Marathon Recovery With Diabetes Tech: CGMs, Pumps + The First 24 Hours

Crossing the finish line of a marathon is a dream for many, and completing one with diabetes is another level of awesome. But that’s just half of the equation when you live with diabetes. 

Your work and recovery don’t necessarily end when the race does. 

The first 24 hours after a marathon can bring some interesting changes to your blood sugar management (TLDR; don’t aim for perfection!). 

Your muscles have burned through their glycogen stores, so your insulin sensitivity is heightened, your stress hormones are going down and you’ll need to replace plenty of carbohydrates and fluids to help your body repair itself. 

Marathon recovery is a big job, but thankfully diabetes technology can make navigating recovery a lot smoother. 

Right after the finish line

The first 24 hours after a marathon are critical because that’s when your body’s repair work is most urgent and systems are most out of balance. We strongly recommend talking to your healthcare provider (HCP) in advance to come up with a plan for you to follow after the marathon, especially for the first 24 hours.

• Keep a close watch on your continuous glucose monitor (CGM). This is important because during the work of a marathon, your body has burned through all its glycogen stores and will be incredibly insulin sensitive for a while afterwards. 

The difference between closely monitoring your CGM during a marathon versus after is this: during a marathon, you’re to answer the immediate question of whether you need fast-acting carbohydrates in the immediate moment. After a marathon, you’re looking for trends: are you going too low overnight? Do you need less insulin per carbohydrate? Does that mean your meal-time insulin dose has to change?

• Monitor your blood sugar trends. Keep an eye on CGM trend arrows, especially after eating, before bed and overnight when you’re more at risk for overnight lows. And if you haven’t already, this would be a good time to turn those low alerts back on and shift them from 85-90mg/dL during the marathon to 70mg/dL post marathon!
• Talk to your HCP about post-marathon insulin dosing. Depending on your individual diabetes management plan, you may need less insulin than usual for up to several weeks post-marathon. 

Refueling after the marathon

After a marathon, your body needs a little bit of everything: calories, carbohydrates, protein, fluids and especially electrolytes.

Carbs and protein

One not-so-secret ideal recovery drink is chocolate milk. This is because chocolate milk has the perfect 3:1 carbohydrate-to-protein ratio to help rebuild damaged muscles and refill empty energy stores, plus it’s delicious. Dairy-free chocolate milk options also work, too: soy milk in particular offers a meaningful amount of protein per serving.

You will also probably have to eat more than you think you should. Running a marathon burns A LOT of calories. So don’t be shy if your hunger comes back with a vengeance and you eat a lot extra in the days following your run! 

The diabetes caveat, however, is that recovery nutrition and refueling require close insulin management. Use your CGM trends and an individualized insulin plan rather than assuming you can eat without dosing or dose as if you didn’t just run a marathon. 

Hydration and electrolytes

Don’t forget to drink plenty of water. It’s not unusual to be dehydrated and have low sodium levels after running a marathon. It’s important to replenish both, so choose an electrolyte drink like Gatorade Zero or Buoy drops.

Check in with your care team

Don’t be afraid to give your diabetes care team a quick call to run insulin dosing, carb-to-insulin ratios and temporary correction factors. Running a marathon is a huge undertaking, and it’s important not to treat recovery like an afterthought!

Heat, cold and your diabetes tech

After a marathon, many runners turn to hot or cold therapy to ease sore muscles and calm inflammation, whether that’s a long soak in a warm bath or a few bracing minutes in an ice bath. These are popular recovery tools, but if you use an insulin pump and a continuous glucose monitor (CGM), big temperature swings come with a few extra things to think about. This includes:

• The type of insulin pump you use. With a tubed pump, like the MiniMed 780G system, you can temporarily disconnect from your infusion set for certain recovery activities. A tubeless pump stays attached to your body at all times, which is convenient day to day but can change the logistics of post-race recovery.
• Insulin temperature. Extreme heat and cold can denature insulin, and big temperature swings can affect device performance and even adhesion. 
• How heat and cold therapy impacts your blood sugar. The positive stress of cold or heat therapy may impact your blood sugars. Be sure to monitor your CGM during these activities and make adjustments accordingly. 

Heat therapy

Heat therapy expands blood vessels, boosts circulation, and delivers oxygen and nutrients to damaged muscle fibers. This makes it a great option for marathon recovery. You can try taking a warm bath, dipping in a hot tub, or luxuriating in a long, hot shower or sauna.

Cold therapy

Working in the opposite direction, cold therapy constricts blood vessels, alleviates swelling, numbs sore muscle tissue and calms the inflammatory response post-marathon. 

Some runners turn to cryotherapy or jumping in an ice bath to deal with post-marathon inflammation. If that’s too much, localized icing of sore muscles can still be beneficial. 

CGMs and insulin pumps

Insulin pumps and CGMs have manufacturer-specific temperature and water-exposure limitations and thresholds. Make sure to read your user manual to see which activities may be off-limits for your diabetes equipment. 

While tubed pumps have the ability to disconnect for hot and cold activities, with tubeless pumps, you may need to be more cautious. Work with your healthcare team to determine what may be safe and best for your recovery.

If you’re unable to fully immerse your tubeless pump in hot or cold environments, portable options like heating pads or ice packs for localized treatment may be a better alternative. 

Be sure to plan accordingly depending on how you manage your diabetes. 

Rest and Recovery

Once you’ve eaten (a lot) and rehydrated, the most important thing is to rest and make sure you’re consistently stretching so your muscles can start to repair themselves.

Stretching

Gentle stretching and easy yoga can help you transition from running for hours to recovering safely. Aim for comfortable movement: an easy child’s pose, gentle hip openers, relaxed hamstring work and slow mobility. If something hurts, don’t force it.

In addition to stretching, foam rolling can be an excellent option for people looking to get a deep tissue stretch after their run. Foam rolling releases tight fascia, encouraging blood flow through muscles that feel particularly stiff. 

Sleep

Sleep after a marathon is so incredibly important, not only for the rest it provides, but also to aid in muscle repair and recovery. Sleep helps with inflammation reduction, glycogen replenishment, and protein synthesis to help rebuild tired, achy muscles. 

Sleep more than you think you should; aim for at least seven hours every night. Stretch every morning. Do not force a “shake out” run or exercise much (or feel the need to exercise at all!) for the first few days. 

Compression

Beyond Type Run’s marathon team runners love compression socks or the Hyperice Normatec recovery boots, which are air compression boots designed to increase circulation, reduce swelling and accelerate healing. Scroll the internet! Maybe sign up for another marathon! But whatever you do, don’t do too much exercise before your body is fully recovered. 

Take it easy. You’ve earned it!

And there you have it: Keep your CGM nearby, charge your devices and make sure you have all your insulin and pump supplies nearby. Pay extra attention to your blood glucose levels after meals, before bed and overnight. Know that you may need to lower your insulin doses for a while post-race (talk to your diabetes care team about any changes you’re hoping to make).

Your blood glucose won’t be perfect. You’ll be really sore. But you ran a marathon, which is an amazing feat! Let your body recover and let your diabetes tech make it easier to do so.

Diabetes tech is constantly evolving. Stay up to date on the latest with our Diabetes Technology Guide.