Diabetes in the Competitive Athlete

Abstract

Diabetes mellitus is the most common group of metabolic diseases and is characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most patients with diabetes are type 2 (90%); the remaining patients have type 1 disease. Athletes with diabetes range from the athlete participating in various youth sports to the competitive Olympic athlete and present a significant challenge to themselves and the medical staff who care for them on a daily basis. Each sport and the type of exercise have their own effects on diabetes management with numerous factors that significantly affect glucose levels, including stress, level of hydration, the rate of glycogenolysis and gluconeogenesis, and the secretion of counter-regulatory hormones. This article provides a general overview of diabetes mellitus, the effects of exercise on glucose levels, and a detailed review of the potential complications encountered in the management of diabetes in the athlete.

Type 1 Diabetes Mellitus and Exercise in Competitive Athletes

“…Even sports on a competitive level can be managed by patients with type 1 diabetes [1] and, indeed, this number is increasing [2]. Using an adapted and intensified therapy they can even reach the same physical performance level as athletes without diabetes [3]. Nevertheless, athletes with diabetes face specific challenges.…”

“…The metabolism of patients with type 1 diabetes depends on exogenous, adjusted insulin injections and variations in endogenous and exogenous factors can disturb the metabolic control. Especially exercise increases the risk of activity-induced hyper-and hypoglycemic events [3]. Physical activity enhances insulin sensitivity and glucose uptake in skeletal muscle which can result in activity-induced hypoglycemia [4].…”

Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management

“…[22][23][24][25] The basic management strategy for type 1 diabetes of decreasing basal insulin rate while increasing carbohydrate intake during exercise to match energy utilization is based on these principles. 15,26,27 It is important to understand the increased risk of hypoglycemia that occurs after exercise, as frequent hypoglycemic events in individuals with diabetes have been linked with longterm morbidity and mortality. 28 The glycemic response to exercise changes with time of day, and risk for nocturnal hypoglycemia is highest when exercise is completed in the evening.…”

“…Appropriate supplies and medical equipment should be brought on any wilderness activity. 15,53 Wilderness athletes should carry documentation of their medical history, basic diabetes management plan, and basic emergency action plan (Evidence grade: 1C).…”

Establishing the multidisciplinary Imperial Physical Activity and Diabetes clinic

“…Challenges arise for people with diabetes during physical activity in matching insulin delivery with insulin requirements to enable provision of metabolic substrate to exercising muscles . People with diabetes and those trying to support them are often reliant on anecdotal or trial‐and‐error methods of management, although expert consensus advice has recently been published .…”