A New Outlook on Training for a Marathon with Type 1 Diabetes

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This post is written by Greg Weintraub, Captain of Team Joslin for the 2016 Boston Marathon.

Greg_Weintraub_with_gorillaEach week I attend a long run hosted by the Heartbreak Hill Running Company. These weekly runs have been central to my training for the 2016 Boston Marathon.  As I mentioned in my previous blog post, these runs are an opportunity to spend time with my fellow Team Joslin runners and the time we spend together each Saturday morning is a tradition that I look forward to each week.

Over the past few weeks, my runs have varied between 14 and 18 miles. These runs require intensive diabetes management from start to finish. At miles six and 11 of these long runs, I test my blood sugar. I slow down and stop on the side of the road. I prick my finger and wait for my glucometer to return a blood sugar. I then calculate how much fuel I need to eat to keep my blood sugar at a safe level. If I take too long of a break while checking my blood sugar levels then my muscles will start to cramp or I will lose momentum.

Water is also an integral part of my long runs. Dehydration causes my blood sugar to go high – and stay high. Water does not directly raise or lower my blood sugar. A lack of water while running long distances will negatively impact my blood sugar, though, so I am always sure to drink water each time I prick my finger.

On these runs, I often find myself hurting, my legs shouting at me to stop or slow down. My body tells me to stop miles before I have completed each long run. I often want to stop or slow down emotionally, too. Just a quick walk would make me feel better, right? But I do not stop or slow down. I keep going – despite the pain and the exhaustion I keep going because of the people with whom I run with. I feel a strong bond to my teammates and an obligation to refuse the opportunity to quit in the face of difficulty. And for the past few months, I have kept going. I have kept running.

Learning How to Run with Type 1 Diabetes

There is no playbook for people with type 1 diabetes who run marathons. There is no set of guidelines regarding diabetes management before, during or after a marathon. When I started running, there was nowhere to turn to learn how to run with type 1 diabetes.

It would have been extraordinarily easy to stop running before I even started running. The lack of resources at my disposal could have served as a great excuse to avoid running. But I refused to allow that to be the case. I refused to allow my diabetes to prevent me from accomplishing this deeply important endeavor. So I did the only thing imaginable. I decided to learn how to run marathons – by running marathons.

I continue to work with my family, friends, and physicians – whom I now affectionately refer to as “my team” – to help manage my diabetes during training. We have collaborated to develop a rudimentary playbook, a basic set of best practices, which enable me to run marathons.

When we started working together in preparation for my first marathon, we knew enough to know what to do on a mile-to-mile basis. But we were short-sighted in our ability to navigate the training process – both physical and emotional – required by a marathon.

What They Don’t Teach You and You Can’t Learn

But now as we are just weeks away from the Boston Marathon, there is an added amount of stress and anxiety that accompanies my training.

We are just weeks away from the event for which I have spent many months and countless hours, training. We are weeks away from the event that plays a central role in my life as I work towards a future free of diabetes.

All of a sudden, the 2016 Boston Marathon feels real. Something about my perspective on training has switched and I am no longer just training. I am training for a marathon that feels to be just around the corner.

Every run that I complete has a new sense of urgency. Every ache and pain is amplified, not in pain but in importance. I no longer have months at my disposal to rest and recover from the weekly long runs or the aches and pains. I have but only a few weeks. Every step I take during my training runs feels more important.

The 2016 Boston Marathon will be my fourth marathon and my third consecutive Boston Marathon. I have learned how to train for a marathon. And I have learned how to complete a marathon with managing type 1 diabetes.

But now, as we approach the Boston Marathon, I realize there is one lesson that is still a work in progress: how to manage the anxiety of the weeks just before the marathon.

Each member of Team Joslin runs for a deeply personal cause. Each member of Team Joslin is passionately committed to the Boston Marathon. It is, truly, an honor to be amongst a group of people who are so strongly committed to the future of diabetes.

Each member of Team Joslin pours their heart and soul into the Boston Marathon. We train together, and we shape the future of diabetes together. But it is a superbly unique experience to be so committed to such an extraordinary event that requires countless hours of preparation, yet only lasts a few hours in duration.

Check back next month to follow along my journey with Team Joslin as we continue to run towards a diabetes cure in the 2016 Boston Marathon.

To learn more about or support the 2016 Team Joslin Boston Marathon team, click here. To become more involved with Team Joslin, please contact: Martha.Ho@Joslin.harvard.edu.

