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Although runners of all levels are welcome at the New York City marathon, its course is unrelenting-a 174-foot ascent in the first mile, another steep climb in Queens, and 26.2 miles of hard asphalt that stretches from Staten Island to the Bronx and back down.
To this already exhausting list, runners with diabetes have to add the mechanics of managing their blood sugars. The balancing act is never an easy one, but even the relatively simple acts of finger sticking and putting the blood on a test strip become more difficult when a runner is on his or her 13th mile, with more than 13 left to go.
Association Tries to Smooth the Road for Runners with Diabetes
In 1992, the International Diabetic Athletes Association (IDAA) claims they approached the New York City marathon's medical director with what they saw as a solution to the problem-placing volunteer stations at three-mile intervals along the course. The volunteer stations, each staffed by two IDAA members, would provide runners with a meter and strips, as well as a carbohydrate source if blood sugars were too low.
According to John Madden, Jr., IDAA board member and one of proposal's original advocates, the then medical director of the marathon, Andrew Rodriguez, required some convincing, but eventually agreed.
"At first [Rodriguez] was very skeptical, but eventually he agreed that we could do this," Madden says. "After the first year, things worked very well with us and the marathon."
Putting on the Brakes
Madden says Rodriguez's successor, Lewis Maharam, MD, FACSM, who assumed the position of medical director for the New York City marathon this year, was unreceptive to the IDAA's idea.
"I described what we did and he said he would think about it, but he was concerned about several things," Madden says. "He was concerned about the possible liability of the marathon."
Eventually, despite several letters from the IDAA, Maharam rejected the idea outright. An October 31,2000 letter from his office to Ann Donahue, president of the IDAA, reads "I want you to know that we have given this manner considerable time and thought. The decision, made by a panel of physicians, will stand. We will not permit testing by your group at our marathon."
"You have something better than a meter there"
Maharam stands by his decision not to allow the IDAA to operate testing stations, and disputes the claim that permission was ever given by Dr. Rodriguez, who passed away in the year following his retirement.
"Dr. Rodriguez did not allow the IDAA to operate stations at the New York City marathon," Maharam says. "The fact that they're saying he did is a falsehood."
Maharam cites state department of health requirements as his reason for choosing not to consider the IDAA's stations, which he says violate the notion of self-testing and would allow people with inadequate medical training to give potentially bad advice.
"I don't think the IDAA is in the business of giving medical advice or aid," Maharam says. He says runners with diabetes who feel like they are in trouble would be better off turning to the medical personnel who are positioned at every mile along the course.
"You have something better than a meter there: you have a physician," Maharam says.
Allan Steinfeld, race director of the New York City marathon and president and CEO of the marathon's parent group, the New York Road Runners Club, seconds Maharam's claim that the race has never officially sanctioned stations for the purposes of BG monitoring.
"If [BG monitoring] was happening, it was never anything that was fully sanctioned," Steinfeld says. He says no major marathon in the United States, from Chicago to Boston, offers this service.
Department of Health Expresses Concerns
Officials at the New York State Department of Health say the IDAA's proposed volunteer stations would, in fact, violate the letter of the law.
"Our concern with the IDAA was that they would provide the meter," says Richard Jenny, PhD, acting director of the clinical evaluation program at the New York state Department of Health. "That's no longer self-directed testing."
Jenny says the Department of Health expects all glucose testing, short of runners monitoring themselves with their own meters, to be conducted by a permit laboratory, and the results reported to a physician for analysis.
"The first time, I stopped at every single stop"
Steinfeld also worries that the need for BG testing on the marathon course is symptomatic of a runner's inability to handle the rigors of a marathon.
"I know people with diabetes who run, and they run seriously and competitively," Steinfeld says. "They go on a training run, which is what you should be doing if you're going to run a marathon, and they're not stopping every three miles to monitor themselves."
Monitoring blood sugars along the course, Steinfeld says, is "Crazy. To go every three miles and see if they need more or need less. They shouldn't be in the marathon if that's the case."
Steve Donahue, an IDAA board member who has successfully completed the marathon three times, says the BG stations provided a valuable boost in his getting across the finish line.
"I stopped at the BG stations and they were very helpful," Steve Donahue says. "The first time, I stopped at every single stop."
Madden, who has also completed the marathon, says training runs are an invaluable part of training for any athlete, but that they don't eliminate the need for glucose monitoring while running. He says marathon officials may misunderstand the role of BG monitoring.
"This isn't first aid, it's just knowledge to prevent anything more drastic," Madden says. "It's the difference between running in the dark and running in the daytime-you can see where you're going."
Madden adds that the IDAA is anxious to follow state regulations, but has yet to receive instruction on how to go about doing so.
"We want to comply with the law," Madden says. "It's no problem."
Nonetheless, this year's ban on IDAA stations shows no signs of easing. Although some runners with diabetes made it across the finish line, they did so on their own. Ann Donahue tells the story of one runner who, in order to avoid being hampered by a fanny pack and the weight of supplies, took drastic measures to test her BGs.
"You know what she had to do?" Ann Donahue says. "Take family members and place them along the course. I mean, this is a nightmare."
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.