Running With Diabetes

Diabetes Management:

“It’s hard to sit on a chair that only has one leg.” – Frank Rogers

Sometimes I’m asked how I manage my Diabetes. Well, as I’m living with Type I Diabetes I have to inject insulin and there are a number of different insulin delivery systems that I can use. I used to be on multiple daily injections (M.D.I.) which for me was the pens, a green pen in the morning, an orange pen every time that I ate (usually 4 times a day) and the green pen again at night, so that was 6 injections a day. On top of this I would need more injections (the orange pen) if I needed to bring my blood glucose level (B.G.L.) down.

The first question I asked when I was diagnosed with Diabetes was, ‘Could I still run?’ This was my biggest worry at the time, and happily the answer was not only could I run, but I needed to run. They didn’t say it in that exact way, but they did give me a lot of literature (which felt a bit overwhelming at the time) but I remember one of the pamphlets said that my life would change, and I would need to eat a healthy diet and exercise more. At the time I was diagnosed I had never smoked, I’d given up drinking for about 8 years, I mostly ate healthily and I had transitioned from being a weightlifter to running marathons. In fact I was training for my 6th marathon when I was diagnosed and I thought that my dramatic weight loss was because of all my training and not because I was ill with a chronic (life long) disease.

My life did change, firstly, I had to learn what Diabetes was because back in 2012, like everybody else in my family and social group, I knew rock all about Diabetes. Almost straight away I went from M.D.I. (multiple daily injections) onto C.S.I.I. which is continuous subcutaneous intravenous injections or pump therapy. The insulin pump I was about the size of a chunky mobile phone and it was connected to me by a tube that went under my skin and was stuck on with a plaster. Going on pump therapy was great, because it made running more manageable and it also meant that I had to learn to count carbohydrates. After a few months of adjustment I was back out running and after a few years I upgraded from a pump to a pod, which is a lot smaller, it sticks on my body with a plaster and there is no loose tubing to get caught on anything.

I’ve now run more marathons with Diabetes than I have without Diabetes, and I’m still running with Diabetes and I’m still running marathons.

As I am living with Type I Diabetes, this means that the Beta cells in my pancreas produce little or no insulin, so I will be on medication until there is a cure found. If I was living with Type II Diabetes, then I might have to use medication, but I also might be able to manage my Diabetes by a combination of education, nutrition and exercise. These three elements are like legs on a stool, and this combination of approaches would allow me to manage my Diabetes more effectively, if I needed more support then I could use the fourth element (medication) but that would be in combination with the other 3 elements, rather than a straight swap.

One of the issues that I have Living With Diabetes (L.W.D.) is that it is an almost exclusively self managed condition, and this remains true whether you are living with Type I Diabetes or Type II Diabetes. I know that I have a checkup every 6 months, which is great as it gives me access to my consultant and my health care team who are absolutely fantastic! I know that if I have any concerns or I’m experiencing any issues then I can take it to my health care team and discuss it with them and they are 100% supportive. With that said, in a good year, (one in which I don’t have any issues or complications) then I see my health care team for about 1 hour a year, which leaves 8,759 hours for me to self manage my condition, and every 4 years (leap years) that jumps up to 8,783 hours.

So that’s a lot of responsibility, and if I was to try to use medication alone then I’m fairly sure that I would struggle to manage my Diabetes effectively. In many ways it would be like trying to sit on a chair that only has one leg. I could do it (for a bit) but it would be a constant balancing act, and I know that even with the best of intentions, at some point I would slip and fall right on the floor. Like I said earlier, “It’s hard to sit on a chair that only has one leg.” so for me to manage my condition I know that I need more support.

The way that I manage my Diabetes is a combination of education, nutrition, exercise and medication. These four elements are like four legs on a chair, and I find this combination of approaches allows me to manage my Diabetes more effectively.

Diabetes is a chronic (life long) medical condition, and currently there is no cure for Type I Diabetes or Type II Diabetes.

If you are living with Diabetes (L.W.D.) then you should have a look at different management techniques, for me this starts with education.

