Tips for Running with Diabetes: one woman’s detailed story

Here at TeamWILD, we encourage and teach our athletes to create Race Plans before their event. And then, once your target event is complete, we encourage you to write a detailed Race Report.

What follows is a Race Report from a new TeamWILD athlete, Megan Schmid. Megan is 30 years old, has had type 1 diabetes for 4 years and she lives in California. Megan just completed her first half marathon. GO MEGAN! We are all very proud of you!

In addition to receiving weekly training plans, diabetes & sports nutrition education, and mental skills training, TeamWILD athletes receive one-on-one feedback and guidance from certified and highly qualified experts in athletic and diabetes performance.

Marcey Robinson, MS, RD, CDE, BC-ADM, reviewed Megan’s Race Report and gave some detailed tips for Megan to incorporate as she trains for her next event: an Olympic distance triathlon!!

We asked Megan if it would be okay to share with you how her race went and share Marcey’s responses. Megan said yes! It’s a long Report made longer with Marcey’s comments, but we think you will enjoy reading one athlete’s story.

Megan’s Race Report is in black.

Marcey’s comments are in blue.

Palm Springs, California, Half-Marathon, Race Report 2/12/12

My Motivation

Two days post race, it’s starting to really sink in that I completed a major goal of finishing a ½ marathon. A year ago, I never would have thought this was something that I could accomplish. A year ago I would have told you that I hate running, that I’m not built to run further than a couple of miles, and that a 10k was probably the top distance that I could accomplish. The major shift in attitude came from training for triathlons. I love triathlons, and in order to race triathlons, you have to run!  In the last year, I found I also love to push my personally perceived limitations. These two things together lead me to train for a ½ marathon in the off-season. My goals were to become a better runner, to learn how to enjoy running, and to break that impossible 6+ mile mental barrier.

Megan, what a great accomplishment – Congrats!  I’m so excited for you and I hope you can take this momentum and fine tune your next race.  I would like to offer you some TeamWILD feedback, comments and some tips to help you. I will add them in to your awesome Race Report.

The Details

Training: My training program was 16 weeks through active.com. (My next training program will be from TeamWILD!) I started out with a base of 6 miles being my longest run to date and running about 10 miles a week. The longest training run was 10 miles and occurred 3 weeks before the race. The next week the longest run was 8 miles (with a total of 18 miles for the week), and 1 week before the race 6 miles. I stuck to the training program for the most part. I got all of the long runs in, however I was not as diligent about getting cross training days in and I did not lift weights at all in the last 3 months. I felt great after my 10 mile run 3 weeks ago, and am starting to wonder if the program tapered too early.

As you athletically train for your event, train your diabetes and nutrition too. Did you have a plan? Specifically a plan to train your diabetes and nutrition? We offer that through TeamWILD, you will get that as you train for your triathlon.

The athletic component is designed with the diabetes and nutrition training woven in each week. We athletic and diabetes/nutrition coaches talk to each other about you! Plus with TeamWILD training programs, you get to talk to us and ask questions. For example, if you wonder about the length of the taper, you can ask us!

The day before the race: Friday night I got about 8 hours of sleep and slept very well. My aunt and uncle have a condo in town and were gracious enough to let me stay there and kept me well fed and rested through the weekend. I went for a 15-minute run Saturday morning, and then had 2 eggs, toast and 2 pieces of bacon for breakfast. I then spent a few hours leisurely strolling through the outlets in Cabazon with my cousin. For lunch I had Panda Express orange chicken and steamed vegetables. For dinner I had ahi tuna w/ wasabe mashed potatoes (approximately 35g of carbs). I went to bed with a BG of 96.

Great job on the sleep, as any of the TeamWILD coaches will tell you, it’s 8-9 hours if you can get it.  Nutrition the day before the race is also important: fuel the athlete with high quality fuel (fruits, veggies, whole grains, lean protein) and be sure to include adequate carbohydrate at meals (We recommend about 60 grams) to assure your glycogen stores are topped off.

Higher fat foods can increase insulin resistance and make blood sugars harder to control.  Blood sugar control becomes important to maximize those glycogen stores on race day; the goal is to avoid hypoglycemia which can deplete them and hyperglycemia which can lead to poor glycogen formation.

Speaking of hyperglycemia, it can also contribute to dehydration.  Lastly, hydration is important both for the day before and day of the race.  As a goal, fluid needs start at ~ ½ your body weight in ounces (for example, if you weigh 140 lbs, start with a goal of 70 oz daily).

Equipment: Animas One touch Ping Pump, Dexcom continuous glucose monitor, 3 cliff shot gels (approx 25g each), One Touch Ultra-mini meter with 3 test strips wrapped in saran wrap around the meter (to keep them dry and secure!), and lancet, all carried in a spibelt.

