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Running With Diabetes: What You Need to know

8 Minute Read
A woman with diabetes goes on a run while wearing a continuous glucose monitor

Running is a great form of aerobic exercise, helps reduce the risk of heart disease, and can be a healthy outlet to reduce stress. Read on to discover tips for a successful run.

From jogging laps on the track to exploring new parks with a local run group, running is an accessible form of physical activity for people of all ages. 

Whether you prefer a meditative solo run or challenging yourself in a 5k race, city jogs, or trail runs, there’s something for everyone. Plus, running is low cost and doesn’t require any special skills: all you need is a pair of running shoes and a place to jog safely. 

Eritrea Mussa, diaTribe’s social media manager who lives with type 1 diabetes, chose to start running several years after her diabetes diagnosis because it was inexpensive and accessible. Now, running gives her the chance to boost endurance, develop mental toughness, and build community through a local running club in Dallas, Texas. 

“Everyone knows running is hard, even just getting started,” Mussa said. “But the only way to eat an elephant is one bite at a time. So that's how I see running – you just have to start putting one foot in front of the other.” 

Benefits of running for diabetes management 

Physical activity is a key component of self-care for everyone, especially people who have diabetes. The American Diabetes Association (ADA) recommends getting at least 150 minutes per week of moderate-intensity exercise. If you are running or jogging, this usually means a conversational pace where you’re able to talk in brief sentences. 

But how does running specifically improve your diabetes management and other health measures? 

Improved insulin sensitivity

According to the ADA, being physically active can make your body more sensitive to insulin, helping lower blood sugar for up to 24 hours or more after exercise. In fact, research suggests that higher-intensity aerobic exercise – such as hill runs or sprints – may lead to even greater increases in insulin sensitivity. 

For Grace Choi, a 28-year-old living with type 1 diabetes in New York City, running has been key to addressing insulin resistance. In addition to taking metformin off-label and trying to eat healthier, Choi said running has helped improve her insulin sensitivity. For instance, Choi noticed that her insulin-to-carb ratio improved after she started running.

Better heart health

Running can help strengthen the hamstrings, quads, glutes, and other lower body muscles, but importantly, it also strengthens the heart. 

“The heart is a muscle you have to train,” said Choi. 

A stronger heart is more efficient at pumping blood to the lungs and throughout your body. It can lead to a lower resting heart rate (the number of times your heart beats per minute when you're at rest) and reduced blood pressure

Running has also been shown to lower triglycerides and increase HDL (“good”) cholesterol. Keep in mind that longer runs generally tend to have larger benefits on heart health than shorter runs.

Given that people with diabetes are at greater risk of developing heart disease, it’s especially encouraging to learn that running can significantly decrease the risk of cardiovascular disease. 

Studies have found that as little as 5-10 minutes of running a day can reduce the risk of death from heart disease. 

Plus, data suggests that running could help stave off early death. In an analysis of over 50,000 people followed for over 15 years, runners lived approximately three years longer than non-runners. 

Boosts mental health 

From experiencing a “runner’s high” to better coping with chronic disease, running has many positive effects on mental and emotional well-being. A 2020 review article comparing many different studies found that runners had reduced depression and anxiety, lower stress, and better moods compared to people who did not lead an active lifestyle. 

“Running has done wonders for my mental health,” Mussa said.

For Robin Arzón, vice president of fitness programming and head instructor at Peloton who lives with type 1 diabetes, mental health and running have been intertwined from the beginning. Arzón got into running after a traumatic incident during college, in which she was taken hostage in a bar in New York City. 

“I go from feeling powerless to powerful when I lace up,” she said. “Once you get into a rhythm, it's really liberating to be able to move one's body like that.”

Beyond improving mental health, research also suggests that regular running can help you establish a healthy sleeping cycle. Likewise, moderate-intensity exercise has been shown to strengthen the immune system, though high-intensity exercise (such as running a marathon) temporarily weakens the immune system. 

Considerations for running with diabetes

While physical activity generally helps to reduce blood sugar, different intensity levels can impact blood glucose in different ways. 

