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Not to be replicated without permission Running with diabetes Marathons and beyond Søren Kruse Lilleøre Copenhagen, Denmark

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Page 1: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Running with diabetes

Marathons and beyond

Søren Kruse Lilleøre

Copenhagen, Denmark

Page 2: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

• I’m employed by Novo Nordisk

• But I’m giving this presentation as a private person

• I have received sponsorships and speaker fees from:

• Abbott Diabetes Care Denmark

• Novo Nordisk

• Medtronic

• Roche Diagnostics

Disclosures

Page 3: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Running with diabetes

Page 4: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Marathons 2003-2013

Page 5: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Every story has a beginning

1st half-marathon May 2002

2nd half-marathon Sep 2002

1st sports injury Oct 2002

D-day Nov 2002

Fatigue

Thirst

Urination

Weight loss

Page 6: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Basics of insulin therapy*

Blood glucose Physical activity Diet

Insulin

HbA1c ≤6.5%

*Based on personal experiences

Page 7: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

• Objectives

• To demonstrate that diabetes is a condition without limitations

• To show that diabetes can be managed effectively through an active/healthy lifestyle

• Outcome

• To change how people perceive diabetes

• To motivate and inspire others

Marathon running with diabetes A demonstration of control

Page 8: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

• Insulin sensitivity

• Insulin-dependent glucose transport

• Less insulin is required

• Muscle contractions

• Insulin-independent glucose transport

• Less insulin is required

• Hepatic glucose production and release

• Counter-regulatory stimuli

• Suppressed by insulin

• Some insulin is required

The effect of physical activity

*Based on personal experiences

Page 9: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Meal-time checklist*

1

2

4

3

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6

7

Current blood glucose

Next meal? When, what and how much?

Post-meal exercise? Reduction in insulin dosage

Pre-meal exercise? Increased insulin sensitivity

Previous injection? Time, type of insulin and dosage?

Previous meal? When, what and how much?

What to eat and how much? Composition of diet?

*Based on personal experiences

Page 10: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

The effect of physical activity*

Measure Inject and

eat Measure Run Measure

Insulin dose (basal and bolus)*

Meal size and post-prandial blood glucose*

Effect of duration and intensity on blood

glucose*

*Based on personal experiences

Page 11: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Marathon running with diabetes* Trust your senses

Finish Start Race

8-10 mmol/l 5-7 mmol/l ???

Hypo? Hyper? Exhaustion?

Perceived blood glucose

Glucose? Glucose? Glucose ?

*Based on personal experiences

Page 12: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Marathon running with diabetes

Copenhagen Marathon 2003

Target: <4:00

Finish time: 3:40 Finish time: 3:13

Copenhagen Marathon 2005

Target: <3:00

Copenhagen Marathon 2004

Target: <3:15

Finish time: 2:57

Page 13: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

The basal dilemma* Finding the right dose is difficult

Hypoglycemia

Hypoglycemia during morning exercise

Hyperglycemia in the afternoon or between

meals

Hyperglycemia

Solution

Reduce basal insulin* Increase basal insulin*

Solution

Based on personal experiences

Page 14: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Polar Circle Marathon 2005

Page 15: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

-19° Celsius

Page 16: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

World Tour 2007

February

May

April

September

November

December

June

HbA1c above target

Great Wall Marathon

Vienna City Marathon

Berlin Marathon

Thesis defense

Honolulu Marathon

Big Five Marathon

7.7 %

New Year Marathon December

Page 17: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Great Wall Marathon

Page 18: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Page 19: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Big Five Marathon

Page 20: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Medical check before entering the valley of lions

Page 21: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Big Five Marathon Finisher

Page 22: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Practice makes master

February

May

April

September

November

December

June

HbA1c above target

Great Wall Marathon

Vienna City Marathon

Berlin Marathon

Thesis defense

Honolulu Marathon

Big Five Marathon

7.7 %

6.8 %

6.4 %

6.6 %

New Year Marathon December

Page 23: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Marathon routine*

CHO-rich dinner

Breakfast 3-4 hours before race start

Continuous BG measurements prior to race start

Water and diluted energy drink at fuel

stations

Energy bar: 21.1 km

Energy bar: 30 km

Energy bar: 37 km (optional)

Post-race BG target

Activity BG Basal Bolus

8 mmol/l

5-7 mmol/l

Post-race dinner

Bed-time 5-6 mmol/l

Bed-time

?

