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With proper control and reasonable precaution, diabetes should not keep anyone from participating in sports. Diabetic athletes routinely compete in athletic events from Iron Man triathlons to professional football. New insulin pumps and blood glucose monitoring devices make it much easier for athletes to monitor their bodies response to exercise and act according to physical needs. While diabetes can be effectively managed, the associated risks require careful planning for training or competition. it is important to consult your doctor before starting an exercise program, so a complete risk assessment can be performed and a safe training and competition schedule can be designed.
Exercise for the Diabetic Athlete
Because exercise lowers the blood sugar levels and helps improve the body's use of insulin, an athlete often needs to reduce the insulin dose before exercise. Exercise also increases the blood flow to the skin and muscle tissue, and increases the amount of insulin in the blood stream. Exercise also acts as a stimulant to the liver, which releases glucose to the blood stream. Because blood concentrations of glucose may continue to rise if the diabetic begins exercise with a high glucose level, it is best to bring the level down prior to beginning exercise.
Balancing Blood Sugar Levels
Diabetic individuals need to maintain a good balance of the body's blood sugar level (between 70 and 180 mg) to be successful with physical activity. The athlete's performance becomes affected when this balance is not maintained. When the body produces too much insulin, the blood sugar levels drop, causing hypoglycemia to occur. With a lack of insulin, the blood sugar will rise and result in hyperglycemia. Because some of the symptoms of the two conditions may look like normal reactions to exercise (sweating and paleness), it is important that a diabetic athlete (or a coach) is aware of the following symptoms.
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Symptoms of low blood sugar (hypoglycemia)
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Symptoms of high blood sugar (hyperglycemia)
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- decreased physical performance
- variable mood
- paleness
- tremor
- headache
- sweat
- poor vision
- fatigue
- hunger
- dizziness
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- sleepy
- dry mouth
- frequent urination
- fatigue
- extreme thirst
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What to do for hypoglycemia
If a diabetic senses the onset of low blood sugar she can take measures by eating or drinking food with a high concentration of carbohydrates. If the athletes does not realize that she is experiencing a low blood sugar problem, it is important for a coach or training partner take action and offer carbohydrates to the diabetic. In very extreme situations, the athlete may not be able to swallow or may become unconscious. If this happens, call for help immediately. A physician or paramedic may inject glucagon, which is a hormone that releases glucose from the liver into the blood stream. After receiving glucagon, the person should soon regain consciousness.
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Safety Tips for Diabetic Athletes
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- Check your blood sugar levels before and after workouts and every 20 to 30 minutes during prolonged exercise.
- If blood sugar is under 100 mg/dL, take a snack containing 15 to 30 grams of carbohydrate before you exercise.
- If blood sugar is excessive (over 250 mg/dL for type 2 diabetes or over 200 mg/dL for type 1, postpone exercise until you bring it down.
- Know the signs of hypoglycemia and be prepared with available snacks.
- Exercise 1 to 2 hours after a meal.
- Avoid exercise at times of peak insulin activity. Morning exercise is ideal. People who have type 1 diabetes should avoid evening exercise, if possible.
- Adjust your insulin dosage, if necessary. (Follow your doctor's advice, but this usually means reducing the dose of short-acting insulin before exercise.)
- Patients who take oral antidiabetic drugs may need to change their dosages. Follow your doctor's advice.
- After prolonged or intense exercise, you may need extra carbohydrate foods for up to 24 hours to refill muscle starch reserves. Beware of delayed hypoglycemia.
- Drink plenty of fluids: about a pint 2 hours before exercise, and drink after exercise to replace fluids lost in sweat.
- Pay attention to your feet. Wear proper shoes and socks.
- Avoid alcohol around the time of exercise (even the night before a morning workout).
- Wear an ID band of some sort in case of emergency.
- Pay attention to your body, and become aware of your own pattern of blood-glucose response to exercise.
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Remember diabetes is a manageable condition. Be familiar with signs and symptoms of hypo and hyperglycemia to help you to be more attuned to your needs. Always discuss you exercise training schedule with your physician to develop an appropriate plan for your needs.
Why Exercise?
Not a week goes by that we don’t receive two or three e-mails asking us about exercise, why one should exercise, and specifically which exercises burn the most calories. Your health care team tells you to get more exercise and here on these pages, we’ve discussed the many ways to exercise. You’ve tired it, but you hate it or don’t have the time and/or energy to exercise with all of the things you must do daily just to maintain life and home.
Perhaps, it’s time to focus back on the reasons for exercising when you have diabetes. First, before you start any exercise program, discuss your plans with your doctor or diabetes educator so that any necessary insulin and/or medications can be adjusted, if necessary, for your increased physical activity.
