What do Scott Verplank (5 time PGA tour winner), Jay Cutler (Quarterback for the Denver Broncos and the Chicago Bears), and Jackie Robinson (Brooklyn Dodgers) all have in common?

Besides having achieved immense success in their sports career, they have also achieved a measure of success when managing their diabetes.

Had they not managed their diabetes very well, it is safe to say that they would have not been at the top of their careers. Their performance would have been impeded by signs and symptoms of low or high blood sugar.

When not performing at their best on a professional team, sportsmen can be fired for poor performance. So if an athlete is managing their diabetes, they should not be kept from playing professional or any kind of sports when they have the ability to do so.

With all of their team mates counting on them, athletes with diabetes have a lot to think about, prepare for, and do, because of the added complexity that their diabetes brings to the playing field.

There is a list of people in sports with diabetes on Wikipedia. Looking at the length of the list, it is clear that it is

possible to succeed in just about any sport with diabetes. There are literally people with diabetes in every sport imaginable. There are people in football, baseball, basketball, canoe slalom, cricket, cycling, soccer, golf, ice hockey, and more.

What does it take to be an athlete with diabetes?

To be a successful athlete with diabetes, it is going to take some stellar self-management skills. The most important thing that an athlete with diabetes has to worry about is low blood sugars. With proper nutrition and strict control, you too can hit the ball out of the park, or reach the finish line, (all without episodes of hypoglycemia or hyperglycemia).

Hard work or low blood sugar?

Signs and symptoms of low blood sugar include sweating more than usual and feeling fatigued. Since these things can also be signs that you are having a good workout, an athlete with diabetes must be on keen alert, and pay close attention to their body signals.

If you are an athlete with diabetes, you have to stay on top of your blood sugars, lest they get the best of you. There are some things that you will need to do to make sure you stay within an appropriate range for your blood sugars during exercise.

First things first: monitor your blood sugar prior to exercise

If you are getting ready for some intense training as an athlete with diabetes, you will need to check your blood sugars before you set out on your training excursion. You will not want to start exercising until your blood sugar is greater than 70 mg/dl. If it is not at least 70 mg/dl, you will then need to eat an extra snack prior to your exercise routine.

Preparing for the big event

The adrenaline rush that occurs when a person is excited before a sporting event actually does make  blood sugars rise. It is okay for your blood sugar to be a little high, as we will discuss in a  minute. If your blood sugars respond to extremes of hot or cold temperatures, you will want to  account for that, and adjust your plan   accordingly.

Check out all of the details of the sporting event. If it is a race or triathlon, talk to the
person in charge. Learn about the course, and plan your route. Find out if there are check points.  If so, where would it be ok for you to leave an extra meter and glucose gel, or supplies? Can you  leave a kit at each station?

Always consult with your primary care provider when planning sporting events, and before making any changes in your diabetes plan. You may need adjustments to your medications, diet, or other treatments.

Do not forget to snack before the sports event, and carry extra carbohydrates

In general, 15 grams of carbohydrates is enough to snack on if you are exercising for 30-45
minutes. However, you should always carry extra snacks with quick-acting carbohydrates in case you need it for a low blood sugar.

Eating a high carbohydrate meal the night before a race is recommended for athletes to increase their supply of glucose prior to an event. You should cover the carbohydrates with the right amount of insulin. Your body will store some for the event. If you plan to exercise for an hour or longer, you then need to eat 30 grams of carbohydrates prior to exercising. For intense training, such as triathlons or marathons, you may need to eat an extra carbohydrate-containing snack   during your activity. A 15-20 gram carbohydrate snack may be needed every 30 minutes during long, intense   sporting activities.

What about pumpers?

A basal rate adjustment on your insulin pump will be needed during the athletic event. Do not disconnect your pump for more than an hour of exercising without administering an insulin injection. This is especially true for people with Type 1 diabetes, as they always need to have some insulin on board during any activity. If it is a swimming event,  you may have to disconnect your insulin pump if it will not hold up in the water.

Injection and insulin pump site care for sporting  events

All the sweating that is going on during sporting activities revs up your muscles and makes you sweat. Exercised muscles do not absorb insulin so well. Do not inject the muscles most used in exercise. If you are a runner, avoid injecting insulin into your thigh.
The sweating makes pump sites come off, so an athlete with diabetes can try a stronger adhesive or sealant, and make sure to change sites as directed every three  days.

Nutrition is important

Eating 6 small, frequent meals throughout the day that contain carbohydrates, protein, and good fats, is important. This will help to keep your blood sugars steady during events that last the whole day. However, it may be best to avoid high sugar foods and foods with high fat content just before exercise. The amount of carbohydrates that  makes one person feel okay during a race may make another athlete feel sick.

It is best to learn what kinds of food that you can tolerate prior to a sporting event ahead of
time. High fiber foods  work well for some athletes and not for others. Small, frequent meals and snacks will be better for performance than heavy meals during events.

After exercising, you need to refuel. Eat a good meal containing all food groups closely following completion of the sporting event.

What about high blood sugars during exercise, do they not count?

Yes, high blood sugars during exercise is not good. You will want to postpone your exercise plans if your blood sugar is over 300 mg/dl. If your blood sugar is 240 mg/dl or above, you will want to check for ketones with a urine ketone strip before you exercise. These can be purchased at any pharmacy.

If ketones are present, then do not exercise until blood sugars are down below 240 mg/dl, and ketones are absent. The reason that you should not exercise when you have ketones present is because ketones signal that there is a need for and lack of insulin. Exercising when ketones are present will burn fat and cause your body to produce more ketones. This can lead to a dangerous condition known as Diabetic Ketoacidosis (DKA).

Do not forget to drink plenty of water to avoid dehydration when your blood sugars are high and during your exercise routine in general. Also, dose insulin as it is prescribed to you by your doctor. Do not exercise until you are ketone negative.

Following the sporting event

In addition to eating a nutritious meal to avoid post-exercise low blood sugar, you will want to continue to check your blood sugars often. Plenty of water is needed before, during, and after a sporting event. Getting dehydrated can make your blood sugars rise.

Make sure your coach and teammates know you have diabetes

You will want to make sure to let your coach, teammates, and other people who may be present during sports events know about your diabetes. You will want them to know the signs and symptoms of low blood sugar, and how to help you treat it, or administer a glucagon injection if needed.

Special precautions for insulin requiring diabetes

If you take insulin or other blood sugar lowering agents, you will want to have your doctor or sports medicine team evaluate you for decreased insulin or medication needs during exercise, and adjust your dosage accordingly.

When athletes with diabetes take insulin shots, it may be better to perform in sporting events either in the morning when insulin levels are low, or 2-3 hours after the last insulin injection to help prevent a low blood sugar. Rapid insulin may need to be reduced. Again, work with your healthcare team.

What does it take to be an athlete with diabetes?

An athlete with diabetes should have an advanced understanding of how nutrition, insulin levels, and exercise affects them. It is quite the balancing act that they must perform. They have to balance between getting the right amount of insulin and the right amount of carbohydrates in order not to bottom out during a sporting event. The timing of insulin dosing is key to a successful sporting event without incident related to diabetes.

So if you have the stamina, endurance, and sheer drive, along with the ability to self-manage your diabetes, and want to become an athlete with diabetes, what are you waiting for?

Just do it!!! Do not let anyone stop you from reaching your goals in life.

By: Elisabeth Almekinder RN, BA, CDE, Originally posted in https://www.thediabetescouncil.com/everything-you-need-to-know-about-being-an-athlete-with-diabetes/