A good place to start is looking at the types of resistance training, the importance of muscle strength and how certain exercises can make life easier as you age.

Compound and isolation exercises and how they differ

There are largely two types of exercises when it comes to resistance training – compound and isolation.

Compound exercises use multiple joints and muscle groups.

For instance, the chest, shoulder and triceps muscles are used in a push up, with the shoulder and elbow joints moving together.

Compound movements can be grouped together into patterns. One example is the squat pattern seen in lower body exercises, including lunges and squats.

Squats

Lunges

Watch detailed videos for over 20 exercises

Hinge patterns, which include kettle bell swings and deadlifts, involves a hinge at a point on the body, such as the hips.

Upper body exercises can be divided into push and pull patterns.

By comparison, isolation exercises happen at a single joint, as seen in movements such as a bicep curl.

How compound exercises can support healthy aging

Muscle mass and strength is lost as we age, with men losing around 5% of muscle mass every 10 years and women around 4%.

By age 80, individuals will have lost around 30% of their peak muscle mass.

Some diabetes medications, such as semaglutide, can affect muscle mass.

The age at which this drop in muscle mass occurs can differ hugely from person to person, but resistance training can help to negate the changes in muscles mass that happen as we age.

By regularly doing compound exercises, everyday tasks become a little easier as we get older. How well we can execute compound exercises can even be a good predictor of healthier aging.

Many compound exercises replicate everyday task such as getting up off a chair or removing heavy items from a high shelf.

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• Exercising in the evening offers greatest health benefits for people with obesity
• 5 easy ways to sneak exercise into your day

Building athletic ability

In terms of building strength more efficiently, compound exercises allow you to lift heavier weights than isolation exercises allow, as you use several joints.

One study looked at the impact of both types of exercise on athletic ability.

A group of 36 people was divided into two for eight weeks, with one half undertaking isolation exercises and the other performing compound exercises.

At the end of the study, both groups had lost fat but the compound exercise group performed better in terms of cardiovascular fitness, bench press strength, knee extension strength, and squat strength.

Other ways that compound exercises can enhance athletic ability is through the ‘triple extension’.

This is when the hip, knee and ankle are all extend at the same time, which occurs during squat patterns.

Triple extensions are used in running, sprinting, jumping and changing direction, so squat pattern exercises play a vital role.

Isolation exercises

Isolation exercises can still build strength and muscles and are sometimes easier to tack on to the end of a workout, when people may feel too tired to do compound exercises.

Isolation exercises are also useful when individuals want to build certain muscles, for instance for body building competitions.

Getting the most from your workout

While good quality workshops incorporate both compound and isolation exercises, compound exercises should be prioritised if you’d like to lift heavier weights, you want to build several muscles in one workout, you don’t have much time, and if healthy aging is a goal.

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• Morning workouts associated with better weight loss results

Exercise helps everyone live a happier and healthier life, but it can be a challenge to find the time or the motivation to add exercise to your routine.

Here are five simple tips to help you sneak more movement into your day from British Heart Foundation (BHF).

Stay on your feet

You use more calories standing than sitting and you’ll improve your balance too.

Try standing while you talk on the phone, or marching on the spot as you watch a favourite TV show. You could even walk to do an errand instead of driving.

Get into the garden

Gardening is not only great exercise, which will help keep you mobile and manage your weight, but studies have shown it can also help you cope with stress and boost your mood.

Think about getting into the garden regularly to cut the grass, do some weeding, or plant up flowers or veg.

If you don’t have a green space of your own, you can offer to help look after a neighbour’s garden or join a local community gardening group.

Move in a spare minute

The couple of minutes that it takes for the kettle to boil, the washing machine to finish its cycle, or even to brush your teeth, are perfect opportunities to sneak in extra movement.

Try standing on one leg or walking on the spot.

Have a spring clean

Household chores often mean bending, reaching and stretching, and you could get even more active with a serious spring clean.

Hoovering, dusting or tidying involve repeated movements which can help to improve balance and tone muscles. To get more out of your chores try adding some lunges when using the Hoover or mop.

