I just finished reading a really interesting article in the WSJ about type-1 diabetics and participation in high intensity sports. I know – it seems risky, but even as a trainer, I’ve known that such feats were possible with the right training and medical support. In fact, Kris Freeman, an Olympic cross-country skier at the games in Vancouver, was doing a great job while competing – until his sugar plummeted. Still, to see that someone with type-1 diabetes can compete at this level is truly amazing, and inspiring. Obviously, athletes of this caliber train very, very hard, which makes it all the more important to monitor insulin levels while training. Check out the article for the whole story if you wish.

Below I’ve listed some tips for diabetics engaging in physical activity. Obviously, if you choose to train at higher intensities, it is important to get clearance from your physician, and to also work closely with a conditioning coach who has experience working with athletes who have diabetes.
1. Immediately before exercising, test your glucose levels, then again during exercise (especially if you are just beginning a new program). You should re-check immediately after your session as well.
2. If your blood glucose level drops to less than 70 mg/dl or is higher than 250 mg/dl, and you know you have ketones in your urine, do not exercise. If blood glucose is 300 mg/dl or higher (regardless of the presence of ketones),  you should not exercise.
3. If you suffer from diabetes-related foot problems, make sure you were well-cushioned shoes and dry-wicking socks that keep moisture away from your feet.
4. Be aware that certain conditions associated with diabetes, such as autonomic neuropathy, neuropathy, or retinopathy, it is a good idea to seek your physician’s approval before beginning an exercise program. If you have one of these conditions and your physician gives you the go ahead to exercise, it is important that your trainer or exercise physiologist works closely with your physician, as there will likely me restrictions as to what activities you may participate in.
5. Know the warning signs of hypoglycemia; trembling or shaking, rapid heart rate, increased sweating, excessive hunger, headache, irritability and mood changes, impaired concentration, mental confusion, and drowsiness. Stop exercising if you experience any symptoms of low blood sugar and test blood glucose to confirm hypoglycemia.
6. If you are suffering from low blood glucose, eat or drink 10-15 g of simple sugar immediately to restore glucose levels. It is a good idea to keep foods such as raisins, hard candy, crackers, or boxed juice in your gym bag where it can be accessed easily, just in case you need it.
7. After replenishing your glucose, rest for 10-15 minutes before resuming any activity. This will allow the intestines time to absorb the glucose.
8. Continue to monitor blood glucose, preferably within 30-40 minutes of resuming exercise, if possible.
9. After exercise, replenish glucose immediately with complex carbohydrates.

[Sources:

ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 4^th ed, Lippincott Williams & Wilkins, 2001.

Exercise Physiology, 5^th ed, McArdle, Katch, and Katch, Lippincott Williams & Wilkins, 2001

IDEA Fitness Journal, Peggy Kraus, MA,  “Working with Diabetic Clients,” Nov-Dec 2007]