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Optimizing Sports Performance in Children and Young Adults with Diabetes

Optimizing Sports Performance in Children and Young Adults with Diabetes. Jacqueline Shahar, M.Ed. RCEP, CDE. Objectives . Target population, goals and plan Cardiovascular screening 4 components to achieve optimal sports performance Physical activity guidelines for children.

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Optimizing Sports Performance in Children and Young Adults with Diabetes

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  1. Optimizing Sports Performance in Children and Young Adults with Diabetes Jacqueline Shahar, M.Ed. RCEP, CDE

  2. Objectives • Target population, goals and plan • Cardiovascular screening • 4 components to achieve optimal sports performance • Physical activity guidelines for children

  3. Target Population

  4. Exercise and Risk of Death • History: the Greek messenger, Phidippides, ran 26.2 miles between Athens and Marathon. • Vigorous exercise increases the risk for Sudden Cardiac Death (SCD). • 1:200,000 Rootenberg, Advance Rehabilitation, 2009

  5. Pre-Participation Cardiovascular Screening • Pre-participation physical exam (PPE) should be performed before playing competitive sports • PPE is more extensive, but does not examine the heart with ECG due to high cost. • Causes of SCD during sports • Hypertrophic cardiomyopathy • Congenital abnormalities • Marfan’s syndrome Rootenberg, Advance Rehabilitation, 2009

  6. Pre-Participation Physical Exam • A doctor should ask the following questions during a PPE with a child: • Have you ever experienced chest pain or unexplained fatigue during exercise? • Have you ever fainted unexpectedly of felt faint during exercise? • Have you ever been diagnosed with a heart murmur? • Do you have high blood pressure? Rootenberg, Advance Rehabilitation, 2009

  7. Pre-Participation Physical Exam • A parent should answer the following regarding family history • Have any relatives died of heart disease before age of 50? • Do any relatives under 50 suffer from disability relating to heart disease? • Is there specific knowledge of hypertrophic cardiomyopathy, long QT syndrome or Marfan’s syndrome? • An ECG will be preformed to detect any heart problem based on the answers provided. Rootenberg, Advance Rehabilitation, 2009

  8. Optimizing Sports Performance with Diabetes Glucose Metabolism & Exercise Training Nutrition Tips Blood Glucose Management Psychological Training

  9. Glucose Metabolismand Exercise Training

  10. Release of glucose from liver FUELDEMAND need for glucose to enter muscles Insulin receptors sensitivity • Fat stores for energy are used after ~20mins • Release of counterregulatory hormones Physiology During Physical Exertion Insulin requirement • GLUT 4 transport glucose to active muscles

  11. FUEL STORAGE Release of glucose from liver Active musclesneed to replace glucose in muscle and liver Insulin receptors sensitivity • Glucose uptake by the muscle lasts 24 – 48 hours Physiology After Exertion Insulin requirement • Meds adjustments and carbs intake are required

  12. Blood Glucose Trends with Aerobic Exercise Gallen, British Journal of Diabetes and Vascular Disease, 2004

  13. Moderate vs High Intensity Exercise • N=10 Type 1 DM exercised on a bicycle • Age = 21± 4 yr • Group A: 30min continuous exercise at 40% of VO2 peak • Group B: High intensity Ex at 40% VO2 peak with additional 4-s maximal sprint effort performed every 2min Guelfi et al., Diabetes Care, 2005

  14. Exercise and Hormone Changes Guelfi et al., Diabetes Care, 2005

  15. Exercise, Blood Glucose and Insulin Guelfi et al., Diabetes Care, 2005

  16. Intensity and the Effect on Blood Glucose Gallen, British Journal of Diabetes and Vascular Disease, 2004

  17. Exercise Training to Optimizing Performance Endurance Flexibility Balance Speed, Agility & Power Muscular Strength

  18. Exercise Training to Optimizing Performance • Endurance • Continuous aerobic, Interval, and Tempo training • Speed, agility, and power • Skills required in many sports • Directional changes, speed training: use of parachute or bungee cord • Strength • Resistance, and core training • Balance • Proprioception training • Flexibility • Stretching, yoga Essentials of Strength and Conditioning, Baechle & Earle, 2000

  19. PsychologicalTraining

  20. Psychological Training Tips • Self confidence • Social support • Proper arousal level • Music • Guided meditation • Muscle relaxation • Goal setting • Imagery • What is the ratio of psychological vs physiological skills? Foundations of Sports and Exercise Psychology, 4th Ed., Weinberg & Gould, 2007

  21. NutritionTips

  22. ExCarbs • To determine carbs (g/h) • needed for exercise: • Body weight • Type and intensity of exercise • Duration of exercise

  23. Nutrition Tips • Follow a meal plan provided by RD • Hydration • 250mL of fluid intake every 20mins of exercise • Water or sports drinks • Replace electrolytes • Dehydration causes cramps, hyperglycemia, heat stroke • Protein intake • Essential for muscle growth and recovery • 0.8-1.5g/kg/day • Strength and power vs. endurance athletes Riddell et al., 2006

  24. Snacking Choices During Exercise Choose snacks that are: • Convenient to carry • Do not cause stomach upset • Absorb quickly • Sports drinks – Gatorade, Powerade • Gels, GU • Fruit: dried fruits, banana • Juice • Avoid protein shakes

  25. Snacks Post Exercise/Recovery • To replenish muscle glycogen stores and repair muscle damage Eat • Carbs – can follow ExCarb • Proteins - 20-25g protein within 1 hour after exercise • Kashi, Whey protein shakes • Meal Ivy, Journal of Sports Science and Medicine, 2004

  26. Blood Glucose Management with Exercise and Physical Activity

  27. Target Blood Glucose • What is best BG range for muscle performance? • Target BG: 140-230mg/dl • Practice day vs. competition day • BG may be different • Psychological stress and anxiety affect BG pre competition • Check BG pre, during and after exercise

  28. Insulin Adjustments • Short acting insulin • Reduced by 30% to 50% with the meal close to activity time • Bolus adjustments • Use of Regular insulin • Long acting insulin • Reduced by 10-30% for activity/sports performed over a long period of time • Basal, temp basal or disconnect • Small correction dose maybe required • Lag Effect • Principle method - trial and error

  29. Summary • Anticipate time, type, intensity and duration of exercise • Set blood glucose goals with exercise • Check blood glucose every 30min or as needed to evaluate decisions • Determine which insulin/basal/bolus adjustments to make • Follow ExCarbs/ meal plan, protein and fluid requirements

  30. Thank-you ANY QUESTIONS

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