Ultra trail running with diabetes

Having successfully completed the Cape Town Marathon and Magoebaskloof Ultra, Type 1 Robert Barnsley is unstoppable. His next challenge is the Giants Cup Uncut 62km in April 2024 which is part of the Drakensburg Ultra. Here’s his best advice for ultra trail running with diabetes.

Could you tell us your diagnosis story?

It was mid 2012, I was 26 years old then. I went for my bi-annual check-up with my pulmonologist (I was a chronic asthmatic) and part of his routine is a finger prick to check blood glucose.

I was quite excited to talk to him as I had lost an incredible 17kg in 7 weeks and I pinned it to playing squash twice a week. He sat me down and asked me if I needed to urinate often and through the night. Yes, I told him, I was thirsty all the time, but I’m playing squash you know, and I am getting fit. He then told me I had Type 1 diabetes and I needed to be admitted so he could run further tests.

What do you wish you’d known when you were diagnosed?

My brother had been diagnosed with Type 1 a few years before me, and so I felt I knew a thing or two about it. But I do think the whole ordeal of being diagnosed and handed an insulin pen and test kit and pretty much being told to handle it was very stressful. So having given it thought, now I think the best things to know upon diagnosis would be the following (and I guess this list can go on and on):

• Understand that each day is different in the beginning. You are not going to get it perfect so give yourself some grace
• Recognise that something big has changed. You need to accept that. You need to change things, like the way you have your coffee, the way you eat, the time you eat, and even the order of things you eat (nice tip is to eat proteins and fats first, veggies second and the carbs last).
• How to handle a low. Don’t overdo it. But please ensure you have something wherever you are. So, in your car, next to your bed, at work, in your running kit and so on. I have found that the panic of realising you don’t have something when it’s needed speeds up the blood glucose dip.
• Inject before your meal, 15 minutes before is best. I know the docs say that it is not overly serious, but I have found especially for breakfast, injecting the fast acting before has a massive impact. I can now actually avoid a spike for more than half my meals. Having a CGM now (FreeStyle Libre) I can see this in real time.
• TEEL: I wish I had known this. Specifically, the exercise part. I was under the assumption I was a sitting duck. But it is so important to know that just because of the diagnosis, don’t let this railroad your dreams. I read about a Type 1 that summited Everest. So quite literally, the sky is the limit.
  

How did you get into running?

I had always enjoyed it but was so inconsistent it was embarrassing. But one day a friend who was an avid runner challenged me and another friend to do the Cape Town Marathon. We both gave running a go, and both thoroughly enjoyed the challenge.

I remember just being super happy with having achieved it without incident and I was feeling on top of the world.

At about the 33km mark of the marathon I started seeing black spots in my vision. I saw a medic van and thought it would be smart to ask them to test my blood glucose (my CGM is very recent). The medic said, “Why? Are you diabetic? Why are you running? If you’re high or low I’m throwing you in the van!” and I remember turning and just running away. I was not going to be stopped by some medic who didn’t know how hard I’d worked to be here, so I swallowed 2 Glucogels and started to feel better.

My next challenge is the Giants Cup Uncut 62km in April 2024. It is part of the Drakensberg Ultra. And then, who knows, maybe Comrades!

How does running affect your diabetes management?

I think any form of exercise changes the way you manage your diabetes. I know that the more extreme types such as the marathons and ultras do stress my doctors and caregivers out a lot. It is always best to inform them of what you are trying to achieve and to give them as much information as you can, so that they in turn can give you info and tips on what best to do.

Running affects how my body uses insulin. I am no doctor, so I am not speaking from authority here at all, but I do feel that when I am fit, I don’t inject as much fast-acting insulin. I know the aerobic type of workout lowers my sugar naturally.

But in general, exercise just gives me more energy and control. I do not have as many hypers. When I am unfit or not running as much, I tend to have these hypers that creep up. I also know that my night-time sugars tend to be much better when running.

Robert Barnsley

With a CGM I get insight into how much more controlled my sugar is. So as a comparison, when not consistently running, my night-time sugars tend to rise from midnight to the morning, and when I am fit and running consistently, I get a flatter line. They do always start to rise an hour before I wake up, but it’s much better. It’s called dawn phenomenon, but there are ways to deal with it.

What are the best tips you have to offer others with diabetes who want to get into running, particularly longer races?

• Test your blood sugar:

An absolute must is to check your sugar before you run. Remember that the shorter runs are not going to do too much to your glucose levels during the run, unless you are in fact on the way down (CGM will tell you this), so as a rule don’t overdo snacking. You’re doing this to become healthier, so focus on your journey, and don’t go racing people out there on the road. Just do you!

• Good pair of running shoes:

Your feet as a diabetic need to be cared for. Ensure you spend a bit of money on a good pair of running shoes. I know they can cost a bit, but it pays dividends to have your feet in a good pair of shoes. If you are completely new, start off with thin socks. See how they do. If you get blisters, then maybe try something thicker, but generally thin socks are very good. I use Falke ultra-light, and they work very well. With trail, something bit thicker is better, and then also something that is longer is better, as you don’t want stones getting in and causing issues for you. Look after your feet and cut your toenails regularly, apply a good cream on them nightly – this also helps to avoid any hot spots or blisters.

• Snack right:

I will generally take something each hour I run, but I do sometimes skip the first hour, so only from the second hour onwards. It will be in the form of a Glucogel. Just one. Each hour. Also, if you are doing 2 hours and up, make sure you have access to water. You will need to keep hydrated from 1h30 onwards. Make sure you don’t overdrink, as this can cause a stitch. If you are training for something, make sure you are extremely vigilant in the final week leading up to the race.

• Reserve your energy:

Remember that we taper before a race, which means we reduce our running. For a normal person this is fine, and their body doesn’t have an issue, but for us it can throw things out of balance. Try to steer clear of hypos as they can derail everything you have trained for.

Don’t lose focus. Remember that in the lead-up to a race, things change, and you must stay vigilant.

Robert Barnsley

What makes your life sweet?

Jesus, my wife and my kids, friends, and family. God has me here for a reason. I could have gone a long time ago, and I think each diabetic feels like that sometimes when you look back at your close calls, but He uses me, and I am blessed.

My wife is my biggest supporter. She is very in tune with my diabetes and can often pick up when I am going low before I even realise it. It has been a long journey and she has been at my side through each step.

Robert Barnsley

Diabetes comes with its challenges, and I know many diabetics can confirm this. Not only do I have Type 1 diabetes, but also hypertension, hypothyroidism, and high cholesterol. All controlled and in range, but these are just par for the course, I guess.

I run so that I can control my condition better, and it seems to be working. I run far so that I can push the limits of my imagination, and it seems to be working. It’s important to me to be the best example to my kids so that one day they can look back and not have any negative experiences or lose me too early. I do this by doing my level best at controlling this beast.

I hope this inspires someone to get moving and get healthy and fit!

Connect with Robert Barnsley on: https://www.strava.com/athletes/38542979

What to read next?

Caregiver support for people with diabetes: Being a supportive caregiver, family member or friend to a person with diabetes can be both a gratifying and a challenging role. Diabetes affects the whole family, not just the one taking medicine.

The Running Diabetic: Meet Dirk Visser, living with Type 1 and running for better health. Dirk shares some of the highs and lows, and how running impacts his diabetes on YouTube as The Running Diabetic.

People with diabetes can do anything! Neve Quail’s story: We were so inspired to hear about teenager Neve Quail, champion archer and living with Type 1 diabetes. We asked her to share her story here.