NHS Couch to 5K and type 1 diabetes – an experiment of N=1, part 2
After nine weeks of getting up early to run around my local park, I had managed to complete Couch to 5K.
Welcome back to the second part of my blog about NHS Couch to 5K with type 1 diabetes.
I am assuming you are here because you read part 1, but if not, then please do check that out first here. I left my last blog with a few questions:
- Would I be able to complete Couch to 5K?
- Would I be able to run 5K in under 30 minutes?
- What was causing the bump in my sugar level after my first running session in week 1?
- What were my conclusions and advice for people wanting to do Couch to 5K with type 1?
Would I be able to complete Couch to 5k?
My answer to the first question, and the hypothesis of my N=1 experiment, was yes. After nine weeks of running three times a week, nine weeks of getting up early to run around my local park and nine weeks of sharing my running stats with uninterested friends & family, I had managed to complete Couch to 5K.
It was celebrated by my Couch to 5K app coach, Michael Johnson, telling me that I was amazing (I assume this was not done in person due to COVID-19 restrictions), and I even got sent an animated trophy (below).
Would I be able to run 5K in 30mins?
Again, Yes! With hindsight, I had underestimated my abilities after watching a number of Couch to 5K YouTube videos which made running 5K in less than 30 minutes seem almost impossible. Then when I did my very first run at an average pace of 6:20/km, which would equate to 31 minutes and 20 seconds to run 5K, I thought these videos were true.
However, the more runs I did, I soon realised that my pace also included the time when I was brisk walking. As I progressed through the nine-week course and had less walking time, my pace also improved; to the point where I ran 5K in 25 minutes and 47 seconds in week 7.
It was also at this point, when I surpassed 5K, that I became like a Park Run enthusiast who was interested in their running speed. I can say this now with authority, nobody cares about your running speed except you. Not your friends, nor your colleagues and not even Michael Johnson.
In fact, the couch to 5K app is very much about helping you to increase stamina and teaching you to reach 30 minutes of running without stopping. It is definitely not about speed, so please don’t let that put you off. What’s more, I actually ran quicker, and had fewer stitches, when I wasn’t trying to run fast.
In short, be a tortoise, not a hare; you don’t need to run fast to complete Couch to 5K.
What was causing the bump in my sugar levels during my first week?
After completing the first week of three runs, detailed in the last blog, I noticed some bumps in my sugar levels about two hours after my runs. I had put the fluctuations down to three possible reasons:
- The banana Michael Johnson asked me to eat as part of the programme.
- The fact I took off my insulin pump for 45 minutes whilst running.
- The dawn phenomenon.
What I hadn’t realised was that there was a fourth possible reason, adrenaline. However, this didn’t factor into my shorter runs at the beginning, as I wasn’t running at a high enough intensity to cause an adrenaline spike. Spikes due to adrenaline can also be caused in people with t1 diabetes by pre-match nerves, which can be tricky to deal with.
The culprit, in my case, turned out to be the 45 minutes or so that I wasn’t wearing my insulin pump, which just shows the importance of basal insulin to people with type 1 diabetes.
After run three of week one, I considered the idea of getting an elastic waistband to hold my pump whilst I ran. However, I found that just putting it in the zip pocket of my running trousers worked fine. As soon as I started running with my pump, the spikes experienced a few hours after a run were smaller (images below show run 1.1 spike vs run 9.3).
What were my conclusions and advice for people wanting to do couch to 5K with type 1?
The previous question was a teaser for the overall impact of running that I saw on my sugar levels. With the caveats that every person and every day with diabetes is different; added to the challenge that there are over 42 variables that affect the blood sugar of someone with type 1 diabetes, here were some of the things I noticed:
Running when you have a lot of insulin on board is a bad idea.
Having too much active insulin before you exercise can cause a hypo, as it reduces the amount of glucose the liver can add to blood.
On two occasions (images below), where I had high sugar levels before going to bed, my pump had stored up insulin before I ran and when I got about midway through I noticed my sugars plummeted. For the rest of the day, I was dealing with yo-yo like behaviour.
Image above: high sugars between 2am-7am, meant that my pump had given me some insulin during the night and therefore my sugars were dropping already when I started my run. Similar (below).
Running when you have not enough insulin in your body is also a bad idea.
Similarly, having not enough active insulin to prevent the liver from making glucose before you exercise can cause a high blood sugar level, as the glucose your liver produces increases your sugar level. You can see in the image below that having a low sugar level before I woke up at 6 am, meant that my sugars skyrocketed whilst running.
If you don’t have a pump or CGM to view your sugar levels or insulin on board, then regular testing before you run is advised. There are also lots of helpful tips on the Health Unlocked page or on various Facebook groups (6-8).
I only had to stop my runs twice, and this was due to low sugars (before 5mmol/mol) before I started running leading to hypos whilst I ran. My advice, similar to what you should do before driving a car, is to wait until your sugar level has risen above 5mmol/mol and then adjust your insulin accordingly.
Later in the day you may see lower sugar levels.
Delayed onset hypoglycaemia can occur up to 12 hours (sometimes even 24 hours) after prolonged exercise, due to replenishment of muscle glycogen stores and enhanced insulin sensitivity.
