Type 2 diabetes athletes


John Anderson: Proving Type 2 Diabetics Can Be Athletes, Too

People with diabetes have to combat a myriad of myths and misconceptions. Among the most prevalent is the idea that people with type 2 diabetes are “fat and lazy” individuals who “brought it on themselves.” While obesity and lifestyle can certainly contribute to a type 2 diabetes diagnosis, it is by no means a catch-all requirement.

That’s why the story of John Anderson, a life-long athlete with type 2 diabetes, is so intriguing. John is often described as someone who has a “run for fun, run for others, and run for the sheer love of it” attitude. When diagnosed with diabetes in 1989, he first stubbornly refused to accept it. His moment of clarity came years later when he collapsed while shoveling snow at home. After his wife rushed him to the family doctor, he realized that he needed to stop ignoring his illness; he vowed to take every possible measure he could to stay on top of it. John became one of the first participants in Team Type 2, an off-shoot of Team Type 1, the endurance cyclists who have competed in the Race Across America cycling competition for the past 5 years. This year’s Team Type 2 is made up of 18 athletes with type 2 diabetes.

Today, a word with John on this “unusual” combo:

DM) Since you were a lifelong runner and athlete before your diagnosis, do you think your story will help fight the misconceptions that only fat, lazy people get diabetes due to their own poor habits?

JA) I think it is very important for all to see that anyone can develop type 2 diabetes, and certainly you do not need to fall into any special category for this to happen. Diabetes does not discriminate in any way. While there are those who have developed diabetes who do struggle with lifestyle issues, there are a still a lot of us who are active, conscience of our diets and have healthy weight ratios — and we still have developed diabetes.

I cannot emphasize enough that diabetes is a disease that develops internally and is not “brought on by ourselves.” This just does not happen. And yes, I think that the more diabetics who share their stories and make themselves available in their communities, the more we can and will change the thinking that still continues to cloud reality.

Why do you think it was so difficult for you to accept your own diagnosis?

I grew up with a mother who struggled with type 2 diabetes and saw first-hand how difficult this could be to manage on a daily basis. At the time of my diagnosis, I did not want to have to deal with what in 1989 was considered the standard treatments, as I feared the restrictions and the ‘separate’ lifestyle that I had witnessed growing up. So I chose denial and allowed it to continue for 13 years. Being an athlete played a large part in this being able to happen and put off the inevitable.

In retrospect, I now feel I really wasted that time and the opportunity it has brought me to have a much fuller life, and to be living it on my terms and not on the diabetes’ terms.

How did you get involved with Team Type 2?

I was fortunate to be able to come across Team Type 2 as it was being formed in late 2008. Once I found out that I could take my interests and passion for long-distance events to a greater level and talk to others about living with diabetes, I hopped in the saddle right away!

How did participating in the Race Across America effect your own feelings about living with a chronic illness?

Through my participation in the Race Across America, I discovered that what I had previously thought of as ‘limits’ just really did not exist. Living with any chronic disease, every day you discover a lot about yourself and the how’s and why’s and what it takes to move forward day after day. After the race concluded, it was a tremendous affirmation to what I believed and continue to live my life by: I can do whatever I want even while dealing with diabetes every day.

When you tell other people that you have type 2 diabetes, what is the typical reaction? Are they surprised?

When I mention that I live with type 2 diabetes, it is almost always the same reaction. I get the once-over look and then get the ‘wow, you must have lost some weight!’ I follow this with a quick overview of my actual size and diagnosis. The reaction at this point usually does become surprise. Then I take the opportunity to educate about type 2 diabetes and the fact that it is a non-discriminatory disease.

How do you think Team Type 2 has changed the way people look at a condition that is commonly associated with obesity?

Team Type 2 certainly has opened the eyes of many people. We are just like every one else with type 2 in that we are normal, everyday people with jobs and mortgages and families to deal with. We are not their doctor or educator lecturing on the need to do something; we are their equals and are proof that you can have a full, active life by making good choices, being proactive, and maintaining a positive attitude. With that, all things are possible.

Changing a lifestyle from sedentary to active can be a challenge for anyone. What advice do you have for people who might be reluctant to become physically active?

I know it can be both challenging and scary, but the rewards you get right from the start are more than worth the effort. The feelings of empowerment and accomplishment fuel you to want to continue, and very soon you ask yourself what it was that was holding you back.

I also recommend seeking out local resources such as running clubs, bike groups, and mall walkers. These groups are open to anyone and you will be surprised that no matter what shape you’re in, they all welcome new members with open arms and support. You can also join diabetes support groups in your area and look for training partners there.

I think you’ll find that those who practice a healthy lifestyle with diet and exercise are the most open and welcoming people! They give support and advice and time to others. Seek this out. Become one who does, and you can in turn do for another.

Thank you John. It’s always nice to meet a living, breathing myth-buster.

Managing Athletes with Diabetes

Unless you have it yourself, diabetes can seem like a very complicated and scary condition. But as a coach or athletic trainer, understanding it and knowing how your athlete with diabetes controls it can help prevent any complications.

Every person with diabetes is different. Diabetes occurs when the pancreas does not produce the proper amount of insulin to manage the glucose levels in the blood. There are two major types: Type 1 (juvenile-onset) is found in children or young adults and is chronic and not preventable. Type 2 (adult-onset) is found in the older population and can be prevented with proper diet and exercise. Both types are managed through diet and exercise and medication – type 2 is managed through pills, and type 1 is regulated by insulin, which is administered through a regimen of shots or insulin-pump therapy. Most athletes will be either on shots or a pump.

Insulin shots are taken at specific times of the day, which requires the athlete to time meals and exercise to correlate with the off-time and peak-time of the insulin. Physicians can prescribe different regimens based on the patient – in this case, your athlete – and his/her needs and lifestyle. Insulin-pump therapy is a method of continuous insulin delivery that can allow for better control of blood sugar levels and more schedule flexibility for the athlete. The athlete just needs to monitor and adjust the pump’s insulin activity accordingly.

See the signs (below) of low and high blood sugar; if your athlete’s blood sugar is not within a safe, normal level, do not have him/her exercise. Exercise some-times has the same effect on blood sugar as insulin and is most likely to lower your athlete’s blood sugar even more. Exercise is also not recommended with high blood sugar when ketones (determined through a urine test) are present.

Through communication and awareness of symptoms of diabetes, you and your athlete can work together to help control his/her diabetes and enjoy a successful athletic endeavor.

Signs of Low Blood Sugar (Hypoglycemia/insulin shock)

  • Tingling in mouth, hands or other body parts
  • Physical weakness, shakiness
  • Abnormal, profuse sweating
  • Headache
  • Irritability
  • Confusion
  • Dizziness
  • Hunger
  • Impaired vision

Signs of High Blood Sugar (Hyperglycemia/diabetic coma)

  • Frequent urination
  • Increased thirst
  • Fruity-smelling breath
  • Nausea and vomiting
  • Dry mouth
  • Flushed skin
  • Labored breathing or gasping for air
  • Mental confusion or unconsciousness
  • Other Tips

The athlete should:

  • Consult with a physician before participating
  • Test blood sugar before and after practice, and whenever signs of high or low blood sugar occur
  • Eat a snack before practice or games
  • Have a source of glucose (tabs or gel) available during practice and games

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Endurance training can significantly impact diabetics

Regular testing of blood helps diabetics manage their disease. (Photo by Mehedi Hasan/NurPhoto via Getty Images)

Gary Hall Jr., 10-time Olympic swimmer from 1996-2004 was at the peak of his career when he found out he had Type 1 diabetes.

At the time of his diagnosis he was told by doctors that his swimming career was over.

Like any Olympic-level athlete, Hall trained up to eight hours a day and ignored the symptoms he was having.