Dance doing the laundry

Dancing while you carry out a repetitive task like ironing or folding the laundry can help to improve your mood and increase your overall activity.

Put on some music and move to the beat in any way that feels good. Or, add in a simple movement, like side-stepping or marching on the spot.

Want more top tips?

Sign up to BHF’s fortnightly Heart Matters newsletter to receive healthy recipes, new activity ideas, and expert tips for managing your health.

Joining is free and takes two minutes.

Discover support from BHF

Living with diabetes and a heart condition can leave you searching for answers.

That’s why having easy access to information from a trusted source is important. British Heart Foundation is here to help.

Speak to one of BHF’s experienced cardiac nurses. Call 0808 802 1234 for free, Monday to Friday 9am to 5pm (excluding bank holidays) or get in touch via email or online chat.

Visit bhf.org.uk/questions to find out more.

Whether we like it or not, diabetes affects our lifestyle and we have to be careful to keep our lifestyles healthy as a result.

Medication may help keep our sugar levels down but other factors can play a part too.

8 tips for healthy living

The following tips are probably those you’ve been told many times before – but some of them may be new to you.

We all know

eating healthily
and regular activity will help us to keep our body happy. What’s more, cutting out some of the following evils will make a big difference:

Getting exercise

A contributing factor to general health is your

level of fitness
Whether you’re down the gym 3 times a week or simply going for a walk – physical activity is essential in order to keep your fitness levels up.

The government advise people to

exercise at least 3 times a week
for 30 minutes.

Eat away from your workdesk or TV

A study from the University of Bristol in 2010 showed that people who ate whilst using their computer were less aware of what they had eaten and also felt less full than participants who were not using their computer.

It is thought that eating whilst working or watching TV is linked with

overeating
and snacking, which help to promote weight gain.

Concentrate on your eating and you may find you are less prone to snacking.


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Diabetes and smoking

Smoking carries a number of dangers such as an increased risk of cancer,

heart disease
and stroke.

Smoking is even more dangerous if you have diabetes because it affects circulation and can double the chance of developing diabetic complications.

• 
  Diabetes and smoking

What’s more, you can save a considerable amount of money if you give up smoking. Try our

smoking calculator

Regularly go for a stroll

A good walk is beneficial in a number of ways:

• Helps to get oxygen into our lungs
• Beneficial for metabolism
• Helps to
  
  burn calories
• Can reduce stress
• Helps promote better sleep

The NHS advises trying to get 10,000 steps into your day. This works out as about 5 miles but is quite achievable over the course of the day. Adding a stroll outside to your day will certainly help to meet the target.

Alcohol

Excessive alcohol affects the body in a number of ways. Alcoholic drinks have a high calorific value which means that weight gain is commonly associated with drinking.

Drinking affects the body’s small blood vessels (capilliaries) which becomes detrimental to many of the body’s functions such as the

kidneys, eyes and is also a leading cause of

sexual dysfunction

In the short term, alcohol will also make blood sugar control harder to manage.

• 
  Diabetes and alcohol

If you’d like to know how much you drink, try our

cost of drinking calculator

Fast food and take aways

One of the best ways to stay healthy is to ensure fast food and take aways are not a

regular part of your diet
The occasional visit is not going to harm you but you need to be honest with yourself about whether the occasional visit is becoming a regular event.

Fast food and take aways are usually high in all three of the following:

• Refined carbs and/or sugar
• Salt
• Poor quality cooking oil

These factors help to increase insulin resistance, raise blood pressure and increase

cholesterol levels, which over the long term contribute to more difficult blood glucose control as well as increasing the risk of

diabetic complications

Write down your blood sugar levels

They say ignorance is bliss, but for diabetes this can only be a short term effect. If you get a nasty surprise when you see the levels, don’t let this put you off. Taking steps to control your levels will start to give you more assurance.

• 
  Recording your blood sugar levels

Stress management

Take a break from stress wherever you can. Often we react to stress by trying to beat it only to get drawn in further. Try not get consumed by stress.

During times of

pressure, allowing your mind freedom of thought can be helpful.

