Association of Diabetes Care & Education Specialists

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Carbohydrates and Exercise: The dilemma for the adolescent athlete

Mar 03, 2011

I recently had a colleague stop by and ask my opinion on fueling an adolescent athlete for performance. A teen had been diagnosed with type 1 diabetes recently, and was given the “reduce carbohydrates” lecture. His understanding was that he was to restrict carbohydrates to minimize blood glucose excursions. My concern is that he is training 5 days per week (running, biking and skiing) and in reality, he is an athlete who also happens to have diabetes.

There have been so many studies outlining the needs for higher carbohydrate intake for individuals competing in sport. This has been demonstrated in winter sport as well, which may require even higher amounts of carbohydrate to maintain adequate carbohydrate stores due to shivering thermogenesis (and believe me that often occurs at the top of the starting gate in alpine racing!).

I recognize the difficulties of the mismatch of carbohydrate intake, blood glucose and timing of insulin. However, with the meters that check blood glucose in 6 seconds, continuous glucose monitoring systems and insulin pumps, it appears the time of carbohydrate restriction for an athlete with type 1 diabetes is over.

Using technology to teach patients (and us) about appropriate timing of insulin administration with exercise to facility optimal blood glucose levels is much more appropriate than restricting carbohydrates to normalize sugars. This is particularly important in the athlete that strives for top competitive form.

This will take more time, more problem solving and more dedication to diabetes. Individuals in sport are often driven to try “whatever it takes” to achieve performance. As educators, this is our unique opportunity to educate these wonderful young athletes about how working with the numbers may be the most effective way to maximize their own performance. Setting goals for blood sugars, learning from daily training by checking frequently and using sensors, and making adjustments and records may truly teach them so much about their own diabetes, while maximizing their performance. We must NOT shackle them with rules about carbohydrate restriction that have no place in competitive sports.

If you are not knowledgeable about nutrition for sports, team up with a dietitian that has sports experience. She/he may or may not have any diabetes experience and needs your help understanding that aspect of performance. Together, you can help an athlete, whether adolescent or adult, understand the complex, but fascinating interactions of food, exercise, insulin and blood glucose control on competitive outcomes. Are you finding it difficult to problem solve the right amount and timing of carbohydrate intake? Are your young focused athletes ready to listen, check and listen some more? What are your experiences in working with young athletes with type 1 diabetes?

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