Hall explained his symptoms to Men’s Journal. He said he had blurry vision, extreme thirst, ate PowerBars to boost his blood sugar and burned an excessive amount of calories through running, weightlifting and boxing.

“The doctors said exercise was good in moderation, but not at the level I was at,” Hall said.

While Hall is only one example research has shown that endurance training can hinder diabetics if not properly monitored.

The Centers for Disease Control and Prevention’s National Diabetes Statistics Report in 2015 estimated 30.3 million people in the United States had Type 1 or Type 2 diabetes.

In Type 1 diabetes, which is more common in early childhood — and unpreventable — the immune system confuses healthy insulin cells and harmful invaders like bacteria and viruses, so the body destroys the insulin produced in the pancreas. Type 1 diabetes can be passed down genetically or develop at any point in a person’s life.

In Type 2 diabetes, the more common — and preventable — type, the body either does not respond to insulin or make enough insulin. While this type of the disease can develop at any age, it is more common in those who are 45 or older, overweight or obese, physically inactive or pregnant. While type 2 diabetes typically affects people of the aforementioned demographics, it can also be found in endurance athletes.

The German Sport University of Cologne conducted a study last year on whether “Endurance training (3 times per week for 3 months, moderate intensity) alters YKL40, PERM1 and HSP70 (protein levels) skeletal muscle protein contents in men with type 2 diabetes mellitus.”

In the study the men were separated into three groups T1 (6 weeks pre-training), T2 (1 week pre-training) and T3 (3-4 days post-training). Afterward muscle biopsies were taken by selectively imaging antigens in cells of a tissue or immunohistochemistry.

The results showed a significant upregulation following endurance training in all three protein levels.

The proteins HSP70 showed a “fiber type-specific distribution with increased protein contents” in those six weeks pre-training.

HSP70 or also known as ‘heat-shock protein’ are the main component of cell’s machinery. They produce ‘Protein Folding’ a process that gives proteins their 3-dimensional structure and protects cells from stress.

Those T3 (3-4 days post-training) showed a “significant change in the fiber type distribution with an increase in type I fibers and a decrease in type II fibers.”

However, when it came to T1 and T2 (6 weeks pre-training and 1 week pre-training) there was no significant differences or fiber type distribution for all protein levels (YKL40, PERM1, HSP70).

So with the increased training of all three protein levels the study found that it could help manage Type 2 diabetes and even reduce the risk of future complications.

Emma Willingham, Master of Science candidate in Nutrition, Healthspan, and Longevity at the University of Southern California, conducted a review on “The Management and Care of the Type 1 Diabetic Athlete” and found the “most important goal is to keep blood glucose levels at or as close to normal levels as possible without causing hypoglycemia” which requires the maintenance of a delicate balance between hypoglycemia, euglycemia and hyperglycemia.

Willingham first noted that finding a balance among them can be significantly more difficult to achieve in diabetic athletes due to the high demands of physical activity and competition.

As each athlete is different with a variety of factors like type, duration and intensity of exercise should be taken into consideration.

So extra care must be taken because with moderate intensity exercise a lowering effect of blood glucose increases the risk of developing an episode of hypoglycemia.

Without the proper balance, athletes can risk the result of “overinsulinization both during and after exercise,” said Willingham.

“The rate at which the body absorbs subcutaneously injected insulin increases with exercise due to an increase in body temperature and in subcutaneous muscle blood flow. Hypoglycemia can also result from an impaired release of counter regulatory hormones caused by a previous bout of exercise or a previous hypoglycemic episode,” said Willingham.

As a result, Willingham said professionals working with Type 1 diabetic athletes should advise the athlete to reduce their insulin dosage by 50-90 percent prior to activity. Or eating a low glycemic index pre-exercise meal is a good recommendation to help improve performance.

Additionally, with overinsulinization another risk factor that can occur is the psychological stress athletes can experience during a hypoglycemic episode.

According to Willingham, the psychological stress associated with competition frequently associated with increases in blood glucose levels before competition also causes an increase in counter regulatory hormone levels.

“Injury is also associated with increases in the secretion of these stress hormones and can also cause an increase in blood glucose levels — an exaggerated hyperglycemic response in people with Type 1 diabetes,” wrote Willingham.

Willingham explained that when caring for an athlete with Type 1 diabetes, the most important consideration is managing blood glucose levels, with particular attention to hyperglycemia. That is because the greater number and frequency of long-term complications from diabetes can be traced to hyperglycemia rather than hypoglycemia.

“For example, Type 1 diabetics should be screened annually for cardiovascular disease, retinopathy, nephropathy, neuropathy, and a foot exam to check sensory function and ankle reflexes,” wrote Willingham.

Willingham concluded if not properly monitored an athlete’s performance can deteriorate and “experience detrimental internal health effects.”

Cleveland Clinic explains that when an athlete’s blood sugar is not within a safe, normal level athletes are not allowed to exercise.

According to the Cleveland Clinic symptoms of low blood sugar (hypoglycemia) include body tremors, weakness, confusion, slurred speech and eventually coma. Symptoms of high blood sugar (hyperglycemia) include nausea, labored breathing, mental confusion or unconsciousness.

“Exercise some-times has the same effect on blood sugar as insulin and is most likely to lower your athlete’s blood sugar even more. Exercise is also not recommended with high blood sugar when ketones (determined through a urine test) are present,” according to Cleveland Clinic.

Martin B. Draznin, M.D., director of the Pediatric Endocrine Specialty Clinics at Michigan State University said in Men’s Journal, “Exercise has always been encouraged for diabetics because it can help to transport glucose into cells, reducing blood-sugar buildup. However, there are certain activities in which blood-glucose imbalances could lead to inattention and result in serious injury.”

Some of the activities include, “scuba diving, rock climbing, mountaineering — anything where you are really out on the edge and don’t have a lot of backup,” Draznin said.

For Hall, during his peak training he gave himself eight insulin shots daily, double the daily dosage for the average person.

Hall said with that much insulin, his body constantly craved carbohydrates for fuel.

“Basically, you have to have an idea of what every food you consume is going to do to you, and how your body is going to react to it. In a lot of ways, you have to be your own doctor,” said Hall.

“If you eat right, you should be able to cut down the amount of insulin you need,” said Sheri Colberg-Ochs, Ph.D., assistant professor of exercise science at Old Dominion University. “Adding fiber is usually recommended, as is substituting low-fat milk for whole milk and replacing saturated fat and tropical oils with healthy fat, such as nuts and peanut butter.”

Team Novo Nordisk, a global team made up of triathletes, runners and cyclists with Type 1 diabetes founded in 2006 teamed up to prove people with the disease can still participate in endurance sports.

This year from June 11-17 the 16 pro-riders participated in ‘Pedal for 7’, a seven-day UK tour, as they pass through various “United Kingdom towns covering 553 miles through the week,” according to Xpose.ie.

In the article “Going Long: Spring Endurance Sports and Diabetes” written by Matthew Butterman for the blog Diabetes Daily cited Dr. Rafael Castol who works with Team Novo Nordisk and recommended a blood glucose range of 120-180 mg/dL for the team.

“Cyclists on Team Novo Nordisk will often compete in races between 100-160 miles in length or 4-7 hours of duration. For these lengthy endurance efforts, Dr. Castol recommends that athletes eat a mixture of 80 percent of carbohydrate and 20 percent of protein during the first two hours of the race, and from 2-4 hours they will rely on energy bars, fruit, and electrolyte drinks,” said Butterman.

Edward Horton, a professor of medicine at Harvard Medical School and investigator at the Joslin Diabetes Center worked with both diabetic and non-diabetic endurance athletes while studying their glucose metabolism.

In an article for Outside Magazine written by Alex Hutchinson, Horton said the nature of serious endurance athletes, who are neither obese nor inactive, belies an often hidden health risk.

