Diabetes and Exercise

Exercise is an important part of my life.  As a young person it defined who I was, it provided me with a chance to excel and be fit.  I joined Blacktown Little Athletics club when I was 8, I'm sure it was not my choice.  I'm sure mum was getting me involved in sport to help manage my diabetes, but I loved it.  I liked making friends and competing with kids my age.  I represented Blacktown at the state championships and won a bronze medal in my first year of athletics.  I then went on to represent NSW as a 13 year old.  Keeping fit helped me to become confident and allowed me to see I was no different to other athletes my age.  I did understand I had to be more organised but diabetes did not limit my ability. 


I have been involved in a number of sports through out my life soccer, athletics, cycling, rugby league, touch football, swimming and now marathon running.  When I finished high school and began university I stopped my involvement in sport.  This had a negative effect on my diabetes.  My management became very poor, I did not test as regularly and I slowly gained a lot of weight.  It was not until my 3rd year teaching when a friend asked me to play in a touch tournament that I realised I was missing being involved in sport.  Playing touch lit the competitive fire again and I wanted to get fit. I started training and my diabetes management improved.  I tested more and ate better because I was training.  12 months later I was playing in my first Touch Football State Cup team.  


During the competition I could not get my blood sugars right and things did not go so well. My average blood sugar was 16.7 mmo/l which is not good.  Blurred vision is not good for playing touch neither are tired legs.  But it was a massive learning curve.  As diabetics we all need to realise we will never really know how our body will react to exercise so during new competitions or routines we need to test a lot more and be prepared.  It is better to run a little high than be too low. And most important let someone know you are diabetic.  A lot of young athletes are afraid to let people know they are diabetic, In my 25 years competing in athletic events I don't think I have ever had a negative reaction when telling someone I am diabetic. Most people want to do as much as they can to help you out.  


Below is some further information taken from the Diabetes Australia website looking at the importance of physical activity and keeping active. Click on the link above to visit their website and find out more information about Type 1 Diabetes and exercise.


Diabetes and Exercise - Keeping AcT1ve

Everybody benefits from regular exercise. If you have diabetes it plays an important role in keeping you healthy. Regular exercise is an important part of your diabetes management. If you are on insulin, it will help your insulin to work more efficiently and assist with your blood glucose control. However, if your diabetes is poorly controlled (i.e. fasting blood glucose levels greater than 14 mmol/L and urinary ketones) then it is best to avoid exercise until your blood glucose has settled. Exercise in these circumstances can actually elevate blood glucose and increase ketone production. You are discouraged from strenuous physical activity if you are feeling unwell or have ketones present in your blood or urine.

For a person with diabetes exercise helps:
1. Insulin to work better, which will improve your diabetes management
2. You control your weight
3. Lower your blood pressure
4. Reduce your risk of heart disease
5. Reduce stress

We all know that exercise is good for us but diabetes presents some challenges - blood sugar levels can drop low or rise unexpectedly during exercise, but don't be deterred! People
with diabetes can achieve amazing things 

Zippora Karz was a member of the NYC ballet at age 18.  She was diagnosed with Type 1 Diabetes at age 21 and then went on to become a soloist at age 27.
Sir Steve Redgrave is one of only four Olympians to have won a gold medal at five consecutive Olympic Games. This achievement led to him being hailed as Britain's greatest Olympian.  He has also won three Commonwealth Games gold medals and nine World Rowing Championships.

Gary Hall Jnr was diagnosed with Type 1 diabetes in 1999.  Upon his diagnosis, Hall struggled with the possibilities and the effects he knew the medical condition would have on his life. He overcame these worries to go on to win 10 Olympic swimming medals and a number of other international titles.

Will Cross has ascended the highest peaks on all seven continents including Everest and walked to both the North and South Poles. He has also led expeditions to 15 unmapped, unexplored mountains in Greenland and also in Patagonia, Mountains of the Moon, the Sahara Desert, and the Thar Desert of India.

Missy Foy is an extremely well-known long distance runner who was diagnosed with type 1 diabetes at the age of 33. In 2000 she became the first athlete with diabetes to qualify for the Olympic Marathon trials. In 2005 she was ranked #1 in the world for the 50-mile trail race
Closer to home Brett Stewart is an NRLfootballer who plays for the Manly-Warringah Sea Eagles in the National Rugby League. He is an Australian international and New South Wales State of Origin representativefullback known for his prolific try-scoring. He has played his entire NRL career for the Sea Eagles, with whom he won the 2008 Premiership


Dr. Sheri Colberg-Ochs talks about Exercise and Diabetes


Dr. Sheri Colberg-Ochs, an Associate Professor of Exercise Science at Old Dominion University, author of the book The Diabetic Athlete, and a diabetic athlete herself, provides some useful information for managing diabetes around whichever exercise you may wish to do or continue doing. Regular exercise is the most important activity that you can do to slow the ageing process, manage your blood sugars, and reduce your risk of diabetic complications.  The best way to deal with the multitude of variables is to learn your own responses to all of them by checking blood sugar levels before, during, and after exercise. Intense exercise can cause a large increase in blood sugars due to the surge in glucose-raising hormones. You may find that after training for several weeks, your blood glucose does not drop as significantly as it did when you first started training. Regular physical activity improves blood glucose control by increasing the body's sensitivity to insulin. It is crucial to know when your insulins peak in order to determine your blood sugar response to exercise and your need for supplement carbohydrates

Dr Colberg-Ochs recently answered some people with diabetes' questions in an interview conducted by About.com.

