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  Overcome barriers to exercise
 Optimize sports performance
 Provide a realistic exercise
plan to lose weight
 Prevent hypo & hyperglycemia
Plan  Adjust insulin & food
 Start an exercise plan
 Improve exercise training
 Adjust insulin/oral meds
 Manage sports injuries
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
Glucose
Metabolism &
Exercise
Training
Nutrition Tips
Psychological
Training
Blood Glucose
Management
Glucose Metabolism
and
Exercise Training
Physiology During Physical Exertion
FUEL
DEMAND
need for
glucose to
enter
muscles
• Release of
counterregulatory
hormones
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
Physiology After Exertion
FUEL
STORAGE
Active
muscles
need to
replace
glucose in
muscle and
liver
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
Blood Glucose Trends with Aerobic Exercise
Gallen, British Journal of Diabetes and Vascular Disease, 2004
Moderate vs High Intensity Exercise
 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
Guelfi et al., Diabetes Care, 2005
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
Speed,
Agility &
Power
Muscular
Strength
Balance
Flexibility
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
Nutrition
Tips
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 Exercise
Choose 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