Back to Sports Corner Running Marathons with Type 1 Diabetes

Have you ever wondered what it would be like to finish a marathon? All 26.2 miles… For most people it is only a daydream. Add in the fact of having Type 1 diabetes and it seems like it would be impossible. In reality there are many people with diabetes who have completed marathons. One such person is Bill King. Bill was diagnosed with Type 1 diabetes in 1984 and has run 20 marathons. Not only has he completed multiple marathons but he ran the prestigious and demanding Boston Marathon in a blazing three hours and nine minutes. Bill found some time to discuss his marathon experiences and how he has not allowed diabetes to get in the way of his dream.

How do you prepare for the marathon?
Like any sport that requires extreme endurance, the 26.2 mile marathon requires me to train my body to run for several hours. Daily practice requires building a base of mileage over several months and includes a periodic long run that will simulate in marathon distance (up to 20+ miles) as the race gets closer. Knowing when to rest and when to push myself during the last few weeks is vital to ensure the maximum performance in the race. I have found the key for me to perform at my best is to focus on tight control of my glucose and to learn how to consume glucose during my runs, both in my training and racing. Having an ability to check my BG frequently, adjust my insulin delivery with my insulin pump and enhancing my energy and glucose is part of the key for my success.

Is the Boston Marathon more special than other marathons?
The Boston Marathon is unique in that each runner who competes must qualify for entry by running a certified marathon course in a specified time (depending on your age group) up to 15 months prior to the April running of the Boston Marathon. Many years ago, Boston Marathon race officials could not manage a large number of runners over the point to point course so they adopted a qualification standard that would ensure faster runners and smaller crowds. The Boston Marathon is run on the 3rd Monday in April, which is a celebrated holiday (Patriot's Day) in New England. Schools and public access businesses are closed and Boston is electrified with spectators lining the entire course and especially the finish line. In my opinion, there is no other marathon finish more prestigious or exciting than the Boston Marathon finish.

OFFICIAL QUALIFICATION STATEMENT: To qualify for the April 16, 2007, 111th Boston Marathon, athletes must meet the designated time standard which corresponds to their age group. Qualifying times must be run after September 24, 2005. Seeding is based on qualifying times, which are subject to review and verification. All participants must adhere to the guidelines set forth by the B.A.A., USA Track and Field or foreign equivalent, International Paralympic Committee, Wheelchair Sports, USA, Disabled Sports, USA, and the United States Association for Blind Athletes. Qualifying times must be met in competitions observing these same rules. Proof of qualification must accompany the application. Participants must be 18 years or older on race day. Qualifying times are based upon your age on the date of the Boston Marathon in which you will be participating.



Is it harder to control your diabetes during training?
Maintaining control of my diabetes can become more challenging during marathon training due to the constant activity causing higher insulin sensitivity. Just like pushing yourself at anything, when your body is active and tired, the result can sometimes cause unpredictability in insulin sensitivity and adequate coverage of food. When I train more I eat more but my basal rates need to be turned down. I have always found high intensity training to be a great experiment and example of how insulin works in the body and how exercise and activity work to enhance your body.

How do you check your blood sugar during the race and how often?
During a marathon, I try to follow a plan that includes checking my BG every 25-30 minutes. As you may know, checking isn't the difficult part it's convincing myself to get the check done. If you think it's a pain to check while sitting at a table, try getting done at 20 miles into a run.

Is your pump a valuable tool when running?
For me and many athletes with diabetes, the pump is a valuable tool for success because of the ability to accurately match my changing insulin sensitivity throughout the variety of insulin needs while training and racing. I would not be as capable an athlete without the ability to adjust my insulin. The body reacts to stress and activity in a variety of ways which can be unpredictable and difficult to react to, at best. Without the ability to adjust insulin, there would only be one other way to have any impact on glucose; eat something or not.

How do you use your pump differently during training as compared to race day?
Great question! Running in training or practice is generally draining on muscle glucose and has little to no stress from competition or excitement. So my training runs most often need a decreased adjustment of my basal rate and consistent delivery of small quantities of glucose. My race days are the most extreme challenge as it combines the higher insulin sensitivity with the stress of the challenge in performing at your best and the excitement of rubbing elbows with other runners. This competition causes a release of cortisol which can raise BG levels much higher than normal. By using my pump and learning how my BG reacts in every situation, I am much more successful at keeping tight control of my glucose levels.

