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I wanted to share these emails between Blogging Diabetes and a reader in regards to her son training and running in a marathon next May.  If you have any additional insight, please share it via the comments section below the post or through the contact page.

Reader wrote:

I am writing to gather any advice you can give regarding running marathons with type 1. My son is 12 and is training for the LA Marathon in May 2009. He was diagnosed with type 1 in February (age 11) of this year. Everyone I talk to (doctors included) say he can do it but he went low this last weekend while running a 15K and no one seemed to know what to do. I’m actually looking for a running buddy who will stay with him at all times.  My question is what should he have with him to keep from going low, how often should he be checking his blood sugar, etc. Thanks!

My Response:

The first thing that I want to make sure you know is that I am not a medical doctor. I can only tell you what works for me and insights I have based on my history with type 1 diabetes.  You should talk with your endocrinologist to get their insight.

First, there are a few questions I have:
1) How is your son treating his diabetes – injections or pump?
2) Does he have a CGMS (continuous glucose monitoring system)?

The reasons I ask are because if he is on the pump it would be much easier to adjust his insulin delivery (basal) rate and also take insulin (bolus).  Whereas, if he is on injections he would need to work around the fast/slow acting insulin.

The CGMS would be the ideal solution, but some insurances are not coving it and it’s pricey – $350/month plus $999 for the system.  The beauty of this is that it constantly monitors glucose levels and alerts the person as they become too high or too low.  It’s too bad it costs so much because every diabetic on insulin should have one of these.

For the race and training:
Test glucose levels every 25-30 minutes and try to have glucose level normal about 90 minutes pre race.  Try to eat small, frequent quantities of food that don’t require a large amount of insulin.  This reduces the risk of low glucose levels from taking too much insulin to accommodate the food.

Carbs – fruit snacks are good and Clif makes a product called Clif Bloks/Gel, which consist of 50% complex carbs and 50% simple carbs I would recommend about 15-20 carbs every 20 minutes, the 20-20 rule.
http://www.clifbar.com/food/products_shot_bloks/ or
http://www.clifbar.com/food/products_shot_gel/

Another tip I have read is to dissolve some glucose tablets in a bottle of water – about 10 of them.  This allows you to take about 30 carbs with a few mouthfuls of the mixture.  I would use this as the safety mechanism.  If it was me, I would tend to let my glucose levels run a bit high for the race and training.  Post nutrition and extra care are also key because the muscles will be healing and recovering from the stress of the race.
 
I hope this helps.
Let me know how it goes.

Reader Response:

Your email was very helpful. Thanks so much! (and yes, I know you are not a medical doctor)
 
My son is still taking injections, although he should have a pump by Christmas (that is in the works). He was just diagnosed in February of this year. He does not have a CGM. I’d be willing to get him one but he’s opposed to wearing yet another device.

You mentioned that he should eat "small, frequent quantities of food that don’t require a large amount of insulin." What would you suggest? What do you eat? In previous races he has taken cliff bars, smarties, and sports beans. I have also read about the glucose tabs dissolved in water. He’d probably prefer just taking a Gatorade but it’s something to think about. Do you carry all of this stuff in a fanny pack or how do you keep from feeling weighted down?

Things like the "20-20 rule" are very helpful. That’s something I haven’t heard of before. His endocrinologist is very supportive but has offered little practical information about how to best prepare my son for the long distances. I threw up a white flag to them yesterday (help!), so hopefully that will change soon.

I look forward to hearing back from you when you have the chance.
Thanks again

My Final Response:

I just wanted to be sure you knew I don’t have MD after my name.  It would be irresponsible of me not to.  Also, please note that I have not run any marathons with diabetes, so I am telling you what I know versus what I actually do.  That said, I am starting to train for running long distances so I have been researching it a bit.

I understand about the CGM.  I don’t have one, but probably will in the next year or so.
 
For the small amounts of food, I would recommend a banana or two depending on the size.  Also, small bagels are good especially if he can digest whole wheat.  Clif bars are very good.  I would recommend a fanny pack (not real stylish) or a camelback pack that has pockets.  These are more in style right now.

I have also found the doctors to know theory, but unless they actually need insulin therapy, the folks in the trenches probably can give more practical, real-life insight.  If the doctor is good, she will reach out to others in her network to find out more for you or at least point you in the right direction.

I hope this information helps.  
Best regards and good luck!