Diabetes

What is Diabetes?

Diabetes causes high blood glucose (sugar) levels due to:

• not enough insulin produced by the pancreas
• body cells not sensitive to insulin.

This information is for athletes with Insulin Dependent Diabetes

Benefits of Exercise

• Heart benefits in that it improves blood pressure and cholesterol.
• Feeling better.
• Improved weight control.
• Improved fitness.
• Insulin works better.

How to develop an exercise plan

• Each active athlete with diabetes needs to learn to balance their insulin, diet and exercise.
• Develop your own management plan by regular glucose blood testing.
• Have an exercise diary to record your dose of insulin, BGL (blood glucose level) and dietary changes and your exercise (intensity and duration) to work out changes to your insulin and diet before you exercise again.
• Exercise at a time when you have slightly higher blood glucose.
• You may need to reduce your insulin as your exercise program progresses.
• After having your insulin, don't change your exercise programme for that day.
• Every athlete is different and you need to develop your own programme.
• It may take several months to establish the right plan for you.
• All athletes should discuss their exercise programme, diet and insulin with their doctor, dietitian and diabetes educator.

Precautions

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 - avoid heavy weights or intense exercise
• nerves or blood vessels in your legs - swim, cycle or do light weights - avoid running.

• hypoglaecemia 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!

Hypoglaecemia (hypo's)

Hypo means an episode associated with a low blood glucose level (normal blood glucose 3-8 mmol/L).

Symptoms may include:

• sweating
• faintness
• nausea
• fast heart beat.

• 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). Hypo's 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 hypo's immediately with:

• 3 glucose tablets
• or 6 jellybeans and 2 barley sugars
• or 1/2 a can of soft drink (not diet)
• or 1/2 a glass of fruit juice.

You should follow this with some longer acting carbohydrate foods e.g. fruit, yogurt or sandwiches.

If you have a hypo, next time try reducing your insulin or eating a snack before exercise.

What if my pre-exercise BGL is high (>14)?

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.

• If positive for ketones - the insulin level is too low and you should NOT exercise.
• If negative for ketones -  exercise cautiously.

Before starting an exercise programme

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 of intensity, frequency and duration suits you and what changes in diet and insulin  you may need
• wear a medic-alert bracelet or emblem
• understand what hypo's can occur during and after exercise
• understand how to treat hypo's
• make sure your friend or coach recognises and can 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.

Dietary Advice

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: less than 35%
• protein: 12 - 16%.

Athletes get most of their energy needs from carbohydrates (sugar and starch). The energy needs of athletes are usually higher than those of non-athletes.

Use the healthy food pyramid to help you have a balanced diet, with most choices from the bottom of the pyramid and occasional choices from the top of the pyramid. Review your dietary needs with a sports dietitian.

Exchanges

Some 15g exchange includes:

• sports drinks 250 mls 1/2 (1 cup)
• 1/2 a cup of orange / apple juice or 1/2 a can of coke
• 1 cup of skim milk or 200g of non fat yogurt (plain)
• 1 apple, orange or small banana
• 1 slice of bread, 4 rye crisp breads or wafers
• jam or honey sandwich (1 slice of bread)
• banana smoothie (1/2 a banana and 1/2 a cup of skim milk).

Recovery

Start recovery i.e. feeding immediately after exercise to replace energy stores. Have at least 50g of carbohydrate, preferably, easily absorbed foods. For example:

• banana sandwich
• 1 can of soft drink
• 3 glasses of sports drink e.g. Powerade
• 500ml of fruit juice.

Repeat this every 2 hours for 24 hours after intense exercise or after normal meal patterns have been established.

Carbo loading

Travel

Before you travel:

• notify the airline and hotels that you have diabetes and what you may need. (e.g. 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 of delays
• take 2 extra 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.

Areas for special care

Having IDDM puts you at special risk of heart disease and the complications of diabetes involving feet, eyes, skin, kidneys and infections. Being active and having a healthier lifestyle can reduce heart risk factors.