No reason to stop

Diabetes is one of the most common diseases in today’s world. Its effects are particularly harsh on athletes and sportspersons, who need to be on a strict diet and exercise regimen.

Diabetes restricts their efforts, probably forcing many to end their careers too. But the truth of the matter is that sports and diabetes go every well together, provided you exercise some caution. Wasim Akram, the former Pakistani cricketer, has lived with diabetes since the age of 29. But he still managed to carve a name for himself as one of the greatest fast bowlers, who has taken maximum wickets in the world. His secret? Mind discipline: something that he emphasised on throughout his career.

It is a common practice to recommend physical exercise to someone who has diabetes. Physical exercise certainly contributes to improving one’s health and general wellbeing, but don’t forget that it can be fun too. As diabetes is largely a condition that is managed by patients themselves on a daily basis, it is very important to understand what happens to your body during exercise.

This will help improve your blood glucose control, optimise performance, avoid hypoglycemia (low blood sugar) and ultimately, have a better plan to suit the demands of your sporting life.Not a barrierHaving diabetes should not be a barrier to exercise and sports activities. But it is important to have a personalised plan after a thorough assessment and discussion with your sports diabetologist. Changes to the dosage of your medications and food intake (calorie intake) may be needed to prevent hypoglycemia during and after exercise. Advice regarding the appropriate medications and food intake may vary for every person and every exercise regime.

Now, exercise has innumerable benefits, as you would already know. It’s a great stress buster, which increases insulin sensitivity and improves overall diabetes control. What’s more, exercise also promises to reduce your risk of heart attacks and stroke, while making your bones healthier.

Things to consider

For competitive athletes afflicted with diabetes, here are some helpful pointers to keep in mind. For starters, keep a watch on your sugar levels and take
appropriate action as suggested by your doctor. If you observe any symptoms for low or high sugar levels, it is advisable to seek advise from a diabetologist with
expertise in sports diabetes for a proper management plan. All professional sportspersons have a specialised diet and exercise schedule, which needs to be
discussed with the diabetologist.

Individuals with diabetes should be particularly aware of delayed onset hypoglycemia (DOH), which can occur after high intensity exercises, following extended duration activity. This can occur upto 24 hours after the cessation of exercise. Adjustment of food portions and insulin or tablet dose will be necessary to prevent DOH.

Competitive athletes with diabetes treated with insulin are at risk of developing exercise-induced hypoglycemia, hyperglycemia and ketosis (increased acid level) brought on by physical activity and lack of insulin, especially when insulin is omitted or dose has been significantly reduced.

Insulin is required for the skeletal muscles to use glucose as an energy source. When insulin level is low or absent, skeletal muscles are forced to use fat as energy source, which leads to increased production and accumulation of acids (ketones), which will need urgent medical treatment. If not treated, this can be dangerous. Individuals with diabetes should not exercise if insulin level is inadequate. Athletes with diabetes on insulin should not exercise if blood glucose level is more than 250 mg/dl and ketones present and if blood sugar level is more than 300 mg/dl, irrespective of ketones.
Management of competitive athletes with diabetes is often challenging for the diabetologist. Type 1 diabetes patients taking part in sports activities should have an effective management plan after considering the energy demands of the sports activity, intensity of training or competition, their own goals and factors affecting glucose levels to allow safe and effective sports participation. General advise would largely remain the same for patients with Type 2 diabetes, albeit with personalised solutions to suit one’s lifestyle.

Whether or not you have diabetes, if there is a strong zeal to excel in a sport and make most of your abilities, nothing can stop you. With some professional advice and well-devised management plan from a diabetologist you can surely achieve all your goals.

Safe exercise

Monitor your blood sugar levels regularly.
Be aware of how to prevent and treat
hypoglycemia and hyperglycemia.
Understand how different exercises affect your blood sugar level.
Be aware of the intensity of the exercise, to anticipate fluctuation in blood sugar levels.
Find out about insulin sensitivity and figure out where you stand.
Be aware of the amount of sugar in the food you eat.

(The author is consultant — endocrinology, diabetes & bariatric medicine, Fortis Hospital, Bengaluru)