Running and T1D: lessons learned so far
More than one year of complete stop from running, endless hours of feet and knees mobility drills later, my ankles are finally ready to take on running again. I have used this time ‘out of the running game’ to deepen my understanding about the nutrition, the lifestyle and the training factors that concur to the safest possible sporty type-1 diabetic.
Without much information available online, I had to somehow turn all those books, blog posts and podcasts into practical experiments. So I set out to go out and find the best strategies by becoming my own guinea pig…I guess that’s a Curious Diabetic nature!
My aim is to show that endurance sports, as any other sport, can and must be a part of any diabetic’s life. The cost of not exercising is just too big.
However, I don’t want myself nor any other T1 diabetic to get excited and embrace epic stuff unprepared. There are real risks involved, even deadly ones. That is why I will share what I learn from during my training and journey. Sports and diabetes must coexist, but they must do so SAFELY.
Context: plant based nutrition and intermittent fasting
Before I list down my dos and don’ts, here’s a bit of useful contextual information for the new reader:
I follow a plant based diet, based on whole high-carbohydrates foods. This has been a crucial factor to reach a 90% time in range on a consistent basis, and to drastically reduce my insulin resistance;
I am currently intermittent fasting: 19 hours fasting window and 5 hours eating window;
My running volume is relatively contained, since I am still in a recovery phase and I don’t want to push my body too much, risking another injury. My running protocol includes two runs a week, one hour each. Outside running, I walk everyday for at least two hours, I exercise at the gym and have one or two indoor bike rides a week, 1 to 1.5 hours each.
So let’s get to the saucy stuff, here’s what I have learned.
Lesson 1: Don’t get obsessed with carb loading
This is a rookie mistake of mine. Reading all things marathon, ultramarathon and endurance sports, it is clear that carbohydrates are the essential fuel for our body (up to a point, fats and proteins become more and more important when approaching ultra races) adaptation. I started to associate running to carb loading: if tomorrow I run for 30 minutes, today I have to carb-up! While that could be the case for longer or intense runs, it doesn’t really makes sense to overdo it on carbs before each run. A slow run will not tax the energy reserves as much as a tempo run or a long run. Note that I am still getting 80% of my calories from carbohydrates. What I am saying here is that it is not necessary to overfill the glycogen stores ahead of every single run: you will likely not bonk during a one hour run at the park. Our body absorbs around 60 grams ****of carbs per hour, which is around 240 calories/ hour. Beyond that point, it is all extra, unless you’re really pushing your body to its endurance limits. I found this article quite informative on the topic.
What’s more is that too heavy a carb load at dinner time often sent my BG high over night. Ingesting too much in one sitting at dinner time has a very different effect on BG than earlier times in the day: part of the rise will be mitigated by the fact that one walks and is physically active during the day, while at night typically one is sleeping, burning less calories and not taming the glucose just as much.
Lesson 2: The body adapts pretty well to fasted workouts. The key is to eat enough calories
In any case, one must make sure to eat enough calories. Sometimes I failed to reach the calorie intake because I could not comfortably stuff all that food in my body in a 5 hours eating window, or because life got in the middle and I could not eat a snack, or for whatever other reason. When that occurred, running or exercise in general the next day was much harder to endure. Still doable, but without the proper energy levels. A pity!
That has less to do with intermittent fasting than with a proper fuelling strategy: I am always running during my 19 hours fasting window, and 9/10 times I have no problems at all finishing the workout in great shape. The only times this doesn’t happen is when I fail to eat enough the prior day. It is essential to have a rough estimate of the amount of maintenance calories based on a person’s lifestyle. Using online estimates can give a good broad indication: in my case, exercising vigorously for at least 1.5 hours a day requires a minimal 3000kcal intake. Failing to hit that amount for more than a few days in a row will start to impact my energy levels.
When that amount is met, however, fasted running has not been a problem for me with my current running volume. I will revisit this point when I start my marathon and ultras prep.
Lesson 3: High Blood Glucose, Stress and the Sympathetic Nervous System
When running right at the end of the 19 hours fast, I sometimes experienced rising blood glucose.
This was always a mystery to me, until I found Don Muchow’s blog, an authentic treasure for any T1 involved in sports. Don is a T1 diabetic who’s ran across the US, ran ultras, IronMan, marathons and all kinds of crazy long endurance challenges you can imagine. He also writes an extremely information rich and informative blog, which I have been binge-reading lately.
That is how I have discovered that stacking the stress generated by the absence of food with the stress induced by physical exercise can compound the release of cortisol, which spikes blood glucose. Paradoxically, in this case eating with a high BG has actually decreased it, because the Sympathetic Nervous System was not taxed by all those stressors anymore. Food intake equalled a ‘all right, we’re not in danger anymore!’ situation, putting cortisol back to its seat. One other thing I noticed is that a poor slumber kept my BG high the day after regardless of the amount of exercise or insulin I would take. That is, once again, the stress generated by the lack of sleep.
As soon as my body and nervous system were out of the stress zone (fast, workout or sleep deprivation), however, the blood glucose went from the sky to the underground very quickly: This stress keeps the blood sugar high. When the stress is removed, it can “tank” precipitously, to quote Don*.*
This has opened a world of considerations for me about my training schedule and lifestyle overall. Perhaps I am stacking too many stressors on one another: the fast, the workout, the cold shower, sometimes the poor sleep. This is under control now, but what will happen when I increase the length, frequency and intensity of my workouts?
Lesson 4: Weight lifting - hard days “hard”, easy days “easy”
Strength training is essential for long term: it builds bone density, keeps the posture straight and prevents injuries as we get older. Peter Attia’s ‘Outlive’ offers a great explanation on this, for those interested.
However, without proper planning, weight training can get in the way of endurance training, tax the body and lead to injuries. I am not as concerned with the upper body as I am with the lower body, which is involved in running, cycling and leg days. In the past I did the mistake of alternating endurance and weightlifting (one day I run, the day after I train the legs). That exhausted my body, which never had a break to recover and rest the legs. So I switched to a ‘make hard days very hard, and easy days very easy’ kind of protocol, after watching Coach Sage Canaday’s video. The idea is: if you want to train your legs, do so the same day of you run, after your run.
That way, the next day you can give the lower body a proper, full recovery. Also, don’t make the mistake of hitting the weighs before your run. The run will be 10 times harder, I can tell by experience.
Lesson 5: Whole food plant-based: a game changer for recovery
Quick one about eating high carbs, whole plant based. Not only my insulin sensitivity has improved dramatically (just like my time in range and my energy levels). My recovery is much better. It almost never happens that I don’t have the energy for my daily workout, and that my body is not capable of carrying it out. Even more now that I have added endurance to my strength training. Eat plants, you’ll recover faster and better!
Conclusion
This is all I had for this time around. I will revisit some of these points as my training increases in volume and intensity, but so far I am happy with how it is going: very few lows, very stable BG, plenty of time in range and good energy.
Stick around, I am have intriguing racing plans and blog posts to share in the near future.
As far as this training report goes, endurance and diabetes can be done safely!
