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T1 Diabetes and Running

ajr9393

ajr9393

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Aged 31, just two weeks ago I was rushed into resus in DKA and diagnosed with T1 diabetes.

What a whirlwind.

I was a keen runner, and actually had the worst run of my life at parkrun the Saturday before the Tuesday I was in DKA! And now I know why.

I would like to start running again but the anxiety to do so is real! I’m reaching out for some tips of timings for eating / rapid insulin / running etc.

This morning I went out and did just 1mile. As I wanted to see what my body would do.

So I woke up and my sugars were a little high around 12.5. I had my usual lantus and I ate 1x digestive biscuit and off I went. Came home and sugars were quite high. Guessing as it was a short one my body had released sugar and it was yet to start coming down.

I then took a smaller dose of novarapid (3units instead of 5) and had my breakfast. My sugars returned to green zone around 1.5hrs later.

Is this the right way to do it?

I’ve felt quite tired this afternoon.

I have always been a wake up, have 2x choc digestives and run, but maybe I need to change my habits. Any advice welcome from an anxious newly diagnosed t1.
 
Welcome @ajr9393 🙂 Having had DKA so recently and just been diagnosed, you’d be better off leaving the running for a while and focussing on resting and supporting your body’s recovery (with rest and food). That could well be why you felt tired.

Also, your insulin needs are still being established and you’re still getting used to things. Although it’s tempting to carry on as normal, taking it easier to begin with will benefit you in the long run. I appreciate a mile isn’t a long run, but resting is better for now 🙂 It will also be much easier to calculate your strategies later on, allowing you to return to a more usual exercise schedule for you.
 
Once you are sorted (or at the very least recovered from the DKA ordeal) have a look in here: https://forum.diabetes.org.uk/boards/forums/exercise-sport.15/ and search for e.g. "running" - there are quite a few people posting what they do. From memory (I don't run, too inefficient and slow 😉) it's generally a case of taking pre-exercise bolus.
 
Great advice above. Give yourself a couple of weeks to recover from the DKA and browse the linked forum for running.

Unfortunately our bodies all respond in unique ways to our diabetes. There are some general trends, but even then things can go awry. But that’s to be expected. Especially when exercising. I can run one day and have brilliant glucose running a half marathon. Another it all goes to ****. One thing I’d recommend is allowing yourself some grace when that happens. Its not that you’ve done anything wrong, it’s just your diabetes on a particular day.

However, know that you definitely can get back to running, whether you run fast or slow (like me, being more than twice your age ) it’s very doable. You will need to experiment somewhat, as you’ve already started to do. Running fast or slow can affect your glucose levels differently too. Anaerobic exercise tends to increase glucose levels, which faster running is. Aerobic exercise tends to lower glucose levels, which slow running is. I say tends as again bodies can differ slightly.

Running with diabetes is possible. I’ve only been running for about 4 years now. I do it for enjoyment, fitness and to say to my diabetes, you don’t control me, I control you. Occasionally she kicks back and I have a crappy run, but I carry on . Any questions please feel free to ask.
 
I am now so used to my BG going up after Parkrun.... But I have my usual basal and no breakfast and 1 unit of insulin. Can often start below 5 and finish at 12 or so just 24 minutes later. As soon as I finish I have more insulin and walk home. I sometimes need to wait a good 45 minutes until I can eat breakfast.
I am 67 and type 1 for 58 years.
 
JonathanGi said:
I am now so used to my BG going up after Parkrun.... But I have my usual basal and no breakfast and 1 unit of insulin. Can often start below 5 and finish at 12 or so just 24 minutes later. As soon as I finish I have more insulin and walk home. I sometimes need to wait a good 45 minutes until I can eat breakfast.
I am 67 and type 1 for 58 years.
Click to expand...
I’m curious if you run fast or slow during park runs? I’m 68, type 1 for 44 years and I find if I run fast, which I don’t do very often, my BG rises, whereas if I run slow it starts to drop.
 
That's exactly it. Liver likes to dump lots of sugar quickly into bloodstream as fuel and because we don't have any insulin to use this, BG rises. This is under the influence of stress hormones - cortisol and adrenaline. Slower runs, walking and cycling mostly put BG down.
Do you have any quick acting before parkrun?
I was going to be facetious and say i don't whether a 24 minute parkrun is running quickly!
 
Apologies if I have asked this before @JonathanGi but have you tried eating breakfast before a parkrun?
The reason I ask is that my Dawn Phenomenon/Foot on The Floor has a tendency to keep dumping glucose until I eat. It's as if my liver is panicking about me starving myself until it gets the message that I have food and no longer starving. I don't have to eat very much. Or even carbs. A hand full of nuts can be enough to stop the glucose dump.
My (vague) hypothesis is that your park run rise could be exaggerated by this Foot on The Floor liver dump.

Another suggestion which was given to me when I climb was to take a pre-bolus for the expected rise. Like running for you, climbing causes my BG to rise. I suspect this is a good ole liver dump to "fuel" my muscles and deal with the adrenaline/stress of high routes and challenging holds. Before I changed to a pump, I would give myself a "correction bolus" calculated to drop my BG to 3.0 under "normal" circumstances but the liver dump was sufficient to ensure I never hypoed.
Following this approach, I was able to improve my climbing from both endurance and strength perspectives.
 
@ajr9393 as others have said I would give yourself a few weeks of rest.

As with most things with diabetes it is trial and error. It is best to keep trying and giving it ago until you work it out.