Dr. Peter Attia, a long-distance swimmer and cyclist, discovered in 2009 he had insulin resistance despite exercising three or four hours a day. Tim Noakes, a marathon runner and the author of “The Lore of Running,” developed pre-diabetes the same year.

Both had the same underlying cause to their diabetes, a carb-loaded diet.

According to Hutchinson’s article in Outside Magazine, researchers found that elite endurance athletes have insulin sensitivity that is roughly three times higher than healthy non-athletes, meaning they rapidly get the sugar they consume out of their bloodstream and into their muscles without having to produce excessive amounts of insulin.

Although endurance athletes are usually known to consume a high number of calories, Colberg-Ochs is conducting a clinical study in Scandinavia to “examine the effects of very low-carb eating on blood glucose levels in adults with type 1 diabetes.”

Colberg-Ochs surveyed over 275 active individuals with diabetes and found, surprisingly, a large number of athletes claimed to be following a very “low-carb dietary regimens.”

“Based on their responses, it appears entirely possible to undergo fat adaptation and exercise regularly — at least when engaging in endurance type training and events. These exercisers worry less about getting hypoglycemic during events as they have lower levels of insulin on board, but many others accomplished the same reduction in the risk of lows simply by not taking bolus insulin (doses specifically meant to be taken with meals) within a few hours of being active (even if eating more daily carbs).”

The active individuals reported they were consuming only 20 grams of carbs a day. Colberg-Ochs said on average an active individual consumes 2,000 calories per day and gets 15 percent of their calories from carbs. That equals 75 grams per day, which is much more than the 20-30 daily grams the athletes claim to be eating.

In order to determine how low-carb athletes with diabetes need to perform, Colberg-Ochs said it all depends on the sport and level of athlete.

“If you decide to try a low-carb diet, keep in mind that adapting to training with fewer daily carbs requires several weeks, so don’t just cut carbs for a few day and expect to feel good during any type of exercise,” Colberg-Ochs said.

Edith Noriega is a junior journalism student at Arizona State University

Wearable technology now knows if you are a candidate for diabetes

Management of Competitive Athletes With Diabetes

Minimizing Risky Behaviors

The female athlete triad of disordered eating, amenorrhea, and osteoporosis was first identified in 1997 and is often found in women’s endurance sports that emphasize low body weight, such as distance running, or aesthetic sports, such as gymnastics, figure skating, cheering, and ballet.14,15 A study of weight control practices in type 1 diabetes reported unhealthy weight control in 37.9% of adolescent females and found that methods used included skipping insulin or taking less insulin in an effort to control body weight.16 The topic of eating disorders in adolescent girls and young women with type 1 diabetes has been explored in depth, and it is clear that the problem is fairly common and is associated with poor metabolic control.17 Anyone managing female athletes with diabetes, especially those involved in sports having a high prevalence of the female athlete triad, should be sensitive to prevention and early identification and treatment of this problem.

Omission of insulin is a common practice for athletes with diabetes who compete in sports having weight categories, such as wrestling, boxing, and weightlifting. Practices frequently used by athletes without diabetes to “make weight” include dehydration through perspiration, use of laxatives, diet pills, and diuretics, as well as vomiting.18 Even though the National Collegiate Athletic Association and most state high school leagues have implemented programs to reduce unhealthy weight loss in the sport of wrestling, the practice of significantly reducing weight before competition with subsequent weight gain after the event still persists.19 Athletes with diabetes quickly discover they can rapidly lose weight by withholding insulin until after weighing in. Metabolic control is obviously poor during the time that insulin is omitted, and there is always the serious risk of ketoacidosis. This is a difficult problem because the practice obviously works, and athletes with type 1 diabetes are often willing to take the associated risks.

Athletes with or without diabetes require adequate amounts of macronutrients to support their training and sustain performance during competition. A joint position statement issued by the ACSM, the American Dietetic Association, and the Dietitians of Canada summarized general nutrient requirements for competitive athletes.20 These included:

  1. Carbohydrate consumption ranging from 6 to 10 g/kg of body weight/day to maintain blood glucose and replace muscle glycogen during activity. It was stated that a specified amount was dependent on the individual’s daily total energy expenditure, sport type, sex, and environmental circumstances.

  2. Protein consumption ranging from 1.2 to 1.4 g/kg of body weight/day for endurance-trained athletes to maintain nitrogen balance and 1.6 to 1.7 g/kg of body weight/day for strength-trained athletes to permit the accretion and maintenance of muscle mass. If total energy intake is adequate to maintain body weight, adequate protein can be obtained solely through the diet, without fortification from protein supplements.

  3. Fat consumption should range from 20 to 25% of total daily calories, the majority of which should be in unsaturated form. Fat is critically important in athletic diets because it provides energy, fat-soluble vitamins, and essential fatty acids for daily activity and health. Some investigators have quantified this amount from 5 to 10 g/kg of body weight/day, depending on training intensity.21,22 There is no scientific evidence indicating that high-fat diets enhance athletic performance.

  4. Total energy consumption ranging from 37 to 41 kcal/kg of body weight/day for endurance athletes training at moderate intensity to 44 to 50+ kcal/kg of body weight/day for resistance-trained athletes. Strength and power athletes attempting to increase lean mass should consume sufficient amounts of energy to support muscle growth. Numeric estimations of energy intake, the authors noted, are somewhat crude in approximating the energy requirements of individual athletes. However, any athlete must consume enough energy to maintain desirable weight and body composition while training for and competing in specific sports.

  5. Though some diets have become popular in weight-loss circles (e.g., Atkins, South Beach, Pritikin, Zone), there is no scientific data that suggests that any of these approaches will improve performance. Some of these strategies, in fact, promote low or very low consumption of carbohydrates, with the stated intent of producing ketoacidosis, the mobilization of ketone bodies for metabolism. Ketoacidosis, however, is a serious metabolic disturbance, and its detrimental effects in people with diabetes have been well established. It is, therefore, recommended that athletes with type 1 diabetes avoid carbohydrate-restricted diets. A “balanced” diet composed of 55–60% of energy from carbohydrate, 12–18% of energy from protein, and 25–30% of energy from fat is recommended for competitive athletes.

These recommendations for nutrition were developed for athletes without special consideration for type 1 diabetes. They should be used only within the guidelines set forth in the ADA position statement “Nutrition Principles and Recommendations in Diabetes.”23

Strength-trained athletes with diabetes require adequate amounts of protein just like all other individuals engaged in resistance exercise. While the needs of resistance-trained athletes and individuals engaged in chronic intense exercise are higher than those of sedentary individuals, this need is usually met by eating a balanced diet that is higher in energy intake. There is evidence that indicates that large amounts of protein (i.e., > 2.4 g/kg/day), including that provided through supplementation, may place additional stress on the kidneys.24 Individuals with preexisting renal conditions may be particularly susceptible to impaired kidney function during heightened protein consumption.

Athletes often turn to nutritional supplements in the belief that performance will be improved. Competitive athletes with type 1 diabetes should recognize which products may result in harmful effects as well as those that are likely to be a waste of money. Some of the popular nutritional supplements include fat burners, thermogenic enhancers, boosters, ephedra, chitin, medium-chain triglycerides, creatine monohydrate, and androstenedione. These supplements and their use in diabetes management have been previously described in detail.25

Anabolic steroids are synthetic derivatives of testosterone. Though access to anabolic steroids is restricted to specific medical interventions, their use in sports remains widespread in the United States, perhaps involving as many as 3 million athletes.26 Recent media coverage has heightened publicity surrounding anabolic steroids. Available studies have used untrained men taking both pharmacological and suprapharmacological doses of the drug. Whereas most investigations examining pharmacological administration have shown little if any improvement in body composition or strength, some studies employing suprapharmacological doses have indeed shown beneficial changes in lean mass, strength, and performance.27,28 Studies involving the high doses believed to improve performance in athletes are nonexistent, largely because of the ethical considerations of administering large amounts of dangerous drugs to nonclinical populations. Anecdotal evidence indicates that suprapharmacological administration of anabolic steroids in competitive athletes definitively improves performance.

