Injury free running and mastering diabetes: my journey

I was having a look at my running data in Strava the other day and I happily noticed a good increase in my running volumes. I wanted to analyse the data a bit further but had to face the limitations of my free account, which doesn't allow downloads. No problem! My Apple Health account has it all, and it also has all my nutrition and diabetes data. What a wonderful opportunity to put it all together: the running, the eating, the blood glucose!

In this post, I will explain

how I am going back to running after an stress fracture on my ankle,
how am I training to become an injury free runner, for life
how the running is improving my life as a type-1 diabetic.

Let’s roll!

Note: the graphs below were part of an analysis of the data available in my Apple Health account. The code I used to generate them is available on my GitHub profile.

Back at it - Running Recovery

Starting slow: distance, calories and duration

For context, in the second half of December 2022 I started to run again after a long time off due to injury. As part of my 'comeback' from recovery, during the month of december I ran twice a week.

After such a long period off, my body was just not ready to handle a sudden spike in distance, intensity and frequency. However, I needed to introduce some stress to promote adaptation!
That is why "Running" is probably not the right word to describe my first workouts: each session lasted around 30-40 minutes, covering a distance of approximately 5 km, and always alternating walking and running intervals. For example, I did 3 minutes of running, 2 minutes of walking, and repeated for 8-10 times.

This bland approach allowed me to put some kilometers in my legs without stressing my healing ankle too much.

Gaining Momentum: "Running School" Program

From the end of January 2023, I started the Running School's 12 weeks program, ramping up my workout schedule to two 1-hour sessions a week. As you can see below, the Running School period (in the blue) contributed to an overall increase of weekly duration, calories expenditure and distance of my running workouts as compared to the previous period, where I was easing my way back by just walk-running.

In any case, the increase in distance was rapid but still part of a gentle progression. Each running workout (provided by coaches) was meant to curate different aspects of technique, such as

cadence (170 bpm),
rythm,
balance and posture.

Walk-run intervals were still the core of the training, especially during the first three weeks, and the goal was to keep each workout within the aerobic threshol.

Translating this into hearth rate zones, my goal was to spend most of my time in zone 1 and zone 2 (the infamous ‘conversational pace’), with some visits to zone 3. In my case, this meant never going beyond 155 heart beats per minute (bpm). As you can see below, I indeed spent most of my running time in Zone 2 (41%) and Zone 1 (22%), which combined make a good 63% of running done at a conversational pace...perfect for my recovery!

Walking: the magic ingredient

My past injuries (knee pain and stress fracture on the ankles) had one clear cause: one day in 2019 I decided I would run 10km everyday. I almost never ran with that frequency, nor was I used to the distance. Alhtough I could handle the workouts, my body only lasted one month before starting to tear itself apart.

Why? To put it in simple terms, randomly standing up from the couch and lacing up the shoes may be good to start and find some initial motivation, but running in the long term requires investing time to make our body capable to sustain the effort.

You don't become a runner just because one day you decide you run. You become a runner by living like one. By designing your life in a way that is conducive to maintain a healthy body. An healthy body is crucial to live better, and run better.

Bulletproof body for bulletproof running

So how am I building a bulletproof body? One that can get me to the grandiose achievement of being an ‘injury free runner for life’ as I stated at the beginning? I have three ingredients for this potion:

Feet mobility: think how much time you spend on your feet each day. Now consider how much time you spend training them, making them stronger and more mobile. If you’re like me, this thought probably never crossed your mind at all. That is, until you suffer your thousandth occurrence of knee pain, plantar fasciitis, back pain, etcetera. Does this sound familiar? If so, that’s a sign you should consider investing more time into feet care!
Strength training: build a strong core, strong legs and a strong back. I dedicate at least 3 workouts to this during the week, on top of my running.
Walking: you can run all the races you want, but the true difference is in the lifestyle. I keep my body active and in motions at all times. How? I walk to the grocery store, I carry my bags, I don’t sit on chairs if I can help it, I stand while attending meetings or working at my laptop. When I’ve had enough of standing, I sit on the floor or in a deep squat.

Every moment is suitable for some low impact body maintenance. And each moment is good for a good walk! Besides the mental benefits of walking, the more time I spend on the legs in low impact activities, the easier it is to run longer, and faster. Looking at the total time I spend on my legs, running accounts for barely 12%, a tiny portion when compared to the 68% of time I spend walking! (When I want to build endurance without taxing my knees to much, I rely on cycling, which has its good share too!).

True endurance is built in the way we conduct our daily life. Spending time on the legs, keeping the joints mobile and investing in flexibility is the crucial, magic ingredient to reduce the risk of injuries. That is why I walk so much! To spell this in a fortune-cookie fashion, stay ready so you don't have to get ready!

Running, Carbs and Blood Glucose

Lastly, the relationship between the evolution of my running volume and the blood glucose levels really made me smile. As you can see below As my running increased (the green(ish) line), the average daily blood glucose decreased (red line).
This is interesting because in the meantime I also increased my carbohydrate intake, now close to 400 g a day, and witnessed my insulin dosage decrease!

*Note: the blood glucose and the weekly distance are displayed as 3-day rolling averages.*

I mainly attribute this improvement in my insulin sensitivity to the type of carbohydrates that I eat. When it comes to picking the ingredients, as you may know by now, I stick to the Mastering Diabetes “Green Light” foods list: whole, plant based carbohydrates. In practical terms, my main meals are built with whole grains and legumes, while snacks are usually fruits, and despite not being focused on proteins at all I have no problems hitting an average of 100-120g of proteins day. I find that eating this way, allows me to sustain one hour long running workouts without any problem, it locks my blood glucose throughout the workout (and in the hours after), around the value of 110, which is great.

*A typical trend in my blood glucose during and after a run.*

If you run and you have diabetes - or even if you don't- how do you fuel your workouts? Experts and practitioners such as Zach Bitter experimented with low-carb diet, while others advocate for high carb diet. When talking about endurance, I mainly hear arguments in favour of high carbohydrate diet, but it seems to be a hot topic.

Personally, as a type one diabetic, I go high carbohydrates without any doubt. It has proven to be the most effective to control and stabilise my blood glucose.

And you? How do you fuel your runs?