Going for a walk or leaving a decision until the next day can be effective ways to reduce stress and a number of other methods are available.

• More on
  
  stress management

Keeping active is an important part of one’s lifestyle, and particularly for those who either have or are at

risk of diabetes

Even a little extra activity can have a lot of benefits, such as improving insulin sensitivity, improving your feeling of well being,

controlling your weight, reducing risks of cancer and heart problems and helping strengthen bones as well as muscles.

How much activity should I be doing?

Any extra activity you can fit into your day is a plus. The minimum recommended level of activity is 30 minutes at least 5 days a week.

Children should aim for at least an hour a day. The British Heart Foundation recommends that we take 10,000 steps per day to promote a

healthy heart
; this is equivalent to about 5 miles.

What counts as activity?

Activity counts as anything that will up your heart rate a little.

This could include any of the following:

• a brisk walk
• climbing flights of stairs
• shopping (not internet shopping though!)
• gardening
• housework
• DIY
• dancing
• yoga, pilates, tai chi
• active sports

Motivation towards being more active

Some people find it difficult to commit to being more active citing not having enough time as one of the reasons. Whilst activity does involve some investment of time, in the longer ru, a little activity or

exercise
can help to free up time as well as providing you with more vitality.

Activity allows the brain to function better and can help to compulsive behaviours which can lead to your time being better spent. The term healthy body, healthy mind rings true.

Activity and heart problems

People with existing heart problems may need to avoid particularly strenuous activities such as press ups, lifting weights and strenuous aerobic exercise such as running.

Any activity that involves getting up quickly may also need to be avoided. If you have cardiovascular problems, your healthcare team can offer advice as to which activities will be most suitable.

Earlier this year we got a chance to interview

professional snowboarder

Chris Southwell.

At 26 years old, Chris is a world-class snowboarder who spends every winter travelling all over the world doing photo shoots, filming videos and competing on the World Freeride Tour.

Four years ago, Chris was diagnosed as having

type 1 diabetes

D:

Hi Chris, good to meet you. So, you’re a professional snowboarder, what does this mean?

CS:

I have been a professional snowboarder for 8 years now. What this means is that I get paid to snowboard. Its not quite as simple as that, I spend the season following the Freeride World Tour Competition circuit as well as filming for snowboard movies and doing quite a few road trips/photo shoots for various publications. I have been living in Verbier for the past 5 years and I am heading back there this winter. I live with my brother who is also a professional skier so we spend a lot of time riding together which is great fun. I am just very excited about this winter, as I have not been snowboarding since May.

D:

And you have had some serious competitive success recently, and hope to further your world ranking this year?

CS:

Yeah, last season was a good year for me in the competitive sense. I came 3rd at the Scandinavian big mountain championships which was a great result getting a podium in their back garden and I also came 9th at the freeride world tour quest event in Austria which was a great achievement. This season is gearing up to be even better as we have a few more stops on the tour and it all kicks off on the 5th of Feb in Austria .

D:

You are also heavily featured in snowboarding magazines and videos, is this part of your job?

CS:

Yea, to get sponsorship we need to get coverage. In away we are like walking billboards. Over the season I normal get about 20 pages of coverage in forms of press, which is great for my sponsors. It’s also great fun going on filming/photo shoot trips as we go to crazy place. Last season I was in Japan for just 2 days to do a photo shoot and a few seasons ago we did a filming trip all over the States going to 22 resorts in 6 weeks…. It can be quite hectic but that’s part of the job and I love it. What helps is most the time I am riding with my brother so we are always pushing our each other and its always nice to have him around.

D:

And you’ll be based in Verbier this year, are you leaving soon for the winter season?

CS:

Yea, I have been in Verbier for 5 years and cant wait to go back for another season. Verbier is amazing and has everything that you could wish for from amazing powder, great park and fun bars like the Farinet Hotel. Our film crew is also based there and so it makes the perfect base. If you are a keen snowsports fan and have never bee, you really should check out Verbier.