Reports of adverse side effects associated with anabolic steroid use have been documented and included cardiovascular disease, hypertension, hepatic disease, hormonal dysfunction, abnormal lipoprotein changes (increased LDL cholesterol, decreased HDL cholesterol), and personality disorders. No evidence, even anecdotal reports, of the effects of anabolic steroid use in athletes with type 1 diabetes is available. However, because of the known systemic disturbances associated with anabolic steroid use, it is clear that athletes with type 1 diabetes should not experiment with this class of drugs.

Competitive sports are generally safe for anyone with type 1 diabetes who is in good metabolic control and without long-term complications.2 A careful medical history and physical examination can minimize risk. The examination should attempt to identify whether the athlete is at increased risk of orthopedic injuries, back or neck injuries, and dental trauma and should also include visual acuity and hearing screening. For long-term complications of diabetes, the exam should focus on signs and symptoms of disease affecting the heart and blood vessels, eyes, kidneys, feet, and nervous system. A formal graded exercise test is usually not necessary but may be helpful if the athlete has one of the following:

  1. Age > 35 years

  2. Age > 25 years and type 1 diabetes of duration > 15 years

  3. Presence of any additional risk factor for coronary artery disease

  4. Presence of proliferative retinopathy or nephropathy including microalbuminuria

  5. Peripheral vascular disease

  6. Autonomic neuropathy2

The most common acute risks for competitive athletes with diabetes are exercise-induced hypoglycemia and deterioration of hyperglycemia and ketosis brought on by physical activity during periods of hypoinsulinemia. Blood glucose is relatively unchanged during exercise in individuals without diabetes because glucose uptake by skeletal muscles is precisely matched by glucose released from the liver. One important control over this mobilization of fuel is a reduction in circulating insulin. People with type 1 diabetes must rely on exogenous insulin and are unable to reduce circulating insulin at the onset of exercise. This frequently results in hypoglycemia because there is an imbalance of increased glucose uptake by skeletal muscles with inadequate hepatic glucose release.

When insulin is not available to assist in the transport of glucose into skeletal muscles during exercise, glucose uptake is decreased, glucose release from the liver is increased, and there is a rise in blood glucose. Without adequate insulin, skeletal muscles will be forced to rely on fat as fuel, and eventually this can lead to an increase in ketone bodies. Individuals with diabetes should not exercise if insulin is inadequate. Athletes with diabetes should not exercise when blood glucose is > 250 mg/dl and ketosis is present. If glucose is > 300 mg/dl, it is probably inadvisable to exercise even without ketosis.2

Diabetes: Nutrition for Athletes with Diabetes

Many people with diabetes are afraid to exercise because they fear low blood sugars (hypoglycemia). But, with careful control and by eating properly, you can succeed in sports. In fact, there are many professional athletes who have diabetes.

The most important thing is to be aware of the signs and symptoms of hypoglycemia and be prepared. Some-times it’s easy to think you are sweaty or light-headed because you are playing hard. However, this could be a sign of low blood sugar. Other symptoms of hypoglycemia are: weakness/fatigue, shaking, headache, irritability, confusion, dizziness, hunger and impaired vision.

The following are some tips and strategies to help you control your blood sugars and perform your best:

  • Blood glucose levels should be closely monitored before exercise.
  • Do not start exercise with low blood sugars (below 70). Have a snack first.
  • Do not exercise if your blood sugars are 300 or above. Be sure to check for
    ketones in your urine if blood sugars are 240 or above. Do not exercise if there are ketones.
  • A carbohydrate-based meal or snack is recommended one to three hours before exercising.
  • Always carry some form of carbohydrates with you, such as hard candy, dried fruits (raisins), fresh fruits, granola bars or crackers.
  • Be sure to let your coach and/or other teammates know that you are diabetic and what the signs/symptoms of hypoglycemia are so that they can help you if this should occur.
  • If you are on insulin, be sure to talk to your doctor about adjusting your dosage for exercise. Most of the time, having a snack before exercise will suffice.
  • Plan to snack during the activity if it lasts longer than one hour.
  • For day-long events, eat six small meals containing both carbohydrates and protein. (Avoid high-sugar, high-fat foods.)
  • Eat after the event to prevent hypoglycemia and to refuel your glycogen stores. Hypoglycemia can occur four to 48 hours after exercise, so it is important to monitor your blood glucose levels frequently and eat balanced meals and snacks.
  • As always, drink lots of water to prevent dehydration.

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Sports nutrition and Type 2 diabetes

Why’s it good to move?

You’re definitely not sweating the small stuff when it comes to exercise and Type 2 diabetes…

There are many vitally important reasons to make physical activity a regular part of your lifestyle. As well as helping to maintain healthy blood sugar levels, exercise can play a key role in your overall health, as you will find out.

If you could be exercising more, we hope that this information will help you to do so safely, and in accordance with advice from your diabetes team.

Sports nutrition and Type 2 diabetes

What’s the difference between physical activity and exercise?

The terms ‘physical activity’ and ‘exercise’ are often used interchangeably, although there is a small difference: physical activity includes all movement that increases energy use (or calories burned) e.g. housework and gardening. On the other hand, exercise refers only to structured exercise e.g. running or lifting weights.

Why bother distinguishing between the two? For optimal health, only focusing on structured exercise isn’t ideal.

What are the benefits of exercise?

  • Improved blood glucose. An interesting fact, exercising muscles use 7–20 times more glucose than non-exercising muscles
  • Improved cardiovascular health. E.g. lower blood pressure and triglycerides, and increased beneficial HDL cholesterol
  • Contribution to weight loss. Exercise is especially beneficial for keeping weight off for those who have lost weight
  • Improved quality of sleep (but likely not if exercise is performed too close to bedtime)
  • Beneficial for cognitive (brain) function and health
  • Reduced stress hormones
  • Better mood and outlook
  • Improved self-confidence.

Other benefits of exercise include reduced stress hormones, better mood and outlook and improved self confidence.

Exercise and Type 2 diabetes

A study where researchers told people with Type 2 diabetes to “take a short walk right after meals” proved the advice to be a very good exercise prescription.

Results from the study showed that blood glucose levels after meals dropped an average of 12 per cent when people walked for only 10 minutes after three daily meals, compared with walking for 30 minutes at any time of day.

The biggest effect was a 22 per cent drop in blood glucose in the 3 hours after the evening meal.

One specific area of health where exercise is proving beneficial, is cognitive brain function. With Alzheimer’s disease statistics growing, concerns about healthy brain ageing are coming to the forefront.

Evidence indicates that Alzheimer’s disease, and mild cognitive impairment, are disorders of insulin resistance (similar to Type 2 diabetes).

So, any intervention that increases insulin sensitivity may have the added effect of protecting cognitive function. In particular, exercise aimed at increasing and/or preserving muscle mass may be especially beneficial for facilitating healthy brain ageing.

Since muscle mass declines as we age, we have to be mindful of the types of exercise we do, as outlined below.

Defining exercise intensity

Are you working hard enough during your exercise sessions?

To achieve your individual goals – both physically and in terms of your diabetes management – it’s important to know that the exercise you are doing is in line with those aspirations.

