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Running Comrades with Type 1 Diabetes. Alexander Pope is a runner who trains hard and races hard with Type 1 diabetes

By Alexander Pope

07 January 2019

I have Type One Diabetes. I like to run.

My pancreas stopped producing insulin about 13 years ago, at the age of 18. In the early years, you’d never have known. I kept it to myself and got on with it. These days, I’ll probably tell you about it – I’m into diabetes advocacy. You’ve been warned.

Before we start. Type Ones didn’t get the condition from eating too many sweets. Type One Diabetes is a genetic auto-immune condition where your immune system kills off the cells that make insulin. I can eat sugar, and often do. I sometimes need to eat sugar because my life depends on it, and sometimes I just like to eat dessert.

Type Ones have to inject insulin to control their blood sugar. 100 years ago we’d last about 12 months from diagnosis, and die a horrible death. Now, I can live almost normally, doing pretty much anything I want to. It is a burden to manage, and one more variable to think about when I’m training and racing, but it’s doable.

My running CV isn’t too bad. I’ve done 4 x Comrades marathons (8h36 best), 3 x Two Oceans Ultras (4h26 best) and more marathons (3h03 best) and halves (1h25 best) than I can remember – all with Type One Diabetes. There are also some great examples of Type Ones running further and faster than I ever will, proving that you can run really well with diabetes.

Running is good for me, on balance. I usually convince myself that it’s really good for me, but the truth is, it is not always. It is good for general health and making me more insulin sensitive but variation is the enemy of good control. However, to be good at running, you need variation.

If you are a person with Type One Diabetes, can you also run? Absolutely – I’d encourage you to try it. Start by being safe. Here are some of my thoughts on getting started:

  1. Always have sugary snacks with you in case your blood sugar goes low while you’re out. Always.
  2. Plan for low blood sugars after your exercise. You are more sensitive to insulin. Reduce your doses and have snacks to correct them.
  3. Build up your training and get to know how you respond. Start small and build your confidence. Treat each run as an experiment and keep improving it until you have a formula that works.
  4. Remember that some things about diabetes are just hard to predict, so go with the flow. It can make you sit down on the pavement, but if you have your snacks (see point 1) you’ll be on your way again soon enough.

Social media is exposing some amazing feats of athleticism by people with Type One Diabetes. There is a team of professional cyclists racing at some of the biggest races in the world. They are Team Novo Nordisk, and often try to get a rider into the break at Milan San Remo. Look out for that in March 2019. Last year Charles Planet rode on the front of the longest professional one-day monument, managing his blood sugar while he was at it.

At the 2018 Boston Marathon, a number of really fast Type One runners did some amazing times in terrible conditions. A number of them went under 3 hours, and the fastest I saw was 2h45. That’s quick!

So, how do you run well with diabetes:

  1. Technology is changing the way we live and train. We can now get a blood sugar reading every 5 minutes from small devices with electrodes under our skin. “Continuous Glucose Monitoring” is fantastic for managing diabetes and makes training and performing at a high level possible. The tighter the control, the better the body performs.
  2. Use insulin cleverly. It’s a performance enhancing substance and banned by WADA (unless you have a therapeutic use exemption). So take advantage of that, safely. It aids recovery, so put it to work. Take in a balance of macro-nutrients as soon as possible after exercise, and allow the insulin to do what it does naturally – allow the nutrients to be used by your body.
  3. Control what you can. Sleep, stress, and diet are variables that make controlling blood sugars hard. Adding exercise, and a lot of variation in that exercise for high performance, makes it extra hard. So control the variables that you can.
  4. Consistency is helpful (and boring) but worth it. For example, eating the same thing for breakfast every day makes morning blood sugars much easier to manage. By the same thing for breakfast, I mean the same (to the gram) of carbohydrate.

Finally, it’s easy to get the impression on social media that other Type Ones have perfect blood sugar control all the time. Every post has a perfect 5.0 mmol/l glucose level. This is misleading. We all have bad days. Aim to have as many good days as possible, but don’t sweat the bad days.


Comrades Blood Sugar Graph: This is from the 2018 Comrades. It is a print out from my Freestyle Libre glucose monitoring device. I carry the reader with me so that I can check my blood sugar at any time. You can see that it wasn’t perfect – I spent some time above the ideal range. I didn’t have any hypoglycemia (low blood sugar) and I managed to eat enough to have energy throughout the day

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