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June 9, 1999

Exercise and Sports

Question from Phoenix, Arizona, USA:

I am a 26 year old female, diagnosed with Type 1 about 2 years ago. I run 3-4 miles daily and would like to train for a marathon. Is this possible? If so, where do I start?


Running a marathon can be a real challenge for an athlete with diabetes. If you are determined, there is no reason why you cannot run a marathon. With proper training and management techniques the athlete with diabetes can experience the thrill of competing in a marathon just as successfully as an athlete without diabetes.

My first suggestion to you would be to seek out a diabetes specialist (endocrinologist) for a thorough medical check up before beginning intensive training. When you have the go ahead, there are basics you will need to know. These basics are 1) how to balance energy output (calories you burn), 2) energy input (calories you take in) and 3) insulin dosages. A running diary will be your tool for figuring out these basics. You may want to combine your running diary with your blood glucose diary. The following information should be included in your diary.
The Date and Time Your Blood Glucose Level at the start of exercise. Adjustment of Short-acting/Long-acting insulin. Keep in mind, your insulin requirement will change with a change in your training state. The Distance and Time of your run and Place where you run. Your Rate of Perceived Exertion (RPE) How you feel the run actually was; (fairly light, somewhat hard, hard, very hard etc). Heart Rate at rest. (Take your heart rate while you are lying in bed) and during your exercise. Remember to record it! Your weight. Remember insulin requirements change as weight is lost. Amount and Type of extra carbohydrate taken before, during and after exercise (8 to 12 hours after exercise) Blood glucose levels during, immediately after, and 8-12 hour after exercise. Episodes of hypoglycemia; when the episode occurred, symptoms, what your actual blood glucose was, treatment, what insulin was active at the time of hypoglycemia, ideas for prevention of hypoglycemia. Long-term and short-term goals; including time and distance of your training runs and upcoming races may change as a function of the amount of exercise.
Just an added note on Warming Up and Cooling Down: Most athletes pay close attention to warming up. Part of the warm up for the individual with diabetes may involve reducing insulin dose and taking an extra carbohydrate snack before a run. The athlete with diabetes needs to pay special attention to the cool down. Late onset hypoglycemia 8-12 hours after exercise is common. It is important to check your blood glucose several hours after training and take extra carbohydrate if needed.

Finally: Membership in a local running club can provide companionship and running partners. Advice concerning equipment and other considerations can be gained. In addition the International Diabetic Athletes Association (IDAA) may be of some help to you:
International Diabetic Athletes Association
1647 W. Bethany Home Road, #B
Phoenix, AZ 85015
(800) 989-IDAA
Website: http://www.diabetes-exercise.org