Below is a specific definition of intensity that’s based on your perceived effort:

  • Moderate intensity: 50–70 per cent of maximum exercise effort
  • Vigorous intensity: 70–90 per cent of maximum exercise effort
  • Highest intensity: 90–100 per cent of maximum exercise effort

Types of exercise and physical activity

It’s useful to have an understanding of the different types of physical activity and exercise. Types of exercise include:

  • Aerobic exercise: This includes activities such as walking, cycling, jogging and swimming performed at a steady intensity.
  • ‘HIIT; exercise (a type of aerobic exercise): HIIT is an acronym for high-intensity interval training. With HIIT training, low-to-moderate intensity intervals are alternated with high-intensity intervals and can be applied to various types of aerobic exercises such as running or cycling.
  • Resistance exercise: This consists of lifting free weights, using weight machines, performing exercises using resistance bands and the body’s own weight.
  • Balance and flexibility exercises: Examples of this include yoga and tai chi.

For diabetes, greater health benefits are gained from doing a combination of aerobic (or high intensity interval training) and resistance exercise.

A word on HIIT

HIIT training can be a very effective use of time and is increasingly popular, but it may not be safe for those who have diabetes complications or other health-related complications.

If in doubt, speak to your diabetes care team.

Joint mobility may be affected by having high blood glucose, therefore including some form of flexibility work in your weekly exercise routine may also be very beneficial.

Let’s talk briefly about standing and sitting. It’s been shown that sitting for long periods can impair metabolic function.

In particular, too much sitting can lead to a decrease in the activity of an enzyme called lipoprotein lipase, or LPL, which is associated with higher triglycerides, lower levels of HDL, and an increased risk of heart disease. Sitting reduces insulin sensitivity and weakens bone density.

Non-exercise physical activity in the form of standing leads to a 2.5-fold increase in calories burned compared to sitting – employees who stand while they work burn up to 75 per cent more calories per day than those who sit all day.

As such, we need to prioritise increased movement throughout the day.

How much exercise is enough?

While any exercise is certainly better than no exercise, striving to achieve the recommendations, if able to do so, will allow you get the most health gains from a regular exercise routine.

The national guidelines on physical activity and exercise for adults are:

  • Aim to be active daily. Over a week, activity should add up to at least 150 minutes (2.5 hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week. For example, a brisk 30 minute walk and/or lap swimming for 5 days a week.
  • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week, or combinations of moderate and vigorous intensity activity. Before beginning a vigorous exercise routine, speak to your GP or diabetes care team.
  • Aim to do physical activity which improves muscle strength on at least two days per week. For example, perform an exercise routine in the gym where you use resistance exercise machines, or do body weight exercises such as pushups and wall squats.
  • Aim to minimise the amount of time spent being sedentary (sitting) for long periods. American diabetes guidelines, in particular, state that people with diabetes should interrupt prolonged bouts of sitting with bouts of light activity every 30 minutes.

How do these guidelines benefit diabetes?

  • Daily exercise, or ensuring that two days do not elapse between exercise sessions, ensures that you remain insulin sensitive. The insulin sensitivity benefits of exercise wear off after about 24 hours (this is based on a person with Type 2 diabetes engaging in low-intensity exercise for approximately an hour per day).

  • Exercise which improves muscle mass – such as resistance exercise – is important for maintaining or building muscle as it helps the body to be more insulin sensitive. And, as we lose muscle mass as we age, incorporating some form of resistance exercise at least twice per week on non-consecutive days becomes extremely important.

When is the best time to exercise?

The best time to do structured exercise is when you’re most likely to do it! Some find it useful to exercise first thing in the morning, while other prefer to exercise at the end of the day. Be mindful that exercising too close to bed may affect sleep quality.

If you struggle to include exercise in your day, you may find it helpful to schedule exercise into a diary, sign up for a weekly class or find an exercise partner. Being intentional with the timing of non-exercise physical activity throughout the day can go a long way to lowering blood glucose.

Therefore, aim to:

  • Walk for 10 minutes or longer soon after finishing a meal
  • Interrupt prolonged periods of sitting with bouts of very light activity every 30 minutes. This can mean doing a few stretches or chair-based exercises at your desk or going for a walk to get a drink of water.

We also need to look for opportunities throughout the day to make us move more in general. Here are some ideas to promote movement throughout the day:

  • take the stairs instead of lift or escalator
  • stand when speaking on your phone
  • use a standing desk
  • if possible, walk or cycle to work
  • park further away from the shop’s entrance

Exercise ideas by numbers:

  • Stand: for half of your day
  • Take a standing break: every 30–45 minutes
  • Walk: aim for 10,000 steps a day
  • Light activity: as much as possible during the day
  • Moderate intensity activity: aim for 150 minutes per week

Preparing to exercise safely

There are several things to bear in mind if you are beginning a new exercise routine.


The concern of blood glucose going low during exercise may be on your mind.

In reality, most of the diabetes medication used by people with Type 2 diabetes tends not to cause hypoglycaemia. Diabetes medication which requires extra caution is insulin and a class of drugs called insulin secretagogues.

Common examples of this include Gliclazide, Glimepiride and Repaglinide. These medications can cause hypoglycaemia during and after exercise (up to 24 hours after an exercise bout).

Insulin and exercise

Strategies to prevent hypoglycaemia if using fast-acting insulin:

  • If exercising within two hours of a meal where fast-acting insulin was taken, you may need to consider lowering the insulin dose. However, monitor the effects of exercise on your blood glucose and speak to your diabetes team for advice on appropriate insulin reduction, if this is necessary.
  • If exercising before a meal (e.g. exercise before breakfast) then consider reducing the fast-acting insulin dose at the meal eaten after exercise (in this case, breakfast).

If you use tablets such as Gliclazide and have experienced hypoglycaemia during exercise, have a discussion with your diabetes team as it may be an option to decrease the medication dose on exercise days.

Blood glucose

If you take medication which has the risk of causing hypoglycaemia during exercise (i.e. insulin and insulin secretagogues) it’s a good idea to check your blood glucose before exercise and, possibly, also during or after exercise.

If taking one or both of these medications and blood glucose is below 5mmol/L at the start of exercise, consider having a small carbohydrate-containing snack which contains 15–30g of fast-acting carbohydrate.

This may be similar to what you use to treat a hypo – for example, dextrose tablets or fruit juice. Remember, fast-acting carbohydrate is only required if there is a risk of your blood glucose going low (below 4 mmol/l). Do not take fast-acting carbohydrate just ‘in case’ – instead, always carry a source of glucose with you whilst exercising.

If blood glucose is high (greater than 14 mmol/l) before exercise, there may be the risk of your blood glucose continuing to rise because you do not have enough circulating insulin. In this instance, avoid high-intensity, vigorous exercise and, instead, perform more gentle, lower-intensity exercise.

Do you have diabetes complications?

If the answer is yes, you may want to consider the following:

Nerve disease

  • Use suitable footwear
  • Do mostly non-weight bearing activities, especially if gait is altered or if foot deformity is present
  • If you have foot ulcers, avoid weight bearing activity, including jogging
  • If you have postural hypotension, avoid activities with rapid changes in direction to avoid falling or fainting

Eye disease

  • If you have moderate or severe non-proliferative retinopathy, avoid activities that dramatically raise blood pressures, such as weight lifting
  • With severe non-proliferative retinopathy, avoid all kinds of vigorous activity, jumping and breath holding

Kidney disease

  • If microalbuminuria is present, most activities are safe, but avoid vigorous exercise the day before urine protein tests

With overt nephropathy (and if on dialysis), it’s best to avoid high-intensity and strenuous exercise.

Fuel your exercise

An understanding of what to eat – and what to avoid – whilst exercising is central to your success. Although true of all people, if you are living with Type 2 diabetes it can be even more important.

The information below offers some useful starting pointers and may answer some initial questions about Type 2 diabetes and sports nutrition. However, if you require more detailed information, and even the development of an appropriate meal plan, always speak to your diabetes team.

No matter what exercise or physical activity you are taking part in, give yourself the best start diet-wise and fuel yourself for maximum performance.

