+ cwd november 2012 francesca annan rd balancing sports & diabetes

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CWD November 2012

Francesca Annan RD

Drag picture to placeholder or click icon to addBalancing sports & diabetes

+How to manage your sports?

Exercise adds many challenges to diabetes management

Increased activity levels are not always associated with improved control

Diabetes control will influence sports performance

For all nutrition has a major impact on sports performance, fatigue is caused by lack of fluid and fuel as well as low or high blood glucose levels.

If you have good diabetes control and a poor diet you will not perform at your best.

+Exercise type & potential blood glucose effects

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AnaerobicATP-PC

Aerobic

Anaerobic Glycolysis

Weightlifting, power liftingTrack (sprinting) & field, diving (platform & springboard)Golf, American Football, swimming (sprints), gymnastics, fencing, wrestling, baseball, volleyball, ice hockey, track cycling,climbing

Basketball, football, tennis, lacrosse, speed skating, skiing, hockey, middle distance running, speed skating>1500m

Road cycling, cross country skiing, race walking, distance running, triathlon, ultra marathon

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low high

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Muscle massRate of perceived exertionAerobic capacity endurance capacity muscle capillarizationFatigue dehydration ketone production pH

Cognition co ordinationSports skills fatigue

Euglycaemic window of 7-8mmol/L

Blood glucose and performance effects

+Food & performance

Providing enough fuel to exercising muscles is crucial for performance and recovery

In young sports competitors inadequate energy = poor growth

Carbohydrate demands of exercise need to met with appropriate insulin adjustment.

If your child is training for a sport they need to eat more carbohydrate

+Low carbohydrate intakes

Poor growth

Poor adaptation to training

Increased fatigue during exercise (can’t keep up)

Increased frequency of hypoglycaemia post exercise

Low energy levels

+Why does carbohydrate matter?

+How much carbohydrate do you need?

UK recommendations for all – 50% of daily calorie intake

If you need 2000kcal/day you should be eating 1000kcal as carbs

1g carb = 4kcal

If you are training for a sport (3 additional exercise bouts of 60minutes each + normal daily activity) need 60% daily calories from carbs

Everyday activity = 200g/day, training = 300g/day

Different sports have different requirements

+How to spread your carbs & fluid across the day (eating for sport –not diabetes) Always have breakfast to replace liver glycogen stores

Eat 1-2hours before exercise if you haven’t, e.g. if after school activity is 3 or more hours after midday meal, have a snack.

Drink 2-300ml in the 30minutes before activity starts

If activity lasts 45 minutes or longer consume carbohydrate and fluid for fuel and hydration.

Have a recovery snack within 1 hour of completing training/exercise

Distribute carbohydrate across the day as 3-6 meals/snacks

+Carbohydrate food choices

Nutrient poor carbohydrate foods

Use during or immediately before exercise only

Dental health

Everyday carbs

Nutrient rich carbohydrate foods

Low fat

Low GI

Healthy carbohydrate food choices

High fat carbohydrate foods

Limit due to impact of saturated fat on health

Particularly important to manage weigtht

+Carbohydrate food choices

Pre exercise

Rice pudding/custard

Jam sandwich

Jaffa cakes

Toasted teacakes/crumpets spread with honey/jam

Fruit smoothie

Milk shake

Cereal and milk

Post exercise

Mix carbohydrate and protein

Improved muscle recovery if sufficient insulin

Milk shakes

Trail mix

Sandwich with low fat filling

Yogurt drinks

+Carbohydrate choices during exercise

Need to be tolerated and practical

If solid food additional fluid needed, strategies planning and discussing with coaches.

All children need to drink sufficient fluid during exercise,

Practical aspects of carrying/accessing foods.

+ How to eat during exercise

Taken from www.runsweet.comCarbohydrate needs to be distributed across exercise to match muscle uptake of glucose.

+ Sports drinks

When exercise lasts 60minutes or longer – ideal to provide fluid and carbohydrate or fluid & electrolytes

+Aerobic and Anaerobic Exercise

+Eating strategies for sports/competition

Anaerobic/power sports of short duration can be managed by having food between bouts of activity.

Overall energy cost of the exercise may be low but the carbohydrate cost is high.

Aerobic activities of longer duration will require additional carbohydrate for fuel.

Insulin adjustments will reflect the BG responses to meeting your nutritional needs

+Blood Glucose and carbohydrate Check your BG before exercise

Below 5 mmol/L – have some extra carbohydrate

Below 7mmol/L and dropping – have some extra carbohydrate

If your BG is above 10mmol/L consider Type of exercise aerobic or anaerobic Pump on or off Extra insulin needed?

If your BG is above 14mmol/L consider Checking for ketones Delaying exercise Correcting BG Be extra cautious if exercise is anaerobic

+Carbohydrate during exercise for blood glucose management

If exercise lasts longer than 30minutes and is aerobic, during peak insulin action – highest carbohydrate requirement to maintain blood glucose levels.

If exercise is of short duration, anaerobic and insulin levels are low – lowest carbohydrate requirements to maintain blood glucose levels

If exercise is during peak insulin action then approximately 1g carbohydrate/kg/hour to maintain BG

If you weigh 30kg, you need 10g carbohydrate for every 20minutes exercise

+Using CGM

If you have access to CGM you can use trend arrows to manage carbohydrate and BG.

If BG below 7mmol/L and dropping you need between 8 and 20g carbohydrate to prevent hypoglycaemia occurring.

This will need to be immediate fast acting carbs.

+Data from Mike Riddell, Toronto

+Using smart meters and active insulin info

You have information about active insulin before exercise, you can reverse your insulin to carb ratio to “cancel/match’ this insulin.

You will need carbohydrate to match the active insulin + activity carbohydrate if your blood glucose level is 7mmol/L or below

+Protein, diabetes & sport

If diabetes is not well controlled then muscle development is impaired

Taking protein supplements make no difference to muscle gains.

Essential ingredients for building muscles are insulin, carbohydrate, and protein in that order.

Evidence to show that adolescents with poor diabetes control have lower fitness levels and lower muscle mass

+Finding information about food and sports.

Lots of sports nutrition info available on the web.

Sports product manufacturers do not always provide the best source of information

Sports nutrition info from the English Institute of Sport, Australian Institute of Sport, IOC, good places to start

General info from nhs/change4life or Dept Health

Lucozade Sport and Gatorade website/info is ok

+Building an exercise eating and management plan

Keep a training diary – document all BG responses

Eat regularly across the day and adjust insulin according to BG responses.

Always eat sufficient carbohydrate before bed and in the morning.

Check BG between midnight and 3am

+Example........