1          Education      

There are a number of different education courses that you can take which are specific to the type of Diabetes you are living with.

If like me, you are living with Type I Diabetes then, depending on where you live, you should consider attending a D.A.F.N.E. course.

D.A.F.N.E.

D.A.F.N.E. is an acronym that stands for Dose Adjustment For Normal Eating.  This is a structured education programme for people living with Type I Diabetes that was originally imported from Germany and started in the U.K. in the year 2000. The D.A.F.N.E. course aims to provide you with the skills necessary to improve your management of your Type I Diabetes so that you can get on with living your life.

If you are living with Type I Diabetes then the D.A.F.N.E. course is the Gold Standard of structured education. If you are currently spending 1 hour a year with your health care professionals then the D.A.F.N.E. course is a great opportunity to massively increase your investment of time.

The D.A.F.N.E. course is not free, but in the U.K. it is funded, all you have to do is commit to it and invest your time. The D.A.F.N.E. course is a 5 day training course that lasts 9.00 – 5.00, Monday to Friday, together with a follow up half day session around 8 weeks after the course. Alternatively, some centres offer the course 1 day a week over 5 weeks, together with the follow up half day session around 8 weeks after the course. So that’s an investment of 40 hours.

The structured education programme is delivered to small groups (around 6 – 9) of individuals over the age of 17 who have been living with Type I Diabetes (for at least 6 months) and for me it is the peer group aspect of these sessions where the D.A.F.N.E. course really comes into it’s own. The D.A.F.N.E. course emphasises and capitalises on the the experience of the peer group, (both by sharing and comparing different experiences) within a structured education programme led by a qualified D.A.F.N.E. educator.

The aim of the D.A.F.N.E. course is to empower those individuals who are L.W.D. (living with Diabetes) so that they can fit Diabetes into their lifestyle, rather than trying to change their lifestyle to fit in with their Diabetes.

The question I get asked the most about the D.A.F.N.E. course is what is it like, well, rather than me tell you how great the course is here are some videos:

The D.A.F.N.E. course is not available everywhere, it is only available at a Diabetes unit that has D.A.F.N.E. trained educators and doctors. These are called D.A.F.N.E. centres. However, if you have to travel to get on a course then you should do so as it is a great investment of your time and it is one that will help you to improve your management over your Diabetes.

Here is a full list of D.A.F.N.E. Centres in the U.K. and the Republic of Ireland:

 

D.A.F.N.E. courses are also run in Australia, Kuwait, New Zealand and Singapore.

There are other educational courses available which are specifically designed around Type I Diabetes, and if you’ve not had the benefit of one then you should discuss this with your health care team the next time you see them.

DESMOND

If you are living with Type II Diabetes then there are educational programmes that have been specifically developed for you, one of them is the DESMOND course.

DESMOND is the collective name for a group self management education course for people living with Type II Diabetes. This is a 1 day (or 2 half days) course for individuals living with type II Diabetes, so that’s an investment of 6 hours.

Alternatively, if you are living with Type II Diabetes, there is the X-PERT Health course. This is a series of 2.5 hour sessions over 6 weeks for individuals living with type II Diabetes, so that’s a total investment of 15 hours.

The peer group approach enhances learning whilst also addressing feelings of isolation and enables individuals to compare their experiences. Diabetes is a complicated disease and it affects all of us differently.

Diabetes Research and Wellness Foundation (D.R.W.F.) Wellness Days

The charity D.R.W.F. (Diabetes Research and Wellness Foundation) offers Wellness days. These are delivered one day a year, at the weekend in the geographical locations in the North, the Midlands and the South in the U.K. The Wellness Days are there to help with awareness and supportive self management if you are living with Diabetes (L.W.D.). These days are for all forms of Diabetes and include lectures as well as lectures, group talks and opportunities for 1 on 1 discussions as well. Here are a couple of short videos produced by D.R.W.F. in 2018 with more information:

And here’s a longer video, also produced by D.R.W.F in 2018:

Final Thoughts On Education

The reason why the D.A.F.N.E. course, the DESMOND course and the X-PERT health education courses are so effective in helping to improve and individual’s management over diabetes is because the information is presented in a structured manner and then discussed.