It will be still possible to have an active life with exercise as you did before it will just take some time to work out how it works for your body now. You will find our what works for you.

It's been a few years since I ran but I did do it 3/4 times a week at one point. One thing I learnt is for me it is about what level I start at when I go out. If lower than 5.5 I would need some glucose / a snack otherwise I would go low.

I would say have a few weeks rest, speak with your medical team, and then give it another go. Eat what is a steady meal for you that you know keeps you level and then go out. I always found morning the worst time personally for a run due to the old liver dump. Even now I prefer after breakfast with some carbs and fast acting insulin.

Give yourself time, patience and some space for learning. You can do this, will just take some tweaking.

I always thought I had been told don't exercise at 13 or over, but actually DAFNE advise is 15, based on the below, from a recent DAFNE course I attended in Dec 2024. It also then talks about reducing background insulin for the type and duration of exercise.

D:\AaaF\OUT\httpswwwopeneduopenlearncreate_cmid189576_2022-04-26_11-46-46_lj5534\word\assets\w3_fig_3.png


When to delay your exercise
  • If you have had a severe hypo in the last 24 hours (your liver and muscle stores of glucose will be reduced).
  • If your Glucose is more than 15.0 mmol/L before the exercise and your blood ketones are 1.5 mmol/L. Follow illness and sick day rules if you have a positive ketone check.
Note: The presence of ketones indicates that the amount of insulin you have on board is low; exercising in this condition will increase your risk of developing diabetic ketoacidosis (DKA). Wait until your Glucose is less than 15.0 mmol/L and your ketones are negative before exercising.
 
I don’t actually do park runs much. I mostly do longish slow runs. Though I’m also on a pump now which makes any kind of running easier, as after some experimenting have set up some profiles so it gives me the insulin needed to keep me in mostly in range. There are odd days when things don’t go to plan. I personally think 24 minutes for 5k is very fast. Takes me about 35 to 38 minutes. Pre pump my BG was often high when running or went too low. Which is why I petitioned my diabetes team for a pump. Eventually they gave in . I’ve not been running very long. Do you have a CGM so you can see when BG starts to rise? Sometimes the excitement of a race will push my BG up at the beginning and it will then come down during the race. Though that’s more half marathon distance, where there’s more time for things to happen.
 
I used to eat breakfast before but I have find this more uncomfortable since cancer surgery, I think.
I need at least a couple of hours after eating before I can exercise.
I don't seem to be able to fuel myself as well as I used to. I run half marathons without changing basal and have nothing to eat on the run. Last one I ran I finished at about 12.00 and had nothing to eat until 18.00.
I also entered an ultra marathon this year but training was disrupted by a kidney infection which took me a long time to get over. My biggest fear was how to fuel myself!
 
PhoebeC said:
Note: The presence of ketones indicates that the amount of insulin you have on board is low; exercising in this condition will increase your risk of developing diabetic ketoacidosis (DKA). Wait until your Glucose is less than 15.0 mmol/L and your ketones are negative before exercising.
Click to expand...
Or that you are burning fat, the advice should (IMO) be taken with a pinch of salt: https://forum.diabetes.org.uk/boards/threads/normal-ketone-values.110801/

I almost never (in my limited experience of testing them) have zero ketones, even on days with no particular exercise and lots of carbs, so I think that bit especially is very dependant on your body.
 
SimonP said:
I almost never (in my limited experience of testing them) have zero ketones, even on days with no particular exercise and lots of carbs, so I think that bit especially is very dependant on your body.
Click to expand...
Yes. It really depends on the body, I never (again, in my limited experience of testing them) have any ketones at all. Even if my bloods have been very high for days and I haven't eaten. I never get above 0.5.

I am really in a bad way to get any ketones at all.
 
That is really interesting to know, thanks @PhoebeC. I always assumed the ketones guidance was just overly conservative (and that most people were like me and hadn't bothered/needed to do a test in the last 25 years - until the forum sparked my interest and I requested a meter that is) but I guess it would make sense for people to do ketone tests when they are not poorly/high to get some feel of where they sit normally.
 
BG started at 7.3 and finished at 13.2. 23 minute parkrun. I have not eaten much today but have had lots of insulin. Strange condition!
 
JonathanGi said:
I have been turned down for a pump! Too well, apparently. The advice from Runsweet is, don't!
Click to expand...
As you’ve only recently been diagnosed I find it strange that they consider you too well for a pump in such a short space of time.
Curious that Runsweet say don’t use a pump. Is there a particular article you can link to on their site about that. There are many athletes who wear pumps.
JonathanGi said:
BG started at 7.3 and finished at 13.2. 23 minute parkrun. I have not eaten much today but have had lots of insulin. Strange condition!
Click to expand...
This says to me your diabetes control is not well. Or were your diabetes team referring to your general health? How long had you eaten prior to the this run? If a while then it may be worth trying a unit of bolus insulin before running. Making sure you have easy access to some kind of glucose in case you get a sudden drop in BG either during the race or shortly afterwards. And that’s another question, as you finished at 13.2 did your BG start to drop after the run, stay fairly static or continue to rise? Or did you take more bolus?

Sorry about all this questions.
 
I was diagnosed 58 years ago. My HbA1c is 34. I have my usual basal and, usually, one unit of bolus about half an hour before run. Runsweet say don't run sweet, that is don't run with a high BG. Nothing about pumps! Apologies for the confusion!
 
23 minutes is quite quick for my advanced age, so plenty of stress hormones which will always raise BG.
 
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