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Running Marathons and Other Races With Insulin-Dependent Diabetes

Updated on October 14, 2017
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Stephanie is an enthusiastic amateur photographer who loves sharing tips and favorite images.

Athletic Training with Insulin Dependent Diabetes

If you have Type 1 diabetes (insulin dependent diabetes) or know someone who does, you can appreciate how difficult it can be to stay active and train for athletic events without suffering hypoglycemia or other complications.

I have had juvenile diabetes for nearly 10 years, yet my diagnosis at the surprising age of 34 did not stop me from my passion for running. Within five years, I started training for my first marathon and crossed the finish line of the Portland Marathon in 2008! I have since completed an additional six marathons, including the Boston Marathon in 2011, and numerous 1/2 marathons, 10K and 5K races.

This is not to say that you should immediately start a running training program if you have a medical condition such as diabetes, unless you discuss the matter in advance with your doctor.

Over many months and years of training, I have learned what works with my body running long distances. Just six months ago, I suffered repeated hypoglycemic episodes during my runs until I visited my doctor and discovered the cause - new sites for my insulin pump caused my body to react as if I had doubled my medication!

Fortunately, I figured out the issue quickly with my endocrinologist and made the necessary adjustments so I could continue training without complications.

Running the Portland Marathon in 2008 with Type 1 Diabetes
Running the Portland Marathon in 2008 with Type 1 Diabetes | Source

Before a Run: Don't Leave Home without These Items if you Have Diabetes

  • Cell phone
  • Medical ID bracelet or shoe tag
  • Glucose tabs
  • Specialized running gels
  • Water and/or electrolyte solution
  • Salt Tablets (optional)
  • A running partner - highly recommended!

Diabetes Plan Before a Run or a Race

For both my weekly long training runs (8-20 miles) and before a race, I plan my diabetes care at least two days ahead of time.

Your diet should include plenty of slow-digesting, complex carbohydrates with healthy protein and limited fats. Drink lots of water and limit caffeine and alcohol. Get plenty of restful sleep and attempt to minimize stress, which can negatively impact glucose levels.

Before you head out, plan on wearing a fuel belt during any run longer than 30 minutes to carry glucose tabs and energy gels (your safest bet is to carry these items even for shorter runs). I wear clothing with pockets so I can carry my cell phone and blood sugar meter, too. Although I turn off my insulin pump, because medication is not usually needed as excess blood sugar is burned off during exercise, I wear the device so that I can give myself medication, if necessary, after testing or re-fueling.

Training runs are not as time sensitive as races, so I take plenty of time to test blood glucose frequently - about once per hour - and make adjustments as necessary. The information I learn during my training factors into my race day plan.

The night before a race, I set my alarm for at least 4 hours before I intend to rise to give me time to test blood sugar and treat hyper- or hypoglycemia. Then, the alarm is reset for at least 2 hours before the race begins. I test, then eat and plan on testing one last time about 10-15 minutes before toeing the start line of my race.

Reaching Mile 25 of my First Marathon in 2008

Crossing the marathon finish line - check out the fuel pack carrying diabetes supplies
Crossing the marathon finish line - check out the fuel pack carrying diabetes supplies | Source

Training for a Marathon with Diabetes Requires Extra Planning

Although I have been a runner since the age of 18, more than 15 years had passed before I was diagnosed with diabetes. Being insulin dependent completely changed my training regimen.

I can no longer go out for a run without careful consideration of the food and drink I have consumed recently. Complex carbohydrates, carefully tailored to a dose of insulin, with enough protein to prevent a blood sugar crash and sustain the slow release of energy over an hour or more, are required.

Every diabetic will respond in their own individual manner to the types of food and amount of medication that should taken throughout training. Weight loss may occur as you prepare for an endurance race, which can require an adjustment to your medications. Of course, blood glucose levels may also vary on a daily basis based on stress, illness, sleep and even recovery from intense bouts of exercise.

More frequent testing of blood sugar is required when training for a marathon. On long training runs, I stop and test every 45 minutes to an hour, and also if I start feeling light-headed or nauseated. I carry twice as many running gels (for energy/fuel) as a non-diabetic would bring. After being caught 1-2 miles from home and experiencing extreme difficulty moving my legs effectively in the midst of a hypoglycemic episode, I learned never to go out without some fast acting form of carbohydrate with me!

You should work with an endocrinologist and nutritionist to determine the appropriate blood glucose level at which to start a workout, which should be measured no less than 2 hours after a meal. If you start out too low, you will not have any reserves for a workout and may experience hypoglycemia within 20-30 minutes. On the other hand, if you start out too high, the stress of exercise may actually push your blood sugar even higher, causing blurry vision, extreme thirst and lethargy - none of which you want to have during a race!

