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Managing Diabetes in Athletics: Essential Guidelines for Diabetic Athletes

This article discusses the unique physiological considerations and guidelines for athletes with diabetes, authored by Jason Blackham, MD. It covers the effects of exercise on insulin regulation, necessary pre-participation screenings, and the management of blood sugar levels during athletic activities. Key topics include the impacts of exercise on insulin sensitivity, strategies to prevent hypoglycemia and hyperglycemia, and the importance of monitoring blood sugar levels. Tailored exercise recommendations are provided to enhance performance while ensuring safety for diabetic athletes.

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Managing Diabetes in Athletics: Essential Guidelines for Diabetic Athletes

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  1. The Diabetic Athlete:Implications, participation Jason Blackham, MD August 21, 2008 Sports Medicine Rounds

  2. Objectives • Physiology of insulin • Exercise effects on insulin regulation • Pre-participatory screening • Guidelines for the diabetic athlete

  3. Insulin • Glucose transport into • Muscle • Fat cells • Liver • Decrease release of • Free fatty acids from fat cells • Glucose from liver

  4. Exercise on insulin • Decreases insulin • Stimulates glucose transport into muscle • Increases cortisol • Therefore, increase in insulin sensitivity • Allows free fatty acids and glucose to be mobilized for energy

  5. Warnings • Post exercise hypoglycemia at 2 and 18 hours though can last 30 hours • Too much insulin with exercise, suppress glucose release from liver and fatty acids from adipose tissue • If BS >250, then it increases with exercise • If BS is elevated and not enough insulin, then post exercise hyperglycemia occurs due to lack of increase in post exercise insulin

  6. Warnings • Anaerobic exercise may increase BS • Too little insulin, fatty acid metabolism leading to ketones and DKA • With hypoglycemic event, risk of further hypoglycemia

  7. Pre-participatory screening • Good control of blood sugars • HbA1c < 7.5% • Measuring BS at least 4x/day, prefer 6x • Most BS are 80-180 • Know symptoms and what to do for • Hypoglycemia • Hyperglycemia • Know how to adjust insulin/carbs before and after exercise

  8. Pre-participatory screening • Screen for complications • Retinopathy • Neuropathy • Nephropathy • Cardiac screening? • Foot/skin care • Lipids • Ever had DKA or hospitalized for diabetes

  9. Guidelines for exercise • If BS < 80-100, • eat extra carbohydrate prior to exercise, recheck in 30 minutes. • If BS 100-200, goal • If BS >200-250, • Check urine ketones, if + no exercise • If BS > 250-300, • Don’t workout, wait until under control

  10. Guidelines for exercise • How to avoid hypoglycemia • Decrease pre-exercise insulin by 50-80% • Increase pre-exercise carbohydrate • Don’t exercise when insulin is peaking • Measure post exercise BS • Don’t exercise when sick

  11. Guidelines for exercise • Know where to inject- • Don’t inject in working muscle • Heat increases absorption • Cold decreases absorption • Massage increases absorption • Insulin storage between 40-80 degrees • Nutritionist, diabetic nurse

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