Longer, slower runs tend to cause blood sugar to drop over time. People with diabetes may experience low blood sugar (hypoglycemia) during, after, or later in the day, or even overnight after exercise. Meanwhile, shorter, faster-paced runs (such as tempo runs) can cause blood sugar to rise. 

Diabetes technology like continuous glucose monitors (CGMs) and automated insulin delivery (AID) systems can greatly simplify blood sugar management during physical activity; for example, some devices can be put into exercise mode to avoid low blood sugar. 

Fuel appropriately 

Choi advised first thinking about what you need for fuel as a runner. Then, think about how to align your energy intake needs with your diabetes management. For runs longer than 90 minutes, experts generally advise consuming 30-60 grams of carbohydrates every hour during the run. 

Many runners use specialized products, such as packets of gels or chewy gummies, though standard fruit snacks, honey packets, or candies work, too. Just be sure you have pockets, a fanny pack, or another way to carry snacks – Choi recommended buying activewear with plenty of pockets. 

Consider insulin on board to prevent hypoglycemia

As with any exercise, you may need to adjust your basal insulin before you start running to prevent low blood sugar. Be sure to monitor your insulin on board: the amount of insulin that is still active in your body from previous bolus doses. 

Through trial and error, Choi developed a strategy for her runs with her Tandem t:slim X2 insulin pump. While she initially tried using activity mode, she found that this setting dropped her blood sugar too low. So, Choi programmed a specific “run” profile that reduces her basal rate by 75%. For long runs, she makes sure to eat enough carbs beforehand and then boluses for about half the carbs.

Likewise, Mussa adjusts her low alerts to sound at 85 or 90 mg/dL (rather than 55 mg/dL) while she’s in activity mode so that she can address falling blood sugar promptly. 

Some people prefer to exercise “fasted” to avoid dealing with insulin on board. This usually means running first thing in the morning, before you’ve eaten. Exercising first thing can help counter the effects of the dawn phenomenon, which causes blood sugar to rise in the early morning. 

You may need to go through a trial-and-error process like Choi's to determine what works best for your runs. Consult your healthcare provider if you have any questions. 

Eritrea Mussa checks her blood glucose while out on a run

Monitor blood sugar levels

Before heading out for a run, check your blood glucose so that you know where things stand. If you’re low, it’s a good idea to eat a carbohydrate snack and wait to head out until your blood sugar stabilizes. Likewise, if you’re running high, you may want to start your run right away to begin lowering your glucose. 

CGMs are a game changer for exercise with diabetes, as they show real-time glucose readings. 

Of course, getting diabetes devices to stay attached to your skin while sweating can be tricky – Choi said products like SkinTac or Skin Grip have helped her keep sensors in place. 

Many runners use special GPS watches to track their running pace, and some (like the Apple Watch and Garmin) can also display readings from your CGM. 

“I like having a watch that I can look down and it tells me how my glucose levels are,” Choi said. 

If you don’t have access to a CGM, be sure to check your blood glucose before and after exercising using a blood glucose meter. 

The bottom line

Running is a great way to get aerobic exercise, reduce your risk of cardiovascular disease, and improve mental health. If you’re new to running, start slowly and ramp up gradually to avoid injury. 

“It’s okay to start slow,” Choi emphasized. “The fact that you may not necessarily be able to run a mile to start is perfectly okay. You just have to go and try it.” 

Looking ahead, Choi is excited to race in this year’s New York City Marathon with Team JDRF. “Everyone’s running for the same mission: our finish line is turning type 1 into type none.” 

Ultimately, running can serve as a helpful outlet to reduce diabetes distress and may even help you better manage blood sugar levels and cope with chronic disease. 

“Running is incredibly empowering for someone who lives with type 1 diabetes because there are a lot of circumstances we can't control,” Arzón said. “When you tell yourself, ‘I'm gonna run this run today,’ whatever the distance, and you do it, that is incredible. It’s really confidence boosting.”

Be sure to consult your healthcare provider to come up with an exercise plan if you’re completely new to physical activity. It’s also important to keep in mind considerations for exercising with diabetes, such as monitoring blood sugar to avoid hypoglycemia. 

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