Type 1 Diabetes
- Autoimmune destruction of pancreatic beta cells.
- Usually diagnosed in adolescence.
- Rely on exogenous (outside) insulin to manage blood sugar levels.
Type 2 Diabetes
- Insulin is present, but does not function efficiently to stimulate glucose uptake into cells: insulin resistance
- Correlates strongly with obesity and unhealthy lifestyles.
- Usually diagnosed later in life (~ 40 years old)
Benefits of Exercise
- Improvements in health-related quality of life
- Decreases blood pressure
- Improvements in lipid abnormalities
- Increase insulin sensitivity
- Decrease insulin requirements
- Lower hemoglobin A1C levels
- Improvement of cardiovascular fitness
American Diabetes Association Guidelines
Metabolic control before exercise
- Avoid exercise if fasting glucose is >250 mg/dL and ketosis is present
- Use caution if glucose is >300 and no ketosis
- Add carbohydrates if glucose is <100
Monitor blood glucose levels before and after exercise
- Learn the glycemic response to different exercises
- Identify when changes in insulin or food intake are necessary
- Consume added carbohydrates to avoid hypoglycemia with exercise
- Carbohydrate rich foods should be readily available during/after exercise
Healthy Eating for Peak Performance
- 3-6 hours before event, eat a meal of 200-350 carbohydrates.
- Monitor blood glucose levels regularly and adjust insulin doses as needed.
- 1 hour before event, eat 1 g of carbohydrate per kg of body weight.
- < 45 minutes before event, eat 15 g of carbohydrates.
- During prolonged exercise (> 45-60 mins), you may want to intake 15 g of carbohydrates every 30-60 minutes.
- Monitor blood glucose levels @ 1-2 hour intervals.
- To replace glycogen to pre-exercise levels, consume 1.5 g of carbohydrates per kg of body weight within 30 minutes.
- Dizziness, weakness, sweating, headache, hunger, pallor, blurred vision, slurred speech, confusion, irritability, and poor coordination.
- Plan a pre-exercise snack high in carbohydrates, low in fat and moderate in protein content.
- Post-exercise snack should consist of carbohydrates and protein.
- Always have fast-acting carbohydrate sources readily available.
- Reduce short-acting insulin 30-50% to decrease hypoglycemia
- Reduce the action of the pump by 50% an hour before activity for intense workouts
- Reduce the pre-meal bolus for a lower-intensity workout
If hypoglycemia occurs:
Stop exercise, treat immediately with 15 g of carbohydrates and monitor blood sugars every 15 minutes.
- Thirst, fatigue, muscle cramps, blurred vision, nausea, drowsiness, abdominal pain, nausea, vomiting, sweet-smelling breath, and dry mouth.
- Follow your meal plan, exercise program and medicine schedule.
- Know your diet, count total carbohydrates that you are consuming
- Take insulin/medications when prescribed.
- Test your blood glucose regularly.
If hyperglycemia occurs (>250 mg/dL):
- Check for urinary ketones.
- If ketone level is moderate to high, exercise should be avoided until glucose values improve and ketones resolve.
- If no ketones detected, patient may exercise a long with monitoring their blood glucose levels every 15 minutes to demonstrate glucose values are falling.
Avoid exercise if blood glucose values are >400 mg/dL.
- Frequent glucose monitoring is obviously essential for safe exercise.
- Carry some form of carbohydrate snack
- Carry medical identification
- Exercise with a friend who knows you have diabetes
- Carry a cell phone in case of a diabetic emergency.
- Invest in good footgear.
- Use extra care to avoid large fluctuations in plasma glucose when exercising in the cold or heat.
- American Diabetes Association http://www.diabetes.org
- P. Farrell. Diabetes and Exercise: Tips for Better Performance. Gatorade Sports Science Institute. 2003. 16:3 (7-8). http://gssiweb.org/
- J. MacKnight, D. Mistry, J. Pastors, V. Holmes, & C. Rynders. The Daily Management of Athletes with Diabetes. Clinical Sports Medicine. 2009. 28 (479-495). http://www.sportsmed.theclinics.com