# Getting back to running



## spence (Mar 21, 2022)

Hi guys. Getting used to being type 1 now but went for a run with my partner and managed 2.5 miles but my levels dropped to 3.7.i always carry glucose tablets sso was ok.. Before I set off I was 7.5. Is there anything I can do or take before I go out guys. Usually do 5 miles so would like to get back to that if I can. Thanks guys.


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## helli (Mar 21, 2022)

Great that you are getting back to running.
There are a few different approaches mostly based around our bodies using insulin more efficiently when we exercise.
- be aware of insulin on board. This is typically “remaining” bolus from your last meal. I try to avoid exercise less than 4 hours after eating. If you are going to exercise sooner, consider reducing your bolus dose.
- the other option to reducing insulin is to increase carbs. You could have something without insulin (maybe an apple or a biscuit) just before you set off or top up en route. Sometimes I add very very dillute fruit juice to my water bottle so i am taking on carbs on my way round.

The other thing to be aware of is post exercise lows. Keep an eye out for hypos over the next day or so. I was advised to reduce my basal dose by 20% for the next 24 to 48 hours.

As we are all different, this will take some trial and error but, I think, it’s worth the effort.


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## spence (Mar 21, 2022)

helli said:


> Great that you are getting back to running.
> There are a few different approaches mostly based around our bodies using insulin more efficiently when we exercise.
> - be aware of insulin on board. This is typically “remaining” bolus from your last meal. I try to avoid exercise less than 4 hours after eating. If you are going to exercise sooner, consider reducing your bolus dose.
> - the other option to reducing insulin is to increase carbs. You could have something without insulin (maybe an apple or a biscuit) just before you set off or top up en route. Sometimes I add very very dillute fruit juice to my water bottle so i am taking on carbs on my way round.
> ...


I am currently still only taking morning Insulin doses so not doing mealtime ones yet. I guess I just need to make sure my level is fairly high before I set off., thanks for your reply.


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## nonethewiser (Mar 21, 2022)

Eat something like flapjack before setting off, do similar when setting off on long walks to keep bg up.


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## helli (Mar 21, 2022)

spence said:


> I am currently still only taking morning Insulin doses so not doing mealtime ones yet. I guess I just need to make sure my level is fairly high before I set off., thanks for your reply.


Take care about exercising when your levels are too high. Exercising with high blood sugars puts stress on the body causing levels to rise higher. This is why we feel lethargic with high levels.
I avoid a large carb binge such as a flapjack before high intensity exercise because it pushes my numbers too high. I am not too bad to do low intensity exercise like walking with double figures but running causes me problems.


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## spence (Mar 22, 2022)

Thank you for your reply. I guess its just finding a happy medium. I don't want to running marathons. Just be able to do 6 miles like I used to.


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## Rob Oldfield (Mar 22, 2022)

spence said:


> Thank you for your reply. I guess its just finding a happy medium. I don't want to running marathons. Just be able to do 6 miles like I used to.


Has your healthcare team mentioned the Freestyle Libre to you yet?  Far more accessible info about current sugar levels than finger pricks but currently not available to everyone.  









						Type 1 diabetes – Continuous glucose monitoring (CGM) and flash
					

Find out about checking your sugar (glucose) levels at any time with a continuous glucose monitor (CGM) or flash monitor.




					www.nhs.uk


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## helli (Mar 22, 2022)

Rob Oldfield said:


> Has your healthcare team mentioned the Freestyle Libre to you yet?  Far more accessible info about current sugar levels thanReply finger pricks but currently not available to everyone.


I am a true advocate of CGMs and LIbre. 
BUT .... they are not great at the time of exercise when our levels maybe falling faster than usual. 
The focus when running is to avoid the low rather than catching it because it can happen very fast.


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## Rob Oldfield (Mar 22, 2022)

helli said:


> I am a true advocate of CGMs and LIbre.
> BUT .... they are not great at the time of exercise when our levels maybe falling faster than usual.
> The focus when running is to avoid the low rather than catching it because it can happen very fast.


Fair point.  Could they still play a part though....maybe warning if level drops below something like a 6?  

So far my running is limited to half hour tops, and I've not seen big drops happen so my experience on it is limited.


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## Proud to be erratic (Mar 28, 2022)

spence said:


> Thank you for your reply. I guess its just finding a happy medium. I don't want to running marathons. Just be able to do 6 miles like I used to.


Hi @spence. Yes, I think spot on : it's about finding a happy medium.

If you are hoping to build up to 6 mile runs 3 or more times weekly, then you could probably sensibly start lowering your 1 x daily insulin dose, because this is to become your norm. By how much will depend on your individual metabolism; I might (now I'm getting a better understanding of the effect of exercise and activity on me) try reducing to 75 %, then 50% - keeping a simple log of what I'm trying and what happened.

Since you are dosing 1x daily I presume this is not only a basal slow release insulin, intended to cover you for up to 24 hrs, but probably an inflexible type that doesn't lend itself to frequent changes; ie needing time (perhaps 3 days) to take effect. If you are unsure of the flexibility of daily  insulin adjustments you should check with your DSN. He or she would be an appropriate person to ask about your target of 6 mile runs, anyway.

