Nutritional Recommendations For Peak Performance
3.2.1. Daily Macronutrient Needs for Exercise
Diabetic athletes have unique nutritional requirements that should be met to aid in peak performance. Proper understanding of current recommendations for caloric and fluid intake before, during, and after exercise is necessary for successful BG management and prevention of hypo- and hyperglycemia. Energy and macronutrient needs, especially CHO and fat, must be met to maximize training effects and maintain health . The recommended balance of these nutrients for athletes does not differ significantly from recommendations for the general population, though additional calories and fluids may be required for diabetic athletes and varies based on circumstances . Current guidelines recommend 5 – 12 g of CHO per kilogram of body mass per day . Table 1 details daily CHO recommendations for athletes by training load .
Diabetic Athletes Need To Take Extra Precautions When Training
Diabetes is a common disease in society, and athletes are not immune. Scott Crabtree, a senior baseball player at the University of New Orleans, is one of those athletes.
It definitely challenges you, Crabtree said. Ill have days where Ill be in the workout room. Well be lifting weights, and my blood sugar crashes. People don’t understand all the time that I have to sit down for a few minutes and eat a snack or drink some Gatorade and relax for about 5-10 minutes, let that blood sugar start to rise back up before I can get back into it.
While not all people understand, his teammates do.
It’s insane, honestly, said Crabtree’s teammate Zach Thompson. My body hurts all the time because we do so much. We’re out here all day every day and with his diabetes and he’s sweating and having to constantly put insulin in and constantly have a certain snack because it goes up and down so much from being out in the sun and running all day. It’s just crazy that he can do it.”
More than 100 million people are living with diabetes in the United States. An estimated 415 million people worldwide are afflicted 1 in 11 of the worlds adult population. Of that total, 46 percent are undiagnosed.
The story of Crabtrees journey with diabetes has resonated well beyond his close circle. He is a global ambassador for Juvenile Diabetes Research Foundation and mentors kids with diabetes. He uses his story to show them how to manage the disease and live an active life.
Walt Arnold
Antonia Gransson Soccer Sweden
A skilled winger capable of playing with either her right or left foot, Antonia Göransson, 28, was sidelined by a type 1 diabetes diagnosis in 2015. At the time, she had signed a contract to play for the Seattle Reign FC in the American National Womens Soccer League. Determined, she travelled to Seattle against her doctors wishes. The stay was short-lived, though, and she soon felt worse. Göransson returned to Sweden after a few weeks. Back at home she signed with a local team in order to be close to her family and friends while managing type 1 diabetes.
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Selecting An Insulin Delivery Method
The primary goal of exercise management in athletes with type 1 diabetes should be to limit dysglycaemia, with a secondary goal of attempting to replace insulin to healthy physiological insulin levels. Complete restoration of insulin to physiological levels is impossible since insulin is administered subcutaneously rather than released into the portal circulation. While some athletes with type 1 diabetes perform well using multiple daily injections of insulin , others prefer the flexibility afforded by continuous subcutaneous insulin infusion . The latter allows for temporary basal rate reductions in anticipation of and/or recovery from prolonged aerobic exercise, temporary basal rate increases for very intensive aerobic/anaerobic work, and for basal rate reductions overnight, if nocturnal hypoglycaemia is an issue. Hybrid closed-loop technology may support glycaemic management in athletes better than traditional pump therapy as insulin delivery is informed by current glucose levels, glucose predictions, previous insulin delivery and other features of proprietary algorithms that improve overall time in range . Currently approved hybrid closed-loop devices are suitable for prolonged aerobic exercise if a temporary glucose target is set well before the start of exercise .
Henry Slade Rugby Union
Henry Slade has been playing rugby for 12 years, living with type 1 diabetes for the past six6 years, and competing as a fly-half on the England national team for the past three years. His diagnosis came after a routine glucose test:
I was a little bit worried but I knew Chris Pennell had it, so I understood that I could still play rugby.
He has been supporting JDRF since 2014 and has given messages of support to others with type 1 diabetes.
Obviously its a serious condition. Theres no getting around that. But its okay as long as you manage yourself. I check my blood sugar levels about eight to ten times a day. I test before every training session and in between as well.
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Add Variety For The Best Outcome
Practise different types of exercise to experience maximum health benefitsaerobic and resistance training as well as stretching and balance training. People with diabetes often develop poor balance and joint stiffness, says Riddell. Yoga and stretching can help with both of these. While it can sometimes be inconvenient to include dumbbell curls, push-ups, and other resistance exercises to your day, keep in mind that just 20 minutes of resistance training twice a week can lead to major improvements in body weight and blood sugar levels, says Riddell.
