it by doing shortish runs through the park. No problems getting enough blood for a test when you've been running for a while! 

I guess pumps are much better and more flexible that MDI - still considering one especially when I get back to running much longer distances. Guess it might be a problem in triathlon though, with the swimming?


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## Ron Brownlow (Nov 11, 2009)

Tread mills are rubbish I agree but sometimes you gotta do it. 

Personally I'm not sure about a pump but we'll see, I've only been diagnosed for 2 and a bit months so will see how it all goes.

Defo can't swim with the pump and seeing as that's a big part of what I do I think I need to avoid it for now, especially as I'm (hopefully) doing the Channel Relay Swim for Diabetes UK, just waiting for my fund raising pack!


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## Ron Brownlow (Nov 11, 2009)

What 'Park' are you talking about BTW?


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## Northerner (Nov 11, 2009)

Ron Brownlow said:


> Tread mills are rubbish I agree but sometimes you gotta do it.
> 
> Personally I'm not sure about a pump but we'll see, I've only been diagnosed for 2 and a bit months so will see how it all goes.
> 
> Defo can't swim with the pump and seeing as that's a big part of what I do I think I need to avoid it for now, especially as I'm (hopefully) doing the Channel Relay Swim for Diabetes UK, just waiting for my fund raising pack!



You've really got back into it quickly then Ron! I was supposed to be returning to Stockholm to do the marathon there the week I was diagnosed - another one sat out in a hospital! I had DKA and they thought I'd had a heart attack, so it was months before they even let me run at all.



Ron Brownlow said:


> What 'Park' are you talking about BTW?



Just the local park here in Southampton, nothing grand but very pleasant. I do miss the Peak District though, from when I lived in Sheffield - used to go fell running for hours on end!

When does the relay swim take place?


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## Ron Brownlow (Nov 12, 2009)

June - Half Ironman
August 9th - London Triathlon
August 15th - Channel Relay

Should be a fun time!


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## bluepotter81 (Nov 17, 2009)

*Thanks*

Thanks for everyone's advice. I think it just goes to show the 'beauty' of diabetes and how it affects people completley differently in terms of managing blodd sugars.

For example, if I took Novorapid in the morning before exercise, it would almost be a certainty that I would hypo. I'll need to rely on my Lantus from the night before (which will need reduced itself) and I'll still have to eat a substantial breakfast 1/2 hour before the race. Its 10 years now since I was diagnosed but exercise still seems to majorly affect me. I may start the race with sugars close to 20-25 but they tend to fall rapidly.

I like the idea of jelly babies! I spoke to an ex army guy in one of the running shops and he also advised me to eat those every couple of miles.

Thanks.


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