13 Responses to A New Outlook on Training for a Marathon with Type 1 Diabetes

  1. Cristina says:

    Thanks for the inspiring update! I have Type 1 and also enjoy long-distance running (have done a few half marathons and hope to do a full one someday!). Quick question: when you were talking about the importance of staying hydrated, you mentioned “Dehydration causes my blood sugar to go high – and stay high.” I hadn’t realized dehydration can raise blood sugar levels, is that what you meant?
    Thanks for the info and best of luck in the marathon!

  2. Greg says:

    Hey Cristina! I just saw your comment. I am SO happy to hear from you – and I am excited to hear that you have completed a few half marathons. Nice work!

    Dehydration has caused my blood sugar to become high (hyperglycemic).

    When I ran my first Boston Marathon, the weather stayed above 75 degrees throughout the Marathon. Despite checking my blood sugar every 5 – 6 miles and ensuring that insulin delivery was accurate and successful, my blood sugar stayed high throughout that marathon. In that specific case, dehydration did raise my blood sugar.

    I’m not sure if dehydration will always cause blood sugars to increase. However, I have experienced that effect while running.

  3. Cristina says:

    Cool, thanks for the hydration info!
    I’m still building up my mileage this season but maybe we could do a T1D training run! My email’s cristina[dot]munk[at]gmail.com if you want to team up sometime!

  4. Greg says:

    Awesome! I would love to team up sometime.

    I sent you an email. Looking forward to getting to know you!

  5. Mike says:

    How have you found you adjust your pump during a race or long run and how do you fuel during these runs to keep you from going low?

    • Greg says:

      Great question, Mike!

      I usually remove my insulin pump during a long run. I’ve worked with my team at Joslin to figure out the best way to do this – as I don’t want to miss out on basal when I remove my pump. Our solution? For shorter runs, I briefly reconnect my pump every 5 – 6 miles to make up for the missed basal. For longer runs, I use a long acting insulin as basal.

      I also test my blood sugar every 5 – 6 miles. Fueling during long runs is an important, and complex topic. Feel free to send me an email (gregsweintraub@gmail.com). I would love to chat more, and tell you about how I fuel!

  6. Jan Villeneuve says:

    Hi Greg,

    Just following your blog it is so inspirational. I am currently training for my first half marathon in Disney inFebruary and struggling significantly with BS control. I also take my pump off as I was dropping way too quickly even when I adjusted basal rate as per my endo. I believe everyone is different on how our body reacts to exercise,fuel,weather intensity etc so I do respect my endo fully but I think I need to listen to my body as well don’t want another experience of passing out in middle of run and waking up in ER without realizing what happened. I found it interesting to hear that you use a long acting insulin to cover your missed basal, never thought about that. Also, interesting to hear about the water dehydration impact as I drink apple juice diluted of course (don’t laugh) not much water so this maybe why extreme high at end but falls very quickly after race. Would be interested if you could tell me how you fuel with what and when you test what level is you optimum BS before you continue hope this makes sense. Look forward to hearing from you.

    I’m travelling from Canada in February so I also need to take this into consideration so much to think about when one is trying to accomplish a goal when you have type 1 and a lot of people really truly don’t get it!!

  7. Greg Weintraub says:

    Hi Jan!

    Great to hear from you. Thanks for your comment – and your very kind words.

    I am SO happy to hear that you’re training for your 1st half marathon. I ran my first half marathon a few years ago, and I’ll never forget the moment I finished that run. That moment was one of a few that made me realize I can run long distances with Type 1 – and I’m in charge.

    I agree that everyone is different. I’ve had numerous conversations recently, and I’ve taken away a lesson from them all. While different people react differently, many folks with Type 1 benefit from following the same principles. So – definitely try different things that you think might work, whether that’s different types of food while you run, or different approaches towards basal while on a run. You may well find something that works really well – and, in fact, might be used by other people with Type 1 while running. I’m currently preparing for my 5th marathon, and I still find myself making changes on a regular basis.

    I know you asked a couple questions, about what I used to fuel and what level of BS is optimal for me.

    What do I use to fuel? I use Shot Bloks (made by Clif – the same company that makes Clif Bars) for all of my runs. For longer runs, I use Gatorade and Shot Bloks with extra sodium, and I take one salt tablet for every 8 – 10 miles. The extra salt, from the Shot Bloks and the salt tablets, help me to prevent muscle cramping that can occur over many miles. If I run very long distances in very hot weather, I might try to sneak in some diet soda, potato chips, or pretzels along the way, too.