  • Sports nutrition products such as energy drinks and gels are a very convenient source of fast-acting carbohydrate when performing moderate- to high-intensity exercise and long-duration exercise such as marathon running. These products must be used strategically – unless absolutely required for exercise performance or to prevent hypoglycaemia, they are best avoided.
  • For long-duration, but low-intensity exercise such as hiking, and if you are not at risk of hypoglycaemia, there is also no need to consume sports nutrition products such energy gels and sports drinks. Instead, choose whole foods such as bananas or other fruits and nuts if you wish to eat something.
  • Stay well hydrated. In most cases, water is adequate, although you can also consider having sugar-free electrolyte drinks. Increasing your fluid intake is especially important if you exercise with high blood glucose levels.
  • Protein is an important nutrient for building muscle or maintaining muscle mass. Where possible, rely on whole foods to obtain your protein. Protein-rich foods include meat, fish, chicken, eggs and dairy foods – quark, cottage cheese and Greek yogurt are particularly high in protein. Vegetarian sources of protein include pulses, nuts and seeds. Ensure you have some protein at each meal, including breakfast.

Type 1 diabetes is a competitor who never sleeps. It takes a precise diet and a strict training regimen to fight it properly — things elite athletes must perfect. These nine athletes with type 1 diabetes found themselves diagnosed with the condition before they started competing or during their careers.

They went on to win gold medals, scale mountains and earn world championships while living with type 1 diabetes. Check out this list of athletes who serve as an inspiration to all.

Want to learn more about diabetes? Sign up for our weekly newsletter, full of recipes, advice and more!

Jay Cutler – Football – United States

NFL quarterback Jay Cutler received his type 1 diabetes diagnosis mid-career. In May 2008, Cutler announced he had type 1 while he was quarterback for the Denver Broncos. He finished that season with career highs in passing yards (4,526), passing touchdowns (25) and interceptions (25). He also played in the Pro Bowl. Before that game, Peyton Manning, Nick Mangold and Kris Dielman threw Cutler into a pool, destroying his blood sugar monitor. It was all in good fun; however, and a replacement was found before the game.

Will Cross – Mountain Climber – United States

Among mountain climbers — is there a cooler sport? — at least one is managing his blood sugar in the most extreme conditions on Earth: Will Cross. In 1976 at the age of 9, the Pittsburgh native was diagnosed with type 1 diabetes and told he likely wouldn’t live to be 30 years old. Now he’s a professional adventurer earning a living from diabetes-related corporate sponsorships. Of note, Cross has climbed the highest peaks on all seven continents. He’s also led expeditions to unexplored regions of South America, Greenland, Africa and India. In those unforgiving environments, he’s been able to successfully control his blood sugar, hoping to inspire others to take control of their own type 1 diabetes.

Borja Mayoral – Soccer – Spain

Real Madrid soccer player Borja Mayoral, 22, received his diagnosis at a young age. “When I was five years old, I was told I had diabetes,” he says. “At that age I was barely able to understand what that word meant.” His soccer career began with Real Madrid in 2007 when he started playing for its youth organization. Playing in the striker position, Mayoral scored in each of Spain’s three qualification matches for 2015 European Under-19 Championship. In total, he has 31 career goals with many more likely on the way.

Interested in learning more about Diabetes Self-Management resources? See our blood sugar chart, “What Is a Normal Blood Sugar Level?” “The Type 1 Diabetes Diagnosis” and “Six Type 1 Diabetes Symptoms You Need to Know.”

joined the national team in 2013 and helped lead #TeamCanada to a gold medal finish on home soil at the Pan American Games in Toronto in 2015. What are her future aspirations? Her pre-game ritual? Find out at https://t.co/qPLyLSDa8U pic.twitter.com/MoSuvRlW0s

— Softball Canada (@SoftballCanada) June 24, 2019

Sara Groenewegen – Softball – Canada

Professional softball player Sara Groenewegen, 24, has been living with type 1 diabetes since she was 9 years old. Recently, the Canadian athlete had a different, medically-related setback. In July 2018, she contracted Legionnaires’ disease. The athlete started feeling symptoms during the Canada Cup. She spent a week in an induced coma, which derailed her training. She’s fully recovered now and defending her reputation as one of the most feared softball pitchers in the country.

Charlie Kimball – IndyCar Racing – United States

When IndyCar driver Charlie Kimball was diagnosed at 22 years old with type 1 diabetes, he had had serious doubts about racing again. That diagnosis arrived in 2007. Kimball asked his doctor if he would ever be able to race again. The doctor’s answer was reassuring: “There are incredible people doing amazing things all over the world with diabetes — you know, driving a race car shouldn’t be any different,” was the answer, Kimball recalls. Six months later Kimball returned to the track where he finished second during his first race back.

Antonia Göransson – Soccer – Sweden

A skilled winger capable of playing with either her right or left foot, Antonia Göransson, 28, was sidelined by a type 1 diabetes diagnosis in 2015. At the time, she had signed a contract to play for the Seattle Reign FC in the American National Women’s Soccer League. Determined, she travelled to Seattle against her doctor’s wishes. The stay was short-lived, though, and she soon felt worse. Göransson returned to Sweden after a few weeks. Back at home she signed with a local team in order to be close to her family and friends while managing type 1 diabetes.

Adam Duvall – Baseball – United States

Atlanta Braves left fielder Adam Duvall has been overcoming type 1 diabetes one game at a time. Diagnosed in 2012 with type 1 diabetes, the now 30-year-old ball player had some classic symptoms: weight loss (20 pounds in two months), weakness and frequent urination. He had been waking up five to six times a night to pee. Two years after being told he had the disease, Duvall was called up to the big league by the San Francisco Giants. In 2015, he was traded to the Cincinnati Reds. With the Reds he hit his first career grand slam in 2017. That same year he notched his first career walk-off in the 11th inning of a game against the Diamondbacks. He was traded to the Braves in 2018.

Gary Hall, Jr. – Swimming – United States

Olympic swimmer Gary Hall, Jr. had already found success having won two gold and two silver medals at the 1996 games in Atlanta. He won silver in the 50-meter freestyle and the 100-meter freestyle. The gold medals were awarded for wins in the 100-meter freestyle relay and the 100-meter medley relay. At the age of 24, a few years after the games, Hall was diagnosed with type 1 diabetes. The news was devastating. Hall’s doctors said there was a good chance he would never swim competitively again. Undaunted, he swam in the 2000 Olympic Trials, winning the 50-meter freestyle, where he bested a decade old American record. He earned second in the 100-meter freestyle. From there he competed in the 2000 Sydney Games where he earned a gold and silver medal in the team relays. He took home a bronze medal in the individual 100-meter freestyle race.

Scott Allan – Soccer – Scotland

Scott Allan, 27, is currently a midfielder for the Glasgow-based Celtic football club. Since the age of 3, Allan has been balancing the demands of his sport and type 1 diabetes. The Scotland native would snack on chocolate bars before games to keep his blood sugar numbers up while competing. When he was 12 he had to adjust his pre-game ritual. At that age the intensity of the sport increased. He found himself cramping up later in games due to high blood sugar levels. After some experimenting he found that his ideal blood sugar level during matches is between 4–6 mmol/l (72–108 mg/dl). “It’s not really been that challenging in terms of having hypos, the issue for me has always been keeping my blood sugar under 10 mmol/l for a full 90 minutes. If it went high it would cause me to feel fatigued early on, which doesn’t benefit me or the team,” he told Diabetes.co.uk during an interview.

This list contains information about athletes who are diabetic, loosely ranked by fame and popularity. Several famous NFL players, baseball stars, and Olympians have diabetes. Some of these athletes were diagnosed with the disease when they were young, while others were diagnosed during their sports careers. One famous baseball player lost both his legs due to diabetes.

