Diabetes needn’t be a barrier to actively enjoying sports, exercise
Contrary to popular belief, the soaring incidence of diabetes is not confined to just the elderly or the obese, but athletes too can and do suffer from it.
However, having diabetes needn’t be a barrier to actively enjoying sports and exercise. Diabetic sportsmen and women are common and diabetics have achieved some of the highest sporting awards available on the planet.
Sport, or exercise of some form, is an essential part of diabetes treatment. Diabetics, like other people, are healthier when they take regular and appropriate exercise.
Participating in sports, whether they are team sports with a competitive objective, or non-regulated sports with intrinsic rewards, can be a great way for diabetics to stay healthy and enjoy themselves.
The management of diabetes varies for each individual. A regular monitoring of blood glucose concentrations and trial and error (under the supervision of your diabetes specialist) is needed to understand and manage each individual’s response to exercise.
There are many questions with regard to how being involved with sport benefits diabetic participants?
Taking part in sport or exercise is a key way of managing diabetes and keeping the body healthy. Being involved in sport and exercise can help diabetes in many ways:
1) Making it easier for the body to use insulin. Insulin is an essential hormone that aids the body in withdrawing energy from food, the function of which is depleted or entirely prevented amongst diabetics.
2) Building muscle, burning calories and losing weight. Achieving and staying at a healthy weight is an essential part of fighting diabetes.
3) Strengthening of muscles, bones and body.
4) Lowering of risk of complications, including heart disease
5) Improved balance, coordination, strength and endurance
6) Increased energy levels
7) Increased mental positivity and confidence
8) Lower tension and stress
Whether you are a diabetic child playing sports at school, or a newly diagnosed diabetic who wants to get into shape to help control blood sugar levels, sport can have major benefits if conducted in the right way.
Always remember that better fitness means a better response to insulin and a better control of blood sugar levels.
Diabetic patients are often advised to exercise because it can reduce the likelihood of suffering from the complications of diabetes. Unfortunately, exercise can also reveal, or worsen some complications, and screening should therefore, be undertaken before diabetic people either start, or increase their level of exercise.
The screening process should identify any complications of the disease that could be revealed or worsened by exercise and also assess the individual’s current level of control over their diabetes.
A pre- exercise programme should typically consists of:
1) A ‘glycosylated haemoglobin’ (HBA1C) blood test to assess how well the person has controlled their blood glucose over the previous few months;
2) Examination of the cardiovascular system, including measurement of blood pressure and assessment of pulses in the arms and legs, and a test to check blood lipid profile;
3) Examination of the eyes to identify any problems caused by diabetes;
4) Examination of the nervous system of the upper and lower limbs to identify any loss of feeling or weakness due to nerve damage;
5) A check for diabetic foot ulcers;
6) Blood and urine tests to check kidney function.
Diabetic people are at increased risk of ischaemic heart disease, but may not experience the chest pain normally associated with it, because of nerve damage caused by diabetes. The latest published advice suggests that an exercise stress test should be performed if the patient:
1) Will be undergoing vigorous activity (heart rate over 60% of maximum);
2) Has had Type 2 Diabetes for over 10 years or Type 1 Diabetes for over 15 years;
3) Is over 35 years old;
4) Has risk factors for coronary artery disease (eg high blood pressure, high cholesterol);
5) Has any of the cardiovascular, eye, kidney or nerve complications of diabetes.
What are the factors needed to be considered in determining the intensity and duration of exercise? Pre-exercise insulin dose generally needs to be reduced when exercise extends beyond 30 minutes. The level of reduction varies for each individual but, in general, the longer the period of exercise, the greater the reduction required. Adjustments to insulin should be made with the guidance of your diabetes specialist, especially in the early stages of management.
It is easier to manage and predict the body’s response to exercise when metabolic control is good. It is dangerous to commence exercise when blood glucose levels are high and Ketones are present in the urine.
It is common practice to use a mixture of short and long lasting insulin to manage diabetes. It is necessary to predict the peak period of insulin activity to avoid excessive levels of insulin in the blood at the same time as exercising.
Insulin absorption is increased in exercising muscles. The abdomen is usually the preferred site for insulin injection prior to exercise.
Insulin requirements are influenced by the amount and type of food consumed.
All diabetics benefit from a diet high in complex carbohydrates and low in fat – not at odds with general sport performance recommendations! Some Type 2 diabetics need no more than a good diet to achieve control of their diabetes.
Before a training session, a carbohydrate-based (Low GI food) pre-exercise meal one to three hours before exercise is recommended. This may need to be followed up with a small snack closer to exercise.
Blood glucose concentrations should be monitored closely before exercise. It may be necessary to consume extra carbohydrate before commencing exercise if blood glucose is low.
Blood glucose control is easier if you have a consistent training routine. It becomes more difficult in competition situations when the start time is unknown (e.g. athletics) or the length of the event varies (e.g. tennis). Being attuned to the symptoms of hypo- and hyperglycaemia and regular monitoring is necessary in these situations.
During a training session, eating depends on the duration and intensity of exercise.
In general, additional carbohydrate should be considered as exercise exceeds one hour or more or moderate to high intensity. Research suggests 30-60 g of carbohydrate per hour will aid performance in these situations.
It is not necessary to have extra insulin if you eat during exercise. Choices such as sports drinks that provide fluid and carbohydrate are a convenient option for most exercise situations.
Options such as carbohydrate gels, fruit and sports bars may also be tolerated. If additional carbohydrate is required during exercise, it is better to consume small amounts frequently rather than leave it until the last minute.
General sports nutrition recovery strategies are the same as for non-diabetic athletes. Fuel and fluid used during exercise needs to be replaced.
The increased insulin sensitivity caused by exercise lasts for several hours after exercise. Therefore the risk of hypoglycemia persists for some time. Delayed hypoglycemia can occur 4-48 hours after exercise. Preventing delayed hypoglycemia involves making sure you consume sufficient carbohydrate before, during and after exercise. It may also be necessary to reduce the next insulin dose after exercise.
Waking up feeling very tired and groggy in the morning may indicate you have experienced a ‘hypo’ during the night. This is a sign that you need to increase blood glucose monitoring after similar exercise sessions in the future
Athletes with diabetes need to consider the following:
Travel – Diabetic athletes should have a doctor’s note and a copy of their prescription in order that they can travel with insulin, needles and syringes and their blood glucose monitoring equipment. Travel across time-zones can affect blood glucose levels and meals and medication doses may need to be adjusted accordingly.
High-risk sports – The short-term complications of diabetes, especially hypoglycaemia, can increase the risk in sports such as paragliding, parachuting, scuba diving and rock climbing. Diabetic individuals who want to participate in such sports should always seek medical advice first.
Finally, here are some takeaway TIPS !!!
Stay alert and aware, and always taking medical advice,
Know how to recognize the signs and symptoms of Hypoglycemia and Hyperglycemia.
Dr.Vikas Ahluwalia, Director, Diabetes Care Foundation Of India
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