I was diagnosed with Type 2 diabetes nearly 10 years ago, at the age of 32, and it made me a runner.
Immediately after my diagnosis, I began walking on a treadmill several days a week. As I built up my endurance, I started running and began entering local races. I finished my first half marathon, and then I started working on triathlons. Over the years I have added distance and speed and intention to my training. I train 5-7 days a week. I haven’t missed more than three consecutive days of training since I started, even through illness and injury (not necessarily always running, but always training).
Since my diagnosis, I have also cleaned up my diet. Over the years, I have cut out regular cookies (my addiction) and sweets, diet Coke (my real addiction), pop in general, and most recently, I cut out wheat. I have also added in healthy foods. My health has shown the benefits of exercise and diet, but while my medication has decreased over time, I still need medication to manage my diabetes. In the beginning, I was on Metformin and Glimpiride. The Glimpiride caused low blood sugar mid-morning and sometimes while running. I tried Januvia briefly, but it wasn’t managing my blood sugar the way it should. Then I was on Invokana (and Metformin) for several years, until I didn’t need the Invokana anymore. Now I am just on Metformin, and we (my doctor and I) continue to work on finding the most appropriate dose.
My disease is well-managed, but I still have diabetes and I always will. I have only lost 25-40 pounds over all the years and struggle to maintain my current weight. Nothing comes easily. As a runner with diabetes, I am well-aware of the stigma associated with having diabetes, much of it due to the disinformation about diabetes floating around the interwebs. To clear those up, I’m bringing you your friendly Salty Running guide to running with diabetes.
Diabetes Myths and Facts
Diabetes is one of the most misunderstood and ridiculed diseases in the US, even with 30.3 million Americans (diagnosed or undiagnosed) and 84.1 million Americans having pre-diabetes. Type 2 Diabetes, which I have, is the most prevalent form, representing about 95 percent of people with the disease.
According to the American Diabetes Association, “in type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time your pancreas isn’t able to keep up and can’t make enough insulin to keep your blood glucose levels normal. Type 2 is treated with lifestyle changes, oral medications (pills), and insulin.”
There are a lot of common myths around diabetes and some of them involve running (or exercise). There is widespread belief that if you start running and eating right after diagnosis, you’ll lose 100 pounds and reverse your diabetes. Unfortunately, this is true for only a small number of people: those who had only one risk factor for diabetes, obesity. But there are many risk factors for Type 2, including being over age 40; having gestational diabetes; having a parent or sibling with diabetes; being African American, Hispanic, Asian, or Native Hawaiian/Pacific Islander.
Additionally, there are many people who are obese and over-consume sugar who don’t develop Type 2 diabetes and many healthy weight people who do. There are both genetic and environmental components to the disease.
Managing Type 2 Diabetes
Managing any chronic disease is difficult physically, logistically, financially, and emotionally. However, our society has attached special shame to diabetes, believing that people with the disease somehow “deserve” their disease. This seems to give people permission to ridicule people (either generically or specifically) about their condition or make fun of the disease in general.
While Type 2 Diabetes can be managed for some people with diet and exercise only, other people need oral medications or insulin to maintain healthy blood sugar levels. These needs change over time too. It doesn’t mean that a person with diabetes has “failed” in their disease management if they need additional (or different) medications.
Running with Type 2 Diabetes
Running can be complicated with diabetes. Running with your blood sugar too low (or too high) can affect performance and even be dangerous. Balancing electrolyte and carbohydrate intake during training can be a delicate balance between too much and too little.
If you catch it early enough, you may be able to recover from low blood sugar to complete a race. I still remember the nurse who saved a 10-miler for me with some sugar tabs. More often than not, however, when your blood sugar crashes your day is over. This has happened to me in 100 mile rides, Olympic distance triathlon, and a marathon.
Blood sugar crashes really sting. At first you might just feel off, then feel like you are working way too hard for how slow you are going, and then feel disoriented. Worse, you might start blacking out. It’s pretty scary. Different people may experience different symptoms, but these are fairly common. In the race I was able to save, I caught my low blood sugar early, at the “feeling off” stage. However, sometimes it really sneaks up on you before you know what’s happening. One day I was on the treadmill at home – only a mile into a workout it felt HARD for how slow I was running. Really hard. I stopped and checked my blood sugar and it was 43 (it’s not supposed to be below 60). I had to stop my workout and get something to eat.
Low blood sugar and the disappointment of how hard you are working for so little performance can make you ragey and say things you wouldn’t normally…even hurting people trying to help or innocent bystanders. A few weeks ago I was trying to push through a swim workout knowing my sugar was borderline low and getting lower. I was asked to change lanes twice and the second time I went off with the most dramatic string of f-bombs ever heard in a YMCA. It was the diabetes talking (well, and my general annoyance with the aquatics practices at this particular branch, but normally I wouldn’t do that to someone.)
It can also be hard to tell how different medicines will affect you during runs or races. When I was on Invokana, I needed to drink MUCH more than anyone else, which made it difficult to stay hydrated on long, hot, humid summer runs. I basically could not stay hydrated. And I have it “easy” because the oral anti-diabetics are more predictable than insulin or some of the other injection drugs.
I’m writing this to let you know that a diabetes diagnosis does not have to end your athletic career, nor will it stop you from starting one. It can be a long road figuring out what works for you, and you have to learn to be your own advocate – but it’s absolutely worth it.
The American Diabetes Association is a good place to start learning more about diabetes basics and treatment.
Do you run with diabetes? What have your experiences been?