+

Sports & DiabetesFrancesca Annan RD

+Sport important for health and wellbeing – and having fun!

+Having diabetes means you have to think -What do you think will happen to my blood glucose during exercise?

+The “CEO” of your own body

Phil Southerland – founder Team Type 1

+Exercise & Diabetes “Rules”

We all have “rules” – some will be about diabetes, some will have come from our diabetes team, some we may have worked out for ourselves

Exercise & diabetes management often means re writing the rules

So be prepared to change and adapt to manage exercise

Everything about exercise is challenging – increased levels of sport can make diabetes

management more challenging

+Introduction

Look at how you can manage blood glucose before, during and after exercise

Develop a “checklist” to use to work out how to manage your exercise

Look at how much you should be eating and drinking

Question time – discuss your exercise and requirements.

+Can you copy the pancreas when you exercise?

Liver – glucose store

Pancreas – blood glucose measurement and insulin or glucagon production

Blood glucose levels maintained by liver in response to changes in insulin and glucagon levels.

Blood glucose levels during exercise are controlled by a complex system of ‘feedback’ and ‘feedforward’

+What happens during exercise?

During exercise you need to supply “fuel” to your muscles & brain

Muscles need energy in the form of ATP to contract – all exercise uses ATP for energy

You use different energy systems to make ATP during exercise

Knowing how these energy systems work will help you to “think like a pancreas” and get the most from your pump

+What happens during exercise?

To exercise the body activates a number of complex pathways.

The aim of these pathways is to produce glucose for use by the muscles and brain during exercise

You store glucose in your liver and muscles as glycogen. During exercise you convert this store to glucose to use as energy

+What happens during exercise

Everybody stand up, now jump up and down twice

You just made your muscles contract so you could jump.

To do that you needed an instant energy source

That energy source is called ATP

We all have a small supply of ATP in our muscles to provide the instant energy to start exercise

What happens next is very important. If you

want to carry on jumping or run or do any kind of exercise

you need to provided the muscles with

energy.ATP is the energy

source your muscles need.

+Aerobic and Anaerobic Exercise

+Anaerobic exercise

Examples include sprinting (track, bike or swimming), weight training, basketball.

These types of exercise do not use blood glucose as a major fuel source during the activity, they use stored energy.

They will often increase blood glucose levels during activity

+Aerobic exercise

The aerobic energy system uses glycogen stored in the muscles & liver, glucose from the blood and fats for fuel.

Aerobic exercise which lasts for longer than 30 minutes may lower your blood glucose levels.

+Exercise effects...........

So at the beginning of any exercise the body works to provide glucose to the muscles (and brain).

In diabetes you are not able to change the amount of insulin present in the body.

This means you may have too much or even too little insulin when you exercise..........

+What does insulin do?

Insulin allows glucose to move from the blood into tissues.

If insulin levels are high the liver cannot turn glycogen stores into glucose for muscles to use for fuel

If insulin levels are low the liver can over produce glucose, which the muscles cannot use.

+Making adjustments for exercise with your exercise checklist

What type of exercise?

Pump on or off?

Last insulin injection or bolus

How long does the exercise last for?

When did you last eat or drink?

What is your blood glucose level?

+What type of exercise

Aerobic exercise uses glucose for fuel, so your blood glucose level may fall during this type of exercise

Anaerobic Exercise Aerobic exercise

•Anaerobic exercise only uses fuel sources within the muscle. This means that during exercise the blood glucose level will rise.

+Exercise types

Short bursts of fast movements

Usually strength and power sports

Sprinting

Basketball

Some racquet sports

Golf swing

Longer duration activities

Usually endurance sports

Running

Cycling

Swimming

Hill walking

Anaerobic activities Aerobic activities

Many sports are a mixture of both types of activity e.g. team games like football, rugby, hockey

+If you use an insulin pumpPump on or pump off?

If you remove your pump during exercise will you run out of insulin? This is more of a problem during anaerobic exercise

If you have your pump on will you have too much insulin? This is more of a problem during aerobic exercise

For either option you need to check your blood glucose level during exercise to know what is happening.

+How long does your exercise last for?

For the first 30minutes of any exercise you will use stored energy sources, so exercise that lasts under 30minutes may not effect blood glucose.

Exercise that lasts longer than 60minutes will have a much greater effect on your blood glucose levels – ideally you should check your blood glucose every 20- 30minutes during exercise to find out what happens

+When did you last eat or drink

Eating 1-3 hours before any exercise (60mins or more) will top up your stores

It may also mean that you need to make insulin adjustments – depending on your insulin action time

If you eat and bolus 1-2hours before exercise you will need less insulin 25-75% less and you should always use a normal bolus 15minutes before eating.

Ideally you should have at least 1g carbohydrate per kg body weight before exercise lasting 60minutes or longer

+Food & drink during exercise

Should be distributed across the exercise if possible e.g. 10g every 20minutes

Needs to contain high GI carbohydrate so the glucose is available to muscles immediately

Recommended amount = 1g/kg per hour if you have not reduced your meal bolus. Lower insulin levels = less Carbs needed.