Often runners struggle with high blood sugars in the hours leading up to the race. How do you handle these high blood sugars?
When waiting for competition to begin and being very well rested, the highly conditioned athlete with diabetes needs to deal with higher release of glucose from the liver and muscles. By working closely with my diabetes educator and carefully raising my basal rate with a temporary increase, I have a much closer match to what my insulin needs are without delivering a large one-time dose of insulin. If I am successful at keeping my pre-race glucose levels normal, 90 minutes before the race begins, I can readjust my basal rate to a temporary lower level that will match my increase insulin sensitivity once the race begins.

What is your diet like leading up to the race and during the race?
You ask all the right questions. When I am training, my diet is much richer with complex carbohydrates as I find these fuels to be the best to keeping my body energized and my digestion fast. Eating a high carbohydrate diet means aggressive checking of BG before and after each meal and working hard to focus on bolus coverage. The night before the marathon, I always eat a high-carbohydrate meal to ensure available fuel for the competition.

Just before the race, I may graze on a variety of foods like a bagel or some fruit (banana) or a sports bar. I always focus on eating small, frequent quantities so I don't have to take a large bolus which can cause a greater risk of low BG during the race.

During the race I use Fruit Snacks (16-19grams of simple carbs) because of their ease of carry and ability to eat. Once you open the package, you will eat them. I also use a new product from Cliff ( called Gel Blocks. They are very easy to eat and they consist of a nice mix of 50% simple and 50% complex carbohydrates. I occasionally carry a plastic bottle with a mixture of 10 glucose tabs in water (my "silver-bullet"). The tabs dissolve into a glucose-rich solution that allows a quick consumption of 20-40 grams of simple carbs in one or two mouthfuls. I also use PowerBar performance bars and I cut them into smaller pieces and wrap them in wax paper. I place the PowerBar pack into the freezer and grab one on the way out the door. This allows me to follow my 20/20 (every 20-30 minutes eat 10-20 grams) rule of glucose consumption during my workouts.

Do you struggle with low blood sugars in the days following the race?
How my BG reacts in the hours and days following a marathon has a lot to do with how well I performed in the race. If I ran hard enough to cause muscle glucose depletion and trauma to the muscles, I have experienced a 72 hour potential rise in my glucose levels. But more often, I am usually much more frequently experiencing lower than normal glucose levels and I need to readjust my basal rate settings as described by my diabetes educator. This is due to the muscles working to rebuild the glycogen levels and to do so they utilize the glucose in the blood stream.

What advice would you give a person with type 1 diabetes who wants to run their first marathon?
The key to your success will be the patient approach to increased training and allowing the body to adapt to the increased activity very gradually. Many people do not take this approach and they end up with injuries or a poor performance in the marathon. 26.2 mile is a long distance to run and our bodies are not quite equipped to run this distance without great preparation and a disciplined approach to training; there are no shortcuts! Live every day like the most elite athlete; eat, sleep and live like an Olympic athlete. Don't hang all your hopes and dream on one particular race or date. There will always be another run and if you adopt the marathon for life approach from today on you may be lucky to be enjoying the pursuit of happy running 25 years from now.

As you can see diabetes as not deterred Bill from doing what he loves to do. He credits the secret to his success with a positive attitude. A key component to dealing with diabetes successfully is keeping an upbeat attitude. There are bound to be good running days and bad running days just like managing diabetes. Bill feels the people who do it most successfully are those who stay positive about it.

Below are a few pictures of Bill, his wife Betsy, and other team diabetes runners.

Betsy and I after the Philadelphia Marathon
Checking on the run
Boston Diabetes Runners Team

The team meeting with Dr Howard Wolpert at Joslin following the marathon
Bill King running and racing with diabetes and the pump.

Rick Philbin, MBA, M.Ed., ATC

May 2006

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Last Updated: Friday September 07, 2012 11:18:04
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