Lessons Learned From My First Half-Marathon with Type 1 Diabetes
So last week I ran my first official race, the Verona Half Marathon. This was a “training race”, and although I had already ran that distance multiple times on my own during my solo workouts, I wanted to try a complete race experience before my target race for this year, the Pisa Marathon in December.
I am so glad that I did this, because a race is a completely different beast than training on your own. There are so many more variables to consider, and your T1D may behave wildly differently than your usual training. It is a very very good idea to get these factors into the equation as soon as possible to learn how to manage them and surprises on the big day.
Let me distill some of my key learnings, especially related to diabetes.
Lesson 1: Race Logistics
When you train alone, everything is simpler. You drink your coffee and eat your snack at your preferred time, you go to the toilet whenever you feel the need, you just step out of the door and start running.
When you participate in a race, all of that is not possible anymore. If the race starts at hour X, you must be there in advance. If you have to drive to the place, that means you have to account for even more moving time and that if you were used to eat your snack and use the toilet right before the start of your training, you will not be able to do that as easily.
Lesson 2: The Pre-Race Cold
The race was in mid November, starting at 8.15am. I was at the spot way in advance, and since I had to give my race pack to the organization for them to bring it to the finish line, I was out there in my running gear, with a temperature close to 0 Celsius degrees. Luckily for me it did not compromise my race, I managed to stay active with a light warmup that allowed my body to heat up. But this is definitely a factor that I had not experience before, and one that can so easily screw things up: if your stomach is not used to those temperatures it might shut down and make your race a nightmare.
The cold also affected my blood sugars: despite my pre-race sugary snack (with no insulin injected), right before the start I had 160 with the arrow trending down. Never sat that before, and decided to just slam down some extra white sugar (only a small amount) and rice cakes (more of these, as complex carbs are a safer option during a long endurance race ) to be safe. In those moments I cared very little about going high, I shifted my priority to feeding the athlete rather than the diabetic.
Since I was just out of a week of high fever, my insulin sensitivity was still reassessing itself and that made everything more difficult because I could not rely on a predictable response of my blood sugars to the food I ate. Again, I decided to play it “safe” (from a performance perspective), and just eat until I felt comfortable that I would not hit a low.
Lesson 3: Emotions and Blood Sugar
And the biggest lesson was indeed about how my blood sugar behaved. It was unusually trending down at the start despite all my eating, so I had to find a solution to keep it up.
I didn’t watch my levels during the entirety of the run, and only at the end I opened my Dexcom app and saw what happened all in between: after the start it came back at around 190 and stayed there for the first half. From KM 11 on, it moved to 200, which was expected considering the nutrition gels I was eating (40g carbs every 5km). Then, from KM 19 to KM 21 it absolutely exploded from 200 to around 350, and it stayed at 350 for about one hour after the race was finished, despite my abundant injection of insulin.
This had never happened before during any of my long runs, and I attribute it to two main factors:
My feverish body was not yet fully recovered and was behaving in an abnormal way. The high levels of cortisol were still affecting my insulin sensitivity, keeping my BG very high.
The excitement and emotions of running an official race also played a major role in my opinion. I never ran among so many other runners, nor with music and noise around me. These were new factors to me, and emotions DO have an effect on blood sugar levels, often bringing them to higher than normal levels.
What I’ll Do Next Time
There are a couple of notable things to consider moving forward.
The first one is that fever really can screw up things, and that you cannot rely on your usual ratios while your body is sick. I personally prefer to stay on the higher side than to risk lows. Low blood sugar is such a stress for the body that I’ll happily stay at 300 if that makes me feel safe.
The second one is that a proper race, with all the runners, the music, the excitement of the “big day”, is an entirely different beast than your average training. Just do not let stress lead the way and make you do things you’ve never done before. Do not inject insulin before you start if you’ve never done that in training. Do not eat or drink any weird food you’ve never tried in training. Trust what you’ve always done, stick to the plan and stay rational.
Running 32 KM the week after the half marathon, this time with good and steady blood sugar levels.
All in all, the race was a success. I finished strong and preserved the condition of my body by slowing down the pace. Arguably, the slower pace could be another factor that explains why my BG remained higher. However, I enjoyed every mile, and got to know so many new variables that I never considered before. Even though my diabetes was all over the place, I still consider it as a win: higher than normal blood sugar made me feel safer on that particular occasion. My nutritionist said that on race day it is ok to “feed the athlete first, then think about the diabetic”. My goal was to run without surprises and to finish strong, and that’s what I did.
I have learned a ton, and learning is always a great achievement in itself. I can now refine my strategies much more effectively as I move towards my main target, the Pisa Marathon.
