Treatment of diabetes has gone through dramatic changes in the past two decades. Previously, exercise was often overlooked as a "cornerstone" in its treatment as it can be more difficult to maintain blood sugar levels with physical activity as an extra variable, especially for individuals with type 1 diabetes. Nowadays, however, with frequent blood glucose monitoring, exercise can be done safely and without fear of severely upsetting a delicate glucose balance.
Diagnosed with diabetes myself at the age of four in the "Dark Ages" of diabetes (1968), I went through childhood, adolescence, and early adulthood without benefit of a blood glucose meter. I still participated in a wide variety of sports and physical activities, but did many of them feeling less than my physical best (experiencing either high or low blood sugars during them). Growing up I always felt better overall after doing any exercise, although at the time I did not understand the physiology behind it. I also felt I had more control over my diabetes if I exercised. Consequently, I began working out regularly on my own and through participation in sports as a young teenager and have continued being regularly physically active throughout my adulthood.
Not until I had a blood glucose meter did I realize, however, how much better I felt when exercising with my blood sugars in a more normal range. Keeping them normal during exercise, however, has totally been a trial-and-error learning process! At the time I got my first meter, there were very few guidelines or books that could offer me any guidance. I did eventually learn to control my blood sugars for my usual activities, but every time I tried a new or unusual one, it felt like I was like starting over again. When I attended my first IDAA in Phoenix, Arizona in 1990, I met a lot of other active individuals. It occured to me then that I could learn so much from others' experiences that would hopefully make my trial-and-error process shorter and easier. It was from this experience that I eventually got the idea and motivation to write The Diabetic Athlete.
In 1998 I sent out a questionnaire to all English-speaking members of the IDAA (~1700 members) and received responses back from about 250 individuals (some were from those of you reading this!) My questionnaire asked them to describe their usual diet, medication, exercise routines, and most importantly, specific alterations made for a variety of sports and recreational physical activities. They were also asked to indicate their use of current and past exercise guidelines. The Diabetic Athlete is a compilation of these experiences (as well as some general recommendations) that each of you can hopefully use to more easily attain better blood sugar control while doing any type of physical activity.
The first part of The Diabetic Athlete covers the exercise basics. I have always found that knowledge is power when it comes to managing diabetes. I searched out information for years, finally resulted in my earning of a doctoral degree in Exercise Physiology from the University of California, Berkeley! While you do not need a Ph.D. to understand how your body adapts to exercise, you do need to understand the basics in order to make knowledgeable and safe changes in your diet or medications.
The first chapter deals with the basics of exercise prescription: how to monitor your exercise intensity, what type of exercise to do, how often to exercise, and for how long. If you really want to have gains in your fitness and endurance, you will benefit from understanding how to work out properly. Your workout intensity determines alot of the overload on your muscles and your subsequent fitness gains. Warm-ups and cool-downs are important for all athletes, but especially for diabetic athletes who may have some unique diabetes-related concerns.
The second chapter is key to understanding your blood sugar response to any activity. Once you can determine what energy systems and fuels your body uses during exercise, then you can almost predict what your blood sugar response will be and what actions you need to take during and following the activity. It is also important to understand how circulating levels of insulin can alter your normal response to an activity, and what kind of an effect chronic training has on fuel utilization.
The third chapter will help you to understand the types of medications and regimens that individuals use to either replace insulin or improve its production and action. Again, your circulating insulin levels will be greatly affected by differing insulin regimens, timing of exercise, and sensitivity to insulin. Exercise in the morning can result in a very different response all the potential symptoms of hypoglycemia (especially if you gave not had many episodes of hypoglycemia) as they may be different during exercise and after training.
The purpose of fourth chapter is address just some of the many nutritional and ergogenic substances currently on the market in terms of their effectiveness and their safety of use for athletes and, specifically, diabetic atheletes. This chapter addresses nutritional supplements specifically with regard to their effects on athletic performance and on blood sugar regulation during exercise, and those of potential benefit or harm to diabetic athletes are noted.
The fifth and sixth chapters address some special concerns and precautions for diabetic athletes with type 1 and type 2 diabetes, respectively. Chapter five specifically relays some of the athletes' reported responses to published exercise guidelines and gives you the benefit of knowing how other individuals use them. Diabetic complications are, unfortunately, a reality for many individuals with diabetes; exercise can usually still be done, but certain precautions are discussed to make exercise safer.
The second part of the book can really help you reduce your trial-and-error time for participation in almost any conceivable sport or physically activity! This part is arranged into four chapters by type of activity: endurance sports (including running, swimming, cycling, and other sports), power sports (such as basketball and softball), fitness activities (such as aerobics, weight training, and other gym workouts), and finally recreational sports (including current crazes like rock climbing, in-line skating, and snowboarding). In each chapter, general recommendations for diet, insulin, or medication changes are given for each specific sport or activity as well as real-life examples from diabetic athletes who participate in those sports.
While general guidelines alone are never effective for everyone due to individual variability, you can additionally benefit from the knowledge of others' experiences. It is my belief that this combination of basic (the why of exercise) and experiential (the how of exercise) information about exercise can benefit all of us in maintaining blood sugars during any physical endeavor! So lose the excuses! Whether you are interesting in just recreating or want to be a serious competitive athlete, it is time to get out there and exercise!