Exercise, Sports & Diabetes: Going for the Goal

Physical exercise is important for everyone’s health and well-being, but it’s especially important for people with diabetes. The steps a person with diabetes takes to improve overall fitness can be greatly beneficial, because regular exercise helps lower blood sugar levels and keep them in target range. Exercise physiologist Gary Scheiner, M.S., C.D.E., provides proactive diabetes management tips that will ensure healthful and safe physical activity. Included is a helpful checklist and resources for communicating with coaches and school staff.

People with diabetes can play and succeed at sports just like their non-diabetic peers. A recent survey of 150 children, ages 3 to 17, attending JDRF’s 2005 Children’s Congress provides dramatic proof. These kids with diabetes engage in dozens of different activities, from hiking the Grand Canyon to climbing on kitchen counters (3-year-old division). They ski and skate and ride bikes, scooters, skateboards, snowboards, wakeboards, knee-boards, and river rafts. They wrestle, jump on trampolines, and play varsity football. They’ve won first place in competitive roller hockey, sailing, softball, karate, cross-country, soccer, swimming, dirt biking, snowmobiling, and cheerleading.

Through their achievements, these youngsters send the critical message that people with diabetes can participate fully in sports and physical education activities of virtually every description. And with new and more effective approaches to diabetes management, such as sophisticated, portable testing equipment and “smart pumps”, no physical activity should be ruled out.

The Benefits

Physical exercise is important for everyone’s health and well-being, but it’s especially important for people with diabetes. For everyone, regular exercise produces such important benefits as cardiovascular fitness, improved muscle tone and strength, lower blood pressure, help with weight control, positive effects on mood and stress, and the development of self-confidence and self-esteem. “But physical fitness and a sense of well-being may be even more essential for people with type 1 diabetes than they are for anyone else,” says exercise physiologist Gary Scheiner, M.S., C.D.E., head of Integrated Diabetes Services in Wynnewood, Pennsylvania. “The steps you take to improve overall fitness–even if they’re only small steps–will often result in improved diabetes management.”

The reason? Regular exercise helps lower blood sugar levels and keep them in a target range. In working harder, the body uses more glucose to produce energy and improves the way insulin works. Blood glucose levels are lowered and insulin requirements are reduced. The benefits are great, but there are challenges. People with diabetes must be careful about when, how long, and how intensely they exercise, and they must take steps to avoid hypoglycemia–going too low–during or after the activity.

Achieving the Goal

Success in any physical activity for a person with diabetes begins with proactive diabetes management. “Avoiding hypoglycemia is a goal that can be realized through good planning and constant vigilance,” says Scheiner. Good planning means monitoring glucose both before and after exercise, always having glucose tablets or a high-energy snack on hand for unexpected lows, and drinking extra water to prevent dehydration. The athlete with type 1 diabetes must coordinate exercise with diet and insulin therapy, making adjustments in insulin dosing or snacking. Keeping a record of exercise and physical reactions is important, says Scheiner, because each person has his or her own unique response to exercise that can be observed through daily treatment adjustments, and because different types of exercise have different effects on blood sugar. Information to record includes blood sugar readings, foods eaten, the amount of insulin taken before exercising, the nature and length of the activity, and how the person performed and felt during and afterward.

Scheiner says that it is usually not dangerous to exercise with a moderately high blood sugar level. He notes that adrenaline, which jumps during short bursts of competitive, high-intensity activity, can push blood sugar levels up. However, if pre-exercise testing reveals an unexplainable high blood glucose number (over 250), it may indicate there is not enough insulin in the body to allow for a safe exercise session. In that case, it is important to test for ketones in the blood though a simple urine or blood test. “Exercise is fine as long as ketones are negative,” says Scheiner, “but if ketones are positive, exercise should be postponed until insulin is given and the blood glucose number comes down.”

If you have recently been diagnosed with diabetes, achieving ideal control may take some time as you and your health care team develop and adjust an individualized treatment program. But soon you will be safely exercising, whether in sports, physical activities, or just being an energetic person. Remember, while many people with type 1 diabetes have reached high levels of performance, not everyone is a natural athlete or an avid competitor. But being active covers a range of activities, from walking the dog and gardening to competing in triathlons. Wherever your interest or ambition lies, the message is simple: Get going.

Physical Activities at School

For students, an exercise program entails collaboration between the student, his or her healthcare provider and parents, the school nurse, the physical education instructor, and the coach. A 504 plan or other educational plan should be in place for the child or teen and should include specific instructions for physical activity.

Checklist: Actions for the Coach and Physical Education Instructor

  • Encourage exercise and participation in physical activities and sports for students with diabetes as you would for other students.
  • Treat the student with diabetes the same as other students, except in meeting his or her medical needs (remember to respect the student’s right to privacy and confidentiality).
  • Make sure blood glucose monitoring equipment is available at all activity sites, and encourage the student to keep personal supplies readily accessible.
  • Always allow the student to check blood glucose levels.
  • Understand and be aware that hypoglycemia can occur during and after physical activity and that a change in the student’s behavior could be a symptom of blood glucose changes.
  • Be prepared to recognize and respond to the signs and symptoms of hypoglycemia and hyperglycemia, and when a blood sugar event occurs, take initial actions in accordance with the student’s school plan.
  • To treat hypoglycemia, provide the student with immediate access to a fast-acting form of glucose. Consider taping three or four glucose tablets or hard candies to a clipboard or include them in the first aid pack at physical activities, practices, and games.
  • Communicate with the school nurse and/or trained diabetes personnel regarding any observations or concerns about the student.

(Adapted from NIH publication, Helping the Student with Diabetes Succeed: A Guide for School Personnel)

For Further Information:
Have a question about physical activity? Contact JDRF’s Online Diabetes Support Team, which is made up of JDRF volunteers who live with diabetes and are available to offer you immediate, one-on-one support. Certified Diabetes Educators at http://www.integrateddiabetes.com can answer your questions about diabetes and its care. Information can also be obtained from the Diabetes Exercise and Sports Association at http://www.diabetes-exercise.org/index.asp. To learn how to create a 504 or other educational plan, go to www.jdrf.org/diabetesinschool.