Diabetic Runners


coaching a diabetic runner (Read 356 times)


    Hello,  Name is Coach Mitchell.


    I am a middle school coach and have my first diabetic runner.  He has been struggling with getting his levels right and has missed a couple races due to being low.  I love to learn and need some educating.


    One race was at 8:45 am and the other at 4:15.


    I normally have my runners eat foods with 3:1 CarbTonguerotein ratio and for afternoon meets sneak in a snack two hours before the race.  Sneak because we are in school.


    I give them suggestions for the 3:1 ratio.


    I am looking for:


    1.  Good diabetic food suggestions?

    2.  Any advice at all


    Thank you for any thoughts or help.


      A big problem here is that every diabetic is their own individual case. Having no knowledge of how this diabetic is testing his sugars and dosing his insulin, I can only give some general thoughts and even those might not be applicable to his specific case.


      Personally, I avoid eating any sort of snack or meal 2 hours prior to running. The reason I do that is because I want to only have basal insulin in effect if I can. It is generally observed that physical activity decreases insulin resistance, and if I were to have extra bolus insulin active, it increases the chances that my blood sugar will drop too low.


      His being too low prior to those races -- was it because he had eaten earlier, bolused for that, but ended up low? If that's the case, that's another reason why it's my general practice to avoid eating and bolusing 4 hours or less prior to a time I plan to run. If the basal insulin is working properly and you have your blood sugars at a good level then, it is easier to keep them at a good level by not introducing carbohydrates into the system and then having more insulin being put into the body. Assuming this runner is using one of the modern fast acting insulins with approximately 4 hours of activity, you can see why I'm trying to keep the use of extra insulin out of the equation of running.


      Before a race, I monitor closely what's going on. I will start checking maybe every 45 minutes to an hour, that keeps me on top of what's going on, especially if I have bolus insulin that is still winding down. If I find I'm dropping too much, I can compensate with carbohydrate in the form of glucose tablets and I know that for myself that 8g of carbohydrate will raise me about 30 mg/dL.


      But just because 8g raises me 30 mg/dL, it doesn't mean that it's the same for him. This is the kind of stuff diabetics have to figure out with practice and experimentation. It takes some time and diligence, but it can be worked out.

        Hi Coach Mitchell,


        Glad to hear that you have a runner who happens to have diabetes.  I echo ScratchType1's comment on not eating for about 3-4 hours before the race and monitoring blood sugar every 45 minutes to an hour for a few hours beforehand.  If it were my son or daughter, I'd want this to be in 100 - 200 range before a 2 mile (in Michigan middle school races a 2 mile).  If it's a bit low an hour before the event, the runner can take glucose tablets to get it back up to a good range.   (The reason to use glucose tabs is that they give 4 g of carbs/tab.  With sucrose or other carbs, you can get a rebound - going too high).  If your runner has a pump and has been going too low before a race, he/she may need to set a lower basal rate for a couple hours before the event.  Ultimately, this is up to the runner, his/her parents, and the doctor.


        A couple other resources that might help are glucomotive.org and www.diabetes-exercise.org


        The Diabetes Exercise and Sports Association (diabetes-exercise.org) sells a shirt that reads "I run on insulin" on the back.


        Good luck on your season.



          Hi Mitchell,


          Good for you for wanting to learn more!  You have already received great advice from Scratch and Kenny.  As they pointed out, we are all "an experiment of one" in many ways, but there are some concepts that can help narrow down the experiment.  


          I think most people who don't live with Type 1 have the perception that it's all about food.  That is certainly part of the equation, but it is really the combination of insulin, carbohydrates, and exercise (and other factors beyond our control or prediction at times).  


          I utilize an insulin pump and have done it both ways for short runs (3ish miles) eating before, and not eating.  Either way, I tend to follow a 50% rule of sorts.  If I'm not going to eat, and my blood sugar is in a good range, I will cut my basal rate in half about and hour and a half before a run.  If I choose to eat, I eat about an hour before the run, only bolus about half the normal amount of insulin that I otherwise would for the carbs I'm consuming, and leave the basal rate alone.  That works a lot of time....for me.  The best and simplest explanation of this type of thing I have found is a concept called ex-carbs:




          A 3:1 carb to protein ratio is good, and I'd suggest if he/she chooses to eat that the fat content of the food be kept pretty low (since it tends to slow absorption of the carbs....sometimes for several hous). 


          The young person on your team is fortunate to have a coach who cares enough to learn.  In my opinion, the biggest gift you can provide is supporting him or her through the "do not starts", and ecouraging learning from those and making adjustments to run another day, rather than feeling like it is a failure. 

          Progress Trumps Pefection

            Get a copy of "The Diabetic Athlete" by Sherri Colberg


            Good advice here but I'll add my two cents.


            Ask your runner if he's taking insulin for he carbs he's ingesting before the race.  My guess is that he's taking a full dose.  I always dial back (reduce) my insulin by one unit if I'm eating and bolusing before exercise.  (A 'bolus' is an injection of insulin used to cover food or to reduce high blood sugar.)


            Another suspicion is that he's not taking (sneaking) is pre-race snack.


            Depending on how low his pre-race blood sugar is and how much time there is before the race, there's a chance to bring it up before the start if he really wants to run.  Glucose tabs work fine because they come in measured doses.  


            Another thing that can be done, it sounds counter-intuitive but it works, is to have him run some sprints before the race.  Very intense exercise will actually cause a rise in blood sugar in many cases.


            Make sure your runner tests right after racing, too, and eats within an hour.


            It's great to see a supportive and interested coach.  Keep up the good work!