Navigating the Unknowns of Endurance Running as a Plant-Based Type 1 Diabetic - Insulin, Carbs, Hydration, and the Curious Pursuit of Mastery

Hey there, fellow runners and diabetes warriors! Welcome back to "The Curious Diabetic,” where the relentless spirit of endurance running and the power of a plant-based lifestyle converge. In this post, I’ll guide you through all that I am learning about running longer distances as a type 1 diabetic. There are a lot of nuances to consider when the miles increase and the time on the road goes past the hour:

how should you time the insulin injections?
the snacks pre and during the run?
the hydration?
how does it feel to go on an hypo while running?

I'll dive deep into these intricacies while emphasizing that listening to our bodies truly is an art and a skill that can be mastered, and every day reminds me of this. This is that I have called the “Internal GPS”, especially critical in the life of any diabetic who happens to be an endurance junky! So, fellow adventurers, fasten your shoelaces and join me as we start to unpack the secrets and the lessons of mastering endurance sports with diabetes!

My First Long Run, A Leap into the Unknown

As I set out on my first long run, an essential step in my marathon preparation, I found myself in uncharted territory. Handling longer distances presented new challenges, pushing me to reevaluate my strategies and adapt accordingly.

So far, all my outings rarely went past the hour, because in the past months the focus was not on distance as much as it was on developing the best technique and running form. A one hour run can hardly go wrong and I feel I have enough experience to do it no problems. But when the I saw a 1.5 hours session in my Training Peaks calendar, questions inevitably arose: How would my body handle the absence of carbohydrates during the run? When should I time my insulin injections? Should I inject if my blood glucose is rising, as I used to do? Should I go on an empty stomach, just like my usual one-hour runs? How fast would my blood glucose drop?

These were (and are) unexplored territories to me, and they were brimming my curiosity reservoirs. Habitually, I do run fasted in the early morning, without any insulin in the tank. This has been a great strategy so far, ensuring stable blood glucose levels all throughout the run (I even got to the point that I was confident enough to go out without my emergency sugar bars).
But long runs are a different beast: you need more energy for the prolonged effort. So for this time around I decided to go run after my breakfast, a good opportunity to gain first-hand experience on a new set of variables: what foods are best to eat before a run? How much insulin should I take, and when?

The Power of Oatmeal - Long-Lasting Energy

To tackle the energy requirements of endurance running, I experimented with consuming my usual oatmeal and banana two hours before my run. This simple yet nourishing choice is always a great post-workout meal, but this time it also provided me the steady stream of energy I was looking for, ensured stable blood glucose levels and gave no stomach issues throughout the run. The meal is simple but the impact was significant (and in line with the high and whole carbohydrate-rich food recommended by the Mastering Diabetes method!).

A pre-run oatmeal proved to be great to fuel up without side effects. But how should I adjust my insulin? I surely cannot inject the usual amount if I am to run for almost two hours!

The Misstep - Timing and Insulin Injections

…and here comes the first setback, born from fear and uncertainty. Knowing that the long run would naturally decrease my blood glucose at some point, I only took 70% of my usual breakfast bolus, which of course produced an hyperglycaemia.
Concerned about the compounding effect of less insulin, heat and stress-induced cortisol on my blood glucose levels, I took one unit of insulin right before my run.
This decision backfired, causing my blood glucose to plummet dangerously close to hypoglycemia during the last 20 minutes of the run. I still ended in safe territory (around 80), but I felt a decrease in energy and surely I could not have run more without facing big risks. This served as a poignant reminder of the delicate balance required when timing insulin injections during long runs, because during a 3-4 hours marathon one cannot afford to go into hypoglycaemia.
I am thus wondering whether it is acceptable to lower the insulin and go high before the run, and let the run do its job and decrease the blood glucose naturally. To me, this is not ideal because it generates that “rollercoaster” effect that makes diabetes hard to manage, and because I want to run without concerns of such kind.

The “rollercoaster”: going high due to decreased breakfast bolus, trying to fix it by injecting one unit before the run and… going low after the run!
Lesson learned…something to avoid!

