Running with diabetes: Tips for keeping your levels on track

With an estimated 2.5 million people¹ hitting the pavement, countryside or track every week, the United Kingdom is fast becoming a nation of runners.

In many ways it’s the perfect sport; there’s no need to assemble a team, buy expensive equipment or pay for a gym membership. The health benefits are well-known. Running, like other forms of exercise, can help improve your sleep, lower blood pressure, increase heart health and boost your mood².

But what about running with diabetes? Is it okay to join the race? Absolutely. Regular exercise has been found in many studies to help lower HbA1c values and boost insulin sensitivity in people with diabetes³.

However, there are some additional things to consider when starting a new exercise regimen if you are living with diabetes. Here are some tips to keep in mind before your next session, to help you maximise the benefits of running.

Before you start

As with any new exercise, speak to your healthcare professional before starting regular running, especially if you were not engaging in regular exercise previously⁴. They can check your heart health, as well as discuss how best to combine a new exercise regimen with managing your diabetes.

Similarly, if you have been newly diagnosed with diabetes, your doctor can help advise you on how to continue your running programme.

If you take insulin or certain types of oral medication to manage your diabetes, there is a risk of your blood sugar levels going too low if your insulin or carbohydrate intake is not adjusted to account for the effects of exercise⁵. Be sure to discuss this with your healthcare team for tailor-made advice - they may advise you to check your blood sugar levels before starting exercise to see if more insulin or carbs are required, or if you need to check for ketones.

First steps

If you are new to running, set realistic goals. You’re not going to be running a marathon right away, or even a half marathon. Working towards a 5k run is a more realistic aim. By starting with shorter, less intense training sessions, you are less likely to injure yourself⁶. This also allows you to see how exercise affects your blood glucose.

For people with diabetes, foot care is very important and wearing comfortable running shoes with proper support will help protect your feet. It’s also important to regularly check for blisters, sores, cracks or redness⁷.

Keeping well hydrated is important. Unless you are doing a high-intensity or endurance run, water is best. It’s always a good idea to carry a small carbohydrate snack, such as a piece of fruit, in case your blood glucose levels drop⁸.

It’s all about timing

The best time of day to train is the time that fits in with your lifestyle! For some people, the most convenient window will be at the start of the day, for others it will be during their lunch break or after work.

The most important thing when timing your workouts is consistency. By training at the same time of day, you can learn how your body responds to exercise, carbs and insulin and know what to expect⁸.

Running the numbers

The main consideration when running with diabetes is to ensure that your blood glucose levels do not drop too low and cause a hypo. It is important to remember that physical exercise can lower your blood glucose levels up to 12 hours afterwards.

If you use insulin, or other glucose lowering medication, it’s a good idea to check your levels before and several times after exercising.

As general rules for managing your blood glucose during exercise, the NHS recommends the following⁹:

• Monitor your blood glucose levels before, during and after exercise
• Keep a record of your blood glucose levels and the food you eat when exercising, this can help you work out how exercise and food affect your blood glucose
• Monitor your blood glucose levels regularly after exercise, as they can drop for up to 12 hours afterwards, you may need an additional snack or insulin reduction
• Extra carbohydrate based snacks, or insulin reductions, may be needed to prevent hypos during exercise
• Keep hydrated by drinking plenty of water
• If you are unsure what to do about managing your blood glucose levels while you exercise, please contact your healthcare professional

If hypos are interfering with your running programme, talk to your diabetes team, who can advise you on your particular circumstances.

Going the distance

Marathon running is growing in popularity and you’re thinking of taking part, these tips can help you do it safely.

• Many runners, both with and without diabetes, find it helpful to increase their carbohydrate intake before a big race, a practice known as ‘carb loading’. But athletes who use insulin need to be careful, as too many carbs can cause hyperglycaemia if not enough insulin is taken to counteract the increase in carbs¹⁰. Be sure to check with your healthcare team about the best carb/insulin combination for you
• As well as checking blood glucose levels before and after running, it’s important to check regularly during a long run
• Be prepared for low blood sugars by carrying small snacks and drinks with you. Energy drinks and gels can be good choices
• Carry a medical alert card or bracelet or make sure that the people around you know that you have diabetes, as the effects of fatigue and hypoglycaemia can look similar

Whether you are living with type 1, type 2, or prediabetes, with the right preparation, there is no reason why you shouldn’t lace up your running shoes and hit the track.

Sources

1. Statista (2024). Number of people participating in running in England from 2016 to 2022 [Online]. Available at: https://www.statista.com/statistics/934996/running-participation-uk/ (Accessed 4th April 2024).

2. WebMD (2021). Health Benefits of Running [Online]. Available at: https://www.webmd.com/fitness-exercise/health-benefits-running (Accessed 4th April 2024).

3. Harvard Medical School (2021). The importance of exercise when you have diabetes [Online]. Available at: https://www.health.harvard.edu/staying-healthy/the-importance-of-exerci… (Accessed 4th April 2024).

4. Mayo Clinic (2022). Diabetes and exercise: When to monitor your blood sugar [Online]. Available at: https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabet… (Accessed 4th April 2024).

5.Diabetes in Control (2015). What Is the Best Time to Exercise with Diabetes? [Online]. Available at: https://www.diabetesincontrol.com/what-is-the-best-time-to-exercise-wit… (Accessed 4th April 2024).

6. Everyday Health (2018). Type 2 Diabetes: A Start Guide for Exercise [Online]. Available at: https://www.everydayhealth.com/hs/type-2-diabetes/managing-diabetes-sta… (Accessed 4th April 2024).

7. Diabetes UK. Diabetes and Exercise [Online]. Available at: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ex… (Accessed 4th April 2024).

8. WebMD (2020). Exercise Tips for Type 2 Diabetes [Online]. Available at: https://www.webmd.com/diabetes/exercise-guidelines (Accessed 4th April 2024).

9. NHS (2021). Exercise and sport [Online]. Available at: https://www.nhs.uk/conditions/type-1-diabetes/exercise-and-sport/ (Accessed 4th April 2024).

10. Diabetes in Control (2008).Working with Diabetic Athletes: Part 3 [Online]. Available at: https://www.diabetesincontrol.com/working-with-diabetic-athletes-part-3/ (Accessed 4th April 2024).

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