A clinical information dump delivered by a health care professional in a 30 minute time slot is completely different to the same health care professional presenting the information in a peer group session, which is then discussed by individuals who are living with the same type of Diabetes that you are living with.

It’s the same information, but the delivery and the discussion are what makes the difference. I know that I have been in medical situations where I was given a load of information and asked if I understood all the information presented to me. Sometimes I did, and sometimes I didn’t, but my answer was always the same either way, “Yeah I got it.” even when I blatantly did not get it. Peer groups are an invaluable educational and support mechanism, that you can use to increase your own knowledge and to help pass on anything that you have found to be helpful to you in your own management of your Diabetes.

Remember, if you do decide to go on an education course (and I think that you should) then just turning up will not be enough. You are investing your time to improve your management over your Diabetes and (just like running), you will get out of it what you put into it. So you need to participate, what you now take for granted in your management of your Diabetes may well be revelatory to somebody else in their management of their Diabetes, and by speaking up you may well encourage somebody else, who doesn’t have your confidence to share what they do as well.

2          Nutrition     

I used to find information on nutrition confusing. It is a vast topic and a lot of the information is not presented particularly well and even more of it appears contradictory. Often it can feel like what was considered the correct advice last month (or even last week) was completely wrong and now the advice is the exact opposite.

In my book ‘Running With Diabetes‘ I say that:

“A basic understanding of nutrition can result in a vast improvement in your running performance.”

This is not controversial, neither is it particularly revolutionary, but it is worth pointing out.

I was a weight lifter for over 20 years before I became a runner and you don’t have to be lifting weights for very long before you start to learn about nutrition. Just as in running (or any other sport) what you eat when you lift weights will have a massive effect on your performance when you lift.

In the same way understanding the basics of nutrition can result in a vast improvement of your management over your Diabetes.

To be clear, nutrition has very little to do with weight management, in my book ‘Running With Diabetes‘ in Chapter 4 I talk about Nutrition and in Chapter 5 I  talk about Weight Management.  Now, I treat these as two separate chapters as they are two very different topics.

Culturally we are constantly being bombarded with advertising about diets and when you are living with Diabetes (L.W.D.) then it is even worse. To be clear there is (currently) still no cure for Type I Diabetes and there is still no cure for Type II Diabetes.

Anybody who suggests differently is trying to sell you something.

If you are living with Type II Diabetes there are lots of people (some of them doctors, some of them not) who will tell you that they can reverse your Diabetes, all they need is just a little of your money.  At best, they are being overenthusiastic, they probably believe in what they are selling (and they really want you to buy it) but, and here’s my issue, they are saying ‘reverse’ when they actually mean ‘remission’.

I accept that if you are living with Type II Diabetes, then, with exercise and nutritional eating, you may well be able to manage your Type II Diabetes so effectively that it goes into remission. The key difference between remission and reversal is that remission does not have the aura of being permanent, whereas reversal does. So long as you maintain some level of exercise in conjunction with nutritional eating then you may well be able to manage your Type II Diabetes without the need for medication, which is wonderful.  However, this is a harder sell than a ‘new’ diet which will reverse your Type II Diabetes after which you will be ‘cured’. To repeat, there is (currently) still no cure for Type I Diabetes and there is still no cure for Type II Diabetes.

Also, they are aware (or they should be) that what they are saying does not apply 100% of those individuals who are living with Type II Diabetes.

For 99% of the population, diets do not work.

What may work is nutritional eating, and to understand nutritional eating we need to go over the basics of what nutrition is.

Nutrients are what you need to eat to stay alive, and there are 2 different types: macronutrients and micronutrients.  This sounds quite fancy but all macro means is big and all micro means is small, so: macronutrients are nutrients you have to eat in big amounts, and micronutrients are nutrients you have to eat in small amounts.

