Training for a Marathon with Diabetes: An Interview with Dr. Jesús Rivera
Editor’s Note: Eugenia is a member of the 2021 team of Beyond Type 1 runners that will participate in the TCS New York City Marathon. Beyond Type Run is sponsored by Dexcom and Tandem Diabetes Care.
A few years ago, Eugenia thought about running a marathon because her whole family had done it and she didn’t want to be the only one left out. She took on the task of looking for trainers and the first obstacle, according to Eugenia, was finding a coach who knew about type 1 diabetes, insulin, hypoglycemia, etc. Soon after, she met Dr. Jesús Rivera, the founder of Aquiles MD. In their first session, Dr. Rivera explained he had already trained people with type 1 diabetes in disciplines as demanding as a marathon.
Currently, Dr. Jesús Rivera is part of the team that is training Eugenia to run the TCS New York City Marathon with Beyond Type 1 in November. He is a general practitioner at the Universidad Juárez del Estado de Durango, and later specialized in Spain as a sports doctor. We talked to Dr. Rivera about marathon training, the diabetes element and more.
Beyond Type 1: WHAT IS SPORTS MEDICINE?
Dr. Rivera: In sports medicine, we analyze and observe how the body responds to exercise, in all its variants. We discover how neurons, hormones and receptors are stimulated and de-stimulated depending on the physical activity and depending on the intensity of the physical activity.
CAN ANYONE RUN A MARATHON?
Definitely. People have different characteristics and the preparation time for a marathon depends on the characteristics of each person i.e., if a person has one leg, if a person does not have both legs, if a person lives with diabetes, if a person has cancer, if they are pregnant. I believe anyone can run it, but there are certain instances that must be reviewed in a comprehensive way and determine what time is the most appropriate. If you tell me, “Hey, I want to train to run a marathon in two months,” I might advise against it. But if you tell me, “I want to run it at some point in my life when my metabolism, my body, and everything is in perfect harmony, I would tell you, “Of course, no problem.” Anyone can do it.
WHAT DO YOU EVALUATE BEFORE SOMEONE STARTS PREPARATION AND TRAINING?
A complete study is done. Obviously, there must be a comprehensive blood analysis and it is advisable to do a stress test that is part of the specialization of the sports doctor. A stress test consists of evaluating how your body responds to physical activity at different intensities. Through it, we evaluate how much risk there is for your body and do physical activity at different intensities.
You get on a treadmill, we place patches all over you, give you a mask to perform a metabolic analysis of how you inhale and exhale so that we can see the indirect calorimetry and how your body is responding to all the activity. Then we start to do the exercise very slowly and gradually increase the intensity. In this process, we are measuring other variants such as taking a small blood sample and measuring lactate or lactic acid in the blood, which is a very important issue in people with type 1 diabetes.
Obviously, there are situations that can compromise the heart and also blood pressure, so we measure the response of blood pressure to effort. In short, during the stress test we measure all this, we measure the cardiovascular risks, the risks of death, the risks of blood pressure, the metabolic response of the body, and from all this the prescription of physical activity is structured.
WHAT COULD BE A LIMITING FACTOR FOR RUNNING A MARATHON? IS AGE A LIMITATION?
Age is not a limitation. I will share that some people who’ve had COVID, many of them athletes, are developing myocarditis, which is an inflammatory process of the heart, and this carries a significant risk for sudden death. That is why today every person who exercises and who has had COVID takes a stress test before starting to train.
HOW DOES ONE RUN A MARATHON AFTER A YEAR AND A HALF OF A PANDEMIC?
It is never too late to exercise again. Obviously, if you’ve spent a year and a half, two or three years, or a lifetime without running, it will take longer to be ready to run a marathon than if a person has been actively running, but it is never too late.
WHAT SPECIALIST SHOULD YOU USE?
I believe that a person with type 1 diabetes already has a very strong perception of their disease and has already learned to live with it. The moment you start talking with someone, you quickly realize if you are dealing with a person who knows this disease or not.
It is very important to know that more than just any coach, any doctor, whoever trains you, needs to have experience in the subject of metabolic behavior. If we do not know how the body of a patient with type 1 diabetes is going to respond metabolically, it will be difficult to prescribe an exercise regimen.
So, what type of specialist should you look for? Definitely someone who knows about the subject. In Aquiles, in fact, every six months approximately we do a trainer’s workshop course for the prescription of physical activity in people with different types of diabetes precisely because we recognize how important it is to know certain key things in order to be successful.
WHAT HAS BEEN THE BIGGEST CHALLENGE OF TRAINING EUGENIA?
The truth is that the first visit was challenging because she arrived very restless with the question of whether we were really going to be able to help her or not. She is also super studious and meticulous in all these matters. When we showed her that we could help her, she relaxed a lot and flowed quite well.
I believe that the main challenge both with Eugenia and with any other person living with diabetes is to understand how they know their life condition and how they regulate it and then later make the changes. The main challenge is to have good communication and from there, everything is fluid.
Eugenia is raising money for Beyond Type 1 through Beyond Type Run—her fundraising will make a real difference in the lives of those living with T1D.
