Wednesday, February 1, 2023
By: Ruth Watson, Georgetown Medical Student, advocate for women’s health and diabetics and Dr. Matt Sedgley, Director of Running Medicine at MedStar Health
Running is an excellent way to improve your health, both mental and physical. It is recommended that adults living with type 1 and type 2 diabetes spend at least 150 minutes participating in activities such as running. Running increases heart health, increases muscle and bone strength, decreases adipose (fat) tissue, and increases insulin sensitivity.
If you live with diabetes, the increase in insulin sensitivity can lower your hemoglobin A1c (90-day blood sugar average) and may contribute to needing fewer or no medications to manage your blood sugar. If you find yourself in the “pre-diabetes” range, running can be an important part of lifestyle changes aimed at preventing progression to diabetes.
Are you ready to take the first step and start running? There are a few considerations for a successful run with diabetes.
Before the Run
Make a plan! Decide on a route, throw on some stable tennis shoes, and think about your blood sugar levels. In general, exercises like walking, running, and biking will lower your blood glucose. In contrast, exercises such as weight lifting may lead to a temporary and small rise in blood glucose (Although, this is not a reason to avoid weight lifting. Overall, weightlifting also contributes to increased insulin sensitivity and better blood glucose control!)
The combination of medication with exercise can lead to hypoglycemia (low blood sugar). If you are taking medication, you should discuss the possibility of reducing the dose of the medication before running with your doctor. This is an especially important conversation to have if you are using insulin. You should not make any changes to your medications without first checking in with the physician who is prescribing the medication.
Plan to bring light, easy to eat, glucose-rich snacks with you in case you start to feel low blood sugars on your run. Glucose tablets, fruit snacks, and gel packets are examples of snacks that have easy-to-digest sugars that can fit into a running belt or pocket. Double check the number of carbohydrates in the pre-portioned snack you choose to bring, as some snacks may have more carbohydrates than you will need to treat a low blood sugar. Aim for about 15g of quick-acting carbohydrates to treat a low.
If you plan to run for more than an hour, consider how you plan to fuel your muscles and bring other food in addition to your emergency low-snacks. Again, easy-to-digest carbohydrates are your friends here.
Be sure to hydrate with water before your run. If your blood sugar is on the lower end of normal before your run, consider a snack with carbohydrates and a small amount of fat such as a banana with a tablespoon of peanut butter or a slice of whole wheat toast with a few almonds 15-30 minutes before your run.
Prepare your muscles for the run with 10-15 minutes of dynamic stretching. Dynamic stretching means you are moving, rather than holding a static stretch. Walking lunges, leg swings, high knees, and butt kicks are a few examples of active stretches that will prepare your legs for the run.
Let someone know where you intend to run and what time you expect to return and then hit the road or trail!
During the run
It is important to check in with your body during the run. The signs and symptoms of low blood sugar include feeling clammy, sweating, shaking/trembling, nausea, and even confusion. If you start to feel any of these symptoms on your run, you should stop, check your blood sugar, and if low, eat about 15 grams of fast-acting carbohydrates. If possible, let someone around you know that your blood sugar is low and have them sit with you for a few minutes until you are back in your normal range. Typically, resting for 10-15 minutes will give your body time to react to the carbohydrates and your blood sugar will rise back into the normal range.
When your blood sugar has returned to a normal level and you feel better, it is safe to return to running as long as you have another snack in case your blood sugar drops low again. There are reasons besides low blood sugar that you might feel shaky, nauseous, or lightheaded on a run. If these symptoms are happening even though your blood sugar is normal, do not continue your run and seek help.
If you are running for more than an hour, eat other snacks and drink water on your run.
After the run
Your blood sugar may drop following the run. Alternatively, you may see a small post-exercise rise in your blood sugar that will typically come back down on its own. Either way, it is a good idea to check your blood sugar right after the run and about an hour after the run to see how your body is reacting to the exercise.
Have 15 grams of fast-acting carbohydrates nearby in case you experience a low blood sugar after your run. Replenish the water you lost through sweat with a glass of water. Drinking to thirst (not more) is a good guideline for how much water your body needs.
Now, instead of dynamic stretching, do 10-15 minutes of static stretching to relieve your muscles after the run. Focus on holding stretches that target your quadricep, hamstring and calf muscles; holding 30-60 seconds for each stretch.
As you continue to exercise, your body will change and it may get more sensitive to medications. As you run for longer times and distances, your body will become more efficient in utilizing the food you eat. Your blood sugar patterns will change over time as you exercise. Track your exercise (which type, for how long) your blood sugar before, during, and after exercise, and the snacks you eat to discover how your body responds to running. Bringing this exercise log into your next appointment will be helpful to guide the decision with your doctor about any medicine reductions that may need to happen when you are exercising.
Ultimately, running is an amazing way to improve your health and get to know your body. Prioritize safety during your run by making sure someone knows where you will be, carrying snacks, and monitoring your blood sugar. With preparation, running with diabetes is healthy, fun, and it might just turn into your new favorite hobby!