5-6 mmol/l

1-2 U if BG >8 mmol/l

*Based on personal experiences

Page 24: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Berlin Marathon 2007 First marathon with CGM

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08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30

Sensor

Glu

cose (

mm

ol/

l)

Time

Page 25: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Marathon routine revisited*

CHO-rich dinner

Breakfast 3-4 hours before race start

Continuous BG measurements prior to race start

Water and diluted energy drink at fuel

stations

Energy bar: 21.1 km

Energy bar: 30 km

Energy bar: 37 km (optional)

Post-race BG target

Activity BG Basal Bolus

8 mmol/l

5-7 mmol/l

Post-race dinner

Bed-time 5-6 mmol/l

Bed-time 5-6 mmol/l

1-2 U if BG >8 mmol/l

*Based on personal experiences

Page 26: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Athens Classic Marathon Blood glucose profile (CGM)

Page 27: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

A random marathon* July 2011

5.2

7.8 8.2

6.8

4.9 4.8 4.7 4.8

6.9

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21:49 22:50 05:04 07:26 07:47 08:57 09:50 10:45 11:49

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mm

ol/

l)

Time

Energy bar Maxim (40 g)

28 g CHO

Energy bar Maxim (40 g)

28 g CHO

Energy bar Maxim (40 g)

28 g CHO

Start: 8:00 Finish 11:41

8 U Basal 5 U Bolus

*Based on personal experiences

Page 28: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

A random marathon* August 2011

7.6

10.9

6.4

4.6 5.1 4.6

6.2

10.0

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Energy bar Maxim (40 g)

28 g CHO

Energy bar Maxim (40 g)

28 g CHO

Start: 6:00 Finish 9:33

8 U Basal 5 U Bolus

144 BPM

153 BPM

*Based on personal experiences

Page 29: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Marathon des Sables 2009

Page 30: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Marathon des Sables Facts

• The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants

• Participants must carry their own food, clothing, mandatory and personal

equipment • Maximum 15 kg is allowed, minimum 6.5 kg is required • Minimum 2000 kcal/day

• Water is provided in limited amounts in 1.5 litre bottles

• 1.5 litres before each stage, 1.5-3 litres at checkpoints and 4.5 litres after each stage

• Bivouacs are made available between stages

• 8 participants in each

Page 31: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

What to bring?

Food and energy

X 3

~2750 kcal/day

Diabetes management

Insulin and devices Insulin pens • Basal (3) • Bolus (3) Needles (90) Glucose monitoring Blood glucose meters (3) • 150 test strips Continuous glucose monitor (1) • 3 sensors

Page 32: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants
Page 33: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Stage 1 (35 km)

Page 34: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Stage 3 (91 km)

Challenge #1

Mountain after 60 km

Challenge #2

Followed by dunes

Challenge #3

Darkness

Page 35: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Stage 3 (91 km)

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Time

1 U bolus insulin*

Pre-breakfast: No bolus insulin* 4 U basal insulin*

2 U bolus insulin*

*Based on personal experiences

Page 36: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Stage 4 (42.2 km)

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Page 37: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Marathon des Sables 2009 Daily overlay

Page 38: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

In the media

Page 39: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Lycian Way Ultramarathon

Page 40: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Lycian Way Ultramarathon 2011

Page 41: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Lycian Way Ultramarathon 2011 Daily overlay… Saved by CGM

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2.00

4.00

6.00

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10.00

12.00

14.00

16.00

00:00 00:45 01:30 02:15 03:00 03:45 04:30 05:15 06:00 06:45 07:30 08:15 09:00 09:45 10:30 11:15 12:00 12:45 13:30 14:15

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Time (hh:mm)

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Page 42: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Marathon des Sables 2012

Page 43: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

45° Celsius

Page 44: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Rough terrain

Page 45: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Stage 4 (81.5 km)

Page 46: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Stage 4 (81.5 km) More than 21 km of dunes

Page 47: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Sandstorm

Page 48: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Before stage 5 Blister management

Page 49: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Stage 6 Finish line

#129

Page 50: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

1 2 2 2

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Marathons 2003-2013

Page 51: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

#100

Page 52: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Olympus Marathon

Page 53: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

RunFire Cappadocia Ultramarathon

Page 54: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Stage 5 (104 km)

Page 55: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Presentation title Date 55

Page 56: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

1 2 2 2

6 8

12 11

20

36

19

0

5

10

15

20

25

30

35

40

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Marathons 2003-2013

Page 57: Søren Kruse Lilleøre Copenhagen, Denmark · Marathon des Sables Facts • The toughest foot race on earth • 200 – 240 km over 6 stages • 850 participants • Participants

Not to be replicated without permission

Concluding remarks*

• Diabetes management is a full-time job • Continuous adjustments in insulin regimen according to exercise, diet and lifestyle

are required

• Frequent blood glucose monitoring is essential

• No limitations • Diabetes is not a limitation for an “active” life

• Everything is possible, but planning is necessary

• Prepare for the worst, hope for the best!

• Practice makes master

• Nobody is perfect • Everybody makes mistakes

• Unless repeated, they are an important part of a learning process

*Based on personal experiences