If this is to be a once a weekend 6 mile run, I would be inclined to leave my insulin dosing alone and manage it solely by timing and/or extra carbs. Start a fair bit higher, check when practical and take more carb snacks as needed; I appreciate this sits in contradiction to what @helli said earlier - it (accidentally) emphasises the point that what works for one person isn't necessarily true for another. We are all different and I don't feel the lethargy that @helli  does when high. If anything, if I'm feeling lethargic I deliberately get active. But I do agree with @helli about being alert to exercise having an effect on your BG in following days. For me this is irregular, sometimes very little effect the next day and sometimes for the next 3 days; how many days is not particularly obviously related to how active I've been.

I personally wouldn't worry in the slightest about temporarily being high. Either from starting high; or finding that high intensity exercise has created a temporary high surge - a normal consequence of anaerobic exercise; but running without interval training I would normally consider as aerobic exercise. Exercise and medium to high activity will normally bring about a steady reduction in BG, because the exercise reduces your body's resistance to insulin and that then does its stuff mopping up all the excess BG. Hence the tendency to going hypo.

I agree with @helli that Libre is of limited use at this stage. I have an extra app that converts my Libre into a true CGM, with higher alarm settings. So I get notified very early at any threshold (hyper to hypo) that my BG is falling rapidly and I can choose to ignore or respond to that; as well as having an upper threshold for low glucose - giving me extra time to prevent the low before it gets there. But this digression is for another day!

So, it's all about you finding what works for you. It helps to have some understanding about what is happening or might be about to happen.


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## Ian T (Mar 31, 2022)

Hi Spence - I was perhaps similar to you - diagnosed Type 1 (LADA) later in life.  Decided to pick up running again as a sport after a break of many, many years.  These are my experiences/recommendations (some overlap with the comments from others);
 - always run with someone else or until you are really confident you have BG and running under control.  If your partner isn't always up for that then there will probably be running groups in your area that you can join/run with.  I use Beginners to Runners but there are others.  Handily I found some other people with diabetes amongst the group which was great for comfort and advice.
 - build up distances and frequency gradually so you can learn how your BG reacts
 - I personally find Libre 2 is very useful.  I know that others above have different views but I find it helpful to know BG level and trend before I start and, especially when I finish.  I can set alarms at levels high or low enough to alert me to potential Hypos/Hypers with time to do something about them.  I have my phone paired to a smartwatch so I can easily see on the watch what the alert is without having to fiddle around to look at my phone while I am running.
 - I usually start my run with BG a bit higher than I would normally choose.  This then gives me some headroom for the exercise to take effect.
 - I find it surprising how sensitive my BG is to food before a run - a couple of Hobnob biscuits seems to fuel me for up to 10k, for example!
 - I find that a hard run can drive my BG up in the short term but then it can drop away significantly a few hours later - overnight in my case as I run in the evenings.  I counter that by adjusting carb intakes later or, in my case, adjusting rapid insulin dose.  Conversely, a slow run really drags my BG down during the run itself.  If I am out for anything over about 8K at a slow pace then I need to eat something during the run to avoid a hypo, even if I start with BG a bit on the high side.
 - over time, I found that I needed to take less insulin overall but the effect of the running exercise on this built up over a period of time.  As mentioned by others, take advice from your Diabetic Nurse or Consultant before meddling with doses. 
 - I find I need to eat a couple of hours before I run and then again when I get back, so effectively two evening meals in my case.
 - You mentioned glucose tablets - I find them very dry to take, especially if I am running and my mouth may already be dry etc.  I prefer Tesco/Sainsbury Dolly Mixtures (about 80% sugar, come in small packets so light to take with me, cost about 30p per pack) or a sports gel (can be messy to eat on the run, not to everyone's taste but seem to work very quickly).  Keep some full fat coke or similar in the car or at home in case you go low when you finish.  I use the cocktail sized cans as they have enough in them to do the trick and save me binging....

Good luck with it - I'm off for a run now, snow permitting....!


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## spence (Mar 31, 2022)

Ian T said:


> Hi Spence - I was perhaps similar to you - diagnosed Type 1 (LADA) later in life.  Decided to pick up running again as a sport after a break of many, many years.  These are my experiences/recommendations (some overlap with the comments from others);
> - always run with someone else or until you are really confident you have BG and running under control.  If your partner isn't always up for that then there will probably be running groups in your area that you can join/run with.  I use Beginners to Runners but there are others.  Handily I found some other people with diabetes amongst the group which was great for comfort and advice.
> - build up distances and frequency gradually so you can learn how your BG reacts
> - I personally find Libre 2 is very useful.  I know that others above have different views but I find it helpful to know BG level and trend before I start and, especially when I finish.  I can set alarms at levels high or low enough to alert me to potential Hypos/Hypers with time to do something about them.  I have my phone paired to a smartwatch so I can easily see on the watch what the alert is without having to fiddle around to look at my phone while I am running.
> ...


Thanks for your reply Neil. That is really helpful and revelant advice.


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## spence (Mar 31, 2022)

spence said:


> Thanks for your reply Neil. That is really helpful and revelant advice.


I meant Ian. Apologies


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