For sports performance you need fuel – may need Carbs + insulin

Sufficient fluid to maintain hydration

Sports drinks

Jelly sweets

Jaffa cakes

raisins

+Food & drink after exercise

Both food and fluid are needed to promote muscle recovery

Try and eat drink within 1hour of finishing exercise. Drink at least 300ml and keep drinking until you no longer feel thirsty. Eat at least 1g/kg carbohydrate mixed with some protein. Milk is the ideal recovery food

Always eat before bed when exercise has been strenuous or > 1hour duration

+What is happening to your blood glucose level

The more information you have about your blood glucose levels the more in control you will be

If you check your blood glucose before exercise what does this tell you?

If you check 1 hour before, immediately before – what will this tell you?

Before exercise check twice

During exercise/training recommended to monitor every 20-30minutes

After exercise monitor more frequently and overb=nightIf you are exercising competitively the more you know the better your ability to perform.

+Pre exercise BG

Check your BG before exercise

Below 5 mmol/L – have some extra carbohydrate

Below 7mmol/L and dropping – have some extra carbohydrate

If your BG is above 10mmol/L consider Type of exercise aerobic or anaerobic Pump on or off Extra insulin needed?

If your BG is above 14mmol/L consider Checking for ketones Delaying exercise Correcting BG Be extra cautious if exercise is anaerobic

+After exercise………

Exercise can affect your blood glucose levels for hours after you stop.

Why?

You have emptied your muscle and liver stores and you have to replace them – “re fuelling”.

Replacing muscle stores take at least 20hours.

The active muscles are more sensitive to insulin

BUT..............

+Highs immediately after exercise?

During exercise you have increased levels of glucagon, adrenaline, cortisol and growth hormone.

All these hormones push your blood glucose levels up.

So when you stop exercise you can see your blood glucose levels rise and then fall.

This happens in athletes without diabetes! Insulin levels rise after exercise – post exercise insulin resistance

+If you are high after exercise

Check for ketones – some types of exercise can cause ketone production. (usually high intensity/anaerobic activity e.g. Repeated sprints)

High BG without ketones – wait 30minutes and recheck before giving a correction. Use a half correction if needed. Recheck your BG in 1 hour

+Lows after exercise?

Can happen any time up to 24-36 hours after exercise, most likely 6-11hours after exercise

Prevention Reduce insulin post exercise Increase carbohydrate intake particularly before sleep. Reduce overnight insulin doses by 20% - most difficult with

once daily background insulin Aim to eat at least 1g carbohydrate/kg weight immediately

after exercise and before bed when exercise is longer than 60minutes

+Exercise, lows & sleep

If you are low before exercise – you are more likely to go low during exercise

If you go low during exercise you are more likely to go low overnight

Basal insulin requirements usually 20% lower between midnight and 3am after strenuous exercise lasting 60minutes or longer

Low blood glucose levels can happen with no symptoms

+Avoid lows by

Adjusting your insulin for planned exercise

Divide background insulin into 2 daily doses

Using a TBR decrease after exercise. The duration of the decrease will depend on when your blood glucose levels fall.

Reduce your ICR and ISF after exercise – you are more sensitive to insulin

Eat or drink enough carbohydrate to replace your stores quickly within 1-2hours of exercise use the 1g/kg rule to work out how much carbohydrate you need

+Avoid highs by

Trying not to exercise with your pump off

Replace missing basal insulin if high at the end of exercise

Use TBR increase for exercise if needed

Inject insulin before or during exercise if needed

Adjust background insulin doses

Distribute your carbohydrate at the right time during exercise

Take bolus insulin with carbohydrate during competition/anaerobic exercise

+Summary

Check, adjust & eat/drink – before ,during & after any exercise

Accept that exercise management is complex and changes

What works for you may not work for someone else

Remember to eat & drink enough!

+

Your questions?Blackstone Bay, Prince William Sound, Alaska August 2012

+

CWD November 2012

Francesca Annan RD

Drag picture to placeholder or click icon to addBalancing sports & diabetes

+How to manage your sports?

Exercise adds many challenges to diabetes management

Increased activity levels are not always associated with improved control

Diabetes control will influence sports performance

Achieving sports potential- you can!

+Food & performance

Providing enough fuel to exercising muscles is crucial for performance and recovery

In young sports competitors inadequate energy = poor growth

Carbohydrate demands of exercise need to met with appropriate insulin adjustment.

If your child is training for a sport they need to eat more carbohydrate

+Low carbohydrate intakes

Poor growth

Poor adaptation to training

Increased fatigue during exercise (can’t keep up)

Increased frequency of hypoglycaemia post exercise

Low energy levels

+ How to eat during exercise

Taken from www.runsweet.comCarbohydrate needs to be distributed across exercise to match muscle uptake of glucose.

+ Sports drinks

When exercise lasts 60minutes or longer – ideal to provide fluid and carbohydrate or fluid & electrolytes