How to end up on the podium after running a 6-days-run with type 1 diabetes mellitus - A case study and literature review

BACKGROUND: An increasing number of people living with type 1 diabetes mellitus (T1DM) are pushing their physical limits to compete at the sport's highest level. Muscle, liver, and glycogen metabolism can be normal in athletes with diabetes with good glucose management, and modifications to insulin dose and nutrition can facilitate exercise performance. CASE PRESENTATION: We report on a 66-year-old runner with insulin-dependent T1DM. He has run over 90 marathons and ultra-marathons. Thanks to an insulin pump and continuous glucose monitoring, he has completed forty-eight 24-hour runs with an average performance of 133.8 km. Over the years, the runner increased his monthly running volume significantly and decreased his glycated Hemoglobin type A1C (hba1c) levels. Meanwhile, a significant association between monthly running kilometers and hba1c levels could be shown. At the age of 66 years, he finished his sixth 6-day-run in third place overall by covering a total distance of 467.424 km. CONCLUSIONS: These findings show that it is possible to participate in ultra-endurance events while suffering from T1DM without glucose derailing. With a good understanding of the disease and its impact on an individual's body, we can curtail the preparation and execution phases of ultra-endurance events to allow athletes to compete with minimal risk.