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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