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Physical Activity In Youth With Type 2 Diabetes
Randomized trials evaluating exercise interventions in youth with type 2 diabetes are limited and inconclusive, although benefits are likely similar to those in adults. In the Treatment Options for Type 2 Diabetes in Adolescents and Youth study , youth aged 1017 years with type 2 diabetes were stabilized on metformin and then randomized to metformin plus placebo, metformin plus rosiglitazone, or metformin plus lifestyle intervention and followed for a mean of 3.86 years. The lifestyle intervention included modest weight loss achieved through dietary energy restriction and increased physical activity , along with metformin use. The rate of glycemic failure was not significantly reduced in the lifestyle plus metformin group compared with metformin only or metformin plus rosiglitazone. Given the limited data in youth with type 2 diabetes, it is recommended that children and adolescents with type 2 diabetes meet the same physical activity goals set for youth in general : a minimum 60 min/day of moderate-to-vigorous physical activity, including strength-related exercise at least 3 days/week.
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Management Of Competitive Athletes With Diabetes
W. Guyton Hornsby, Robert D. Chetlin Management of Competitive Athletes With Diabetes. Diabetes Spectr 1 April 2005 18 : 102107.
In Brief An effective management plan for an athlete with type 1 diabetes must consider the energy demands of intense competition and training,the athlete’s goals, factors related to competitive sports that may affect glucose homeostasis, and strategies that may be employed to allow safe,effective sports participation. Athletes should be appropriately screened,counseled to avoid risky behaviors, and provided with specific recommendations for glucose monitoring and insulin and diet adjustments so that they may anticipate and compensate for glucose responses during sports competition.
Will Cross Mountain Climber United States
Among mountain climbers is there a cooler sport? at least one is managing his blood sugar in the most extreme conditions on Earth: Will Cross. In 1976 at the age of 9, the Pittsburgh native was diagnosed with type 1 diabetes and told he likely wouldnt live to be 30 years old. Now hes a professional adventurer earning a living from diabetes-related corporate sponsorships. Of note, Cross has climbed the highest peaks on all seven continents. Hes also led expeditions to unexplored regions of South America, Greenland, Africa and India. In those unforgiving environments, hes been able to successfully control his blood sugar, hoping to inspire others to take control of their own type 1 diabetes.
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Gary Hall Jr Swimming United States
Olympic swimmer Gary Hall, Jr. had already found success having won two gold and two silver medals at the 1996 games in Atlanta. He won silver in the 50-meter freestyle and the 100-meter freestyle. The gold medals were awarded for wins in the 100-meter freestyle relay and the 100-meter medley relay. At the age of 24, a few years after the games, Hall was diagnosed with type 1 diabetes. The news was devastating. Halls doctors said there was a good chance he would never swim competitively again. Undaunted, he swam in the 2000 Olympic Trials, winning the 50-meter freestyle, where he bested a decade old American record. He earned second in the 100-meter freestyle. From there he competed in the 2000 Sydney Games where he earned a gold and silver medal in the team relays. He took home a bronze medal in the individual 100-meter freestyle race.
The Impact Of Basketball On Type 1 Diabetes
I asked Lauren if there was anything basketball has taught her about diabetes. It taught me to never settle, she said. My freshman year when I got to Baylor I had really high expectations for myself. When I didnt meet those expectations, I was really down and got in my head. It was mental. Same with diabetes, there are those days when my numbers just will not come down. Im doing everything I can and Im still high. Ive learned I cant let that get to my head, I cant get down on myself. If I push through and dont beat myself up, Ill figure things out.
At Baylor, Laurens Coach Kim Mulkey ended up becoming an integral support figure, not only on the court but with Laurens diabetes. She took the time to learn everything she could, not to make me feel different, but to support me. For other coaches of people with Type 1, Lauren recommends that they learn as much as they can. Most people dont know a lot about Type 1, but you dont need to do an overwhelming amount of research. Inform yourself, then talk to your athlete. Every person with diabetes needs different support. Learn the basics to get them what they need especially the typical symptoms of low and high blood sugars but ask questions too. Laurens Baylor teammates were also incredibly supportive, getting to the point where they could recognize if she wasnt being herself and her blood sugar may be low.
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Avoiding Highs And Lows
Hypoglycemia can impair your childs athletic performance and well-being. Hypoglycemia is more likely to occur during exercise when insulin levels in your childs body are too high and can occur in children with type 1 diabetes who have to inject or pump insulin. Hypoglycemia also can affect levels of blood electrolytes such as potassium, that may reduce performance for hours afterwards. You also will want to keep close surveillance on your childs blood glucose levels and watch out for exercise-induced hypoglycemia, which can occur up to 48 hours after an activity.
When insulin is used as part of the diabetes treatment plan, it often is tempting to allow blood glucose to run too high to prevent hypoglycemia. However, hyperglycemia can be detrimental to athletic performance. When blood glucose levels go above 200 mg/dl, your child will start spilling some glucose from his/her blood into the urine, which upsets the delicate balance of electrolytes such as potassium, sodium, chloride and magnesium in the blood. Electrolyte imbalances can impair muscle function and performance.
The Effects Of Exercise Type Order And Timing
Most sports require different types of training and practices in addition to games and competitions. In some cases, adding high-intensity intervals to a moderate aerobic workout may help prevent hypoglycemia, at least in the short run. In fact, some intense activities actually raise blood glucose temporarily by increasing hormones such as adrenaline and glucagon, which raise blood glucose levels. So a brief sprint either before or after an exercise session of moderate intensity may help protect against hypoglycemia. Keep in mind that blood glucose levels tend to decline less during resistance training such as weight, dumbbell or resistance band than during aerobic activity such as jogging or swimming. If your child is engaging in both types of training, you both may want to choose which type is done first based on starting blood glucose level.
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What Is The Difference Between Type 1 And Type 2 Diabetes
Type 1 diabetes is the most common form of diabetes in youth, but it can also affect adults. People with type 1 diabetes need to use manufactured insulin to keep their blood sugars in a healthy range.Type 2 diabetes occurs when a person has elevated blood sugars, either due to impaired insulin sensitivity, insufficient insulin secretion, or a combination of both. Type 2 diabetes is more common in adults over age 45 but has increased in our youth over the past 20 years.
Hydration And Electrolyte Balance
Adequate hydration during training and competition is required to maintain blood volume and for thermoregulation . Athletes with type 1 diabetes may experience mild to moderate dehydration during exercise if their blood glucose is elevated, which can be exacerbated by the fact that hyperglycaemia increases urinary water loss. Fluid intake during training tends to be higher in type 1 diabetes, as compared with control individuals, perhaps because of elevated thirst caused by hyperglycaemia . In general, plain water or a carbohydrateelectrolyte beverage, depending on glucose level, should be consumed at a rate of ~1 l/h .
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Jay Cutler: American Football
Jay Cutler has been the most notable recent diabetic athlete. This is because Cutler was already in the NFL at the time of his diagnosis, and is already one of the most controversial players in the league. This is for a few reasons including his inconsistent play and a perceived bad attitude at times. However, there is no doubt that Cutler is the best type 1 diabetic American Football player. 2015 is his tenth year in the NFL , which is substantially longer than the average NFL career length of 3.3 years and 4.4 years for quarterbacks. He was selected to play in the 2008 Pro Bowl, and led the AFC in passing yards that season, his first after diagnosis.
Control And Performance For Athletes With Type 1 Diabetes At All Levels
Athletes with Diabetes Hooping it up at the DESA national conference.
If youre an athlete who has Type-1 diabetes, you know how important it is to keep your blood sugar under excellent control. Blood sugar levels have a direct impact on strength, speed, stamina, flexibility and healing capabilities all essential components of success in sport and fitness activities.
There have been many athletes with diabetes who have excelled in their chosen sport . But it isnt without its challenges. Different forms of exercise can have very different effects on blood sugar, particularly when adrenal hormones start to kick in. Recovery from an exercise session may take blood sugar levels to strange and exotic places. Whats more, around-the-clock control is necessary for maintaining appropriate hydration and energy stores for athletic performance.
Through his personal and professional experiences, Gary has helped athletes at all levels to incorporate new techniques for controlling blood sugar and enhancing athletic performance. He and his team of diabetes educators offer many services to Diabetic Athletes of all ages.
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Management Strategies For The Athlete With Type 1 Diabetes
3.3.1. Education
Glycemic control in the diabetic athlete is dependent upon both the athlete and healthcare provider having an appropriate understanding of the pathophysiology of diabetes and its nuances with respect to athletic activity. The cornerstone of management for T1DM athletes is prevention of glycemic excursions while maintaining adequate energy balance for exercise performance . All diabetic athletes should be counseled on the importance of establishing a daily pattern of consistency for all aspects of diabetes management. This pattern of consistency would ideally include a routine of insulin administration, consistent caloric intake, regimented exercise program, and frequent monitoring of BG levels . Each athlete is unique and will likely require personalized adjustments until an optimal routine can be established . Education of those working with these athletes is just as important as educating the athletes themselves. For those T1DM athletes who participate in scholastic competition or team sports, it is vital to ensure that parents, coaches, teammates, teachers, and other adults understand the importance of timed meals, snacks, and adequate fluid intake, as well as recognizing the features and management of hypoglycemia .
3.3.2. Glycemic Control and Target Values in Athletics
3.3.3. Insulin Dosing Adjustments for Athletic Activity
Team Novo Nordisk: Cycling Triathlon Running
Though not either a single athlete, special recognition needs to be given to Team Novo Nordisk, a team of all diabetic athletes competing in cycling, triathlon, and running competitions around the world. This is led by their cycling team, which competes at the highest level, and over the last couple years, has improved greatly, achieving their first victory in early 2015.
The success and high level of competition by Team Novo Nordisk is the perfect example of the potential for all type 1 diabetic athletes to achieve great things. Success does not have to be a rare exception, but can be normal enough to fill an entire team with type 1 diabetics.
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