Running with Asthma & Diabetes

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 One of the best (it seemed) was an inhaler called ‘Berotec’  – eventually withdrawn from the market because, and I quote the press release, “side effects include sudden death”.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:

http://www.diabetes.co.uk/news/2011/Mar/link-between-asthma-and-higher-risk-of-diabetes-reported-96167874.html

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About Tentsmuir

Tentsmuir is a 50 something ex-marathon/ slow-ultrarunner/ sort of mountainbiker with Asthma and Diabetes. He is often to be found going round in circles in the Tentsmuir Forest trying to make sense of the contradictions in history, Buddhist philosophy and Scottish malt whisky. Also to be found stravaiging in the Scottish mountains, in deep jungles or lurking on Twitter @Tentsmuir
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16 Responses to Running with Asthma & Diabetes

  1. FunkyPlaid says:

    Sincerely, a tremendous inspiration. Dogged-tude, is what I’d call it. And well-constructed, to boot. 🙂

    That Metformin can be a nasty nurse, as well. A previous flatmate of mine had some terrible side-effects from it. Also a runner, coincidentally.

  2. Tentsmuir says:

    I did have metformin problems of sorts, but really I think it was the brand rather than the medicine. When first put on it I had horrendous indigestion after taking it. Not had that for a while since changing manufacturer.

  3. Robin Eyre says:

    Nice article. Keep up the good work.

  4. inactivazma says:

    Wow I think what you do is amazing. I can’t help but marvel that the human body–especially one with asthma and diabetes is capable of this. Were you always a runner if only for shorter distances. How do you possible train to run for so long?

    • Hi – thanks for the kind words. I really only started running about 8 years ago when I turned 40. The training has just been a build up ever since. I tend to run 3-5 times a week and increase the distances the closer I get to a marathon or ultra. I am no fitness freak so I don’t do all the gym work and ‘interval’ or ‘tempo’ type running. I just go out and enjoy nature on the trails, wonder at the world we live in and try to understand my place within it. If I have had a bad day running, I tell myself tomorrow will be better. And off I will go again. Like I read in your own blog, I write about it to encourage others, so than you again for your reply 🙂

  5. ctomasiewicz says:

    Wow, a double-whammy but you are handling it so well. With just my asthma I find there are enough variables to juggle – the temperature, altitude, pollen count, food, timing of medication….but you’re handling an extra set of variables. Keep it up! My running has slacked over the last several months due to lots of travel, but I’m running (well, walking) a half marathon in a few weeks at high altitude in the state of Colorado. I can’t wait to just be with a group of motivated people, taking in the sights that you can only get when you go the distance.

    • Thanks very much for the kind comments. The diabetes did come as a big bummer – the asthma I’ve had so long its just part of who I am. But I have found running really helps and am heartned every time I find another asthmatic runner. I think you have to have it to really know what its like. Good luck on that half mara (esp at altitude – gulp) and hit the trails when you can. Look forward to reading how you’re gettin on 🙂

  6. Karl Mohan says:

    Very encouraging mate. I am like yourself, both an asthmatic and diabetic. Unlike you, my parents and grandparents are diabetic, so was a matter of time. Kept fit etc, but could not prevent it. Started running this year, and am progressing gradually, with an intention to run a marathon next year. Keep up the great work!

    • Tentsmuir says:

      Cheers Karl – that’s three of us I now know of in the Asthmatic-Diabetic club. If you use twitter follow @YogadanceAnna (T1 with asthma). Also a marathon/ultramarathon runner currently readjusting to running in cold weather after a long stint in Italy. Stick at the running, expect setbacks and then drive a coach and horses through them! Cheers, Steve

  7. Good read even more so because my youngest is asthmatic. Looking at the some of the side effects of his inhaler, my wife and myself decided to try and limit his inhaler use, possible also because he couldn’t understand the difference between out of breath and asthma. There are still times when it has to be used, most notably when he has a cold.

    One of the things we have done to try and aid his asthma is get him swimming. This allows him better control of his breathing (breath control was the “old” way to manage an asthma attack) and cycle. He managed a 12 mile uphill cycle into a headwind the other day. If he carries on like this he might end up an ultra runner….

    Just a quick word of caution to other parents. We made this decision after reading a lot, but we do carry his inhaler round just in case. This was our decision, it’s up to you to find your own information and do what you think is right for your child. Just don’t copy me I may have missed something

    • Tentsmuir says:

      Cheers Daniel. I agree that inhalers should be taken with caution. I suppose though, that it is dependent on the severity of the condition and the triggers. But certainly if your son has an awareness that there is an inhaler available should he require it it will be a comfort.

      The important thing you are doing which was denied to me on medical advice in the 60s/70s, is to keep the young man active. I think if I had been encouraged to get out more then rather than be restricted as to what I could do at the first sign of an asthma attack, I’d have been in better shape. Once my folks worked that out and I started enjoying the mountains with the Scouts / joined the rugby team, things improved …. a lot!

      That said – I have not been one of the lucky ones who “grew out of it”. It is still with me, is weather dependent and severe at given times of the yer. But you learn to cope, realise that you can usually push through, and certainly never let it stop you trying anything.

  8. Pingback: Blog Silence, Injury and the Long Road to Redemption | Tentsmuir

  9. Consuelo says:

    What an inspiration! Thank you for sharing this with me. Are you still on Metformin, same dose? I’m curious to know how distance running has changed your diabetes management overall. Are you eating more carbs? I am. My Hemaglobin A1c stays the same in spite of the increase. That’s interesting about the ketones. I’ll have to ask my doctor why mine aren’t being monitored.

    • Tentsmuir says:

      Hi Consuelo. Thanks for the kind comments. I actually do not eat many more carbs now except the day before and of a big race or run (though I always carry carbo gels for distances over 18 miles). I am still on Metformin at the same dose, but on long race or training days (over 10 mile / 16km), the doctors have asked me to drop that to two. I still carry the third with me in case my BGL hits 17 (old UK scale) as that is the level the ketones may kick in. There is no quick fix for a T2 at that point, so I noe try to monitor BGL every 45 mins/1hr AFTER the first 2.5 hours of running. I so often run 2 hour training runs I am pretty sure of my levels to that point. As you’ve read in my blog, there is a thought among certain doctors that T2 diabetics on metformin do not need monitored. My own doctore monitors my activity closely and as a result I have been on several research programmes. The truth is the understanding of T2 diabetics who push ourselves as we do is still an evolving science. Until we can encourage others to get out there, the emphasis is going to be elsewhere. Keep up the great blogging and I look forward to reading how your training and racing develops. Thanks again 🙂

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