Betsy Hartley is an accomplished ultrarunner with finishes at the demanding Trans Rockies 6-day stage race and Mountain Lakes 100. She’s also an avid aid station volunteer, whose support and enthusiasm has saved many runners.
What many people don’t know is that Betsy went from being a 400-pound woman with Type 2 diabetes to a fit ultrarunner who—against all odds—has managed her diabetes with diet and exercise.
In our interview, she shared techniques for navigating a healthcare system that doesn’t always support women’s health, and talks about how to support running partners throughout the changes related to menopause.
Before diving into the interview, here are a few notes. Diabetes mellitus refers to a group of diseases that impact how the body uses sugar (glucose). Type 2 diabetes occurs when the body stops responding to insulin, which is the hormone that allows glucose into cells. Blood sugar levels rise, causing tissue damage and delaying wound healing.
While menopause does not cause diabetes, it alters our response to insulin and changes how fat is deposited. These changes may increase women’s risk of developing diabetes, particularly women who enter menopause early (before 42), or who experienced gestational diabetes.
How did you discover ultrarunning?
In July 2011, I said, “I’m more afraid of what I would lose if I died than I am of what I’m going to have to change if I really want to start to live.”
I started walking more. And then I decided I was really good at walking. I loved to walk. I was walking everywhere. I signed up to walk a 10k. And then I decided I was going to do a marathon. And everybody was like, “You know, there’s like stuff in between, right?”
I ran the marathon and finished it, and I just remember thinking it was fun. I enjoyed the medal and pinning on the bib, but it was on a road. Then I learned about trail running. I had this glorious moment with Ken Ward who said, “You don’t have to run fast, you just can’t stop.”
Training for a 100-miler was a two-year process. I put a 50k and a 50-miler in and built in the Trans Rockies 6-day run because that would be my long block before my 100-miler. I strategically built all of it so that I could be as successful as possible.
But I did it mostly because I fell in love with the community. It was hiking, running and problem solving. There’s this common language no matter what the politics, religion, upbringing, background—there’s that commonality. It’s just a beautiful commonality of effort. And I was hooked.
Has menopause impacted your diabetes?
I thought I knew what the relationship between estrogen and insulin looked like, and now estrogen’s not there in the same way. And I think insulin’s a bit of a bully. In 2012, I went off all diabetic medicine and in the last year, I’ve started back on a few. I’ve spent hours crying over the fact that I worked so hard to get off all these meds and now I’m back on them. But I have to be on the meds to preserve my health while I’m sorting everything out.
When did you first realize something had changed?
When I started to feel my glucose management getting a little unstable. I immediately went into self-flagellation: “I need to tighten my diet. I’m not reading labels enough. I’m not lifting heavy enough, I’m not running hard enough. I’m going out on too many easy runs. I need to sign up for more races.”
In hindsight, the biggest piece for me was that I woke up one morning and my mojo was out the window. I can piece together now that my glucose was unstable, my periods were irregular and I had night sweats. I really thought night sweats were because I’d worked out really hard and had no air conditioning.
All those little pieces were not adding up until I went to the doctor and said, “The problem is I can’t sleep.” She asked me if I noticed loss of motivation or mood changes or glucose control. I said, “Well now that you mention it,” but I couldn’t put the picture together until I went to a doctor.
You mentioned the ultrarunning community. How has it helped you?
I think there’s a lot of emotional help that comes from knowing you’re not alone. I started finding other women in their fifties who were active and struggling with menopause. And I was like, okay, first of all, I’m really glad I found you. Second of all, why the hell is nobody talking about this stuff?
We need to make it okay for those conversations where we can say, “You’re not alone.” You think, oh my God, I’m losing my mind. And then you go on a group run and three other women are like, “Oh my God, me too.” And suddenly, this is normal.
The important part comes when you’re with a group of people and mention you are only sleeping 2 hours a night. When they all stop and tell you that isn’t normal, it’s time to get help.
What advice or words of wisdom would you like women and their partners to have?
I want to help women learn to advocate for themselves. I have experience with diabetes, so the menopause journey to find a doctor who will actually listen is not foreign to me. Some women maybe haven’t had to advocate for themselves in the healthcare system, so keep a journal, go into your doctor and say, “These things are happening and I can’t make sense of the picture. What do you think?”
You know your body best. And if you are being told that it’s all in your head or that’s just what happens at your age, that’s not okay. You need somebody to pay attention and a practitioner that says, “You’re right. That is alarming. I don’t know how to help you get to the bottom of it right now, but let’s try this.”
I also feel like being mad at your body is just a waste of time and energy. She’s telling you stuff. You have to respond. Quit beating yourself up over the fact that you’re living long enough to age into a process. Women used to be dead before they would get to this point. Maybe you go from pinning on a bib to adventuring. Maybe it looks different, but you can still be an endurance athlete.