Jennifer asks: "Why does my blood sugar actually rise after my regular morning exercise session?"

Dr. Colberg-Ochs answers: Many things can affect your blood sugar response to exercise, and it is normal for intense exercise to actually cause a rise in blood sugars." "In all likelihood, both the time of day that you are exercising and what you are eating for breakfast are probably having a large effect on your sugars. Morning exercise is notorious for causing less of a drop in blood sugars, even when compared with the exact same type of exercise done later in the day. The reason for this is that after you fast overnight (not eating between dinner and breakfast), your body releases extra hormones to keep your blood sugars normal, particularly high levels of cortisol and growth hormone, and the livers in diabetic people often overproduce glucose overnight as well. These hormones, while working well to keep your blood sugars normal overnight, also make your insulin less effective, thereby creating an "insulin resistant" state in your body in the early AM. By eating breakfast, you 'break' your 'fast' and provide alternate fuels that allow the levels of these hormones to then drop. So, breakfast is important, but it is also the meal at which our bodies have the hardest time with carbohydrates causing a bigger increase in our blood sugars. You may want to stick with a lower carb breakfast, saving them for after your workout when your insulin action has improved. Also, you may want to experiment with exercising at different times of day to see the effect. If you do continue with your morning exercise, though, the temporary elevations in your blood sugar will be just that: temporary. If they begin persisting past an hour or two, though, then you will need to rethink your strategy."

Carl asks: "I want to exercise to decrease weight and become more healthy. However, I have found that my sugar level drops quickly when I exercise. This of course leads me to feel as if I need to eat, and in return for eating I feel I defeated the purpose of the exercise which was to burn calories and lose weight. Is this cycle avoidable? Or is the eating actually ok?"

Dr. Colberg-Ochs answers: "If you're using exercise to try to lose weight, then it would definitely be better to minimize the additional eating. However, a few simple changes in your diet and/or medications could easily help you to break this cycle. If you are able to make changes to your regimen, though, then you should be able to correct this problem. If exercise is causing your blood sugar to drop, then you can either lower your insulin dosages (consult with your physician if you don't know how to do this on your own), or adjust your diet for exercise. When you know that you are going to exercise following a meal or snack, eat foods with more carbohydrates in them (but that have approximately the same calorie content as what you would have eaten otherwise). These carbs will then be available to your body during exercise and should help prevent any drops in blood sugar. If you still have to eat something afterwards to compensate, consume only quick-acting carbs that will quickly correct your 'low' feeling, like a glass of soft drink, or 5-6 dry biscuits, but that will add relatively few calories. Do not eat foods high in fat or protein as they will not quickly correct a low blood sugar!"

Ian asks: "I'm a rock climber operating in the upper grades of the sport ... I rarely see any info regarding diabetics in 'power' sports like climbing/bouldering as opposed to more endurance based sports such as rowing/long distance running. Any thoughts on better diets/regimes for power athletes?"



Dr. Colberg-Ochs answers: "Power athletes with diabetes need about the same carbohydrate intake as anyone else participating in such a sport, but having diabetes, it is vitally important for you to balance your food intake with your insulin to maintain your blood sugars in the most normal range possible." "Muscle glycogen (the storage form of carbohydrate in muscle) is only effectively replaced when your blood sugars are under control. Furthermore, being in poor control can cause you to dehydrate, which can also have a negative effect on your performance." For a more detailed discussion of this topic and helpful suggestions, please consult my book, The Diabetic Athlete (Human Kinetics, 2001), which details regimen changes for over 86 sports and recreational activities as well as giving nutritional advice. The two main things for any diabetic athlete to think about are 

Metabolic control before exercise: 

• Ingest carbohydrates if glucose levels are below 5.5 mMol/L. 
• Avoid exercising if fasting glucose levels are more than 14mMol/L and ketosis is present, and use caution if glucose levels are greater than 17mMol/L and no ketosis is present. 
• Blood glucose monitoring before and after exercise 
• Identify when changes in insulin or food intake are necessary. 
• Learn the glycaemic response to different exercise conditions. 

Food intake for exercise:

• Consume carbohydrate as needed to avoid hypoglycaemia. 
• Keep carbohydrate-based foods readily available during and after exercise. 
• Conduct further reading about Diabetes and Exercise

DIABETES AUSTRALIA - http://www.diabetesaustralia.com.au/