How To Run An Ultra Mara­thon With Dia­betes

Writ­ten By Katie Hick­ling

Katie is an ama­teur ultra run­ner (emphas­is on the word ama­teur — her words, not ours!) who, when not run­ning, tries to fit in a career in fin­an­cial ser­vices tech­no­logy. Oth­er interests are also known to include dogs, crick­et, and writ­ing Ultra X art­icles.

4 May 2020

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Read­ing Time: 5 minutes

I have been liv­ing with type 1 dia­betes for 18 years. I was dia­gnosed at the age of 7 so I can’t really remem­ber life without it. Type 1 dia­betes is an autoim­mune con­di­tion where the body attacks and des­troys the cells in the pan­creas that pro­duce insulin. In a nor­mal per­son, the body is able to main­tain blood gluc­ose with­in a safe mar­gin (typ­ic­ally 5–7 g/mmol). How­ever, without insulin, type 1 dia­bet­ics are unable to con­trol their blood gluc­ose levels expos­ing them to the dangers of high and low blood sug­ar.

The exper­i­ence of hav­ing a high blood sug­ar can be described as sim­ul­tan­eously hav­ing the flu and a bad hangover. With low blood sug­ar the ana­logy I like to com­pare it with is when your iPhone runs out of bat­tery and starts to switch off power to non-essen­tial apps. The same scen­ario occurs with the human body. As a res­ult, dia­bet­ics have to try as best they can to con­trol blood gluc­ose by bal­an­cing car­bo­hydrate intake, activ­ity levels and tak­ing man­u­fac­tured syn­thet­ic insulin either by injec­tion or infused through an insulin pump.

Run­ning with dia­betes

I took up ultra-run­ning about 2.5 years ago. I came from a sport­ing back­ground hav­ing rep­res­en­ted my uni­ver­sity at triath­lon and play­ing com­pet­it­ive ten­nis since the age of 10. Although I was used to a busy train­ing sched­ule man­aging dia­betes, some­thing as demand­ing as ultra run­ning was always going to be a chal­lenge. How­ever, I remem­ber read­ing about a type 1 dia­bet­ic who sum­mited Everest, so I thought well if they can get someone up there in one piece then I might be able to do this. The past couple of years have been a steep learn­ing curve but I have now learnt to con­trol my dia­betes well enough so I am able to take part in these events as any “nor­mal” per­son would be able to. Dia­betes shouldn’t be a hindrance but it is safe to say I am always learn­ing some­thing new.


Some of the extra con­sid­er­a­tions I have to take into account when train­ing and racing are mainly around car­ry­ing enough car­bo­hydrate and back-up med­ic­al sup­plies. For a long run, I will take enough food to make sure I can have a car­bo­hydrate based snack every 15 mins if I need it, as well as sur­plus in case of emer­gen­cies. I will also carry back-ups of all my med­ic­al sup­plies so in the event that any­thing fails I am still able to carry on. This some­times makes it look like you are set­ting off for a 100 miler when you are only going out for a 2 hour train­ing run, but after sev­er­al occa­sions where I have eaten through all my food sup­plies with­in the first hour it is always bet­ter to be over-pre­pared.


Dif­fer­ent types of train­ing also vary in the ways they impact blood gluc­ose levels. A hard tempo or hills ses­sion can send blood gluc­ose sky rock­et­ing as it causes large amounts of the stress hor­mone cortisol to be pro­duced. Where­as a long steady state run can cause blood sug­ars to drop as it raises your meta­bol­ic rate, mean­ing you burn through gluc­ose a lot quick­er than nor­mal. When racing I will look at the course map before­hand and try to pre­dict where cer­tain sec­tions (eg a hard down­hill or a sus­tained climb) might have an impact on my sug­ar levels, so I know when to take extra fuel or increase insulin.


For any dia­bet­ics who are con­sid­er­ing tak­ing part in ultra mara­thons, I sug­gest seek­ing the advice of a pro­fes­sion­al and just going for it. It doesn’t take me to say this, but the NHS are amaz­ing and the teams I have worked with have been very sup­port­ive in help­ing me achieve everything I have wanted to. How­ever, one thing I have real­ised is that often this is as much a learn­ing exper­i­ence for them as it is for me. Fun­nily enough, I don’t think ultramara­thons and dia­betes are a key top­ic on the med­ic­al school cur­riculum and most doc­tors I have worked with haven’t had many patients who have done these types of chal­lenges. So, it is import­ant to devel­op a good part­ner­ship where you can work well togeth­er and learn from one anoth­er.

Final thoughts

On a final note, I would like to think that the exper­i­ence of liv­ing with dia­betes also gives some com­pet­it­ive advant­ages over “nor­mal” ultra-run­ners. Firstly, it gets you very well-prac­ticed at fuel­ling cor­rectly when run­ning and makes you more in tune as to when you need to eat dur­ing a race — some­thing which is very import­ant when run­ning long dis­tance.

A lot of ultra-run­ning events also oper­ate on the prin­ciple of self-suf­fi­ciency and being able to suc­cess­fully man­age your­self well. Hav­ing to rep­lic­ate the job of a failed organ every­day does a pretty good of pre­par­ing you for this! I have quite a big chal­lenge com­ing up at the start of 2021 and my exper­i­ences of man­aging type 1 dia­betes will be very help­ful in the psy­cho­lo­gic­al pre­par­a­tion for this.

Last but no means least, it may just get you free race entry. The Lakes in the Day 50 mile ultra held in the Lake Dis­trict offers free race entry to dia­bet­ics. The race dir­ect­or is him­self a type 1 dia­bet­ic, so uses this as a way to encour­age dia­bet­ics into the sport. A pretty good incent­ive if ever you needed one!

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