    What is my optimum BS? That’s a great question – and a question that we could spend many hours discussing. Generally, my optimum BS is 250 – 280. However, I try not to allow my BS to go that high before or during a run. What does that mean? It means that I’ll have enough food to raise my BS to 250+. However, I’ll start running before the food has impacted my BS entirely. That way, I’ll receive the full impact of the food, without the food raising my BS all the way up to 250 (or higher). My blood sugar tends to drop a lot during very long runs, so I test every 6 miles – and raise my BS to 250+ each time I test.

    As a note, never feel embarrassed by what you use to fuel. I’ve read stories about ultra-marathon runners who eat pizza and sandwiches during their very long runs. I also recently watched a documentary about a guy who ran a 100 mile event – and ate 60+ vanilla bean Gu packs along the way. Find what works for you – and take it in stride. If it helps to get you to the finish line, it’s the right thing for you.

    Feel free to reach out to me via email at any time. Always happy to continue talking, and sharing tips.

    Email: gregsweintraub@gmail.com

  8. Garrett says:

    Hi Greg!

    First of all, you are so inspirational!! A lot of good information here. I hope The Boston Marathon last year went well!
    It’s almost been 10 years since my T1D diagnosis and I just started getting into running about 5 months ago. Last month I ran my first half marathon, and I am now training for the 2017 Chicago Marathon in October. I’m pretty nervous considering my BS was below 60 for half of the race in March! I ended up having about 4 cliff gels and about 10 glucose tabs during that time. That obviously taught me a lot about what I need to do moving forward regarding during the run managment.

    My question is, what’s your overall nutrition like when you’re training? How many carbs do you eat a day/do you concentrate majority of your carbs in one part of the day/how would running earlier in the morning compared to later in the day effect you?
    I’m currently eating majority of by complex carbs in the morning, and small about of complex carbs/simple sugars when needed throughout the day and I consume mostly veggies and protein.


  9. Hi Greg,

    I’ve had type 1 for 23 yrs now and am hitting 30. One of my goals is to get up to running a marathon but I have SUCH a hard time pushing myself and navigating my blood sugars. I find when I push my body my blood sugars spike and become almost unresponsive to insulin for a good 2 hrs.

    How do you fuel and have you noticed any similarities?? I’d love your advice!

  10. Ron A says:

    I have been 32+ years as T1 and the last 3 as runner. I started in 2014 and have run 7 marathons, 3 halves and a ton of training in between. The first 6 months I was ingesting so many gel packs even to run the shortest of runs that I started looking for another way because it made minimal sense to me to need to eat so much glucose in order to run. I found that many runners (mostly non t1) were doing a ketogenic diet so that normal fueling issues (bonking and nausea) were no longer issues. I then found that some T1s were also doing this. I started in September 2014 and have been eating as such since. It also helps significantly in BG (blood glucose) control. A1C is pretty low. Insulin regiment is pretty low in quantity due to the lower load of carbohydrates. It is different in that things affect BG that maybe would be obvious when eating more carbs.

    The spike in a run is generally due to the liver dumping sugar due to adrenaline which is natural. I get that spike normally (but not always in long runs). The only way to control that is through a fast acting beta blocker. The other way is to treat the symptom with insulin. Any fast acting insulin in my drops me significantly because I get so insulin sensitive. That is why I am going to be using Levemir before in low dose to see if that is enough to cover.

    I am not so sure that it is the dehydration that is the cause of the spike, but is something that is also happening at the same time. My last marathon I drank some 2+ liters in the race and had no big issues with dehydration. I have my camalback on since I have to bring so much gear with me on runs and that allows me to not have to stop to drink.

    There is so much that goes into racing for non T1s. Being a T1 is not easy on its best day. Doing both can be done.

  11. Rosie says:

    Just completed the Blackmores half marathon here in Sydney yesterday. What a fabulous day. While i manage my T1 well for the half wondering now if I could do it for the full. Not a fan of the Gu gels or Jelly babies, use glucodin but obviously wondering if these would be sufficient to fuel me for the full marathon or would you recommend bananas – which I see everyone eating on the day of a marathon. My concern there is that I would have to carry my needle and inject as I go – do T1 usually do this as they go?

  12. Ryan says:

    Hi Ron,
    I am a 43 year old with T1d for the last 30 years, got hooked on running about 3 years ago. I have completed one full and many halfs, getting ready to run NY next Sunday!!
    Like you, I typically eat a diet low in carbs – even during marathon training / long runs. My question to you (and all you other T1d peeps) is regarding carb loading during the days leading up to the race – I am concerned it would throw me out of whack, but almost everything I read is directing me to do it – thoughts?

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