World Diabetes Day: Managing the Condition for Endurance Sport

In honor of World Diabetes Day we asked James Stout to share his knowledge about how to manage diabetes in endurance sports. James is a type 1 diabetic who competed at a high level as a cyclist and rower. Today he’s adjunct professor of world history and runs a non-profit program that works with people living with diabetes and obesity in the indigenous community, and uses exercise and education to empower people to live healthier and happier lives.


Managing a job, family, and a training and competition schedule can be challenging. Most of us can think of a workout we have skipped or an event we haven’t performed our best at due to “real life” getting in the way. But for athletes living with diabetes there’s another factor in the mix; managing blood glucose. Blood glucose isn’t something people with diabetes can choose to ignore, as it can impact their performance and health, but despite the extra complications, thousands of athletes with diabetes still compete at the highest level in dozens of sports.

I’ve been one of them. When I was diagnosed with diabetes I was rowing at Oxford University, I was tired all the time and couldn’t perform at the level I had become accustomed to. I kept losing weight, drinking more water and urinating. Looking back, these are tell-tale signs of diabetes but back then they were just inexplicable and annoying. Since then, and since being told by a not-so-progressive doctor that I should take up chess, I have learned that not only can I manage m diabetes during exercise, but that it is much easier to manage my diabetes when I exercise. Although life with diabetes can be challenging, I am lucky enough to have access to education, life-saving medication and exercise. With 13 years since my diagnosis, there’s a lot I have learned and doubtless a lot I will still learn. Collected below are some of my tips for anyone with diabetes (type one or type two) who is looking to start out on their exercise journey.

Check yourself before you wreck yourself
We’ve all heard that knowledge is power, but the old cliché has never been more true than with diabetes and exercise. The more I know about how a certain food or training session impacts my blood sugar, the more I can be informed about how to react. In my first months with diabetes this meant checking a lot, working out that interval sessions sent me high during the session and low later in the day, working out what foods did and didn’t work and how much insulin it took me to get through a crit. I worked out that sleep, training stress, anxiety and anger all impacted my blood sugar. I did this by keeping a diary with my food, mood, training and blood sugar. It was a lot of work at the time, but I wanted to succeed and honestly feel that the hours I spent on this project paid off at a much higher rate than those I spent slogging away on the bike or in the gym.

Notice Patterns
We all know that sugar increases blood glucose, but so does stress. This means that often you’ll see a spike in blood glucose before a stressful event (I used to experience a jump in blood glucose in the time it took me to go from the rollers to putting on my skinsuit and rolling to the start line of a crit) or during an interval session. This is normal, your body is getting sugar into the bloodstream when it senses stress in case that sugar is required to run away from a predator, or set a PR.

Timing Matters
The same food in the morning and the middle of the day will have a different impact. You’ll notice this if you’re keeping a diary. Be sure to train at least a few times at the time you want to begin your goal event. If you’re flying to a goal event, and using insulin, be sure to start moving your doses to the new time zone a few days before and, if at all possible, fly out early.
When training finishes, diabetes doesn’t

After a hard training session, you’ll notice a blood sugar spike. This seems counter intuitive as you’ve just been burning carbs but it is, in fact, totally normal. Your body is getting ready to “go” again. Gradually your blood glucose will come down and you’ll experience lower blood sugar throughout the day and night after you exercise. If this spike, or the subsequent low, is a concern to you talk to your medical team about developing a post exercise protocol that might involve extra insulin and a bedtime or afternoon carb snack.

Pack a Snack
I can’t emphasize this one enough. Athletes without diabetes can get away with heading out and chancing it, but the consequences of taking risks for people with diabetes can be much higher. I always head out with about 10g more carbohydrate than I expect to need for a given training session, and a $10 bill. It isn’t fun eating two packs of chews while I shake and sweat sitting under a tree in the middle of nowhere, but at least I know that I can make it home if I do that. I like to follow up the fast acting carbs with a good mixed macronutrient snack when I experience hypoglycaemia, I might end up a little high that way, but at least I am not in danger.

You Don’t have to be Perfect
we all make mistakes in all aspects of our lives and diabetes is no different. You’ll have bad days, but if you stick with an exercise routine you will become healthier and happier for it. Sometimes you’re going to be out of your range, and that’s sometimes desirable. I damn sure wouldn’t start a 100-mile gravel race or a multi pitch climb at 80, but I would happily do so at 180. I spend most of my life in my target blood glucose range, but I also spend most of my life outside having adventures and I wouldn’t swap a little more time in range for a lot more time inside!

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by bonkbreaker

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