Diabetes

Phyiscal activity and diabetes

02/23/2000 04:49PM

Question:

How does diabetes affect athletes?

Answer:

Let me address both how diabetes affects the athlete and how athletics or exercise affects the person with diabetes. The basic problem in diabetes is that fuels, especially carbohydrates (like sugar and starch) but also protein and fat, don't get distributed to the tissues they usually go to (for example, to the muscle, brain, liver and fat tissue) in the necessary manner and build up in the blood and outside of the cells in a person's body. Vigorous physical activity generally involves increased muscle activity and an increased need for fuel in the muscle. Alterations in fuel distribution because of diabetes and alterations in fuel distribution from exercise going on at the same time can have opposite effects. Exercise generally tends to lower the blood sugar but there are situations in which it can cause it to rise. Changes in diabetes medications and food intake are frequently needed to prevent dangerous consequences and it is best when those are planned for in advance. If the activity and the medicine and the diet are not coordinated, this can put the person at risk for either very high blood sugar (hyperglycemia) or very low blood sugar (hypoglycemia). There are also some differences in how it affects people with type 1 diabetes versus those with type 2. Type 1 diabetes is the form in which all the cells which produce insulin have been destroyed. People with type 1 diabetes require insulin treatment. Once the insulin is taken, it directs fuel to its target tissues, regardless of the demands of the exercise. There are mechanisms in the body to prevent the blood sugar from going too low when the muscle demands more fuel during and after exercise. They can prevent low blood sugar in this situation but only up to a point. Most people feel warning signs of hypoglycemia like sweating, nervousness, a forceful or rapid heart beat and that warns them to eat something to prevent hypoglycemia from getting out of hand. However, in some people with type 1 diabetes, those hormones that protect against low blood sugar don't work properly. Those people need to be more on the lookout for lows and perhaps compromise on how "tightly" they control their blood sugar. Planning means timing exercise in relation to medicines and meals, sometimes reducing medicine or increasing food or both. Type 2 is due to a combination of effects, both a partial loss of insulin producing cells and a reduced ability to respond to insulin. Exercise markedly improves the body's response to insulin the blood sugar and that is key to achieving excellent blood sugar control using the smallest amount of medicine possible. Physical limitations or injuries can make finding a practical form of exercise a challenge but the payoff is great in terms of improved blood sugar control and sense of well being and reduced risk of heart disease. In summary, there are dramatic benefits of exercise for people with diabetes. However, it is important that they understand how their particular medicines and diet will affect their response to exercise and plan accordingly. That is an important benefit of receiving care for diabetes by a team approach with physician and teaching nurse and dietician.

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Response by:

Robert M. Cohen, MD
Associate Professor
Division of Endocrinology and Metabolism
Department of Internal Medicine
College of Medicine
University of Cincinnati