The Diabetic Athlete

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There once was a time when people with diabetes were afraid to exercise because they feared low blood sugar. Nowadays, diabetic athletes are encouraged to participate in all types of sports and activities. The key is to balance blood sugar levels by carefully monitoring food intake, insulin levels, and activity levels. 

Diabetes is a widely know disease that causes high blood glucose (sugar) levels. Two types exist. The first is Juvenile onset diabetes (also known as type 1 diabetes) and is characterized by an early onset (under the age of 25) and occurs when the pancreas does not produce enough insulin.  The second is  Type 2 diabetes , the most common form of diabetes, occurs when the cells are not sensitive enough to the insulin being produced , and is typically linked to a family history of diabetes, obesity, and lack of exercise. The age of onset is usually after 40.

Whether type I or Type II, a diabetic athlete needs to be aware of the signs and symptoms of low or high blood sugar levels and be prepared accordingly. The following are some general tips to follow. More detailed recommendations can be given to individual athletes depending on his/her specific case. 

•Blood glucose levels should be closely monitored before exercise
•A carbohydrate-based meal or snack is recommended one to three hours before exercising.
•Always carry some form of carbohydrates with you, such as hard candy, dried fruits (raisins), fresh fruits, granola bars or crackers.
•Blood sugar levels will rise and fall throughout the day as food is eaten. As food is consumed, the blood glucose levels rise. The level of the increase depends on the type of food that is eaten. For this reason, athletes with diabetes need to eat foods rich in the carbohydrates that gradually increase blood sugar such as, high-fiber fruit (apples, oranges), legumes, milk, most whole-grain multigrain breads, and most pasta. They should decrease foods that result in a sharp increase in blood glucose like simple carbohydrates found in cookies, cakes, chips, sodas, and most junk-food. (For more information about carbohydrates read my article “The Role of Carbohydrates in Athletic Success”)
•If hypoglycemia (low blood sugar) occurs, symptoms include: Dizziness, Headache, Intense hunger, Pale and clammy skin, Confusion/disorientation, Physical weakness. Treat hypoglycemia immediately with ONE of the following: 6 jelly beans, ½ a can of soft drink (not diet), or ½ a glass of fruit juice. Wait 15 minutes. If symptoms persist, repeat. Do not START to exercise with low blood sugars (below 70). Have a snack first.
•In case of high blood sugar (Hyperglycemia) symptoms include: Fruity-smelling breath, Nausea/vomiting, Labored breathing, Dry mouth, Flushed skin, Confusion and Unconsciousness followed by coma. This condition is only reversed by providing the athlete with insulin. An injection of insulin usually prevents the individual from lapsing into a coma. This condition is a life-threatening one and one in which emergency medical services should be immediately called. 
•Be sure to let your coach and/or other teammates know that you are diabetic and what the signs/symptoms of hypo/hyperglycemia are so that they can help you if this should occur.
•If you are on insulin, be sure to talk to your doctor about adjusting your dosage for exercise. Most of the time, having a snack before exercise will be enough.
•Plan to snack during the activity if it lasts longer than one hour.
•Select low fat, high carbohydrate snacks before, during and after exercise. 

Approximately 15g of carbohydrates are needed every 1/2 hour of moderate activity. As snacks, this means: 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) 

•For day-long events, eat six small meals containing both carbohydrates and protein. (Avoid high-sugar, high-fat foods.)
•Eat after the event to prevent hypoglycemia and to refuel your glycogen stores. Hypoglycemia can occur 4 to 48 hours after exercise, so it is important to monitor your blood glucose levels frequently and eat balanced meals and snacks.
•Drink lots of water to prevent dehydration.

References:

•American Diabetes Association.,  www.diabetes.org 
•Shugart, C., Jackson, J., & Fields, K. (January/February 2010). Diabetes in Sports. Sports Health
•Sports Medicine Australia , www.smasa.asn.au