Running in the Zone

It was pitch-black by the time they got to the trail.  After driving nearly nine hours through the sandy expanse stretching across the border of California and Arizona, Amy Carrion and her husband, Alex, were standing on the brink of the Grand Canyon, 500 miles away from their home in Los Angeles, about to run 50 miles through one of the largest canyons in the world.

Carrion never would have considered running rim-to-rim-to-rim in the Grand Canyon two years ago. Having been diagnosed with Type I Diabetes at age 12, she mostly stuck to the safety of roads.

Breaking Down Type I Diabetes

No one knows exactly what causes Type I diabetes (see “Type I vs. Type II below”), but the disease causes the pancreas to stop producing insulin, a hormone that helps our bodies transfer glucose (sugar and carbs) from our bloodstream into cells, where it’s stored as energy. Without insulin to help the body utilize excess glucose, a person will lose energy, often becoming irritable, dizzy or lethargic, then go into a coma, and—if their condition is left untreated for as little as 48 hours—die.

“I used to be very scared of doing anything so remote,” Carrion says.

According to the American Diabetes Association, nearly 1.25 million Americans have Type I diabetes.  That’s less than one percent of the overall population, though that number is expected to rise in the coming years.

Dr. Anne Peters is one of the world’s leading diabetes clinicians and director of Clinical Diabetes Programs at USC’s Keck School of Medicine. She’s worked with a wide range of elite athletes with Type I diabetes, including runners who have traversed Death Valley, traveled across the U.S., and finished seven marathons in seven continents in seven days.

To help simulate the function of the pancreas in everyday life, those with Type I diabetes receive a constant flow of insulin at a low dose throughout the day. This is called a “basal rate.” They must also administer doses of fast-acting insulin (called a “bolus”) with each meal, to counterbalance the amount of sugars and carbs they’re consuming. This means diabetics have to be familiar with the exact quantity of sugars and carbs they’re consuming at all times (see “Managing Diabetes below”).

“They have to do a friggin’ math equation before every meal,” Dr. Peters says. “There are insulin pumps that can figure out the math for you, but you still have to count carbohydrates, and then you have to adjust [the pump] based on your exercise—the whole system is so hard.”

Think Like an Engineer

Type I athletes face the added challenge of figuring out how to quantify the way their bodies react to hormonal shifts while they’re running, as both stress and adrenaline can cause blood-sugar levels to rise.

Dr. Peters says to have good diabetes control it helps to think like an engineer: collect data, analyze patterns, adjust accordingly—and understand the system’s never perfect.

“Unfortunately, or maybe fortunately, it’s happened more than once where my pump system has failed because of altitude, rain, or sweat,” says Stephen England, an ultrarunner from New York with Type I diabetes. “Or, my CGM may fall off my stomach or my arm, wherever I put it; or, it may just fail.  You can’t always control every element.”

England, who runs for Team Type 1, has completed over 50 trail races, including 11 100-mile races and the Tahoe 200. In extreme weather (hot or cold), England has had to develop strategies to keep his insulin close to room temperature. He’s also learned to have extra insulin and carbs on-hand in case blood-sugar levels drop or spike, and to anticipate be equipment malfunctions.

This past June, while England was half-way through Big Horn 100, his Personal Diabetes Manager (PDM)—which is a digital device that allows him to control how much insulin to administer—lost all charge and died.  (It was supposed to last one week.) So, England quickly switched to Plan B, which meant giving himself insulin injections from mile 55 to the finish.

“It’s really about preparing for the worst-case scenario,” he says. “And if that means I carry more supplies in my hydration pack than my competitors, then so be it.”  So far, England has been able to get to the finish line of every single race he’s started, which, he says, “is a really proud thing to have on my resume.”

Carrion completed R2R2R—her first 50-miler—that evening in May, after nearly 17 hours on the trail. It was hard, she said, and at mile 40 she hit a low; but, she had everything she needed to bring her glucose levels back within range and emerge from the canyon an ultrarunner. 

Carrion has learned to be aware of her blood-sugar level at all times; she also always makes sure she has extra food, insulin, a back-up glucose monitoring device, as well as a running partner.

“And if all those things are in check,” she adds, “then there’s no need to be scared.”