In the images above you can see that at around 6pm, 10-12 hours after my run, I seemed to have a period of lower sugar levels. This seemed to be a regular pattern, especially when I started reaching distances close to 5K.
It may be worth considering tracking your basal rates and also reducing your basal rate/dose of insulin if this continues. Also eating something with slow-acting carbohydrates like porridge for breakfast can be good.
The longer I ran, the steeper my drop in sugar levels.
Finally, the longer I ran, the steeper my drop in sugar levels. This is quite obvious, but the important takeaway is that I began to put some jelly babies or a tube of glucotabs in my pocket once I began to run 5K+. Especially, on the walk home I saw my sugars slowly drop after about 20 mins.
For those interested in running longer than 5K, you should either be regularly taking on carbohydrates whilst running or reduce your basal insulin before running (some people have Temporary basal rates on their insulin pumps set to only 10-20% of usual just before, during and a few hours after).
Utilising the social forums I mentioned above, can be a great way of calculating your estimated insulin and carbohydrate needs. However, you will need some experimenting to find out what works best for you.
General Advice (related to running, rather than type 1 diabetes).
Have an accountability partner
There will always be a reason to not run; every shade of the weather not being good enough, your running gear is in the wash, you feel hungover (side-note, as long as you drink extra water, light-intensity running can be good for a hangover), the online shop might come mid-run.
First off, I would advise taking the Florence Nightingale approach of not giving yourself excuses. Secondly, find someone else to take the Couch to 5K journey with, who can be your accountability partner (for want of a better phrase).
I was very lucky to have my close friends Mile, Tim, Matt & Becca all decide to take up running at around the same time. I also had an amazing diabetes specialist nurse called Kate posting regularly on Facebook about her runs, which spurred me on.
I would advise doing Couch to 5K with support from either friends, family or many of the people on online forums like Health Unlocked (5-7). They also might be interested in your running speed, maybe.
Make sure you do the right preparation
I mentioned this in the first blog, but it is worth repeating, please make sure to do your warm-up and cool-down stretches (3), they really helped me to not have injuries and recover quicker between my runs.
Having slightly longer rest days is perfectly fine too, you may need to repeat some of your runs if you don’t feel comfortable moving onto the next stage just yet.
The other thing to stress, particularly for those with diabetes, is the importance of looking after your feet. Please make sure to have good running shoes and even anti-blister running socks.
Additionally, for the longer runs, make sure to bring some gluco-tabs or jelly babies (remember - each jelly baby typically has 4-5g carbs) to have if you start to feel your sugars dropping mid-run or notice that you have a lot of insulin on board before you start running.
As mentioned above, I always chose to run first thing in the morning (around 7-8am), during the winter months when temperatures went as low as one degree Celsius, I wore an icebreaker. I found it better than a beanie hat, which I found would overheat my head during a run. This was despite my wife saying I looked like Mother Teresa with a beard.
Now is probably one of the best times to do Couch to 5K
When reading about Couch to 5K, I stumbled upon a Metro article about people using lockdown to start the plan, where 10 women who had a range of fitness levels were recounting their experiences. What I found interesting, is that many had tried Couch to 5K before, but had given up due to not being able to find the time around work and commuting.
Lockdown, in a weird way, has given many people back that commuting time in the morning and Couch to 5K can be an excellent way of filling the gap. So much so, that there has been a 92% increase in the number of downloads of the Couch to 5K app (almost 1 million from March to June 2020). It can also be a good way to see a friend (see previous paragraph about accountability partners).
The other thing that should never be overlooked is the mental health boost that running/regular exercise can bring, which again is even more important than usual right now. Couch to 5K definitely improved my mood and made me more productive at work. It also gave me a reason to regularly get up and out on cold winter mornings.
I will sum up by saying that doing anything with type 1 diabetes takes a little extra planning, but it should in no way act as a barrier to completing Couch to 5K. Whether you have type 1 diabetes or not, Couch to 5K provides a gentle introduction to regular exercise, and can be of great benefit to your mental wellbeing.
Overall, I really enjoyed it and had a great time carrying out this experiment. So go on, start your own N=1 experiment today, because that is what life with type 1 diabetes is all about. As for me, it is time to find a new challenge, stay tuned until next time…
References or links
- NHS Couch to 5K website - https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/
- Type one run - for those wanting to try a more intense C25K programme - https://www.typeonerun.org/couch-to-5k
- Warm-up and cool-down for Couch to 5K - https://youtu.be/i6h9HbbdLhA
- Website for people with diabetes who want to try to exercise with type 1 diabetes - http://www.runsweet.com/
- Websites to calculate your carbohydrate and insulin needs – https://excarbs.sansum.org/exercise-intensity-calculator/
- Sporty Type 1s Facebook group - https://www.facebook.com/groups/SportyT1
- Parkrun for people living with diabetes - https://www.facebook.com/groups/parkrun.for.people.living.with.diabetes/?ref=share
- Health Unlocked social forums for type 1 diabetes - https://healthunlocked.com/couchto5k/posts/138311389/type-1-diabetes-blood-glucose-before-running-matters-soooo-much
