Andrew Heilbrunn, Head Biokineticist and Director at the Centre for Diabetes and Endocrinologist’s (CDE) fitness centre, says he strongly encourages regular exercise for people living with diabetes.
He adds, however, that ad hoc exercise can cause havoc with blood glucose levels because it is difficult to know how much insulin to decrease or increase and how much of a snack one would have to take.
When people participate in sport and regular training, it becomes easier to make regular adjustments to insulin and people can make better choices with their snacks to prevent hypoglycaemia. This process leads to better blood glucose control and a healthier lifestyle.
Endurance sports, particularly, require discipline and a process of trial and error before athletes with diabetes can compete and keep their levels under control. “Because the endurance athlete is constantly burning calories and needing to replenish stores, it’s critical that levels are monitored throughout the event and for 24 hours after the event. Weight training, on the other hand, produces more adrenaline which keeps blood sugar levels more stable. However, weight training can also lead to hypoglycaemia in the next 24 hours post exercise.”
He believes with the right team of professionals aiding the patient – doctor, dietician, diabetes nurse educator and biokineticist with a speciality in diabetes, the patient can participate and enjoy sport at a competitive level. “There is also great technology out there providing athletes with a continuous live record of their blood glucose levels as they train and compete,” he adds.
He explains that the most common risk associated with sport and diabetes is a hypoglycaemic episode, which can ultimately result in a hypoglycaemic coma.
Typical signs of hypoglycaemia are weakness, impaired concentration, cold sweats, excessive sugar cravings and a pale complexion. Heilbrunn says it’s important to keep a diary to monitor blood glucose levels and hypoglycaemic episodes.
“The more episodes, the more you have. After 45 minutes of exercise, there is more chance of becoming hypoglycaemic for 24 hours post exercise.”
He highly recommends a small (10 to 20g) carbohydrate snack 20 minutes before you start exercising and every 20 minutes during exercise. He also recommends a protein snack such as yoghurt before bed. “This will help prevent hypoglycaemia overnight, after prolonged exercise. It’s also very important not to participate in a big event if you’ve had a hypoglycaemic episode in the two weeks prior to the event.”
Another risk is ketoacidosis. This condition develops when patients do not have enough injected insulin circulating. The result is that the body searches for another form of energy and breaks down fats and proteins instead of using glucose as an energy source. This process leads to an excess acidity in the body. Typical symptoms include stomach cramps, vomiting, diarrhoea, dehydration, a loss of consciousness and ultimately a keto-acidotic coma.
For people newly diagnosed with type 1 diabetes who want to get involved in sports but haven’t previously been active, Heilbrunn recommends starting slowly. Patients should monitor their levels before and after exercise and before bed. Initially it will be a case of trial and error but they shouldn’t give up. He adds that a combination of cardio and resistance training in a gym is a good way to start. This can be monitored and it’s easier to keep levels stable with this kind of exercise.
“Consistency when exercising is important. 30 to 60 minutes every second day or 30 minutes every day is great. Globally, it’s recommended that on average, all people should do one hour of physical activity daily. This hour can be made up of a combination of activities including getting up every few minutes at work to walk around the office, gardening at home and planned exercise. It doesn’t have to be an hour in the gym every day. The key is to be active,” he says.
The correct nutrition is also essential to maintaining better levels when exercising and playing sport. “It depends on the length of exercise as to how you should eat and snack. Timing is important. You can’t exercise, for example, when your insulin is peaking without a snack. You will need to snack at that time. Snacks can include peanut butter sandwiches, bananas, half a sports drink or a sports bar. Ideally, you should be snacking every 20 minutes. When doing endurance exercise, the first hour is generally covered by breakfast.
Every 45 minutes to an hour after that, you will probably need to snack and drink. It is safer to have too much sugar than too little during these events,” he explains.
For Heilbrunn, besides the physical benefits of exercise, the psychologically advantages of sport and exercise are excellent for those living with diabetes. “It improves stress levels and the general management of the condition. It’s never too late to get started.”