Who is the most famous athlete who is diabetic? Adam Morrison tops our list. Adam Morrison was diagnosed with type 1 diabetes when he was 13 years old. Jackie Robinson was diagnosed with diabetes after he retired from baseball in 1957. Jay Cutler was diagnosed with type 1 diabetes in 2008. He administers daily insulin shots to manage the disease.

Ron Santo hid the fact that he had diabetes for much of his career. He had both of his legs amputated in the early-2000s. Arthur Ashe had type 2 diabetes. He contracted HIV from a blood transfusion he received during heart bypass surgery and died from AIDS-related complications in 1993. Gary Hall, Jr. was diagnosed with type 1 diabetes in 1999. The following year he won the 50 m freestyle at the Olympic trials.

Do you think that having diabetes makes it more difficult to be a professional athlete? Share your thoughts in the comments section.

Athletes with Type 1 Diabetes

Athletes with Diabetes – Hooping it up at the DESA national conference, 2008.

If you’re an athlete who has Type-1 diabetes, you know how important it is to keep your blood sugar under excellent control. Blood sugar levels have a direct impact on strength, speed, stamina, flexibility and healing capabilities – all essential components of success in sport and fitness activities.

There have been many athletes with diabetes who have excelled in their chosen sport (see athletes with diabetes list at bottom of page). But it isn’t without its challenges. Different forms of exercise can have very different effects on blood sugar, particularly when adrenal hormones start to kick in. Recovery from an exercise session may take blood sugar levels to strange and exotic places. What’s more, around-the-clock control is necessary for maintaining appropriate hydration and energy stores for athletic performance.

Integrated Diabetes Services is led by one of the few certified diabetes educators who also happens to be a masters-level exercise physiologist. While not exactly a “world-class” athlete, Gary Scheiner participates and competes in a wide variety of sports and fitness activities. He served on the Board of Directors for the Diabetes Exercise & Sports Association for many years (now Insulindependence), and advises athletes and exercise enthusiasts with diabetes worldwide. In 2006 he received the Julie Betshart Award for the study of exercise and diabetes by the American Association of Diabetes Educators. He continues to speak nationally and internationally for both patients and healthcare professionals on exercise, diabetes and blood sugar control.

Through his personal and professional experiences, Gary has helped athletes at all levels to incorporate new techniques for controlling blood sugar and enhancing athletic performance. He and his team of diabetes educators offer many services to “Diabetic Athletes” of all ages.

Our services for Athletes with Type 1 Diabetes

  • General blood sugar stabilization
  • Sport-specific blood sugar control
  • Insulin pump fine-tuning
  • Prevention of hypoglycemia (including delayed-onset lows)
  • Sports nutrition specific to diabetes
  • Strength-training principles
  • Interval training programs
  • Use of continuous glucose monitoring
  • Anthropometric measurements (in-office only)

The Service Process

All consultations are available in-person or remotely via phone and the internet (including video conferencing).

Prior to your initial consultation, we’ll send you a self-care assessment packet to complete and return to us. That way, we won’t waste your valuable time with questions and topics that are of no interest to you. The assessment will be reviewed by your personal diabetes coach who will begin formulating a teaching/management plan in preparation for your scheduled consultation.

During the initial consultation, we will discuss your personal goals, review your current diabetes management plan and offer suggestions for improving your control. We will formulate a system for keeping and communicating records, provide essential education, and outline a plan for helping you achieve your long-term goals.

After the initial consultation, follow-up options include individual consultations scheduled at your convenience, or a retainer service that includes monthly scheduled consultations and unlimited access to our team (to review records, answer questions and make necessary adjustments).

Diabetic athletes need to take extra precautions when training

Woman with diabetes checking her blood glucose using her glucose meter. (Photo courtesy Getty Images)

Diabetes is a common disease in society, and athletes are not immune. Scott Crabtree, a senior baseball player at the University of New Orleans, is one of those athletes.

Managing diabetes can add an additional level of difficulty to training and performing for athletes because of the need to monitor and maintain insulin levels that may naturally spike or crash depending on the workout.

“It definitely challenges you,” Crabtree said. “I’ll have days where I’ll be in the workout room. We’ll be lifting weights, and my blood sugar crashes. People don’t understand all the time that I have to sit down for a few minutes and eat a snack or drink some Gatorade and relax for about 5-10 minutes, let that blood sugar start to rise back up before I can get back into it.”

While not all people understand, his teammates do.

“It’s insane, honestly,” said Crabtree’s teammate Zach Thompson. “My body hurts all the time because we do so much. We’re out here all day every day and with his diabetes and he’s sweating and having to constantly put insulin in and constantly have a certain snack because it goes up and down so much from being out in the sun and running all day. It’s just crazy that he can do it.”

More than 100 million people are living with diabetes in the United States. An estimated 415 million people worldwide are afflicted — 1 in 11 of the world’s adult population. Of that total, 46 percent are undiagnosed.

The story of Crabtree’s journey with diabetes has resonated well beyond his close circle. He is a global ambassador for Juvenile Diabetes Research Foundation and mentors kids with diabetes. He uses his story to show them how to manage the disease and live an active life.

“To have something like that,” UNO baseball coach Blake Dean said, “that he can share with other people and overcome, it sets him up for the rest of his life because he knows how to deal with adversity.”

“It’s good for everyone to see that Division I athletes do have this,” UNO baseball trainer Tyler Trahan said. “Professional athletes do have this. It’s good to know that there is a way to still compete at a high level.”

Athletes around the world are forced to deal with this disease in their daily life as well as their career in athletics.

There are two major types of the disease. In Type 1 diabetes, the body stops producing insulin, a hormone that enables the body to use glucose found in foods for energy. People with Type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults, but can occur at any age.

Type 2 diabetes results when the body doesn’t produce enough insulin or is unable to use insulin properly. This form of diabetes usually occurs in people who are over 40, overweight and have a family history of diabetes, although today it is increasingly occurring in younger people, particularly adolescents.

“In our profession, you’re supposed to be tough… I thought it was something I would just bounce back from,” former NFL quarterback Jay Cutler said as he explained the process many people go through when first diagnosed with diabetes, especially those expected to be “tough” and healthy for work like professional athletes.

Today, Cutler is comfortable discussing the emotional side of diabetes as well as the physical challenges.

“Sometimes, I take pride in it; sometimes, I feel bad for myself. There’s a whole range of emotions you go through.”

Cutler revealed the challenges of being a diabetic pro athlete in a series of videos.

Hypoglycemia is one of the symptoms most often related to diabetes. This condition is caused from having a blood sugar level too low to keep a body energized. Being aware of the signs and symptoms of hypoglycemia and being prepared is important. Sometimes it’s easy to think extreme sweat or light-headedness is a result of playing hard. However, this could be a sign of low blood sugar. Other symptoms of hypoglycemia are weakness/fatigue, shaking, headache, irritability, confusion, dizziness, hunger and impaired vision.

Some tips and strategies to help diabetics control blood sugar levels and perform at peak levels:

  • Blood glucose levels should be closely monitored before exercise.
  • Do not start exercise with low blood sugars (below 70). Have a snack first.
  • Do not exercise if your blood sugars are 300 or above. Be sure to check for
    Ketones (when your cells don’t get enough glucose, your body burns fats instead thus producing ketones) in your urine if blood sugars are 240 or higher. Do not exercise if ketones are present.
  • A carbohydrate-based meal or snack is recommended one to three hours before exercising.
  • Always carry some form of carbohydrates with you, such as hard candy, dried fruits (raisins), fresh fruits, granola bars or crackers.
  • Be sure to let the coach and/or teammates know you are diabetic and what the signs/symptoms of hypoglycemia are, so that they can help if the state occurs.
  • Users of insulin should talk to their doctor about adjusting dosage to account for exercise. Most of the time, having a snack before exercise will suffice.
  • Plan to snack during the activity if it lasts longer than one hour.
  • For daylong events, eat six small meals containing both carbohydrates and protein. (Avoid high-sugar, high-fat foods.)
  • Eat after the event to prevent hypoglycemia and to rebuild glycogen stores. Hypoglycemia can occur four to 48 hours after exercise, so it is important to monitor blood glucose levels frequently and eat balanced meals and snacks.
  • As always, drink lots of water to prevent dehydration.

