• Hyperglycemia/Hypoglycemia
• Nursing
• Diabetes Mellitus

• Hyperglycemia/Hypoglycemia
• Nursing
• Endocrinology
• Diabetes & Metabolic Syndrome
• Diabetes Mellitus

Anne Peters, MD, University of Southern California, Los Angeles, California, USA, discussed the challenge of caring for athletes with type 1 diabetes (T1D). Since athletic training and competition can markedly disturb blood glucose control, it can be difficult to manage diabetes in individuals who exercise excessively. Dr. Peters highlighted the importance of personalized care to optimize glycemic control for maximal health benefits and athletic success.

The Nutrition and Athletic Performance Joint Position Statement of the American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada, most recently revised in 2009, suggests that athletes should eat 6 to 10 g/kg body weight of carbohydrates per day [Med Sci Sports Exerc 2009]. For many patients with T1D, this can represent a challenge in insulin dosing. Higher amounts of carbohydrates require larger doses of insulin but increased workouts may improve insulin sensitivity and lower insulin requirements. This balance between carbohydrate ingestion, exercise and insulin dosing can create a difficult balance for athletes to maintain.

Dr. Peters emphasized the need to understand the basics of exercise physiology. Muscles obtain glucose from their glycogen stores as a primary energy source, and once these sources are depleted, there is a balance between glucose production and uptake by exercising muscle. Immediately following exercise, in nondiabetic individuals, catecholamine levels rapidly decline and insulin increases, with restoration of muscle glycogen. Consequently, in individuals with T1D, glucose uptake may occur to such an extent that they become very sensitive to insulin and potentially hypoglycemic.

For individuals with T1D, the fear of hypoglycemia is the strongest barrier to regular physical activity, and is certainly a concept that athletes often struggle with [Brazeau AS et al. Diabetes Care 2008]. Although many athletes report reduced performance when their blood glucose levels are high, they conversely run into other problems if blood sugar levels are low. Hypoglycemia can occur during exercise for various reasons, including:

• ▪ Insufficient carbohydrate intake

• ▪ More rapid insulin absorption

• ▪ Challenges in reducing basal insulin levels in individuals receiving injectable insulin

• ▪ Differences in insulin sensitivity before, during, and after exercise

• ▪ The potential for acute and delayed hypoglycemia

Studies have confirmed that decreasing the amount of insulin at the meal prior to exercise can lower the risk of hypoglycemia immediately after exercise [Rabasa-Lhoret R et al. Diabetes Care 2001]. Therefore, Dr. Peters recommends that athletes take half their usual insulin dose at the meal before exercise; then, if the blood glucose level is <150 mg/dL, a 15- to 30-g carbohydrate snack is advised. A carbohydrate intake of 15 to 30 g is subsequently recommended for every 30 minutes of exercise. After exercise, a 30- to 60-g carbohydrate snack should be given with half of the usual insulin dose, and it is important to work with the athlete to reduce the overnight basal insulin level to prevent development of delayed postexercise hypoglycemia.

Dr. Peters concluded that the key to diabetes management in athletes is personalized care to help tailor solutions for their individual needs. Since blood glucose response varies between individuals and also their sports, it is important to investigate each athlete's response to their different activities. In addition to working closely with a physician, athletes with T1D should work with a registered dietitian to optimize their nutritional requirements. She stressed that this approach, aided by technology such as continued glucose monitoring, enables optimal management of blood glucose levels during training and events, allowing the athlete with T1D to compete safely and effectively.

• © 2013 MD Conference Express®