Here’s a quick video produced by C.N.N. in 2014, which discusses Diabetes, Nutrition and Food Labels:

Food can be categorised in a number of different ways.  The most helpful way is to put them into different food groups:

1. Carbohydrates 
2. Fat
3. Protein
4. Fruit and Vegetables

The first three food groups (carbohydrates, fat and protein) are macronutrients and the last food group (vitamins and minerals) are micronutrients.  

It is important to make this distinction because your body uses each type of nutrient in a different way, and to explain this we need to have a look at the Nutrition Quadrant.

The Nutrition Quadrant

Each of your macronutrients and micronutrients have an essential role for your body to function:

Primary Fuel Carbohydates	Protection Fat
Building Blocks Protein	Prevention Fruit and Vegetables

When you eat or drink you start the process of breaking the food or fluid down into smaller and smaller pieces (digestion) which means that the food and fluid changes state and becomes something else that your body can use, so let’s have a look at what resources the food groups break down into:

Carbohydrates: These are broken down into glucose, which your body then uses as its primary fuel (or go-to fuel) that your body uses to generate energy.

Fat: This is broken down into fatty acids which your body then uses as protection for your vital organs; in simple terms your body creates a layer of fat to surround your organs (including your heart and your brain) which is designed to act as a protective cushion that absorbs the shock of any sudden impact or trauma.

Protein: This is broken down into amino acids which are the building blocks your body uses to build and repair your body.

Fruit and Vegetables: These are broken down into vitamins and minerals which your body uses for prevention against infection and disease.

So with this new information we can now update the Nutrition Quadrant:

Primary Fuel Glucose Carbohydates	Protection Fatty Acids Fat
Building Blocks Amino Acids Protein	Prevention Vitamins and Minerals Fruit and Vegetables

To be clear, the nutrition quadrant is still the same, all we are doing is updating it with the changed state of the food groups; that is, the resources that your body extracts from the food and fluid that you eat and drink.  This is an important distinction as once you start viewing food and fluid as resources (which is how your body views them) then you can move forward and understand what’s going on inside your body every time that you eat or drink.  And once you understand how your body works then you can start using this information to help improve your management over your Diabetes.

If, when you look at the Nutrition Quadrant, you notice that you are eating a lot of one particular quadrant and very little (or none) of another then your eating is out of balance.  This can be tricky to resolve and the internet is not the best place to get advice (because there is a lot of noise and misinformation) so the best option is to enlist the help of a diabetes trained dietician.  This is what they do for a living and most of them are very good at what they do, and some of them are superb at what they do.

When your eating is out of balance you are not providing your body with the raw materials it needs to keep working efficiently and you are compromising your body’s continued operation.

Any dietary regimen that is overly limiting or restrictive is ultimately unhelpful and you need to eat nutritiously.  

This is not about eating less.  This is about eating more.  

For some of us nutritional eating may mean eating more carbohydrates, for some of us it means eating more protein, for some of us this means eating more fat and for some of us this means eating more fruit and more vegetables.

The aim of nutrional eating is to eat a balanced variety of food that will help your body to continue to function for as long as possible.  

3          Exercise         

Whether you are living with Type I Diabetes, Type II Diabetes or I.G.T. (impaired glucose tolerance or pre diabetes) then incorporating exercise into the management of your diabetes will contribute massively to the effectiveness of your management.

Exercise can be anything, from walking, to running, to gym time, lifting weights, athletics or sports. Whatever form of exercise you want to do is completely up to you and the main criteria is that it should be something that you like, because when it is something that you like doing then there is more chance that you will keep doing it. With that said, it can be exciting to take up something new, especially if you are not sure that you can do it.

Effects Of Exercise On Your Blood Glucose Level (B.G.L.)

Here I am going to split exercise up into 3 different levels of intensity:

1. Easy
2. Intermediate
3. Hard

And the reason why I’m splitting them up into 3 different levels of intensity is because your body reacts differently to each level and this impacts your B.G.L. in different ways.

