Diabetes Mellitus

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Implications for the Athletic Individual

Athletes with insulin-dependant diabetes mellitus (IDDM), or Type I diabetes, can safely participate in athletics but they do require special consideration.

IDDM is a result of the failure of the beta cells in the pancreas to produce insulin. Insulin is a hormone that assists in regulation of blood glucose (sugar) levels. With out insulin sugar stays in the blood stream and is not absorbed into the cells to be used for energy. Once the cells have used their stores of glucagon (glucose stores in cells) they rely on free fatty acids (FFA) for energy. Metabolism of FFA’s for energy results in the production of ketones. High levels of ketones in the blood lead to a dangerous condition called ketoacidosis. This condition is also seen in individuals who have chosen a “protein only” diet and is very detrimental to normal body function.

In normoglycemic individuals insulin and counter-insulin hormones manage this carefully orchestrated balance. A disruption in this balance is what leads to diabetes. Control of glucose levels is then the job of the diabetic person. He or she must check blood sugar levels on a regular basis to determine the amount of insulin to inject to maintain normal body function.

Exercise changes this delicate balance even more. If the IDDM athlete has too low a level of insulin during exercise an increase in counter-insulin hormones may increase already high levels of glucose and ketones and can even precipitate diabetic ketoacidosis. Conversely, high levels of insulin can attenuate or even prevent the increased mobilization of glucose and other energy substrates induced by exercise, and hypoglycemia may result.

Pre-Participation Evaluation

Prior to beginning athletic participation the IDDM athlete should be evaluated by his diabetic specialist for and diabetic related problems that may be worsened by exercise. The evaluation should address the cardiovascular system, peripheral arterial disease, proper kidney function, and proper neurological function. All of these systems can be adversely affected by diabetes.

The main concern in the young athlete should be self-sufficiency. That is, is the athlete mentally mature enough to self test multiple times daily and adjust his/her insulin delivery to accommodate these changes? The diabetic athlete must be “in-touch” with their body enough to know when additional sugar or insulin supplementation is necessary.

Participation Concerns

The presence of microvascular disease is a grate concern to the IDDM athlete. The peripheral vascular and nervous system is often compromised in IDDM; this can result in poor circulation and nerve function in the extremities. This problem can result in a simple blister becoming septic (infected) without the athlete’s awareness.

Due to this it is very important for the IDDM athlete to take exceptional care of their feet. Decreases in sensation can lead to the formation of friction blisters or cuts. Since the peripheral vascular system is compromised these simple injuries heal more slowly and require constant attention to prevent infection.

Prevention of friction blisters should be part of normal athletic participation. This includes proper fitting shoes, choice of appropriate socks, use of gel insoles, and daily inspection of the feet. Socks that are a 50 - 50 cotton blend are the best choice. All cotton socks tend to absorb more water, making friction blisters easier to form. If a blister does form, proper care should include: padding, use of lubricating ointment, and prevention of infection.

Proper hydration is very important to the IDDM athlete. Dehydration will severely affect blood glucose levels and cardiac function. Pre-hydration should include 17 ounces of fluid consumed 2 hours prior to exercise. Fluid consumption during athletic participation should be approximately 2 cups for every 30 minutes of participation. If the level of sweat loss is extreme, this amount should be increased.

Nutrition & IDDM

Proper nutrition is essential for the IDDM athlete. Nutritional considerations are only slightly different for this athlete relative to the nondiabetic athlete. The goals of the nutrition plan should be to maintain glucose, lipid, and blood pressure levels. If weight loss is medically desired, a diabetic specialized nutritionist should be consulted. A hypocaloric diet is associated with increased sensitivity to insulin and improvement in blood glucose levels. Moderate weight loss (10 - 20 lbs.), when medically indicated, has been shown to reduce hyperglycemia, dyslipidemia, and hypertension.

Spacing of meals (spreading nutrient intake, particularly carbohydrate throughout the day) is another strategy that can be adopted. IDDM athletes need to change meal patterns to balance blood glucose levels and insulin injection relative to the changes that athletic participation cause.

The most widely believed misconception about nutrition is that simple sugars should be avoided. There is very little scientific evidence that supports this assumption. Fruits and milk have been shown to have a lower glycemic response than starches (i.e. pasta, potatoes, and bread), and sucrose (table sugar) produces a glycemic response similar to that of starches. From a medical stand point; first priority should be given to the total amount of carbohydrate consumed rather than the source of the carbohydrate.

There is not a “diabetic diet” that all athletes can abide by. The recommended diet can only be defined as a nutritional prescription based on assessment of needs and treatment goals and outcomes. A diabetic specialized registered nutritionist should construct the diet. This should be based on monitored metabolic parameters that include blood glucose levels, glycated hemoglobin, lipids, blood pressure, body weight, and renal function. Other considerations should be quality of life, athletic participation level, and self-management.

The bottom line is that the athlete must be willing to assume responsibility for their body’s proper function. This may be inconvenient at times but positive results far outweigh the inconvenience.

More detailed information on Diabetes Mellitus can be obtained from the American Diabetes Association at www.diabetes.org.

©2000 - 2006 David Edell

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM