Type 1 and Training for the Boston Marathon

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Greg_Mile 20

Greg at mile 20 of the Boston Marathon

The Boston Marathon is defined by hills:  those we must run up, and those that we must run down. This perpetual change in elevation is uniquely symbolic for my own training process.

I don’t always see the hills that I must run up and down. But I always feel the hills. I always feel the ease of running downhill, and the difficulty of running uphill. There are many moments that are flat. Not good, but not bad. There are, however, even more moments that feel as easy as running downhill, or even more difficult than running uphill.

Running Without Focus

I disconnect my pump while I run. However, my pump provides a continuous stream of insulin (‘basal’) at all times. I don’t receive this insulin while running. I always find another way to administer the basal I miss while running.

I took an injection of Lantus the Friday before the Super Bowl. Lantus mimics basal administered by the pump. Just hours after this injection though, I knew something was wrong. My blood sugar was abnormally high. Every attempt to bring my blood sugar to a normal level wasn’t working. My blood sugar stayed high all night long.

I woke up at 7 am the next morning. It was time for my weekly long run. I knew I had to run, regardless of my blood sugar. I dragged myself out of bed, put on my running shoes, and drove to Newton to complete another long run with the Heartbreak Hill Running Company.

Soon thereafter, I found myself standing at the base of Heartbreak Hill. I was physically prepared for this run, but I wasn’t emotionally prepared. I wasn’t focused on running 13 miles. And I knew that I wasn’t going to become focused on running 13 miles. With that, I set off running.

I stopped to test my blood sugar several miles later. I pricked my finger, and placed blood on the test strip. My glucometer counted down the seconds until it provided a result. My blood sugar barely dropped since I started running.

I drank a few sips of water, and started running again. My running partner, who also has type 1 diabetes, was surprised. I usually eat food after testing my blood sugar, to ensure my blood sugar is at a safe level for exercise. The lack of food was a disruption in my routine, and caused me to continue thinking about my blood sugar.

We slowed down several miles later. I tested my blood sugar again. It was still very high. We only had three miles left to run. I knew, at that moment, that I wouldn’t settle into a rhythm while running. This couldn’t be more important. Endurance running is a uniquely difficult sport, requiring deep concentration for hours on end. On this morning, though, I had to think about every step I took.

I realized, though, that I could still perform one aspect of my long run routine. I looked across the street and found Heartbreak Bill, the gorilla mascot of the Heartbreak Hill Running Company. Heartbreak Bill comes out long run and I take a picture with Bill every time. I walked across the street, and realized he was holding a sign. The sign said:

Greg and Bill_Do Your JobDo Your Job

Heartbreak Bill couldn’t have had a better message. My run on that morning was nearly impossible. I knew the remaining miles would be arduous. Bill and I took a picture. He held his sign, and I pointed at it to emphasize its importance.

The remaining three miles of this run were some of the hardest I have ever run. I looked straight down at the ground for the overwhelming majority of these miles, exuding all of my effort to simply take one step after another. I finished my half marathon, though, and I did my job.

Running Without Energy

I woke up the following Saturday morning. It was 7 am, and I was staring at my ceiling. I wasn’t sure if I would be able to run 13 miles.

I stood at the base of Heartbreak Hill that morning, staring towards the top. I took a deep breath, and set out to run another half marathon. Heartbreak Hill didn’t pose much of a challenge that morning. My legs felt fine. My breathing was under control. My run was off to a very anti-climactic start.

Something felt different by the time I finished the second mile. The spring in my step was gone. My legs felt weighed down by cement blocks. My entire body felt exhausted. Something was wrong. I continued to feel this exhaustion with every step I took. I had no clue what was causing this exhaustion. But I thought of my photograph with Heartbreak Bill the previous week, and I kept running. I kept doing my job.

I reached mile 6 a short while later, and it was time to test my blood sugar. I pricked my finger, and placed blood on the test strip. My glucometer counted down the seconds until it provided a result. My blood sugar was low. My blood sugar, though not dangerously low, was much lower than it should be while running.

I proceeded to eat. A lot. I ate multiple energy gels, simply hoping to raise my blood sugar enough to stay safe. I drank multiple cups of water, to wash the sugary taste of the energy gels out of my mouth.

In that moment, something clicked. Something made sense. I realized that my exhaustion was caused by my low blood sugar. My body simply didn’t have the energy necessary to perform at a high level. I took a deep breath. And I continued running.

No amount of mental fortitude would help to overcome this exhaustion. My exhaustion wasn’t an imagined barrier. Instead, the exhaustion was a very real manifestation of my diabetes. But I could not allow my diabetes to prevent me from finishing this half marathon. Giving up was simply not an option.

I tested my blood sugar at mile 10. My blood sugar was still very low. And yet, I still had three miles to run.

Those last three miles were the most difficult three miles I had ever run. I could barely lift my legs, much less lift them high enough to maintain a decent running form. I stayed hunched over, hoping that leaning forward would propel me forward. I kept pushing. I kept running.

I finally finished my run. I had to sit down for a few minutes. I had to breathe. And I had to let the exhaustion, that had plagued me for several hours, lift off of my shoulders and disappear.

Do Your Job

I ran my first marathon in 2013. I knew, then, that I had to keep running. I didn’t know, though, what my journey would entail in the years to come. I didn’t know how few resources there were in existence for long distance runners with Type 1 Diabetes. I didn’t know how it would feel to run a half marathon with a very high, or very low, blood sugar. I simply didn’t know what was in store for me, as a long distance runner with Type 1 Diabetes.

The up and down hills have never gone away. But I learned along the way, and I learned everything I need to know.

I kept running. I kept learning. And I kept doing my job.

2 Responses to Type 1 and Training for the Boston Marathon

  1. Arturs says:

    For me the biggest problem is running with high sugars – I can still do my daily training 10k or 13.1 mile but only at a slow pace. With high sugar my leg muscles hurt and I am out of breath soon. With low sugars I never stop to run, just eat some gummy bears or candy while running.
    Another thing, runs in the morning are much more difficult, I know reasons why but don’t quite know how to handle them. Runs in late afternoon or evening are piece of cake – it is hard for me to run 10k at 56:00 in the morning, but I can do a 10k at 49:00 easily in the late afternoon/evening. I wish somebody would give me guidance how to improve when running in the mornings.

    • Greg Weintraub says:


      Really interesting to hear about how high and low blood sugars impact your running. I was curious how other runners with Type 1 feel when their blood sugar is high or low during a run.

      Let me know if you want to talk (privately) about running in the morning. I know that the difference between 56:00 and 49:00 is significant. My email is below. Feel free to reach out, and we can chat about keeping you at 49:00 pace at all times of the day.

      Email: gregsweintraub@gmail.com

      Great to hear that you’re hitting these distances. Consistently running 10k or 13.1 has made those distances easier for me to run – and I’ve been able to focus more on my diabetes management while running (compared to just trying to finish the distance.)

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