Hit the pavement - Diabetes WA
 In Healthy Hints and Hacks

Whether you want to lose weight, get fit or find the motivation to exercise, running has many health benefits. For people living with diabetes, running on a regular basis can not only help to reduce the amount of daily insulin required, but can also lower the risk of stroke and, for people with type 2 diabetes, help combat insulin resistance.

As the saying goes, slow and steady wins the race. And if you’re tackling your first fun run, Diabetes WA exercise physiologist and diabetes educator Marian Brennan recommends slowly building up the intensity and duration of your runs.  “Couch to 5kms is a great example of a gradual exercise program and maybe a good place to start for those who are new to running,” she says.
“Consider asking an exercise physiologist for a program or visit the event website for some generic programs which are safe to follow.”

It’s also worth noting that running can impact blood glucose levels (BGL) in different ways for people living with type 1 diabetes compared to those with type 2 who require insulin.
For those who have existing diabetes-related complications, problems with blood vessels in your eyes, legs, kidneys or heart, a history of heart problems or stroke or have recently experienced big fluctuations in BGLs, Marion strongly advises consulting your GP or endocrinologist before commencing any new training program.

Not sure what target range you should aim for during a run? For people with diabetes who require insulin and are undertaking light to vigorous activity, Marian suggests starting with a BGL between 7 and 10mmol/L. When moving up to high intensity activities where you know your BGL will rise, aim for 5-7mmol/L, while sustaining between 5.5-10mmol/L during activity. If your BGLs are above 15mmol/L for prolonged periods of more than two hours, check for ketones as too many in your bloodstream can be life-threatening. She adds that if your ketones are less than 0.6mmol/L, it’s safe to continue, but if it ranges between 0.6 to 1.4mmol/L, be very cautious and stick to light exercise for a maximum of 30 minutes. If your ketones are above 1.5mmol/L, Marian says exercise should be avoided.

Hypoglycaemia – when BGLs fall dangerously low – can be difficult to recognise during exercise. However, some typical signs of hypos can include sweating, shaking, dizziness and increased heart rate.

“This is why monitoring during your run is crucial, even if you feel OK,” Marian says. “Monitor your BGLs at least every 20 to 30 minutes for activity lasting longer than 30 minutes.
“Hopefully by checking regularly, you can avoid letting BGLs dip below 4mmol/L.”

On race day, it’s worth carrying your blood glucose monitor with you and also having a hypoglycaemia prevention kit on hand.

“A person living with diabetes competing in a fun run should always carry their blood glucose monitoring device with them, especially if they are competing in the longer distances,” dietitian Ashling Turner says.

“They should also carry their usual hypoglycaemia prevention kit, which could be 15g of fast acting carbohydrates in the form of six to seven jellybeans, glucose tablets or 200 to 250ml of fruit juice.”

Ashling adds that it’s also a good idea to do your research ahead of race day to see what is provided at the various hydration stops along the event course.
“Some of the stops provide a small plastic cup of energy drink like Powerade which may assist in managing both energy and blood glucose levels,” she says.
If you notice signs of a hypo with falling BGLs that drop below 5.5mmol/L, you may want to consider having some fast-acting carbohydrates – think gels, sports drinks, lollies or jellybeans.
“If you check and notice you are having a hypo (less than 4mmol/L), stop running and treat the hypo as per normal,” Marian says.
“Commence running once your BGLs have come above 7mmol/L. If your BGLs drop below 2.8mmol/L or you require assistance in treating your episode of hypoglycaemia, we do not recommend activity for the next 24 hours.”

Whether you’re a beginner, intermediate or advanced runner, a decent pair of shoes is a must. Marian recommends replacing them at least once every 12 months, or sooner depending on how often you run. While it’s often thought that people need to “wear in” their runners, Marian says as long as your shoes are comfortable from the start, don’t rub and provide the right support, then you’re on the right track. The biggest no-no when it comes to footwear? Running in wet shoes. “It might be tempting to pour water over your head, but this inevitably wets your socks and shoes, creating the perfect environment for blisters,” Marian says.

“It’s also worth checking your feet before and after each run to monitor any changes. If you notice any signs of infection or inflammation, seek medical advice right away.”

Fuelling your body with nutritious, wholesome foods is particularly important when upping your physical activity levels. If you’re planning on tackling the 12km run or the half marathon, Ashling says it’s worthwhile speaking to your dietitian or diabetes educator to work out a nutrition plan that will help you prepare for the longer distances.
“Every individual has different needs and practising different carbohydrate combinations before, during and after training based on individual blood glucose levels will assist in maximising performance,” she says.
While the food you eat in the lead up to the fun run is pivotal to how you will feel on race day, Ashling says there are some misconceptions about what people should eat the night before.
“There can be a misguided idea that someone competing in a fun run needs to eat a very carbohydrate heavy meal on the evening before the race,” she says.
“People living with diabetes should follow their usual routine of a varied meal, comprising of protein, vegetables and one to two serves of carbohydrates.
“It is a good idea to choose wholegrain carbohydrate varieties for their added health benefits including increased fibre, vitamins and minerals. These include brown rice, and wholemeal and wholegrain pasta and bread served with a nice variety of vegetables.”
On race day, Ashling suggests having a small breakfast or snack before making your way to the start line.
“Anywhere from one to two hours before the event should be enough time for the food to settle and for our bodies to be able to use the food as energy,” she says.
“That should also be enough time to not feel sluggish from the food, which can make it uncomfortable to run.
“It is a good idea to trial what foods work for us immediately before going for a run, as some people may prefer one to two slices of toast or some cereal, whereas others may prefer a smaller piece of fruit.
“Some people may even prefer a larger meal one to two hours prior and a small snack just before starting.”

Last but not least is ensuring you stay hydrated. Not only can dehydration cause blood glucose levels to rise, but it can also impact your overall performance.
“Hydration is very important, particularly on hot days,” Marian says. “Hydrating with electrolytes is a good idea, particularly if running for greater than 60 minutes. Fluid replacement during exercise is very individual and can be dependent on many factors.”
To prevent excessive dehydration during a run, Marian recommends drinking enough water to prevent losing more than 2 per cent body weight due to fluid loss.



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