The guinea pig
When I was diagnosed in 2007, I had completed my first marathon and I was preparing for my second one. My main concerns were improving my time, keeping injuries at bay, not hitting the wall, and just completing the race. I’ve always been a turtle but one who has ambitions of turning into a hare. The diagnosis threw a monkey wrench into all this because, in addition to performance, I had to start thinking about my blood glucose as well.
How do I train, fuel my runs and maintain energy levels while keeping my blood glucose at an acceptable level?
My confidence in our information age quickly withered when I started my research on Type 2 diabetes and sports. Among the books, articles, websites and blogs with fueling advice, there were very slim pickings for Type 2 diabetic athletes. At that time, I had not yet found any diabetes board, and even there I later found little additional information available to a Type 2 diabetic athlete. Most articles were understandably written for non-diabetics and Type 1, as well as insulin dependent Type 2, diabetic athletes, and any mention of non-insulin dependent Type 2 diabetics seemed to be an afterthought. Articles on Type 2 diabetes and exercise were written mostly for sedentary, overweight or elderly patients who are new to exercise. There was a shortage of practical dietary advice available to Type 2 diabetics who compete in sports. Although there has been an increase since my diagnosis, the overall picture today is more or less the same.
With the dearth of what I thought was useful information, I had to forcibly conscript the only qualified, unpaid, athletic, Type 2 diabetic human guinea pig I could find – me – to get the information I needed. My experiment began with conventional wisdom.
Most experts say that the fueling needs of a Type 2 diabetic who is not insulin dependent is no different from those of a non-diabetic athlete. This means that an insulin-resistant Type 2 diabetic who cannot process carbs is told in different ways, such as the following, to eat large amounts of carbohydrates.
- High intensity exercises (e.g., marathon training runs) will help you utilize carbs and burn carbs quickly so, go ahead, eat carbs.
- Go for high quality carbs with low glycemic index, such as whole grains, fruit juices, whole wheat pastas and whole grain multigrain breads.
- You must eat or drink an appropriate carb-rich food one to three hours before, or during, exercise. Something like 15 grams of carbs for every 30 minutes of moderate intensity exercise, or 60-80 grams of carbs per hour for high intensity exercise.
- Reduce the carbs if you are on a weight loss program.
The words, numbers and details may change but the message was the same – I, a Type 2 diabetic runner, need lots of carbs.
What did I do? Of course, I listened to the experts, like the good girl that I am.
Did it work? As far as my blood glucose is concerned, of course not!
High carb: BG highs and lows
As I prepared for my second marathon, I maintained a high carb diet for my marathon training runs and followed conventional advice, to maintain high energy and to avoid hypoglycemia. At that time I had three diabetes medications, including Amaryl which could cause hypoglycemia. I managed to wean myself off sugar and stuck to the so-called healthy carbs, except Clif Bars which I ate during long runs. The result was that I swung high and low.
First, the highs. My BGs tended to rise during training runs, especially short intense ones, and a number of these highs lingered after my runs. Contrary to what experts said, my body did not quickly burn the pre-run chocolate soy milk and the Clif Bar I munched during long runs.
Then, the lows. My BG also swung to the low end. Lows for me meant becoming disoriented, having difficulty concentrating, being light-headed, and on occasion having extremely dark moods during or even after long runs. Since I had enough carbs in my body to run a small power generator, it had to be the effect of Amaryl. My GP put me on the lowest dose but the only thing that worked for me was to stop taking Amaryl on the days of my long runs and races. But even then, I still experienced lows. (Note: I completely stopped Amaryl about three years ago, and am now on metformin only.)
First attempt at low carb
Marathon training does not give me the license to eat like my non-diabetic friends. Nothing influences blood glucose more than carbohydrates, even if you exercise like a fiend. I cannot control my blood glucose if I continue to eat massive amounts of carbohydrates.
So, I tried low carb. By this time, I was a member of a diabetes board and was lurking on other diabetes boards. A growing number of Type 2 diabetics were talking about how low carb helped them control their BGs and gave them more energy. So, naturally, I gave low carb a try.
I first reduced my daily carbs to around 50 grams a day. I had low blood sugar, even though I didn’t take Amaryl on long runs and race days. I also had difficulty getting a handle on my blood glucose. I had other issues, too, which I’ll write about next time. After a miserable three months, I slowly added more carbs until I reached the happy range of 90 and 120 grams a day. Given the unhappy results of my first attempt, I avoided low carb for many years.
Moderate carb: Ok but not ideal
After trying the high and low ends of the eating spectrum, I settled on moderate carb. By moderate carb, I mean 90 to 120 grams a day (here, I’m ignoring the widening definition of low carb). This seems to have worked for me for the last five to six years. Still, the results are not what I’d like them to be. For one, although I usually get running-related BG levels that are personally acceptable and which would go down very quickly (usually within an hour after I’ve stopped running), I would be far more comfortable with lower numbers. Two, I also get high BGs, whether or not running related, more often than I would like. Hence, I’ve revamped my current eating plan to give low carb another chance (This is something I intend to write about next time). But to those who are interested, here are the salient points of my pre-revamp plan:
- I did not eat before runs shorter than one hour.
- For long runs and races, I had breakfast at least two to three hours before, and sometimes a small amount of yogurt or fruits right before, heading out. Running within an hour or two of a meal disagrees with my digestive and excretory systems.
- For long runs and races, I replaced sports or energy bars, gels or drinks with bananas or oranges, which were kinder to my stomach, were easier to carry and eat, did not make me thirsty, and tasted much better.
- I consumed electrolytes which had no or few carbs.
- I ate as soon as possible after running. I took advantage of the short window right after running when I could eat more fruits without spiking my blood glucose too much.
- I maintained a daily carb intake of between 90 to 120 grams. Additional carbs during running and race days were between 10 to 30 grams total.
Some more lessons from my personal guinea pig
- I have accepted that exercise-induced high BGs will happen even if I go on a low carb diet so I don’t lose sleep if my BGs go up. But I have a BG threshold which, if I cross often enough, would initiate a review of my training.
- Avoid racing every time I run. While I can’t completely avoid high BGs, I can reduce the frequency. Thus, when I’m not training or during long runs, I try to run at a more leisurely pace, which tends to result in small BG rises. In any case, this is also good for injury prevention.
- I do not need to eat a lot of carbs before and during my runs.
- Test. I cannot emphasize this enough. I still find it useful to test even if I don’t go too low anymore. I especially test if I change anything in my training program. I used to find testing bothersome, but those few seconds, or even minutes, of testing may save me from ending in a DNF (Did Not Finish) or worse.
- Carry a medical bracelet, tag or ID, and glucose tablets (just in case).
If you have additional advice or would like to share your training experiences, lessons and secrets, please do not be shy.
Next post: Giving low carb diet one more chance.