Trieste Half Marathon - Diabetes Management Strategy

A few weeks after my Rome Marathon and a few blood glucose rollercoasters, I decided to put myself to the test once again. I really want and need to nail my blood glucose management strategies prior and during endurance races, and the only effective way to do that is by…racing!

As I am moving my first steps into trail running and ultras, I must become a true blackbelt in my insulin, carb and performance planning. My last marathons were smooth enough from a running standpoint, but if I look at my diabetes data, I ran both of them in hyperglycemia.

My mantra for endurance races was:

Everything is acceptable on race day as long as I don’t get into hypoglycemia.

So I had that white sugar or those extra rice cakes if that made me feel more comfortable about completing the mission. And that was acceptable to me as long as I spend the rest of my life in range 90% of the time.
The mantra is still there, untouched, but I ultimately do sports to take care of my health, so I now crave for excellent glucose management in and out of races.

My real goal is to become able to complete any physical endeavor with steady, in range blood sugar, without hyperglycemic dramas. To do that, I must keep optimizing nutrition strategies, insulin timings, snack timings, and so on. I must keep iterating through my errors to come up with a nutrition plan that makes sense, is logical, and leaves little room for mistakes.

And so here we are, toeing the start line of yet another race!

Carb Loading Week And Day Before

Let’s dive straight into the plan.

The goal for this half marathon is not performance related but diabetes related, and is the following: start with a blood glucose of 180 and keep it under between 150 and 200 all throughout the race. This is a scenario I can in large part create with some careful planning. Let’s start with the carb load that will get me to race day.

Carb Loading: Foods and Quantities

My target is to get 10 grams of carbohydrates per kilogram of bodyweight on most days of the week. I weigh 65kg, so my race week daily intake will range between 600 to 700 grams of carbohydrates per day. As a personal preference, for a marathon I normally start shifting my attention towards carbs already on Monday, but in the case of a half marathon I might only start doing it on Wednesday or Thursday.

In order to keep my time in range as high as possible, I won’t stock up my glycogen stores on refined foods. I will avoid white breads and other similar baked products and get my carbohydrates from whole foods such as fruits and grains until the second to last day.

I always always always accompany any serving with leafy greens and any vegetables I can get my hands on: that is one of the best tricks in the book to smoothen the glucose curve.

I also love getting energy from fruits because they also hydrate me! Hydration is always crucial, even more so before a long run in hot weather. Water rich foods are a must in these times, and I couple them with plenty of water and coconut water, for some electrolytes.

To help with blood glucose stability during a carb load, one thing that has helped me in the past is to avoid one big carb load on the day before. I often read about people eating that huge pasta bowl or pizza for dinner leading up to the race. Huge porti of this type not only disrupts sleep, but they’re guaranteed to shoot blood glucose to the outer space.

To avoid that,I prefer a smooth but constant high carb intake throughout the entire week (again, mostly fruit and whole grains), so that my glycogen stores are being slowly filled with nutrients dense foods that are also packing me with micronutrients. This approach is ideal because it means the day before the run I don’t have to exaggerate with portions, reducing the risk of big spikes.

And as the race approaches I gradually reduce the fiber intake, reducing the amounts of fruits and vegetables in the 24 hours before the start and going for foods like white rice and potatoes, to avoid or at least limit stomach troubles.

Race Day: Insulin And Pre Race Snack

Race day is here, and there are several scenarios to consider. The ideal one is waking up with a blood glucose of, say 120, eating a small snack that will get me to the starting line with 180-190, and not having insulin on board while running.

Things are not always ideal, though! I might wake up with 300, or with 60. What to do, then? To have a plan for all possible scenarios, I use an “If…then…unless” approach.

I’ve heard this approach on the FTF Warrior Podcast, which I highly recommend, and have been adopting it with great success in my runs since.

Plan A: Waking Up With Ideal Blood Glucose

If I wake up with a good blood glucose (for instance 120), then I will eat my snack (banana or rice cake or medjool dates) using 1/3 of the insulin I’d normally get for that snack, based on my previous 24 hours ratio. So, if my ratio yesterday was 10:1, and I am about to consume 30 grams of carbs, my bolus would be 30/10=3. Since I’m about to run 21k, I’ll take one third, which is 1. That should rise my blood sugar enough to create a margin of safety from hypoglycemia, without going into hyperglycemia.

Plan B: Waking Up With High Blood Glucose

If I wake up with a hugh blood glucose (for instance 250), then I will eat my snack (banana or rice cake or medjool dates) using 2/3 of the insulin I’d normally get for that snack, based on my previous 24 hours ratio. Using my previous example, with a ratio of 10:1, my bolus would be 30/10=3. Plan A is 1 unit, but I have to bring it down a bit, so I’ll take 2 units and see what happens. I might also divide my snack in two, eating one half upon injection and the other half after thirty minutes. This should give me time to come down enough to eat my snack without worrying about getting into the highs again. If that happens, I still have an half marathon of opportunities to bring it down.

Plan C: Waking Up With Low Blood Glucose

If I wake up with a low good blood glucose (say, 60), then I will some white sugar or other similar stuff to get myself out of danger.

Then I will apply plan A.

Plan D: What If It Still Goes South?

Suppose I’ve followed my plan A/B/C, the race is about to start, and I read on my CGM that I am at 300. Damn! What now? In this case, I’ll just be at peace with the fact that I’ll be in hyperglycemia for a few hours: I will not take any insulin because that will almost surely shoot me down into hypoglycemia while I am running and I don’t want that to happen. I will also keep getting my running gels as per plan, getting around 40 grams of carbohydrates per hour. I will deal with my hyperglycemia once I’ve got my medal.

What if the opposite happens, and ten minutes before the guns shoot I read 121, trending down? In that case, I’ll get a few tabs of sugar (I always bring extra sugars and gels than I need in my running belt), and a few extra rice cakes or a banana if I can still reach them, to have some more complex carbohydrates too. I’ll do what I need to do to get myself up around 180-200, and get my run gels as per race plan, even an extra one if needed, no overthinking.

The Importance Of Planning

I guess this is article highlights the importance of planning more than anything else.

My first races were fine if I look at the performance, but a from a diabetes management perspective. I only had a plan A, and when the conditions for that plan were disrupted I had to guess and adopt an emergency, reactive approach. One that surely got me to the finish line but not quite satisfied with my glycemic index.

As I run more and get more experienced, I am finally understanding the importance of having multiple plans, all supported by the numbers I log into my diabetes journal.

Taking notes about my ratios, my carbs intake, how my body is likely to react to certain situations is an essential component to build a solid layer of intel I can trust and leverage with any new challenge I decide to take on.

I can make informed decisions, craft better plans, become a healthier diabetic and a better athlete. I either get it right, or I learn.

In next week’s article, we’ll discuss how it all worked out and note down the learning points. See you then!