A running buddy asked me this week “which is worse for your running, being asthmatic or being diabetic?” And since it’s Diabetic Week, I thought I’d try to formulate a proper answer. As a regular runner for some eight years, my asthma manifests itself more regularly and more obviously than my diabetes – indeed there is seldom a time when I run either in training or events that I don’t display some asthmatic symptoms. Usually I have to use my inhaler once before I start and again within the first 10-15 minutes of any event, but less so in training, perhaps because I don’t push so hard but content myself with long steady runs. That said, asthma has only once nearly stopped me from completing a race (the Coll Half Marathon in 2010 where running the first six miles uphill into an Atlantic gale-force wind meant the lungs took an age to settle). However, three times diabetic symptoms have manifested themselves to the point where I have been concerned at an event. Interestingly that was only once during a race (Alloa Half Marathon 2010 – hypoglycemic; blood sugars down to 2.1 resulting in a mid-race fuel break and a slow trot home for the last mile). But twice after the event was finished (most severely after the Bamburgh Ultra Trail Marathon) I have found myself paying the price for poor fuelling strategies resulting in rather severe nausea/hypos and a total rethink of how to take fuel on board before, during and after an event. The last is always the most difficult as I simply feel repelled by the thought of eating after an ultra run either in training or at an event.
I have had chronic asthma since I was about three. I had a terrible time with it as a teenager missing two months of school on one occasion and I once even heard a doctor tell my parents I might not make it to the morning. I have been through a number of drug regimes to cope with this condition. One of the best (it seemed) was an inhaler called ‘Berotec’ – eventually withdrawn from the market because, and I quote the press release, “side effects include sudden death”. So I was moved back onto Salbutamol for instant relief and Symbicort twice a day for long-term prevention. I am trying, with some difficulty, to move across to the ‘Symbicort Smart’ regime, but this year has been tough and the Salbutamol required more than it should. There are periods of the year in Scotland (Autumn/Spring) that seem to provoke the onset of restless nights sitting up in bed trying to get the lungs to settle. The damp of the Autumn and the pollen of the Spring are infuriating – and asthma seems to be the chronic condition that affects me more and takes its toll. The after effects include a constant feeling of tiredness and lethargy which makes going for a run the last thing I want to do. But I have convinced myself I do not really have a choice. For one thing my breathing becomes easier both during and after a run, and I also need to maintain my active life-style to help control my diabetes.
I was diagnosed with Type 2 Diabetes in 2001. There is no history of diabetes in my family and I was a long way from being inactive or seriously overweight. Indeed I was and am a regular hill-walker and a very keen and active cyclist. I fall into that category of T2 Diabetic that cannot be explained through the ‘usual’ (but often inaccurate) diagnosis of obesity, over-eating or idleness, and I only found out I had the condition through a random check after moving house and changing my GP. In retrospect I think I had it for a good few years before diagnosis and was aware of some kind of problem during outdoor activities, most notably nausea after eating on trips to the mountains. I changed my diet slightly but did not think too much about it before being diagnosed.
For the first six years I dominated my diabetes through diet and exercise alone taking up running after a 15 year break and resurrecting my interest in the game of shinty. I ran my first race of any distance in 2006, the Loch Ness Marathon, coming in at 3hr 59mins and 1 second. I went into training for my next marathon (Iceland 2007). But then disaster: I was playing shinty (stupidly at age 44?) when my Anterior Cruciate Ligament (ACL) ruptured in April 2007 and, being told I was too old for reconstruction surgery, hobbled around on crutches and gained weight fast and finally lost control of my diabetes. I eventually had surgery to tidy up some damaged cartilage, but they did nothing to replace/repair the ligament. I was also told I’d never run again and found myself struggling to control the diabetes as a result. To combat at least some of the side effects I was put onto a regime of Metformin 500mg three times per day. But the inactivity took its toll and by the end of 2008 I had undergone laser eye surgery to remove blood clots from the back of my left eye. At this point diabetes certainly seemed to be the more critical of the two conditions and without intervention, worse might follow – blindness, amputation etc. As if to mock, my asthma also worsened during this period. Exercise really does help these conditions.
So it was I found myself on the ‘dreadmill’ building up the strength in my knee slowly over the next 18 months. I started entering races again – small ones (5k and team relays etc). But by the end of 2009 I had racked up a couple of half marathons and a triathlon in Scotland and a 15km race in Australia. I then moved back up to marathons in 2010 (getting a PB at Edinburgh 3:43:20) and Ultramarathon distances by 2011. On top of the numerous long runs in training I have completed 10 marathon/ultra events since 2010 and in the process brought both the diabetes and the asthma back under some degree of control. Hilariously PBs at all distances have come minus the ACL possibly due to the slow build-up and care taken during the recovery from the knee operation (22min for 5k/ sub 45 for 10k/regularly sub 1:40 on half mara/usually in the 3:40s for mara etc). Moreover, after completing my first Ultra I really felt I had stuck two fingers up to both asthma and diabetes.
The increase in running has led to participation in a number of research studies into diabetes. I have also recently been given a blood testing kit again. My diabetic doctor at Ninewells (Dr Ellie Dow) takes a great interest in my endurance events and was surprised that I did not have a testing kit. Once I was put onto Metformin in 2008 someone decided I did not need to test my blood sugar levels anymore, a decision I still do not really understand. But after I raised concerns about my symptoms during and after long runs (and I expressed my desire to continue with the longer distances), the Doc insisted I have one – not just to test blood, but also ketones which she was keen that I monitor. This has proved invaluable as I now have a much clearer idea of when to take on fuel and also when to take my foot of the gas slightly (not that I am a fast runner, but sometimes I do push it a bit). I also realise that whereas 4-5 years ago I would always have slightly high blood sugar level even after a long run (10-12), even a short 10k can send me down to 2.1 these days, though the average is between 3.8 and 4.5 after exercise. But there is no consistency here. I came back from a 20 miler last week and found I was at 8.5. My doctor would no doubt assert that this is evidence of good fuelling and better than going low. I certainly felt really good after the run and not ‘glaikit’ as I sometimes get when low.
But how to answer the question “which is worse?” Truthfully, you can’t. On a day when your lungs are tight and you have not slept and your breathing has not settled even after 20-30 minutes on the run, then asthma seems like the main threat. When the laser probes your eye or you are having a hypo during a race or the nausea is attacking you after a long run, then diabetes clearly feels like the real enemy. But in truth, both are killers, both need to be controlled and, in this regard, I have found that running is something of an answer to them both. And, curiously, without them I doubt if I would ever have run a marathon or an ultra – what’s that about ‘clouds’ and ‘silver-linings’?
For anyone interested in the links between asthma and diabetes: