Diabetic AthletesQuestions answered in this presentation• How does Type 1 Diabetes affect athletes and athletic

performance?• Does this condition affect pre competition and post

workout meals?• What is Type 1 Diabetes and how does it affect

nutrient transportation?• Are Type 1 Diabetic Athletes at a disadvantage?

What is Type I Diabetes?

What is Type I Diabetes?

• Also known as Juvenile Diabetes

• Autoimmune basis

• The beta cells of the pancreas can no longer make the correct amount of insulin because the body’s immune system has attacked and destroyed them.

• Tis disease tends to occur before the age of 30

• Includes only about 5% of diabetics.

Bolus: regular or fast acting insulin injection

Symptoms

Treatment and Control

• Insulin injections

• Change in diet (nutrition)

• Physical activity

• Controlling blood pressure and cholesterol

Overview:

• Non-diabetic when BG levels rise above normal (70-99 mg/dl fasting), the hormone insulin is released to help lower

• Type 1 the pancreas has a reduced or in ability to release insulin; ALWAYS insulin requiring

How Type I Diabetes affects Athletes and performance

• Insulin levels on Exercise Glycemia

– Physical activity promotes the uptake of glucose into active muscle cells

• This is why correct timing and dosage of insulin are key to the effective glucose management during exercise.

• Maintaining energy levels throughout exercise/performance becomes less manageable needs to be planned

How Type I affects performance and athletes

• Timing of Exercise– Late evening can result in nocturnal hypoglycemia– Early morning exercise can result in later-onset

hypoglycemia– Higher chance for hypoglycemia when participating in

successive days of practicing/competing.

• Does not have to affect performance if levels are steady pre-competition (with the exception of endurance athletes)

Type 1 Diabetes & Athletic Performancev

• Hypoglycemia abnormally low levels of glucose in the blood (low blood sugar) negatively impacts diabetic performance

• Dramatically lowers exercise performance• Causes onset fatigue reducing exercise endurance• Reduced ability to secrete beta-endorphins during

exercise increasing perceived effort • Poor metabolic control causes decrease in maximal

aerobic capacity• Reducing insulin & increasing carbohydrate/fluid intake

allows individuals to compete at optimal performance

Above are things that can happen if one is not meeting their body’s requirements.

What’s normal levels of Glucose?

Hypoglycemia

• 40-80 mg/dl

Hyperglycemia

• 120-400mg/dl

Normal80-120 mg/dl

(some website say 70-99)

Strategy Pros Cons

Reduce pre-workout bolus Reduced hypoglycemia during exercise (reduce Carb requirements)

Requires planning

Adjusting pre-exercise and during exercise basal rate

Same as above Requires planning as basal adjustments may need to be made 60 minutes prior to the beginning of exercise

Carbohydrate feeding during exercise

Useful for unplanned exercise (or long)

Counter productive if exercise is for weight control

Pre-exercise or post exercise sprint

Reduces post exercise hypoglycemia

Effect limited to shorter and less intense exercise

Reducing basal insulin post-exercise

Reduces nocturnal hypoglycemia

May caused raised fasting blood glucose

Taking caffeine pre- exercise Reduced hypoglycemiaduring and after exercise; reduce Carb requirements

Impairments of fine motor control

Risks & Benefits of ExerciseWith Diabetes

Benefits Risks

Same as people without Type 1 Hyperglycemia

Increased whole body insulin sensitivity

Hypoglycemia

Potentially lower A1C in children and adolescents with type 1

Muscoskeletal Injury

Cardiovascular Accident

Daily macronutrient intake

Carbohydrate - 55 to 60%

Fat - 25 to 30%

Protein - 12 to 15%

Pre-Competition Meals

• Consumed 3 – 4 hours before competition

• Critical to maintain BG levels in the near-normal range (4 to 7 mmol/L)

• Beverage containing 1 to 2 g carb/kg body weight should be consumed 1 h prior to competition to maximize pre-exercise glycogen stores

• 6% carbohydrate electrolyte beverage containing simple sugars like sucrose & fructose are ideal

Pre-Workout Meal1. Check BG about one hour before2. Options

– Coconut water with one ounce of raw nuts– 2% organic milk or yogurt with a piece of fruit– All natural whey protein with flax seeds and frozen

broccoli– Pepper, carrots, and hummus wrapped in a slice of

turkey breast

3. Calculate amount of insulin you need from your snack so you can be within 100-150 mg. (depends on individual)

• Carbohydrate ingestion is essential for maintaining BG concentrations

• Carbohydrate intake delays fatigue & provides fuel for oxidation

• The amount consumed depends the exercise intensity, gender, age, and the timing and dose of the last insulin injection

• 1 to 1.5 g carb/ kg body weight should be consumed during exercise

• Continue fluid intake (250 mL every 20–30 min)

Intake During Competition/Exercise

Nutrient Intake Following Exercise

• Carbohydrate intake is needed to help replenish liver and muscle glycogen stores.

• Carbohydrate intake should be within the first hour following exercise

• Consume slow-acting carbohydrate to protect against post-exercise late-onset hypoglycemia

Post Workout Meal

• Having carbs to protein in a ratio of 4:1

• This will help prevent low blood sugars later

What the Athletes have to say…

Famous Type I Diabetic AthletesJay Cutler

"The more you put in your body the more you have to regulate it with insulin. So later kickoffs you're talking about breakfast, lunch and a pregame meal, so that's more food you've got to be aware of and what you put in your body. A noon game, light breakfast, a little fruit and some insulin and I'm good to go." (Jay Cutler ESPN)

Ron Santos"But I don't want this to go outside this room," I said. "I expect you to judge me by what I do on the field. I just don't want to hide anymore.” (Ron Santos)

Final Reminders

Interview Summary1. Diabetes DOES affect performance a great deal2. Most often, the more intense the work out the less insulin

you will have to take.) 3. Also, I can't speak for others but for me, adrenaline affects

my sugar levels A LOT. Because I know this about myself, whenever I am in a competition, I test a ton, monitor my sugars, and do the best I can to keep them level.

4. DISADVANTAGE; no matter how much you try to control, body does what it wants

Conclusion:” I am lucky and blessed to have medicine and technology that enables me to live. If you have a good outlook and proper guidance, there is not much a diabetic can't do. It may take a lot more effort on our part, but it is a responsibility you take on for love of your sport or fitness goals. It sucks, but it is still manageable.”

Sources