Pisa Marathon with Type-1 Diabetes: Full Recap
And so I ran my first marathon as a type-1 diabetic! It took me 4:38 hours to finish the Pisa Marathon, and it went exactly how I wanted it to go: intentionally slow and at a constant pace, incredibly relaxing, no injuries and no diabetes-related issues.
Endurance sports with type-1 diabetes is a tricky business and a constant iteration through experiments and mistakes. My training build leading up to the event was essential not only to safely accumulate the miles in my legs, but even more to understand how the diabetic in me would react to longer distances and increasing efforts.
Running a marathon is no joke, and many things can go wrong. But with some planning and a good understanding of the factors at play, it is more than doable!
And so I ran my first marathon as a type-1 diabetic! It took me 4:38 hours to finish the Pisa Marathon, and it went exactly how I wanted it to go: intentionally slow, at a constant pace, incredibly relaxing, and with no diabetes-related issues.
To me, the key attention points were:
Get all the carbs in without screwing my blood sugar levels;
Manage my race breakfast and bolus without it producing hypoglycaemia during the race;
Being in range and at full energy all throughout the race.
And I am so happy because they all went according to plan! So let me unpack the nitty gritty details of how I did it!
Carb loading keeping a maximum carbs-to-insulin ratio
I arrived in Pisa on Friday, to make sure that my Saturday would be entirely focused on fueling and resting. On Saturday morning I did some light yoga and mobility exercises to lubricate the body and the joints, and went for groceries: bananas and white rice for my Saturday menu, and blueberry jam and rice cakes for my pre-race breakfast.
Besides the groceries and the stretching, I didn’t do much movement after that, so I knew that a sedentary day would somehow impact my blood glucose management. I aimed at around 700 grams of carbohydrates, coming from ~600g of white basmati rice (uncooked), some bananas and some smaller carby snacks here and there.
I knew that eating large portions of more refined carbohydrates (such as white rice, considered a “yellow light” food) was likely to spike my blood glucose, and I also wanted to avoid nighttime hyperglycemia. So my meal plan consisted in eating small bits all throughout the day to reduce the likelihood of big spikes, and eating most of my food before 5-6pm, to give myself some extra time to digest well, and catch rising blood sugar before bed time.
I injected 50 units of insulin (42 rapid + 8 basal) and ended up being in range 90% of the time, which made me happy and optimistic for the upcoming day of the race.
I could also resist the temptation of overdoing my carbs on Saturday - which is easy to do before a marathon. I find it useless to stuff yourself with carbs only on the day (or the evening, as some people do) before, and opted for a higher-than-usual carb intake during the entire week of the race.
I averaged 700g of carbs a day, mostly coming from whole green light foods naturally high in carbohydrates and low in fats (mainly fruits, dates and potatoes through the week, mainly rice and potatoes on the day before, to limit the fibre intake). I found fruits to be just perfect because they keep me hydrated, filled me up with minerals and micronutrients and kept the carbs up without adding extra fats. And they optimized my insulin sensitivity, which is the ultimate goal. I always coupled each serving with big portions of greens - every day except of Saturday, where I nullified my fiber intake to avoid any stomach issues.
Carb loading through the week with fruits and leafy greens. Apples, bananas, arugula with some oats and chia seeds in this bowl!
And I also drank incredible amounts of water (3/4 liters a day minimum), which are essential to prevent injuries and cramps on race day.
That week of eating and drinking put my mind at ease because I knew that my glycogen stores were full, my body was hydrated and all the conditions were set to complete the race without troubles.
The day of the race
Yellow Light Breakfast
After a very poor night of sleep, I woke up, checked my BG (180, great), went to the toilet and got my breakfast in.
I usually wait 2/3 hours after I wake up to eat and drink my coffee - which helps regulating the energy during the day and to optimize the circadian rhythm - so it still feels weird to me to wake up and put food in my mouth straight away. But it’s marathon day, so we do what we have to.