Great job with having an equipment plan. I would offer one more tip, it’s great you thought of keeping your strips dry and secure, but be careful about taking them out of the container they come in.  Glucometer strips are highly sensitive to temperature and humidity changes which can damage them to the point of being unusable.  Didn’t happen this time but it usually isn’t worth risking. We’ll offer lots of ideas for testing during races through the TeamWILD Athlete to Athlete Tips series.

Megan at the start line of the Palm Springs Half Marathon

Race Day: I woke up 2 hours before race start with a BG of 125. I had slept for about 7 hours, and felt rested despite pre-race jitters waking me up a few times during the night. I had oatmeal for breakfast 35g of carbs and in retrospect way over bolused insulin for the time frame. I would have been fine if I had eaten 3 hours before the race, or if I’d bolused half the amount. My basal rates were set at -80% of normal from 45 minutes prior to race start and for the first hour of the race, -70% for the second hour, and -65% for the rest of the race.

That race day meal is of utmost importance to restore your glycogen stores that you burned through during the night, and I would aim for at least 60 grams of carbohydrates, if not more (depends on your total energy needs).

It was great you took concern as to how to bolus for this meal and relate it to time, many athletes actually wake up very early to eat breakfast and have it fully digested/no active insulin prior to the start of the event.  That works for some because it helps to avoid those early race sugar drops; however, to account for the pre-race jitters, some athletes benefit from having a small bit of insulin on board.

You may need to play with this a little more to find that out for you.  As far as your diabetes plan during the race, I really encourage you to watch the TeamWILD Diabetes Training videos included in your Olympic triathlon training program.

There is one tip that I just have to tell you about now! We encourage you to have your goal during your race be to achieve blood sugar control AND exercise performance. To do that, you need to fuel the exercise with carbohydrate (your 25 g would be just under the 30-60 g carb/hr that is scientifically recommended) and adjust insulin to support that – the rule should be never to decrease insulin less than 50%.

Now this might sound like a formula for a low blood sugar, but I assure you that once you understand fuel metabolism and diabetes, you will see how important it is to have that insulin around.  What you will achieve is blood sugar control AND performance.  Maybe performance that will exceed what you ever thought possible. This is specifically what we help athletes with diabetes understand and achieve!

It was a gorgeous day on Sunday. There had been a bad windstorm the night before, but in the morning everything was calm and clear and the temp was around 55 at 7 in the morning. My anticipated pace was 12:30min/mi, with a total time of 2hrs and 40 min. I started the race with a BG of 180, which I felt was great at the time. Again, in retrospect if I had checked insulin on board, I would’ve not been so content with this number. I started off slow, calm steady pace. My biggest fear was to get caught up in the moment and take off way too fast.  The course was mostly flat, with a gradual incline from miles 2-4 and one big hill in the middle of mile 4. The remainder of the course was flat, twisting and turning through the neighborhoods just up against the mountains in Palm Springs.

Great job at paying attention to insulin on board, you are ahead of the game!

My target BG is typically 120 – 150. Around 30 minutes in I checked my Dex, which showed 145 with a slanted down arrow. I took 1 gel and kept my steady turtle pace. 15 minutes later I checked again, 124 with a slanted arrow down. This was a little troublesome to me. I don’t like downward slanting arrows when I’m running! My game plan had been to take 1 gel every 45-60 minutes and I had no fast acting sugar with me. I took a second gel at 45 minutes into the run, and took a drink of gu electrolyte mix from the aid station (unknown carb count). At 1:10 into the race, the dex was reading 119 and the arrow had finally leveled out. I was content with that! At this point I was also behind schedule, just reaching mile marker 5. I tried to pick up the pace a tiny bit, but again was fearfully of overexerting myself too early.

So by mentioning this, I hope you see the importance of having both fuel for exercise and quick acting sugar to treat hypoglycemia.  These actually are very different.  Your gels have maltodextrin as the carbohydrate and therefore are absorbed slower – this is great to fuel exercise, but not treat a low blood sugar.  I would encourage you to carry glucose tabs as well so that you could get instant absorption of that sugar and recover quicker (less time lost maybe next time).

At the halfway point I picked up a gu gel pack at the aid station to restock my spibelt bringing my total carbs in possession to 50g, which also eased some anxieties. I also managed to test my BG while running! That was a first and something I was overly proud of in the moment. So at the halfway point my official BG was 138, with the Dex still reading 120 with level arrow. From this point on my BG was stable and minimally concerning. I took one more gel in mile 9. BG ceased to be a concern in the last half of the race, for which I was thankful.  I needed all of my focus on the run itself, which of course became a major struggle.

Hooray, testing as you ran!  Even with a CGM, we at TeamWILD recommend a finger stick every at least every hour of your event.

Despite the battle with the BGs in miles 2 – 5, the first 9 miles of the course were amazing. The view coming down from the hill in mile 5 of Palm Springs was spectacular. The moon was still out and the early morning light gave everything that beautiful pink and purple hue. My fellow runners were all very cheerful and friendly and everyone seemed to be enjoying the day. Around mile 9, the run stopped being fun and started being work. I had been meditating/praying all morning mostly with thoughts of gratitude, but in the last 3 miles I turned to asking for focus and resolve and the strength to get through it.