Exercise is good for your diabetes, your general health, your heart, your mood, and your confidence. We’re not talking strenuous aerobics, using a cross-country ski machine, or working out at a health club here, just a few minutes of increased physical activity rather than watching TV and thinking about exercising. You hardly have to break into a sweat. Ridiculous? Not at all; the latest studies show major health benefits from exercise so modest that it doesn’t even feel like a "workout."
Besides significantly decreasing insulin resistance, making it easier to control your blood sugar levels with less insulin and/or medications, even modest exercise can also reduce blood pressure and cholesterol, reducing risk of cardiovascular disease. Other benefits include better weight control, increased sexual desire and pleasure, better memory, less risk of colds, and better sleep and less insomnia. Moderate exercise has also been proven to help replace the nicotine high of smoking, making it easier to cut down or stop smoking. Since exercise moves major joints through their full range of motion, exercise can be beneficial in the management of arthritis.
Adding Physical Activity to Your Daily Life
- Take a walk--as little as 20 minutes a day of brisk walking adds up at week’s end. Walking can keep blood sugar levels under better control and helps prevent bone-thinning osteoporosis Add walking downstairs and park your car a few blocks away from the mall, church, office, or friends’ home. When you’re ready, try walking up stairs; go only half way at first and work up to climbing all the way. Take a walk before lunch; you’ll eat less and will suffer less from mid-afternoon "slump." Keep a pair of walking shoes at work for walks at lunch or break time.
- Instead of meeting the gang for coffee and doughnuts, make a date to take walks, go for a bike ride, or go dancing.
- What else can you do? Walk a little more briskly when shopping; stretch, bend, and lift a little more when doing work around the house or apartment. Washing floors, vigorous sweeping and vacuuming, and other household chores can add up quickly (see chart below). Play with your child, grandchild, or pet. If you’re a grandparent, offer to walk the baby. Pushing the little one in a stroller is a great exercise and allows you to "show off" your "little angel." Take an older child to the park and push them on the swings and merry-go-round. Play a game of tag.
- Start out slowly and increase your activity as your body adjusts. It takes about eight weeks to start feeling the physical and emotional changes of exercise, longer if weight loss is your goal. Only do things that are fun; find a buddy and exercise together. Vary your exercise so you don’t get bored.
- Moderate exercise will make you feel better able to cope with tension and stress. It creates self-confidence which boosts self-esteem. Endorphins released by exercise have an antidepressant effect
If you have diabetes, always test your blood before and after any exercise. For most, the safe pre-exercise blood glucose range is from 100 to 250 mg/dl. If yours is less, have a snack to raise it before exercising. If it’s between 100 and 150 mg/dl, test during exercise and be prepared with glucose tablets or a 15 gram carbohydrate snack to treat hypoglycemia. Some physicians tell people with type 2 diabetes not to exercise with a blood glucose level over 200. Check with your health care team for their recommendation. If you have type 1 diabetes and your blood glucose level is higher than 250 mg/dl and you have moderate or high levels of ketones in your urine, don’t exercise until your gotten your readings down near normal. Call your doctor if your ketone levels remain high. With either type of diabetes, don’t exercise if your blood glucose is greater than 300 mg/dl. Contact your physician and make sure it’s down before you do even moderate exercise.
If you use insulin, don’t exercise when your insulin is peaking; a muscle exercising absorbs insulin faster than muscle at rest. Ideally, wait an hour to exercise after injecting insulin. Everyone should drink fluids during and after exercise.
Calories Used by Daily Activities--Based on a 150-Pound Person*
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Activity |
Calories Per 30 Minutes |
| Making beds |
70 |
| housework |
75 to 125 |
| strolling |
105 |
| raking leaves |
115 |
| lawn-mowing (power) |
125 |
| lawn-mowing (push) |
150 to 225 |
| gardening |
150 to 225 |
| slow swimming |
150 |
| golf, pulling cart |
150 |
| golf, carrying clubs |
150 to 155 |
| moderate walking |
150 |
| ice or roller skating |
155 to 240 |
| badminton |
175 |
| square dancing |
175 |
| bowling |
200 |
| tennis, singles |
210 to 240 |
| downhill skiing |
240 to 300 |
| moderate bicycling |
330 |
| running |
330 or more |
| *Source: National Exercise for life Institute
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Keep track of when and how long your exercise, along with your blood glucose control. You’re sure to see a change. And, don’t forget to have fun while you exercise! Exercise Log
| Date |
Activity |
Time
Spent |
BG Before |
BG After |
Comments |
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ADA exercise pages
http://www.diabetes.org/main/health/exercise/faqs.jsp
See also Joslin tips
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