Today, medicine and health researchers are making advancements in treatment, management and prevention for diabetes. Apps such as Fooducate and Glooko help people log their sugar and food intake. Newer advances in blood sugar devices allow people to test their levels and get results within minutes. More people and athletes are using smart pumps such as the Continuous Glucose monitoring (CGM) device that sticks to the skin and monitors blood glucose throughout the day. Some devices can be set to auto mode to control insulin levels.

“The FDA is dedicated to making technologies available that can improve the quality of life for those with chronic diseases – especially those that require day-to-day maintenance and ongoing attention,” said Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, in an announcement from the FDA. “This first-of-its-kind technology can provide people with Type 1 diabetes greater freedom to live their lives without having to consistently and manually monitor baseline glucose levels and administer insulin.”

While more people are diagnosed with diabetes each year, advances in technology and medicine help find more ways for people to seek medical help and control of the disease.

Other athletes and sports figures with diabetes

Walt Arnold (former football player, Kansas City Chiefs)
Bill Carlson (Ironman triathlete)
Bobby Clark (former hockey player, Philadelphia Flyers)
Jay Cutler (former quarterback, multiple teams)
James “Buster” Douglas (professional boxer)
Mike Echols (cornerback, Tennessee Titans)
Darren Eliot (former hockey player, L.A. Kings)
Pamela Fernandes (Olympic gold medal cyclist)
Curt Fraser (former hockey player, Minnesota North Stars)
Kris Freeman (Olympic skier, silver medalist)
Rich Gedman (baseball player, Boston Red Sox)
Bill Gullickson (former pitcher, Houston Astros)
Gary Hall, Jr. (Olympic swimmer/gold medalist)
Jonathan Hayes (former football player, K.C. Chiefs)
Chuck Heidenrich (professional skier)
Jason Johnson (pitcher, Baltimore Orioles)
Billie Jean King (tennis legend)
Ed Kranepool (former baseball player, NY Mets)
Kelli Kuehne (LPGA two-time champion)
Jay Leeuwenburg (guard/center in NFL)
Mark Lyle (professional golfer)
Gary Mabbutt (UK soccer champion)
Adrian Marples (Ironman triathlete)
Michelle McGann (LPGA)
Corbin Mills (bike racer)
Adam Morrison (pro basketball player, LA Lakers)
Calvin Muhammad (former football player, Washington Redskins)
Freddie Patek (former baseball player, K.C. Royals)
Steve Redgrave (Olympic rowing gold medalist)
Dan Reichert (pitcher, Kansas City Royals)
Art Shell (former football player, Oakland Raiders)
Mike Sinclair (former NFL defensive end)
Sherri Turner (pro golfer)
Jerry Ujdur (former baseball player, Detroit Tigers)
Scott Verplank (pro golfer)
Jo Ann Washam (pro golfer)

Dustin Paré is a journalism student at Arizona State University

Editor’s note: For the coming 2019-2020 academic year, the Global Sport Institute’s research theme will be “Sport and the body.” The Institute will conduct and fund research and host events that will explore a myriad of topics related to the body.

Endurance training can significantly impact diabetics

Playing Competitive Sports

Being active is important for people with diabetes. But for those who are driven to be athletic and want to make it to the competitive level, we have some suggestions about how you can do this in a healthy and safe way.

Participating in competitive sports can have long-lasting benefits. Besides setting the foundation for a lifetime of physical activity, playing sports during high school and/or college also offers emotional and social rewards.

Athletes with type 1 diabetes can compete safely, as long as they maintain good control of their blood sugar and plan for, monitor, and react to changes in blood sugar levels that can happen because of different levels of exercise intensity and duration.

Look below for tips on setting up a sports care plan for practices and games. You’ll also find advice on what to include and how to compete safely on the same turf as teammates and competitors who do not have diabetes.

Discuss any competitive sports you may want to join with your diabetes care team, especially if you are experiencing diabetes-related health problems. While most sports are safe, some may be risky for people with type 1 diabetes who have eye, nerve, or kidney issues.

Develop a diabetes sports care plan

According to the National Athletic Trainers’ Association (NATA), every competitive athlete with type 1 diabetes should have a diabetes care plan for team practices and scheduled games. The NATA recommends that you and your health care team consider including the following in your diabetes sports care plan:

  • Blood sugar guidelines, including how frequently blood sugar should be checked and what pre-exercise levels would prevent you from playing
  • Insulin guidelines, including the type of insulin you are using, dosages, and adjustment strategies for planned activities, and insulin correction dosages for high blood sugar levels
  • A list of all other medicines, supplies, and instructions, including those used to help with blood sugar control and those that are used to treat other diabetes-related conditions
  • Guidelines for recognizing and treating low blood sugar (hypoglycemia). Make sure fast-acting carbs, such as juice, crackers, and glucose tablets are available
  • Guidelines for recognizing and treating high blood sugar (hyperglycemia). Make sure supplies for measuring the level of ketones (a measure of very high blood sugar) in the urine or blood are available
  • Emergency contact information, including the name and phone numbers of family members and health care providers
  • A medical identification bracelet

You should share your sports care plan with your coach and make sure he or she understands what to do in an emergency. Let the coach know that assistance from team members may be needed in the case of severe low blood sugar.

To avoid blood sugar highs and lows during and after sports competitions:

  • Match insulin to activity intensity. Blood sugar levels can also go too high if physical activity is too intense and/or insulin levels are too low. Sometimes during vigorous exercise, the nerves signal the liver to release stored sugar, which can cause a rapid rise in blood sugar levels. High-intensity activities, which burn more than 7 calories a minute, include running, playing singles tennis, bicycling at more than 10 mph, swimming laps, and circuit training
  • Don’t start out too high! A high blood sugar level can go even higher because of exercise
  • Check for ketones. If blood sugar is too high, the body might produce ketones (acidic waste products that can occur when fat is broken down for energy) and a dangerous condition called ketoacidosis can result
  • Don’t go too low!

—Be mindful of length of time: Blood sugar levels can go too low if you engage in physical activity for long periods of time

—Eat something first: Engaging in physical activity on an empty stomach can cause low blood sugar

—Plan ahead for insulin and food needs: This may take some trial and error, as well as the help of the diabetes care team. Adjusting insulin dosage and food intake to the planned level of physical activity can help keep blood sugar in a safe range

—Stop if there are any warning signs: Just going “5 minutes more” can be dangerous. Take a moment to eat or drink something with a high level of carbohydrates

—Keep “emergency carbs” close at hand: Always keep some form of high-sugar food handy, just in case it is needed. This can be a soft drink (nondiet), fruit juice, glucose tablets, raisins, or hard candy

—Monitor later, too: Blood sugar levels can drop even 16 to 24 hours after physical activity because the body uses blood sugar to replace sugar that has been used by the muscles

Prepare for team travel

When traveling with the team, always remember to take all diabetes medicines along. If traveling takes place over several days, also take your updated prescription(s) in case medicine or supplies need to be replaced. Be prepared for unusually long bus rides or travel delays by having prepackaged meals and snacks (especially fast-acting carbs) close at hand.

Expect the unexpected

It’s important to prepare for the unpredictable, such as when, for example, the game lasts longer than expected, the weather suddenly changes, or it is unusually hot or cold on game day. The very thing that makes sports exciting—you never know what’s going to happen next—is the thing that can make it challenging to manage your type 1 diabetes during competition. However, by planning ahead for (and responding to) factors that affect blood sugar levels, it is possible to stay safe during games.

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