For example, my "sweet spot" is a blood glucose level of 140-150 mg/dl prior to exercise. If my workout will exceed one hour or is especially intense, such as hill repeats, I bring 2 gels (1 plus a spare) to take every 45 minutes. Each gel has approximately 20 grams of carbohydrate. Depending on my then-current blood glucose level, I may take about half the amount of insulin I would ordinarily inject for the same amount of carbs.

50 Marathons in 50 States with Diabetes

Better to be Overprepared when you Race with Diabetes

If you have insulin dependent diabetes, an extreme swing of blood glucose levels is not only scary and dangerous, but potentially fatal. I cannot stress enough that any healthy, active diabetic person should add marathon training to their routine, only after clearing it first with their endocrinologist.

My motto is "better safe than sorry." In other words, I make sure to be over-prepared for a long training run or a race, rather than run the risk of aid stations not being fully stocked. Before heading out, I tell my husband how far I am going, when I expect to be done and make a plan to check in with him throughout the run or race.

Remember that low blood sugar can result in confusion and impact the ability to make appropriate decisions. In fact, I have a card in my wallet that says "I am not intoxicated; I have diabetes ." If hypoglycemia sets in quickly, you could lose your way or even refuse offers of help!

Running last fall, my friend noticed that I was having difficulty carrying on the conversation and had a tough time answering her question about what my plans were for the evening. She asked if we should stop so I could test, but I told her I was fine. Another few minutes passed and she directed me to stop! I was not OK! Fortunately, we were able to get some juice at a local coffee shop while we called for someone to come pick us up.

Crossing the Finish Line of my First Marathon!

Refuel Properly After a Race or a Run

Immediately after finishing a marathon, another endurance race or a long training run, a diabetic athlete should test their blood glucose. Drink plenty of fluids afterward, stretch and plan on consuming an athletic recovery drink or balanced energy bar with a mix of carbohydrate, protein and fats.

I usually test my blood glucose more frequently for the 24 hour period after an especially long run or race. I find that levels can suddenly plummet in the afternoon or evening at times. Other days, the stress of a grueling race can result in hyperglycemia, nausea and exhaustion.

After reading this hub, you may be thinking that it takes a lot of work, effort and planning to run a marathon or other races with insulin dependent diabetes. The answer is, yes it does! Yet, I would not give up my love of running simply because I developed Type 1 diabetes. My passion for racing helps keep me healthy, happy and fit. My overall blood glucose levels, measured as A1C, are below 6.5%, toward that of a non-diabetic person.

As long as my health permits, I am going to continue running!

Do you have a Medical Condition that affects your Hobbies/Fitness?

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© 2012 Stephanie Marshall


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    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thank you so much Kelley!! I really appreciate the comment from you. I've been offline at baseball tournaments this weekend, so am finally getting to reply. Best to you! Steph

    • profile image


      9 years ago

      I see you created a hub on running with type 1 diabetes You go girl this is wonderful. As a type 1 diabetic this has been and continues to be difficult for me. Thanks so much Steph. Voted up, awesome, useful, and SHARED! Take care, Kelley

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thank you Melovy - I really loved that hub of yours and am honored you would link to this one! All the best, Steph

    • Melovy profile image

      Yvonne Spence 

      9 years ago from UK

      This is great Steph! How wonderful that you have been able to carry on running and I agree with the others that this a very inspiring read! In fact, if you are okay with it I will link to it from my hub on how to realise your limitations and exceed them.

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thanks Barry!

    • barryrutherford profile image

      Barry Rutherford 

      9 years ago from Queensland Australia

      Another great hub Steph well done!

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thanks bd, it does take a lot of preparation and planning to run marathons and races with diabetes/insulin. I appreciate the comment!

      And, I loved running with my little Flip videocamera to film portions of the race. I think its really fun to watch and relive those moments. :) Best to you, Steph

    • bdegiulio profile image

      Bill De Giulio 

      9 years ago from Massachusetts

      Hi Steph. Never realized how much preparation is needed to remain active with type 1 diabetes. Good for you for not letting it stop you. This is all very good info and advice for those who are dealing with diabetes. I loved the moving video that you were taking as you ran the Portland marathon, great idea. Keep on running. Voting up and sharing.

