Running a marathon with diabetes

These inspiring stories have been supplied by Juvenile Diabetes Research Foundation.

Rupert Judge - 3hr 22min 35sec
One month after my twenty-ninth birthday, I started to feel indescribably tired. I blamed it on being extremely busy at work and the hot weather. I was sleeping endlessly but would get up during the night to drink a pint of ice-cold milk to try to satisfy the desert within. Fortunately, my wife, Louise, kept telling me to go the doctor, which I eventually did. Within 48 hours I was doing my own injections and blood tests.

I knew exercise would be good for managing my diabetes but it was not until I went to a business conference near Birmingham, where the hotel had a pool and gym, that I exerted myself. I had enjoyed swimming in the past, but now I found it difficult, becoming breathless very quickly. I knew I had to do something about this, decided to start running and soon became hooked on my Sunday morning run.

I stepped up my running when I entered a 10k charity run in my local town and this had a dramatic effect on my diabetes, my blood glucose dropping significantly. I joined the Woodbridge Shufflers Running Club to help me train for the run.

As a result of my increased running, I found I needed to eat more, particularly about 12 hours after exercise as well as immediately afterwards. My favourite post-exercise food was natural museli, which has lots of low-glycemic ingredients. I used dextrose tablets as a top-up but discovered I would get high blood sugar later in the day, which was of no use in a race. A friend then introduced me to isotonic drinks, which I found very beneficial, providing both glucose and water.

In 2002, I decided to enter the Flora London Marathon and, after failing to get a place in the ballot, I contacted the Juvenile Diabetes Research Foundation after reading an advertisement in Marathon News. The prospect of raising £1,500 seemed daunting at first but I soon realised it wasn’t going to be so hard, and the money kept rolling in.

The marathon presented new challenges regarding my food and drink intake with isotonic drinks alone not providing enough glucose. A type of jelly bean proved the answer. Also, when going on 20-mile training runs I would reduce my insulin mix. I use Novorapid and Human Insulatard, usually 4:16 units respectively. For a long run, I would typically alter them to 2:12, which prevented my blood sugar dropping below 4mml as long as I didn’t push too hard.

On marathon day, I started with my usual pre-run breakfast of natural museli with added raisins and skimmed milk, a slice of bead with honey and water. I ate 90 minutes before the start. My blood glucose at the start was 24mml – but don’t panic, this is normal pre-run. I used the testing stations on the course and drank lots of isotonics and water, which was just as well because I was still very dehydrated at the finish. I was delighted with my time of 3:22:35 – and by raising more than £5,500 for JDRF.

The support of my family was invaluable. I saw my wife and boys, Christopher and Matthew, at Tower Bridge and gave them all a hug. When I crossed the finish line, I raised my arms and attempted to smile for the cameras, which took a lot of effort. I was relieved and elated and completely worn out, but I said to myself ‘I am a Marathon Runner!’

Paul Hay - 3hr 20min 38sec
Thirty four years ago, at the age of 13, I was diagnosed with type 1 diabetes. How diabetic life has changed since then. While the incidence of the disease has increased, so has the awareness of the general public – and no longer is it an embarrassment and inconvenience.

With the advancement in insulin delivery and blood-sugar-monitoring systems, together with the increasing availability of low-fat foods, making the diabetic diet a health diet for all persons, my overall control is better than it has ever been.

Five years ago, my wife, son and I joined a local fitness centre. We soon joined the running club and enjoyed the social life attached to it. The stress and strain of work was increasing and we felt we needed something to ease the situation.

After a few months and a considerable amount of persuasion, I entered my first, short race – a 10k – which I enjoyed thoroughly. Another couple of races followed and within 12 months I was running my first Flora London Marathon. I could hardly believe it.

The training had gone reasonably well. I had a few hiccups and I did not complete all the long runs laid down in my training schedule. But it was the start of a learning process. After each run, I made a note of all the factors I believed were causing problems and tried to make the necessary adjustments next time I ran. I slowly built up a picture of what I considered to be the optimum conditions for a successful run.

