Sports, like exercise, play a large role in most kids' lives. A child with Type 1 is no different. Yet it seems as if including the physical component with diabetes management adds a wild card that often trumps all other management efforts and brings with it a whole host of questions and unknowns.
To find out why this is, I needed to dig and talk to some of the experts in the field of managing sports, exercise performance and diabetes. Like most things with this condition, there is no formulaic answer, no silver bullet. More often than not, the answer is just as much art as it is science, and is dynamic with varying situations.
Physiology, Sports & Type 1
My first discussion was with Joe Largay, a Physician Assistant and CDE with the University of North Carolina, Chapel Hill and Chair of the Board of Directors for the Diabetes Exercise & Sport Association. He was diagnosed with Type 1 twenty-five years ago right after he'd made the decision to become a competitive cyclist. At that point in time, he explains, there was very little information available on managing Type 1 and exercise. Today, he counsels and coaches Type 1 athletes on how to better managing their condition while improving their athletic performance.
Largay laid the ground work for me by explaining that managing one's diabetes as effectively and efficiently as possible when participating in sports "gets down to knowing physiology ... [each person is] an individual and needs to take into account how your body reacts to these three variables [in terms of the activity]: duration, frequency, and intensity."
To delve deeper into these ideas, let's first look at the intensity factor. Take the example of Gary Hall, Jr. the Olympic swimmer who dominated the 50M freestyle event, also known as the "Splash and Dash." This event, a sprint, is of very short duration and likewise of high intensity. Consequently, Hall's blood sugar actually went up during and after the event, due in part to the high level of adrenaline. Athletes participating in these types of events typically increase their levels of insulin in order to better manage their BG and thus their performance.
However, athletes that are involved in endurance sports (or those with a long duration) like cross country running or skiing, must take a different approach. Because the duration of the activity is much longer, blood sugars instead will go down. Therefore, athletes decrease insulin doses for better management.
Finally, let's consider the frequency variable. Take the soccer player who has several practices per week and then plays in an elimination tournament over the weekend. During the various games that he participates in for the tournament, he tends to use up the stores of energy he has and his body will not have the chance to replenish these stores. Subsequently, he has a higher likelihood to suffer from hypoglycemia.
For another example from this scenario, consider a Type 1 athlete who plays on a competitive sports team that has an offense and a defense, like football or basketball. The amount of time that this athlete plays in the game can be variable, and depends on how well one's offense or defense is playing in response to the opponents'. If a Type 1 player is on the offensive line on a football team, and the opponent's offense if weak, then he will be getting a lot of playing team (duration) many times during the game (frequency), which can then cause the player to be faced with BG levels going down. On the other hand, if during the next game on his team's schedule, a player's team faces a team with a strong offense, this same player may spend a lot of time on the bench, thus reducing the frequency and duration of his play and then causing his BG levels to rise.
Rick Philbin, a Type 1, agrees that anyone managing Type 1 needs to start with the physiology and what type of activity will be undertaken (i.e. is it aerobic or anaerobic). The key to physiology is nutrition. Philbin, who headed up the Sports Central panel of The Children With Diabetes conference this past July in Orlando, urges athletes and their parents to "forget the diabetes and go into the nutrition needs for the sport and adapt accordingly."
Philbin, a board member of DESA, stresses that diabetes is an individualized disease and reminds Type 1 athletes that there is "a lot of trial and error," when it comes to managing diabetes while trying to get the most of any physical activity, whether it be competitive sports or exercise, and it all boils down to a "balancing act."
Some questions that the athlete needs to answer includes: How long does your insulin last? How do you adjust accordingly? How much insulin do you have on board? What food are you eating? Is it the right food?
Gary Scheiner, CDE and Founder of Integrated Diabetes Services, author of Think Like a Pancreas, and fellow DESA board member, offers counseling for Type 1 athletes who are managing their diabetes with intensive insulin therapy (meaning either via a pump or with multiple daily injections). Scheiner, who has found that the continuous glucose monitor has been a great asset to monitoring athletes and their performances, points out, "if you can predict, you can prevent it," in terms of high and low blood sugars.
In addition to the type of exercise being performed and what type of food is being consumed, there are other variables that play a factor in sports performance and impact blood glucose levels which include:
- Adrenaline -- which can cause a rise in blood glucose
- Personality type -- Type As have different responses to activity and blood glucose then Type Bs.
- Stress -- particularly when it comes to anticipating a sporting competition or event, again which can cause an increase in blood sugars.
- Weather -- is someone competing in a hot, humid environment (which can increase BG levels), or cold situations (which can cause BG to go down)?
Although this post has just scratched the surface in terms of diabetes management, sports and exercise, there are resources available for support. Look into your local chapter of DESA (http://www.diabetes-exercise.org/conferences-regional.html) and consider attending one of their regional conferences. In addition, check out these books:
* Gary Scheiner's Think Like A Pancreas
* Calorie King, A Fat and Carbohydrate Guide
* Sheri Colberg's Diabetic Athlete's Handbook
Takeaway message: don't let Type 1 keep your son or daughter off of the field, court, track, pool or wherever. The resources and expertise are there to help your child succeed.
Published On: September 07, 2010