This is further motivating my exploration of alternative methods, such as an insulin pump, which could be trained to release just the right amount of insulin during the run, in order to avoid problems.

Hydration - Quenching the Thirst for Success

Beyond nutrition and insulin, proper hydration emerged yet again as the unsung hero in this endurance feat. It is no secret that staying hydrated is paramount for optimal performance and recovery. I usually drink 3-4 litres of water per day, but I never take drinks during my run.
This time, I wanted to test my body a bit harder and train on some fatigue: I decided to run at noon, under the summer sun, and with no water. It was not too dramatic, but by the end of the session I could definitely feel the thirst and how much my body was screaming for water.

This was proof that sip by sip, we replenish the fluid our bodies crave, a crucial factor to maintaining energy levels and preventing complications arising from dehydration. I cannot overstate the importance of hydration when it comes to conquer those challenging miles.
From now on, I will bring water during my long runs. It is just too important.

Fuelling and Recovery - the Plant-Based Powerhouse

All right! The run is done and the miles are on the legs. Time to recover!

Embracing a plant-based diet empowers me to do so by taking full advantage of nature's bounty. The Mastering Diabetes method provides a roadmap to harnessing the power of high and whole carbohydrate-rich foods, and I find that approach to work wonderfully.

My post-run snack is nothing less than a big bowl of vibrant fruits (aka “Nature’s candies”), those that naturally put a smile on your face. In particular, I love a big bowl of apples, bananas and berries. Then I moved on to lunch, which included nutrient-dense vegetables (cauliflowers, broccoli and salad) with some wholesome grains (brown rice) topped with some canned chickpeas. All the macro and micro nutrients my body needed were there to revamp my energy, aid in muscle recovery, support overall well-being for the remaining part of the day and get ready for the next run. Every meal is a golden opportunity to nourish the bodies with nature's finest and unlock our true potential as endurance athletes.

Why should you not feast on the best plant-based and carb rich foods, which also happen to be the best ones to increase insulin sensitivity, keep blood glucose in-range and manage type-1 diabetes?

Listening to the Body's Symphony

In the rhythmic symphony of endurance running, our bodies play the lead role. It's vital to listen attentively to their cues during the run.
In my example, after an hour I noticed a decline in my technique and an accelerated heart rate—a clear sign of fatigue resulting from mishandled nutrition and timing of insulin injections. By tuning in to these messages, I can make the necessary adjustments, prevent the same setbacks, and ensure the my next run is smoother and more enjoyable. Which is: a much nicer and pleasing symphony!

Endurance sports with diabetes are a continuous journey of discovery. Countless factors come into play, some of which we cannot control. The spikes in cortisol due to stress, for example, can unpredictably spike blood glucose levels. Or maybe you realise your insulin sensitivity changes dramatically while you run, for reasons you do not know. But once you becomes were of them, these factors can become part of the equation: you may not control them in full, but you can start accounting for their chance to occur.
As you gain experience and refine your approach, you can better tune your body - your inner orchestra - to play the best symphony it is capable of.

Embracing the Relentless Curiosity

Running is a beautiful pursuit, and running with diabetes makes it all the more complex - and interesting! The essence of "The Curious Diabetic" blog is in its very name: a commitment to exploration and a passion for learning. I am armed with an unwavering spirit of curiosity: as I embrace the unknown at every additional stride and mile, I know things increase in complexity, but I also know I am mastering the knowledge of my own body.

Reframing diabetes in these terms makes every mile an opportunity that brings us closer to unraveling the complexities of this condition. Isn’t this incredibly motivating?

It surely is for me, and I will continue to write about what I learn about my body.
I have a marathon to run, and I have plans to run way beyond the marathon distance…this means that there is so much more to test, learn, and document!

So, dear reader, let’s persevere and relish the joys of discovery. Boundless curiosity, unwavering determination and a positive mindset are the key ingredients to a life well lived. Diabetes is our best friend, our golden opportunity to become more aware of your body day after day.
Don’t miss the chance to explore it, learn and develop mastery of your self!