While this may sound relatively straightforward, I think all diabetics will agree with me when I say that the most frustrating part of being an insulin-dependent diabetic is that you never know what your blood-sugar levels will be. As a result, when I run I have come up with a set of conditions that I try to stick to before and during a race.

In my first London Marathon in 2000, I finished in three hours 53 minutes. Apart from stopping to go to the toilet after 13 miles, I ran all the way without any diabetes-associated problems. My blood sugar was relatively high at the finish because I made sure to take in more than enough carbohydrates along the way, particularly in the last few miles.

This was the start for me and the confidence I gained from it was indescribable. I had done really well. The feeling was incredible. My wife and family were very proud. Having listened to many of the other members of my club in the pub, who insisted that one marathon was enough, I was already having other thoughts. What could I have achieved if my blood sugar had been lower at the start (due to the anxiety and increased flow of adrenalin) and towards the end?

In 2001, I managed to knock 10 minutes off my previous time. At my fourth attempt I ran 3:20:38 – more than 33 minutes faster than my first London Marathon. I was delighted because everything had gone to plan. On the morning of the race, I reduced my insulin level, had my normal breakfast and started the race within the optimum blood-sugar range. During the race, I made sure I took sufficient fluids and consumed carbohydrate gels every 30 minutes. At the end of the race, my blood sugar was 5.8mMol/l, within the non-diabetic range. Not bad, eh! What more could I ask of myself?

Peter Standing - 3hr 17min 39sec
Running marathons has become a habit for me. The 2003 Flora London Marathon was my sixth consecutively and I also ran the New York marathon in 1998.

Running with diabetes is a complicated business, and although I have always run to keep fit, I don’t know what it is like to run a marathon without diabetes. I was diagnosed with type 1 diabetes in 1996, and shortly afterwards completed my first (14k) race in Sydney Australia. I was bitten by the bug and was not going to let my diabetes get in the way if I could help it.

My training schedule is pretty complicated. Planning a run starts hours before I lace up my running shoes and start limbering up. And the longer the run, the longer it is in the planning – and the greater the adjustments I need to make to my normal routine. I will eat more breakfast and take less insulin before a morning run, leaving me a higher-than-normal blood-glucose level – about 15.

I can’t skip the insulin injection entirely, because without it my body wouldn’t be able to convert glucose in to the energy I need, but still need to make sure my levels are high enough to avoid a hypo during the run. On longer runs, I will also need to take additional glucose every 40 minutes or so.

The aim is to keep glucose levels in the ‘normal’ range, which non-diabetics do automatically as their bodies adjust to tiny changes in glucose and insulin levels.

And once the run is over, that’s not the end of it. I will test myself straight after the run; I’m not keen on stopping during a run to test unless absolutely necessary because you can really lose rhythm and momentum.

I will then, almost always, take on board some glucose/food. Even if my sugars are within a normal range, the effects of exercise on glucose levels can last for hours and sometimes several days for endurance activities like the marathon. So I will continue to test myself during that time. After this year’s marathon I kept a close eye on my glucose levels – testing around five to ten times during the 24 hours after the marathon.

Like all marathon runners with a few under my belt, I’m more prepared/able to go the distance and do all that training. The years of running have helped me to understand what happens to my glucose levels during and after exercise. But as with many other areas of life, diabetes is unpredictable; however hard you try to get good blood-sugar levels.

I am a proficient runner and it is really frustrating for me that so often my diabetes thwarts my efforts. I don’t always have problems, and when that happens it is just fantastic. But during previous marathons I have experienced hypos, with very low sugar levels. Running out of insulin, leading to very high levels, is not good for performance. In 2002, I just could not get my sugar levels high enough before the start of the race and it affected me from the word go. But I will not let diabetes stop me running marathons, and I’m determined to beat my personal best of 2 hours 57 minutes.