REGULATIONS FOR THE CULTIVATION OF SPORT IN DIABETES
Glycemia and sport and recreation
First of all, you must know that a person who is treated with insulin and takes more than usual physical effort, burns a lot more glucose in the muscles. For this reason, hypoglycaemia may be dangerous for health. You can reduce this risk by injecting less insulin than normal (preferably in consultation with your doctor) or eating more carbohydrate-rich foods.
If you have diabetes and want to play volleyball or tennis, swim a longer distance or set off for a few kilometers bicycle walk - how to protect yourself against hypoglycaemia?
First of all, we should measure glucose before sports or recreation. In the case of too low blood glucose - before eating, take food abundant in carbohydrates, such as a sandwich. In the case of a longer effort, for example a few-hour bicycle trip or a walk, you should bring with you a supply of dry food rich in slowly absorbed carbohydrates (eg sandwiches) and sweetened drinks. In the case of the first signs of hypoglycaemia: drowsiness, dizziness, muscle tremor, weakness, abdominal pain, speeding up the pulse - we should drink a glass of sugared drink and eat a portion of the provision appropriate for the planned efforts. For people with type 1 diabetes, the dose of injectable insulin should be reduced by 30-50% before starting long-term exercise.
What can happen to us in a few hours after completing recreational exercises, sports games, and walks?
After stopping the physical effort, the body tries to regenerate the energy reserves that have been used up. This means that even a few hours after the end of the game or walking, a severe hypocrisy may occur because the muscle cells continue to take sugar from the blood. For this reason, the blood sugar deficit (hypoglycaemia) may persist with the unpleasant symptoms mentioned above at night or even on the following day. A good way to prevent such consequences is to measure the glucose level - after the end of exercise and depending on the result, eat a meal sufficiently rich in slow-release carbohydrates.
How to avoid excessive physical exertion?
Some of the exercises - running, dancing, tennis, etc. can be an unhealthy effort. Therefore, it is recommended to regulate the intensity of physical exercise through diabetes self-monitoring, such as: profuse sweating, faster breathing, and tiredness. If we feel excessive tiredness, we should slow down the pace of exercise and rest.
Are there any measurable indicators of effort, which should not be exceeded?
A measurable indicator of the intensity of the effort is the frequency of heart rate pulses. It is believed that in patients with diabetes, physical exercise should not exceed 140 pulses per minute. (It is easy to count pulse hits by measuring their number for 15 seconds and multiplying by 4). The rule should however be to consult this indicator with the attending physician.
PHYSICAL EFFECT IN DIABETES TYPE 1
When a person with type 1 diabetes should not take physical exercise?
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The basic condition for undertaking the effort is - as we mentioned above - very good control of diabetes. The contraindication to undertake sports training or other excessive exercise is fasting blood glucose concentration above 140 mg% (7.77 mmol / l), and in 2 hours after exercise - from 220 mg% (12.2 mmol / l) and daily glucose from 30.0 g or positive acetone test. First, the results of treatment with diet and insulin should be improved, and then the benefits of physical exercise should be used.
Glycemia and training - at what level of blood sugar (glycaemia) can you train safely?
According to the fairly liberal guidelines of the American Diabetes Association (ADA), with the lower blood glucose lower than 300 mg% (16.8 mmol / l) and absence of ketoacidosis, you can take up training while maintaining caution and (supervising the doctor) and often controlling the level of sugar in blood. However, you should refrain from the effort if your blood glucose exceeds 250 mg% (13.9 mmol / l) and ketoacidosis occurs.
What do experienced athletes with type 1 diabetes say about the optimal blood sugar level?
Athletes with type 1 diabetes - requiring insulin injections - say they are in the best form when they start training at lower glucose concentrations, i.e. within 70mg% - 200mg%.
What is currently considered the most important in the medical recommendations for physical exercise in people with type 1 diabetes?
If the doctor has previously ruled out the risk of macro and microvascular complications - patients undertaking training or physical recreation should recognize how the body's glucose levels change in response to different physical exercises.Depending on the level of sugar diagnosed, they should learn under the supervision of a doctor using reduced doses of insulin, as well as regulating glycemia and preventing hypoglycemia with carbohydrate-rich foods.
When should you use an extra portion of carbohydrates before exercise?
It is accepted that an additional portion of carbohydrates is necessary when the blood glucose concentration before taking physical or recreational activity is lower than 100 mg%.
When will we use an extra portion of carbs, and when to reduce the dose of insulin?
In the case of an effort limited to 45 minutes - it is usually enough to consume extra carbohydrates, eg sandwiches before training or playing football. However, if the effort is longer, especially if it is intense, then the intake of carbohydrates is not enough. In these cases, it is necessary to reduce the insulin dose before exercise.
How to modify the dose of insulin to make a long-lasting effort, for example, all-day long journeys in the mountains?
From the first day of wandering, you should measure your blood glucose in the morning and inject yourself half the dose of insulin you need. At noon and in the evening - also measure your glucose level and inject half your insulin dose. The next day we use the same pattern, except that we reduce the insulin dose - only by 30% compared to the initial dose we usually use before intense exercise. Rapid-acting and delayed-acting insulin doses decrease proportionally to the same extent. The above diagram is a general pattern - therefore it is always better to have a glucometer with you and, based on current blood glucose measurements, adjust the insulin dosage and the abundance and frequency of carbohydrate-rich meals.
Do you have type 1 diabetes requiring insulin injections - can you do professional sports?
Yes, maybe, but the decision must always be a doctor who must assess the general health of the person.
Are there any sports not recommended for this disease?
Unfortunately, there are disciplines where hypoglycemia is life-threatening. These include: piloting, parachuting, climbing, diving, swimming in open water areas (sea, lake, river). In some sports, such as swimming in a pool, the danger can be partially prevented by the belaying of an accompanying person and a lifeguard.
What should be the preparation for practicing physical exercise and active recreation of patients with type 1 diabetes, requiring insulin injections?
As we could already see - in some patients with type 1 diabetes, taking long-term physical exercise, including regular training, may be detrimental. Therefore, taking physical exercise and recreation should be preceded by diet analysis and training on its appropriate use for various types of physical exertion. A similar analysis and training should concern the modification of insulin dosage, in terms of the planned effort and its intensity. Ideally, people who have not had experience in this respect have undergone special training under the supervision of a doctor.
