1. Balancing sports & diabetes
CWD November 2012
Francesca Annan RD

2. 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
For all nutrition has a major impact on sports performance, fatigue is caused by lack of fluid and fuel as well as low or high blood glucose levels.
If you have good diabetes control and a poor diet you will not perform at your best.

3. Exercise type & potential blood glucose effects
Weightlifting, power lifting
Track (sprinting) & field, diving (platform & springboard)
Golf, American Football, swimming (sprints), gymnastics, fencing, wrestling, baseball, volleyball, ice hockey, track cycling,climbing
Anaerobic
ATP-PC
Basketball, football, tennis, lacrosse, speed skating, skiing, hockey, middle distance running, speed skating>1500m
Anaerobic Glycolysis
You have to be able to provide information to our athlete about the type of exercise they are doing and explain the potential effects on blood glucose levels
Road cycling, cross country skiing, race walking, distance running, triathlon, ultra marathon
Aerobic

4. Blood glucose and performance effects
Cognition
co ordination
Sports skills
 fatigue
Muscle mass
Rate of perceived exertion
Aerobic capacity
endurance capacity
muscle capillarization
Fatigue
dehydration
ketone production
 pH
Blood glucose
Euglycaemic window of 7-8mmol/L
low
high

5. 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

6. 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

7. Why does carbohydrate matter?

8. How much carbohydrate do you need?
UK recommendations for all – 50% of daily calorie intake
If you need 2000kcal/day you should be eating 1000kcal as carbs
1g carb = 4kcal
If you are training for a sport (3 additional exercise bouts of 60minutes each + normal daily activity) need 60% daily calories from carbs
Everyday activity = 200g/day, training = 300g/day
Different sports have different requirements

9. How to spread your carbs & fluid across the day (eating for sport –not diabetes)
Always have breakfast to replace liver glycogen stores
Eat 1-2hours before exercise if you haven’t, e.g. if after school activity is 3 or more hours after midday meal, have a snack.
Drink 2-300ml in the 30minutes before activity starts
If activity lasts 45 minutes or longer consume carbohydrate and fluid for fuel and hydration.
Have a recovery snack within 1 hour of completing training/exercise
Distribute carbohydrate across the day as 3-6 meals/snacks

10. Carbohydrate food choices
Everyday carbs
Nutrient rich carbohydrate foods
Low fat
Low GI
Healthy carbohydrate food choices
Nutrient poor carbohydrate foods
Use during or immediately before exercise only
Dental health
High fat carbohydrate foods
Limit due to impact of saturated fat on health
Particularly important to manage weigtht

11. Carbohydrate food choices
Pre exercise
Rice pudding/custard
Jam sandwich
Jaffa cakes
Toasted teacakes/crumpets spread with honey/jam
Fruit smoothie
Milk shake
Cereal and milk
Post exercise
Mix carbohydrate and protein
Improved muscle recovery if sufficient insulin
Milk shakes
Trail mix
Sandwich with low fat filling
Yogurt drinks

12. Carbohydrate choices during exercise
Need to be tolerated and practical
If solid food additional fluid needed, strategies planning and discussing with coaches.
All children need to drink sufficient fluid during exercise,
Practical aspects of carrying/accessing foods.

13. How to eat during exercise
Taken from
Carbohydrate needs to be distributed across exercise to match muscle uptake of glucose.

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

15. Aerobic and Anaerobic Exercise

16. Eating strategies for sports/competition
Anaerobic/power sports of short duration can be managed by having food between bouts of activity.
Overall energy cost of the exercise may be low but the carbohydrate cost is high.
Aerobic activities of longer duration will require additional carbohydrate for fuel.
Insulin adjustments will reflect the BG responses to meeting your nutritional needs

18. Blood Glucose and carbohydrate
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

19. Carbohydrate during exercise for blood glucose management
If exercise lasts longer than 30minutes and is aerobic, during peak insulin action – highest carbohydrate requirement to maintain blood glucose levels.
If exercise is of short duration, anaerobic and insulin levels are low – lowest carbohydrate requirements to maintain blood glucose levels
If exercise is during peak insulin action then approximately 1g carbohydrate/kg/hour to maintain BG
If you weigh 30kg, you need 10g carbohydrate for every 20minutes exercise

20. Using CGM
If you have access to CGM you can use trend arrows to manage carbohydrate and BG.
If BG below 7mmol/L and dropping you need between 8 and 20g carbohydrate to prevent hypoglycaemia occurring.
This will need to be immediate fast acting carbs.

21. Data from Mike Riddell, Toronto

22. Using smart meters and active insulin info
You have information about active insulin before exercise, you can reverse your insulin to carb ratio to “cancel/match’ this insulin.
You will need carbohydrate to match the active insulin + activity carbohydrate if your blood glucose level is 7mmol/L or below

23. Protein, diabetes & sport
If diabetes is not well controlled then muscle development is impaired
Taking protein supplements make no difference to muscle gains.
Essential ingredients for building muscles are insulin, carbohydrate, and protein in that order.
Evidence to show that adolescents with poor diabetes control have lower fitness levels and lower muscle mass

24. Finding information about food and sports.
Lots of sports nutrition info available on the web.
Sports product manufacturers do not always provide the best source of information
Sports nutrition info from the English Institute of Sport, Australian Institute of Sport, IOC, good places to start
General info from nhs/change4life or Dept Health
Lucozade Sport and Gatorade website/info is ok

25. Building an exercise eating and management plan
Keep a training diary – document all BG responses
Eat regularly across the day and adjust insulin according to BG responses.
Always eat sufficient carbohydrate before bed and in the morning.
Check BG between midnight and 3am

26. Example