I started getting a side ache in mile 10 that I never really got rid off. In mile 11 I started following a young lady who had the same pace for me for about ½ a mile until she stopped to walk. As I passed her I offered words of encouragement, and when she complained of a side ache I called back “Me too! You can keep going! Don’t stop!” In mile 12, I felt like my body was failing me, I was so exhausted. I could no longer keep focus and was losing my resolve not to walk. I actually stood still for a few moments trying to muster up some more will to keep moving. Then the universe sent me motivation embodied by the girl I had passed in mile 11. She came up along side me and said, “You can’t stop! You’re the reason I’m still running. Run with me!” We ran the last mile together, and actually sprinted the last 0.1 into the finish line. I could not have kept running without her. She was truly a godsend.

Mental strength, great job! For your tri, you’ll get to work with the TeamWILD Mental Skills coach Ginger Vieira.  But, that said, what I’m thinking here is HYDRATION.  It’s the one thing I haven’t heard you mention yet.  The goal is 1 standard water bottle/hr.  When I hear side ache, dehydration could be the issue.

I crossed the finish line and saw my cousin and uncle waiting and cheering for me. I promptly collapsed and checked my BG: 108! I call that a success! My finish time was 2:49:52, pace 12:58. 8 minutes over my goal. They had a bionic division for people with replacement hips and knees. I still think I should have counted for that division given I have an artificial pancreas!

Yay!

Post Race: I had a bit of BG rollercoaster post race. I set my basal to -30% of normal and ate a large orange without bolusing. 1 hour later my BG was 326! I returned my basal rate to normal and made a corrective bolus. Ate toast, eggs, and bacon as a post race meal. 2 hrs post meal my BG was 69. After that my insulin sensitivity seemed to return to its normal pre-race level. Yesterday and today I’m a little sore, but doing pretty well. BGs are on target, however I’ve been a little indulgent in my eating habits. Cupcake 1 day post-race, yes please!

But now here comes the BG fall-out…hyperglycemia post endurance exercise is most often due to dehydration and the result of reducing insulin too much during exercise.  The fact you had that side ache and tie it in with this info, hydration was likely a big culprit but also, think about how your body has to re-adjust to the lower basal insulin (it takes 90 min post a basal change to realize the effect).  In addition, insulin sensitivity due to the exercise kicks in usually 4-8-12 hrs later and lasts up to 24 hrs depending upon the duration of exercise.  During this time, you are at risk for hypoglycemia and likely need adjustments to bolus and maybe basal insulin. We here at TeamWILD can help you figure out these adjustments!

Conclusion

In this last year I’ve come to realize that I love participating in events. I will never be a top competitor in my age group, but I feel such a sense of accomplishment when I finish. It is such an amazing experience to work towards a goal, train for months, and then participate with a 1,000 other people in the same event. I love the sense of camaraderie that everyone has. I also feel triumphant when I achieve good BG control through an event. Sometimes it can be overwhelming to juggle all the equipment and supplies and mental strategies, and it can seem like such a hassle. Training has helped me want to have better control and understanding of my insulin needs, to wear med alert jewelry, to carry glucose with me where ever I go, and to try and be in harmony with my diabetes rather than always fighting it. In turn, diabetes has helped me appreciate just being out there participating and finishing. When I can cross the finish line with a BG of 108, I’ve definitely won the day!

Up next: Wildflower Olympic Distance May 6^th!

Yes, You Did It!  The thing about making a race plan is that you race your plan but you also have to adapt to whatever issues come your way and you did that – fantastic!  You will continue to have success with your races/events because you took the time to evaluate your race day and learn what worked and what didn’t.

Now with TeamWILD, you can find more ways to not only meet your goals, but even reach higher and make new ones.

Thank you for sharing and GO WILD! We are here to support you on your way to an amazing WILDflower experience! ~ Marcey

If you would like to have access to the awesome experts at TeamWILD, sign up for one of our walk, run, cycling or triathlon training programs. Or come to one of our CampWILD Training Camps!!

From Megan, after she read the comments from Marcey:

Thank you for the feedback!

I did drink water at every aid station (probably about 50 – 75 mls each time) and there were 8 of them. I just didn’t think to mention it in the report. But this is why I want to work with you guys at TeamWILD. I’ve been trying to figure all of this stuff out on my own, and it’s working ok but obviously it needs improvement!

Also friendly reminders to do the right thing are always good (like I knew I needed fast acting glucose in my belt, but just didn’t have room. I chose the meter over the glucose tabs! I plan to invest in an amphipod race belt soon so I carry more things comfortably and don’t have to make those choices.)

Megan, we are so excited to work with you!!! GO WILD! ~ Mari