High Alert

Affecting more than 270,000 New Zealanders and 890,000 Australians, diabetes has reached epidemic proportions, but there is one way to slow, and even pause, the effects – running.

Allan Bolton, 50, an 11.42 ironman with type 1, says regular exercise helps people with diabetes use insulin more efficiently, reduce risk of heart disease and lower stress and blood pressure. “Getting to know the beast is the only real way to stop diabetes from holding you back,” he says. “Don’t see yourself as the victim, own it.”

Right type
Firstly, it’s important to recognise the differences between type 1 and type 2. As Bolton discovered, being a runner does not grant you immunity from developing type 1. The adventure sports specialist from Sydney was diagnosed at 18 and has been insulin dependent ever since.

Type 1 is an autoimmune disease where the pancreas stops producing insulin. Without insulin, the body’s cells cannot turn glucose (sugar) into energy. Instead the body starts to burn fat and proteins, which can cause dangerous chemical ketones to build up in the blood. The result: Ketoacidosis, which can lead to dehydration, loss of consciousness, coma and even death. This is avoided by managing blood glucose levels with daily insulin injections.

No one knows why the pancreas stops working properly, but some research suggests a traumatic event or viral infection can trigger the immune system to destroy the insulin-making beta cells of the pancreas.

For Bolton, his doctors believe he contracted Hepatitis B from a water sponge used after a game of Rugby League, which triggered the onset. Type 1 typically strikes people under 30, but can develop at any age.

Type 2 effects 85 to 90 per cent of all people with diabetes and although there is a genetic predisposition, it often results from lifestyle factors including poor diet, obesity, high blood pressure and not enough physical activity. The pancreas may still produce insulin, but the body fails to use it properly. The good news? It is possible to manage type 2 with healthy eating and regular exercise, but as the disease progresses tablets or insulin may be needed. Type 2 usually affects adults over 45, but increasing numbers of young New Zealanders and Australians are diagnosed every day. Incredibly, 58 per cent of people at high risk or diagnosed with pre-diabetes can avoid type 2 with healthy, active living.

Test, don’t guess
Whether you have type 1 and want to continue running after being diagnosed, or type 2 and want to use running as means of getting in shape, it’s important to test your blood glucose levels 30 minutes before setting out. Joel Tuccia, accredited exercise physiologist for the Australian Diabetes Council, explains the normal blood glucose range before exercise is between six and eight millimoles per litre of blood (mmol/L). “It’s generally okay to run if your blood glucose levels are below 15mmol/L,” he says. “If it’s less than six mmol/L have some carbs before you leave such as a banana, and if it’s higher than 15 and there are ketones present in your blood or urine test, wait until the levels drop before running to avoid the risk of ketoacidosis.”

Tuccia says running can cause blood glucose levels to increase or decrease depending on intensity, so it’s best to test on the run if your training session or race is 45 minutes or longer, especially if you are recently diagnosed or new to running.

Calculating counts
Everyone’s fitness level and use of insulin is different so there is no set formula when it comes to fueling and hydrating before, during and after a run if you have diabetes. But Bolton has developed ext1d.com.au, a website to help calculate and educate people about managing blood glucose levels when it comes to exercise.

The aim, he says, is to avoid hypoglycemia – dangerously low blood glucose levels. “Everyone with diabetes will experience this at some stage, it’s part of the game. The problem is symptoms (such as feeling tired, shaking and sweating) are the same as fatigue.”

To avoid hypoglycemia, you should always plan your carbohydrate intake before running and carry a hypo pack on the run. The pack includes 15 to 30 grams of fast acting carbohydrates such as a carbohydrate gel, juice box, jelly beans or easy-to-run-with sugar packets, which should be taken at the first sign of symptoms.

After running it’s important to continue blood glucose testing every two hours, recommends Tuccia. “Because the body is ticking over at a higher metabolic rate you are at risk of hypoglycemia for up to 15 hours after exercise,” he says.

Bionda Hiensch, a six time half marathoner with type 1, says runners should not be deterred by the constant calculation of blood sugars, fuel and hydration. “Diabetes can be managed, you just have to be more aware of what you’re eating and when,” says the 41-year-old from Terrigal, NSW.

Time and pace
So, how much running should you do? Diabetes New Zealand and Australian Diabetes Council both recommend at least 30 minutes of exercise a day. “To train regularly runners with diabetes can get into a routine of eating similar foods and running at similar times of the day, to help regulate blood glucose levels,” suggests Tuccia. But, with the guidance of your coach and medics, there’s no reason why your training program can’t incorporate different distances and intensities.

Bolton says as your fitness improves overall insulin sensitivity usually increases, which means reducing your insulin dose – preferably under the guidance of a sports nutritionist. “When running longer distances at moderate intensities you generally need more carbohydrates during a run,” he says. While during shorter more intense training sessions, such as intervals, your blood glucose levels don’t drop as much due to hormonal stress responses.

A word of advice: when selecting what time of the day to train, it’s best to avoid the heat. Running in hot conditions can increase blood glucose levels, warns Hiensch. “The more you practice in your expected race-day conditions, the better understanding you will have of how your body will respond,” she says.


Best foot forward

Diabetes can affect the feet in two ways – it increases the risk of developing peripheral vascular disease, which reduces circulation, and neuropathy or nerve damage, which reduces feeling and sensitivity, says Tuccia. The concern for runners is that you may not feel an injury, hot spot or blister developing, while reduced circulation can mean the injury takes longer to heal, increasing the chance of infection or further damage.

“Runners with diabetes should check their feet daily, change their socks after running and have their running shoes fitted professionally to ensure good support,” says Tuccia.

To avoid injury never run in bare feet, keep your toenails trimmed, have corns or calluses treated by a podiatrist and don’t overheat your feet in a hot bath or by resting them too close to radiant heaters.

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When you’re not running, it’s worth hitting the gym for some supervised strength training, according to the International Diabetes Institute. Their research found strength training helps delay or even prevent the onset of complications associated with type 2 in older Australians. In fact, supervised strengthening classes have been proven to decrease blood glucose levels by 14 per cent in six months.

At Southern Suburbs Physiotherapy Centre in Melbourne, Rob O’Donnell, a physiotherapist, says resistance classes have helped people with diabetes successfully improve the way their bodies use insulin and in some cases reduced their reliance on medication. Muscles are storage tanks for glucose, so the bigger the muscles the more glucose they can store, which is why O’Donnell recommends taking two classes a week for at least three months.

For more information about type 1 and 2 diabetes see Australian Diabetes Council or Diabetes New Zealand.

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