A diabetic runs nine marathons in 2019

Markus Sauer runs nine marathons or ultras in nine federal states within half a year. What is special: The 28-year-old from Styria is diabetic (type 1). With his project, in which he is supported by the Austrian Diabetes Society (ÖDG) and supervised by experts from the University of Graz, he wants to draw attention to the fact that running a marathon with diabetes is not only possible, but also improves the quality of life. The Salzburg Marathon is his fourth station. The project kicked off at the Vienna City Marathon, with the final taking place in his hometown of Graz in October.

The idea for this remarkable venture matured in a process that began with an initiative of the Graz Marathon together with the diabetes outpatient clinic of the Graz state hospital. Diabetics should prepare for the Graz Marathon 2018 under medical supervision. Markus Sauer got in touch, after all he was a marathon runner before he was diagnosed with diabetes in 2015 and had finished one marathon as a diabetic and had to abandon another. Using a sports-scientific training plan, he prepared himself and ran the Graz Marathon in 2018 to the end. Although not everything went according to plan at the event from a medical point of view, he felt surprisingly good and finished in 3:47 hours. But what was even more important: From running, his sugar levels improved. An experience that the 28-year-old now wants to share with other diabetics. "I would like to show that diabetes does not cause everyday stress at all and should not prevent anyone from trying something and pushing their limits," emphasizes the 28-year-old from Styria. "Everything within reasonable limits and preferably with a doctor's consultation."

Organizational challenge in everyday running

In general, a distinction is made between two types of diabetes mellitus (colloquially: diabetes). Type 2 diabetes, also popularly known as adult-onset diabetes, is a disease known to many and is much more common in our society. Type 1 diabetes has significant differences. An autoimmune attack paralyzes the islet cells in the pancreas and destroys most or all of the body's ability to a) produce the hormone insulin, which makes the sugar in the blood available to the body's cells, and b) to respond when there is too much insulin in the body or other factors lead to hypoglycaemia. Patients must constantly monitor their blood sugar and manually inject insulin into the body via a syringe or pump in order to a) funnel the sugars (all carbohydrates) ingested from the diet into the body's cells for processing and b) to provide the body with a permanent baseline amount provide insulin. In the case of a marathon runner like Markus Sauer, this is a major organizational challenge, because precise planning is required. This is because exercise helps the body burn sugar, which is why less insulin than normal is needed when you are under the influence of exercise. Otherwise there is a risk of hypoglycaemia, which in the short term is a significantly greater health risk for diabetics than high sugar levels.

In an interview, Markus Sauer explains how marathon running works as a diabetic in practice

Graz Marathon 2018 with great learning effect

When Markus explained his project to his supervisor Alex from the University of Graz, he considered the project to be very ambitious, but wrote a training plan with which Markus should prepare for stations one to five in spring 2019. He drew optimism from the final performance test at the Graz Marathon 2018, when the doctors came to the realization that if the sugar level had been in the optimal range, Markus could have run a time of around 3:20 hours. But the following went wrong: When he reached his desired value of 180 before the start, the trend arrow (the expectation for the coming time calculated by the blood glucose meter using a sensor) pointed downwards. The safety alert bells rang and Markus took a milk-protein drink (2.5 BE – BE = recognized measured value of the carbohydrates received) to prevent a feared hypoglycaemia after about 20 minutes. However, since the basal supply rate with insulin was set to 15% based on training experience as planned and the protein in the drink ensured a long-term effect, the sugar in his blood not only rose a little, but too much and remained constantly high. Despite the enormous physical exertion, he no longer had to eat anything containing carbohydrates by the time he reached the marathon goal and even needed additional insulin. "Despite the bad values - the doctors even wanted to take me out of the half marathon - I felt physically fantastic throughout the race and didn't have any muscular problems at all," he says.

Individual effect, individual strategies

The Graz Marathon 2018 was a great learning curve for Markus. The right way to deal with diabetes and the effect of exercise on it are individually different anyway. Correct strategies must be worked out in consultation with the attending physicians. Since this competition, he has been better able to coordinate physical exertion and assess the consequences on the sugar level. For example, the Linz Marathon 2019, when he encountered the same phenomenon with falling sugar levels before the start with only briefly effective glucose, went as desired - target time: 3:30:41 hours.

It is helpful that the 28-year-old can plan every day precisely, which allows good timing between everyday work, the type and time of nutrition and the training rounds. The longer the planned unit, the more carbohydrates he eats at lunch. Coordination with the programmed basal rate is also based on numerous experiences and documentation. “Ultimately, meticulous documentation is key. This is how you gain experience and discover the right strategies. Thanks to many experiences, I now have a good feeling. For example, I can use my pulse rate to see how my sugar level will be in the next few minutes.”

insulin pump

Markus relies on an insulin pump, he used to inject himself with insulin. A major advantage of the pump, apart from the better handling during a marathon run, is the possibility of constantly delivering a programmed, small amount of insulin (= basal rate), the percentage of which can be changed at any time for a certain period of time. Patients who rely on injections inject a depot of a long-acting insulin into the tissue from which the body feeds once or twice a day. For Markus, the greater precision of the pump is a big advantage because it brings effectiveness and precision and keeps his sugar levels more stable at night.

However, the pump has a disadvantage. The part of the body has to be changed every three to five days, and a small catheter is placed through which the insulin supply runs. Since Markus, as a well-trained marathon runner, has a very low body fat percentage, the potentially available areas are rare. For example, he has so little fatty tissue on his thigh that it is not possible to attach the catheter there. Because the needle hits a muscle or blood vessels, it is firstly very painful and secondly ineffective in supplying the body with insulin. His insulin pump is usually located in the lower back area.

Improved quality of life

Returning to regular running has improved his quality of life. “My long-term score has improved significantly since I started my project. The sugar levels are much more stable and there are fewer fluctuations. That also applies to days when I don't train," says the man from Graz. In addition to insulin supply, regular and extensive exercise is an important part of medical therapy for diabetics. Finally, exercise reduces the need for this drug in a natural and generally healthy way. With his project "nine marathons in nine federal states", Markus Sauer succeeds in drawing attention to the fact that a marathon is not an insurmountable obstacle for a diabetic. His passion for running and his improved health values through sport are an increase in his quality of life.