As a general guideline:

1. Easy intensity exercise lowers your B.G.L. : examples of this are easy walking, gardening, easy running and shopping.
2. Intermediate intensity exercise lowers your B.G.L. (at a quicker rate) examples of this are hard (fast) walking, football, field hockey, intermediate running and skiing.
3. Hard intensity exercise raises your B.G.L. : examples of this are weight lifting, boxing, running fast (sprinting) and rugby.

Now it is worth pointing out that the above is only a general guideline to how your body (and your B.G.L.) reacts differently according to the intensity of the activity that you engage in. Your body and your blood glucose level (B.G.L.) may well respond differently but it usually will respond in the same way in the same situations. Once you know how an activity or exercise affects your B.G.L. then you can anticipate the effect and create blood glucose protocols that are bespoke to you and to your body’s response to that particular activity or exercise.

In my book Running With Diabetes, I go into why this happens, using running as an example (because I love running) and once I’ve explained the principles of why your body, and your B.G.L. reacts the way it does then you can apply this information to any exercise or activity. Here’s an example:

If I run a 5K at easy intensity, so a relaxed, easy run, then I know that this will lower my B.G.L. at a fairly slow rate.

If I run the same 5K at an intermediate intensity, so a concentrated, intermediate run, then I know that this will lower my B.G.L. at a quicker rate. This makes sense because I am burning more fuel to run faster.

If I then run the same 5K at a hard intensity, so a fast, competitive run, then I know that this will raise my B.G.L. The harder I run then the faster my B.G.L. will spike up. Again this makes sense because my body knows that I am going to be using more fuel, so it starts to release more fuel (glucose) into my system. The issue I have with this is that, as I am living with Diabetes, my body is suffering an excess of fuel (glucose) beyond what my body can burn up to create energy.

Now, I know that not everybody loves running as much as I do, so here’s a quick video produced by Diabetes UK in 2019 that showcases Sarah and her thoughts about exercise and how it can improve your physical health, as well as helping you to manage your Diabetes.

And here’s another quick video produced by Diabetes UK in 2018 that showcases Chris and his thoughts about exercise and how it can help improve and maintain your mental health, as well as helping you to manage your Diabetes.

4          Medication   

Before we get into medication it would be helpful to go over what Diabetes actually is. So here’s a video from 2013 that was made by Diabetes U.K.

Here’s an updated (and shorter) video from 2018, also made by Diabetes U.K. and narrated by Philip Schofield.

Here’s a short video about Type I Diabetes from 2018, also made by Diabetes U.K. and narrated by Philip Schofield.

Here’s a short video about Type II Diabetes from 2018, also made by Diabetes U.K. and narrated by Philip Schofield.

There are lots of different videos explaining what Diabetes is, and I find the ones made by Diabetes U.K. are the most helpful.

So tells us what Diabetes is, but what is it like for somebody who is living with Diabetes (L.W.D.). Heres a short video from 2018 made by the American Diabetes Association (A.D.A.) and narrated by Tracy Brown who is the first CEO of the American Diabetes Association who is also L.W.D.

The main medication used to treat diabetes is insulin, here’s a short and fairly technical video from 2018 made by RMIT University.

Risk Management

In my book ‘Running With Diabetes’ I say that if you are living with Diabetes (L.W.D.) then this increases certain risk factors.

If, like me, you are living with Type I Diabetes then you are more susceptible to depression then individuals who are not living with Diabetes (L.W.D.) and having a risk management strategy or coping mechanism in place (such as running), can help you to manage your depression so that if you do get depressed then it is not as severe and it won’t last as long. Also bear in mind that there are a range of treatments and help available, all you have to do is ask for it.

If you are living with Type II Diabetes then you are more at risk of cardio vascular disease (C.V.D.) or heart disease and one of the ways in which you can manage this risk is with running (or exercise generally) as it uses, stresses and then improves your cardiovascular system.

Another way in which you can manage the increase risk of C.V.D. (heart disease) is by talking about it, here’s a couple of videos from Diabetes Australia from their Take Diabetes 2 Heart campaign from 2018.