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Hi AE,

      I have a good friend from college who has a daughter (age 15) with Type 1 diabetes. Like me, she is a runner. But hopefully, others with the disease will realize that they can still be very active and set lofty goals! Best, Steph

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thanks Tom! Not everyone can run a marathon, that is for sure! I do hope to inspire those that are runners pre-diagnosis of diabetes, or show that people that have had the disease for years might still be able to participate in endurance races. Best, Steph

    • always exploring profile image

      Ruby Jean Richert 

      9 years ago from Southern Illinois

      This is a great hub. Other people with type 1 diabetes will be inspired reading about your accomplishments. Good advice throughout. Thank you for sharing..

    • tom hellert profile image

      tom hellert 

      9 years ago from home


      i can't do the marathon thing- viscious plantar faceitis....and little to no desire...I understand your desire to do this but i am....totally hip to you wanting to do this.... I am very impressed..I admire you for this and I admire very few people...


    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thank you CloudExplorer - definitely avoiding processed food is a healthy choice for diabetics and others. I really appreciate your comment and am off to go read your hubs on diet, diabetes and exercise. Cheers, Steph

    • CloudExplorer profile image

      Mike Pugh 

      9 years ago from New York City

      Greatly important and informative article here, I have a few friends and family members with diabetes and me and my wife just helped her sister recently with learning about alternative natural remedies, or better healthier food choices to assist her in her blood glucose levels.

      She was eating to many processed foods, and food high in starch, oily fatty foods, and high fructose corn syrup, and so we simply helped her to gain a much better awareness about eating veggies, juicing, and the not so well known issues with blood ph levels.

      I also wrote a few hub on the issues affecting people today in dealing with fighting many ailments, and diseases related to eating of certain foods. This hub is truly breath taking to say the least, and goes to show what someone truly must go through to fight such a retched disease as diabetes.

      You a strong person, and hopefully more people can find it in them the same strength you have found in your battles with diabetes. Exercise is definitely a key to the fight for sure, heath consciousness is the other.

      Outstanding Job! voted up and getting shared everywhere I can share it, thanks for being so strong @stephhicks68.

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thanks Pamela - its funny, one of the first thoughts I had when diagnosed with diabetes is, "well, now I will never be able to run a marathon." Fortunately, I was wrong! It does make it easier with today's medical technology, having an insulin pump and easy to use blood sugar meters. Cheers, Steph

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Hi Tony - thanks! I know what you mean about taking our bodies for granted. I certainly did so before developing diabetes. So appreciate your comment. Best, Steph

    • Pamela99 profile image

      Pamela Oglesby 

      9 years ago from Sunny Florida

      It is impressive to me that you are able to manage your diabetes well enough to run in marathons. This was a terrific hope that gives hope to all that deal with medical issues. Voted up!

    • Tony Flanigan profile image

      Tony Flanigan 

      9 years ago from East London, South Africa

      Wow! Steph, you're a true hero of the running world. We mere mortals just take our body's for granted, and never attempt what you have done. Congratulations, you have every reason to be proud of your achievements!

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Hi teaches - thank you! Its funny, but after writing this and reading the first few comments from you guys, I'm kind of emotional!

      With respect to the question about bruising, I do feel like I bruise easily and that it takes a while for the bruises to go away. I know that people with diabetes tend to heal more slowly than others, as well. Best to you and your son - Steph

    • teaches12345 profile image

      Dianna Mendez 

      9 years ago

      I was cheering for you as you cross that finish line! You are an inspiration to those who deal with obstacles such as diabetes in every day life. I enjoyed your hub and you made it so interesting while giving pointers on running your race. My son, who has diabetes, just asked me if people with diabetes bruise easily or tend to have bruises show on their bodies for no reason at all. Do you know if this is a normal condition?

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thank you much, ktrapp! I'm excited (and humbled) to think that my story can be inspiration for others. Best to you, Steph

    • stephhicks68 profile imageAUTHOR

      Stephanie Marshall 

      9 years ago from Bend, Oregon

      Thank you so much RealHousewife! I do love running and I'm glad that I've managed to keep it up with the diabetes. Really appreciate your kind comment. All the best, Steph

    • ktrapp profile image

      Kristin Trapp 

      9 years ago from Illinois

      I found every word of this Hub to be interesting and inspiring. I love how you never let your diabetes diagnosis keep you from your passion of running. It is a lesson for all of is with various obstacles. Thanks for chronicling your experience.

    • RealHousewife profile image

      Kelly Umphenour 

      9 years ago from St. Louis, MO

      Wow! Now that is amazing. First - Hat's off to you! Oh my - just the stamina to run a race - put aside the hard work you do to track your sugar intake etc. I really enjoyed the hub and the great info - I will be sharing everywhere.

      Second - the hub looks so professional. It is really stellar:)


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