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The Diabetic Athlete: Implications, participation

The Diabetic Athlete: Implications, participation. Jason Blackham, MD August 21, 2008 Sports Medicine Rounds. Objectives. Physiology of insulin Exercise effects on insulin regulation Pre-participatory screening Guidelines for the diabetic athlete. Insulin. Glucose transport into Muscle

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The Diabetic Athlete: Implications, participation

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  1. The Diabetic Athlete:Implications, participation Jason Blackham, MD August 21, 2008 Sports Medicine Rounds

  2. Objectives • Physiology of insulin • Exercise effects on insulin regulation • Pre-participatory screening • Guidelines for the diabetic athlete

  3. Insulin • Glucose transport into • Muscle • Fat cells • Liver • Decrease release of • Free fatty acids from fat cells • Glucose from liver

  4. Exercise on insulin • Decreases insulin • Stimulates glucose transport into muscle • Increases cortisol • Therefore, increase in insulin sensitivity • Allows free fatty acids and glucose to be mobilized for energy

  5. Warnings • Post exercise hypoglycemia at 2 and 18 hours though can last 30 hours • Too much insulin with exercise, suppress glucose release from liver and fatty acids from adipose tissue • If BS >250, then it increases with exercise • If BS is elevated and not enough insulin, then post exercise hyperglycemia occurs due to lack of increase in post exercise insulin

  6. Warnings • Anaerobic exercise may increase BS • Too little insulin, fatty acid metabolism leading to ketones and DKA • With hypoglycemic event, risk of further hypoglycemia

  7. Pre-participatory screening • Good control of blood sugars • HbA1c < 7.5% • Measuring BS at least 4x/day, prefer 6x • Most BS are 80-180 • Know symptoms and what to do for • Hypoglycemia • Hyperglycemia • Know how to adjust insulin/carbs before and after exercise

  8. Pre-participatory screening • Screen for complications • Retinopathy • Neuropathy • Nephropathy • Cardiac screening? • Foot/skin care • Lipids • Ever had DKA or hospitalized for diabetes

  9. Guidelines for exercise • If BS < 80-100, • eat extra carbohydrate prior to exercise, recheck in 30 minutes. • If BS 100-200, goal • If BS >200-250, • Check urine ketones, if + no exercise • If BS > 250-300, • Don’t workout, wait until under control

  10. Guidelines for exercise • How to avoid hypoglycemia • Decrease pre-exercise insulin by 50-80% • Increase pre-exercise carbohydrate • Don’t exercise when insulin is peaking • Measure post exercise BS • Don’t exercise when sick

  11. Guidelines for exercise • Know where to inject- • Don’t inject in working muscle • Heat increases absorption • Cold decreases absorption • Massage increases absorption • Insulin storage between 40-80 degrees • Nutritionist, diabetic nurse

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