49-LB: “You Don’t Know When the Sugar’s Going to Kick In”: Experiences of People Managing Type 1 Diabetes during a Marathon

There are many benefits of regular exercise in diabetes, but people with type 1 diabetes (T1D) also have the risk of short-term complications. There is a lack of research and information about how individuals with T1D should prepare and recover from endurance exercise. The present study had two primary objectives: 1) Understand how previous runners experienced participating in a marathon and 2) Understand their experience managing their diabetes while training for and recovering from a marathon. The study included 10 participants who had previously participated in the New York City Marathon with the Beyond Type 1 Team (mean age 33.3 ± 12.9 years, duration of T1D 13.2 ± 14.8 years, A1c 6.59 ± .7%), 80% female, 90% on insulin pump and 100% on CGM. Interviews were transcribed and thematically analyzed. Themes included (but are not limited to): methods to maintain euglycemia, preparation to reduce glycemic variability during endurance activities, and managing blood glucose variability during the marathon and recovery period. Diabetes devices were identified as a key theme given how integral they were to marathon preparation and performance. Multiple participants discussed using specific CGM and pump site placement to prevent the devices from falling off. Participants described various strategies to prevent hypoglycemia during their runs (both for training and the marathon). Some participants described frequent disruptions to their training plan due to diabetes and setting a higher target glucose to accommodate for the exercise. This data provides initial insight into the decision-making that occurs for people with T1D who participate in endurance activities - including food preparation, planning ahead for supplies and insulin manipulation, in-the-moment management decisions, and recovery period glucose management.