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

Target Population

Type Type 1 DM Active Involved in competitive sports

Type 1 or 2 DM Not athletic Sedentary Over weight/obese

Goals Prevent hypo & hyperglycemia Optimize sports performance

Overcome barriers to exercise Provide a realistic exercise

plan to lose weight Prevent hypo & hyperglycemia

Plan Adjust insulin & food Improve exercise training Manage sports injuries

Start an exercise plan Adjust insulin/oral meds

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

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

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

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

Optimizing Sports Performance with Diabetes

GlucoseMetabolism &

Exercise Training Psychological

Training Blood Glucose Management

Nutrition Tips

Glucose Metabolism

and Exercise Training

Physiology During Physical Exertion

Release of glucose from liver

Insulin receptors sensitivity

•Fat stores for energy are used after ~20mins

Insulin requirement

• GLUT 4 transport glucose to active muscles

need for glucose to enter muscles

FUEL DEMAND

• Release of counterregulatory hormones

Physiology After Exertion

Release of glucose from liver

Insulin receptors sensitivity

• Glucose uptake by the muscle lasts 24 – 48 hours

Insulin requirement

• Meds adjustments and carbs intake are required

Active muscles need to replace glucose in muscle and liver

FUEL STORAGE

Blood Glucose Trends with Aerobic Exercise

Gallen, British Journal of Diabetes and Vascular Disease, 2004

Moderate vs High Intensity Exercise

Guelfi et al., Diabetes Care, 2005

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

Exercise and Hormone Changes

Guelfi et al., Diabetes Care, 2005

Exercise, Blood Glucose and Insulin

Guelfi et al., Diabetes Care, 2005

Intensity and the Effect on Blood Glucose

Gallen, British Journal of Diabetes and Vascular Disease, 2004

Exercise Training to Optimizing Performance

Endurance

Muscular Strength

Flexibility Speed, Agility &Power

Balance

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

Psychological

Training

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

NutritionNutrition

TipsTips

ExCarbs

To determine carbs (g/h)

needed for exercise:

1.Body weight

2.Type and intensity of exercise

3.Duration of exercise

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

Snacking Choices During ExerciseChoose 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

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

Blood Glucose Management with Exercise

and Physical Activity

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

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

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

Thank-you

ANY QUESTIONS