If you have problems with your:

• feet - avoid running and see a podiatrist and your doctor
• eyes - avoid high impact sports and heavy weights
• heart or blood pressure Œ avoid heavy weights or intense exercise
• nerves or blood vessels in your legs - avoid running, swim, cycle or do light weights.

Plan to increase your exercise level slowly (by only 10% a week)

• Hypoglycaemia can occur during exercise, after exercise or hours later.
• Have high carbohydrate food / fluids available before, during and after exercise.
• All athletes should drink fluids during exercise.

A "Hypo" means an episode associated with a low blood glucose level. (Normal blood glucose 3-8 mmol/L) Symptoms may include sweating, faintness, nausea or fast heart beat. (These symptoms can also occur with intense exercise). Other symptoms such as blurred vision, headaches, clumsiness or pins and needles around the mouth may alert you to a "hypo". Carry a blood glucose meter or have one available so that you can test your BGL (or read a strip visually). "Hypos" can occur up to 24 hours after exercising. Your usual symptoms may occur sooner and be less predictable when you start an exercise programme.

Treat "hypos" immediately with:

• 3 glucose tablets
• or 6 jelly beans or 2 barley sugars
• or 1/2 can of soft drink (not diet)
• or 1/2 glass of fruit juice
• You should follow this with some longer acting carbohydrate foods e.g. fruit, sandwiches, yoghurt

If you have a "hypo", next time try reducing your insulin or take a snack pre-exercise.

Exercise hormones cause glucose to be released from the liver. When there is not enough insulin your muscles are unable to use glucose, so your blood glucose level will INCREASE.

• If your BGL is higher than 14, check your urine for ketones.
  • f positive for ketones - the insulin level is too low, you should not exercise.
  • If negative for ketones - exercise cautiously

• Try and get good blood glucose control and be prepared to test your blood glucose regularly
• See your Doctor to:
• Check - heart risk factors, eyesight, feet and kidneys
• Develop an exercise plan by discussing
  • what type, intensity, frequency and duration of exercise suits you
  • what changes in diet and insulin you may need
• Wear a Medic-alert identification bracelet or emblem
• Understand that hypo's (low blood glucose) can occur during and after exercise
• Understand how to treat hypo's
• Make sure your friend or coach can recognise and treat a hypo

Below is a flow chart which shows how to develop your own exercise programme.
Monitor your exercise, diet and insulin to achieve the best control of your blood, glucose level.

Athletes with diabetes should consume their usual healthy diet, with some extra choices of carbohydrates. Healthy eating is based on balance and variety.

An athlete's diet should have:

• Carbohydrate 55-70%
• Fat <35%
• Protein 12-16%

Athletes get most of the energy needs from carbohydrate (starch and sugar). The daily energy needs for athletes are usually higher than non-athletes.

Use the Healthy Food Pyramid to help you have a balanced diet, with most food choices from the bottom of the pyramid (bread and cereals) and occasional choices from the top of the pyramid. Review your dietary needs with a Sports Dietician.

Select low fat, high carbohydrate snacks before, during and after exercise.
Approximately one exchange is needed every 1/2 hour of moderate activity.

Some 15 G Exchanges include:

• Sports Drinks 250 mls (one cup)
• Half cup of orange / apple juice or half can of coke
• One cup of skim milk or 200g non fat yoghurt (plain)
• One apple / orange or small banana
• One slice of bread, 4 rye crisp breads or wafers
• Jam or honey sandwich (one slice of bread)
• Banana smoothie (1/2 small banana and 1/2 cup skim milk)

Start "recovery" feeding immediately after exercise to replace energy stores.
Have at least 50g of carbohydrate, preferably rapidly absorbed foods eq.

• 4 rice cakes with 4 tsp of jam or honey
• banana sandwich
• 1 can of soft drink
• 3 glasses of sports drink eg Powerade
• 500ml of fruit juice

Repeat this every 2 hours for up to 24 hours after intense exercise or until your normal meal pattern is established.

Before you travel

• Notify the airline and hotels that you have diabetes and what you may need (eg diet and cool storage); take extra food in case the right food is not available or there are delays
• Ask your doctor for a letter and details of whom to contact in an emergency
• Check your travel insurance
  • if you are unable to get insurance contact your state branch of Diabetes Australia
• Ensure that you have
  • extra insulin
  • extra syringes
  • a spare glucometer battery and extra testing strips
  • extra food /fluid with you (in case there are delays)
• Take 2 separate supplies of insulin and snacks; pack them in 2 separate pieces of hand luggage
• Time change with travel may alter your insulin and dietary needs. Check with your doctor or diabetes educator

On arrival at your destination

• Change to local time
• Take more frequent BGL's - run slightly high to avoid hypo's
• Be careful with alcohol and unusual foods