My usual breakfast consists of fruits. Since on marathon day fibers were not an option for me, I went for a yellow-light breakfast made of 3/4 rice cakes with blueberry jam and coffee. I never eat big on race morning, because the carb loading has already been done and this is just a top up to start with energy. Coffee helps to give the body a good kick, and to empty the stomach before the race.
Rice cakes and jam are a match made in heaven!
I took 2 units of insulin to handle those ~70g of carbs, (half of the normal dose for that amount of carbs, based on my C:I ratio), just to tame any spike.
The race: feeding the athlete first, then the diabetic
My time in range was all good (BG around 180) until the moment we started to run. Then the adrenaline started to kick and my blood glucose went absolutely nuts: in the first hour of the race I was trotting around with a BG of ~360, for no logical reason other than I was very excited. That could be scary at first, because with such a high glycemic index it’s easy to conclude that no more carbs should make it into our system.
However, when I run I am feeding the athlete first, and only then I deal with the diabetic in me. Since I had no intention to bonk or cramp, I stuck to my nutrition plan despite high BG, and ate one gel (35g carbs) every 45 minutes. That kept my BG out of range for the first 15km, but then the aerobic exercise started to produce the desired effect, bringing me down to around 200. I kept a constant pace from the first to the last kilometer, always felt energetic and crossed the finish line with a big smile and a blood glucose of 150.
Post race meal: recovery first
I immediately ate 5 apples. Then, don’t ask me why, I took the absolutely random amount of 15 units of insulin. I barely need that much when I eat a large meal on a normal day, and I injected it right after running a marathon. Go figure.
Anyway, since I didn’t bring any food with me (big mistake), to compensate all that insulin and to meet my immense hunger of the moment I went to a local bakery and asked for a big “schiacciata” (essentially, bread) with a ton of grilled vegetables and vegan spreads inside.
Not ideal, but plant-based and functional.
It was far from my ideal meal: it contained plenty of yellow light foods such as olive oil, refined carbohydrates and processed soy products, but if there’s a day where such an indulgence is allowed that is probably on the day of a marathon, so I was ok with it.
Also, after putting the body under such an immense stress it is critical to give it some nutrition to help it kickstart the recovery process, and if that means having to eat some less-than-ideal and slightly more processed food, then let it be. In any case, after a marathon my insulin sensitivity was at its best ever, so I had no problems coming from that meal.
Later in the afternoon/early evening I finally reverted to my “Mastering Diabetes approved” green light foods: I snacked on some leafy greens, some beans and a couple of bananas. That sent me to bed fully replenished and with some good nutrients to help the body recovering at its best overnight.
Then I slept 9.5 hours.
Final considerations: Endurance with Type-1 Diabetes
There are so many learning points for me personally after this marathon that I will probably have to write other articles to go through them - and I will.
As far as this article goes, there are many lessons I take with me.
The first and most obvious one is that endurance sports with type-1 diabetes is totally possible. Be that a marathon, your first 5k, or a run around the world, diabetes will not hold you back as long as you respect it and give it the attention it deserves.
Time in range during the week of the marathon. The highs occurred mostly during the race.
The second one is that carb loading with diabetes is an art. If one focuses on filling the tank only on the day before a race with the infamous big bowl of pasta for dinner, the risk of spikes in blood glucose is high.
I find that eating high carbs during the entire week (mostly fruit) and then cutting fibers and focusing on pure carbs the day before (such as white rice), is much easier to handle. Also, eating smaller amounts here and there instead of three big servings helps immensely in avoiding the blood sugar rollercoaster.
Third, the excitement of such an event can make blood glucose go bonkers. That is why my BG skyrocketed to 390 minutes before the start qnd it is the same thing that happens before giving an exam, or speaking in public, or doing anything that somehow makes you feel stressed and excited. Adrenaline, stress and excitement all play a huge part in our life with diabetes. Learning to cope with stress is a great investment of your time, but we should also accept that that is normal, and it is an aspect of diabetes that we need to welcome, appreciate and respect.
This was my first of many endurance events. I plan to do many more in 2024 and beyond, hopefully raising some funds for research on type-1 diabetes and inspiring other fellow diabetics to melt some asphalt too, because it is good for the body and for the soul.
