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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  1. Mar 17, 2011

    In regards to insulin during pregnancy. NPH is the recommended long acting insulin during pregnancy. I would suggest providing some evidence based literature to the physician in regards to better control with a rapid acting insulin (even for gestational). I agree with you, titration of the dose, and reduced hypoglycemia would be two advantages. Here is one recent citation that may be helpfu. Curr Diab Rep. 2011 Feb;11(1):28-34. Insulin analogues in the management of the pregnancy complicated by diabetes mellitus
  2. Mar 17, 2011

    Regarding Lantus and hypoglycemia. My option is the lantus should not be held, it is a 24 hour basal and withholding will result in hyperglycemia later. That said, however, one must discover why the 38mg/dl BG. If Bg values have been low consistantly, Lantus should (and must) be reduced. One could hold the Lantus until BG is treated (perhaps 30 minutes). Also, one low Bg predisposes the individual to a second low and may depress counterregulatory hormones and symptoms. So make sure everyone is aware and aim for higher Bg values for up to 12hours.
  3. Mar 17, 2011

    I have a question about insulin use for T1 patients who are pregnant. I am trying to find documentation about what is the accepted practice for these particular patients. I was consulted on a 5 weeks pregnant 26yo T1 who has been T1 since age 13. She has been using Lantus and Humalog for her basal/bolus/correction regimen. The OB doctor has changed her to NPH and Regular bid with correction 4X day with Regular insulin. His bg goal for her is 60---110. This seems impossible to me using this regimen and given the fact she is T1. Isn't Humalog a category B drug with pregnancy? This OB doctor treats lots of women with gestational diabetes but I don't think he tx a lot of T1s. Is anyone seeing the basal analogs used instead of NPH? It would be a lot easier to titrate her bg if we used NPH and Humalog instead of NPH and Regular. Also she is employed and does not have a sitting job. I appreciate any help or suggestions anyone can provide.
  4. Mar 14, 2011

    I have met and worked with a number of adolescent and young adult athletes. Triabetes is an excellent organiziation and you can follow participant's blogs to learn how they manage highs and lows with endurance exercise. Most athletes with type 1 who test their blood glucose during exercise are better able to balance their dietary intake/performance/insulin. However, I do find some high school aged kids don't test often enough and I hesitate to clear them for formal sports participation if they have elevated hbA1c and are unwilling to monitor more often. I would love to hear how other folks handle this and yes I agree with you Carla, let's not restrict carbs with activity!
  5. Mar 08, 2011

    Should Lantus be held if patientt's blood sugar is 38?

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