D:

Four years ago, you were diagnosed with type 1 diabetes. How did your diagnosis come about? Do you have a family history of diabetes?

CS:

At 22, I was having a great summer in the south of France but felt something wasn’t quite right. I had a constant thirst, which I put down to the heat, was going to the loo 8–12 times a night and was very tired in the mornings. After a quick trip to the doctor, I was sent straight to a French Hospital, where I stayed for 10 days, with only one doctor who spoke English. My blood glucose was 43mmol/l, so I was not in a good way. They looked after me well and transferred me back to hospital in England for another two days. The only person to have diabetes in my family was my Granny who had

type 2

, so it did come as a surprise when I was diagnosed.

D:

Initially, it was scary. Life was suddenly very uncertain. My head was full of questions like ‘why me?’ and ‘what do I do now?’. I was mainly concerned with how it would affect my snowboarding. But with a great group of supportive friends, family, doctors, nurses and sponsors behind men, I quickly put my doubts and fears to one side.

D:

How has having diabetes affected your snowboarding?

CS:

Being diabetic has not really had an effect on my snowboarding. It’s all about preparation and that comes down to two main factors: a good diet and being prepared. A good

diet

means three meals a day. Breakfast consists of cereal and fruit – plenty of carbohydrates to keep my

blood glucose levels

stable during the morning. (Breakfast is always determined by what I plan to do during the day.) Lunch centres on having enough carbohydrates to last the afternoo, so it’s normally a bowl of pasta, a plate of chips or a sandwich if I’m in a hurry. Depending on how the day went with regard to

blood glucose

levels, I eat what I want for supper but always have my fill of greens.

CS:

Being prepared means making sure that everyone I snowboard with, go drinking with and play sport with knows that I am a diabetic. When I’m snowboarding, I’m a lot more intense with my riding partners and explain all the signs indicating high or low blood glucose levels. I make sure that they carry a hypo treatment with them at all times in case I lose mine.

CS:

Being diabetic has never stopped me from taking part in a snowboard event. The only real problem is getting tired a bit quicker than other riders, so I take a few more days off. Everyone has been so supportive of me that I can’t see any problems occurring in the future. My positive attitude plays a very important part in my career, as does safety, of course. As I said, it’s all down to preparation.

D:

You are a positive role model for people with diabetes, and show that being diagnosed doesn’t hold you back. You’ve been recognised by the JDRF as an ambassador, what does this role entail?

CS:

I like to use my experiences as a top-level athlete to try and inspire young people who have just been diagnosed or are struggling with their diabetes to try and releases that they can still live life to the full. I spend my days jumping off 100-foot cliffs and hiking powder faces and I have not let diabetes stop me. I am living my life to the full and my recent control has impressed all the doctors so my body is as healthy as ever. With JDRF I am helping them raise awareness about living life to full with Diabetes and I am just hoping my life experiences can encourage and motivate people. Being an ambassador for them means a lot to me and I find it such an honour helping people. I am also involved in a lot of fun rising for them. Next summer I am going from London to Paris on a Penny Farthing in just 3 days dress as Victorian for the charity JDRF. It’s going to be a huge challenge but 1 am looking forward to. In 2006, I went from John O’Groats to Land’s End on a monkey bike dressed up as a cow for

Diabetes UK

, I just love doing crazy charity fun raising projects.

D:

If you could say something to

young people with diabetes

to inspire them, what would it be?

CS:

On or off the slopes, even with diabetes, with the right control, determination, positive outlook and attitude, you can achieve even your wildest dreams. I’m still living mine.

D:

Good luck on the tour this year, and with your career as a snowboarder. Would you like to give a shout-out to any sponsors?

CS:

Yea, like to thank all my sponsors, Oakley, Allia, Verbier Sport +, Hotel Farinet, Pro-Tec, John Nike Leisuresport and Ski Club Of Great Britain. Also like to thank all my riding buddies, Mum, Brother and every one that has helped me get to where I am with my Diabetes. I hope to see you on the slopes.

Diabetes can’t stop you from keeping fit and active. There are loads of famous sportsmen and athletes like Steve Redgrave who have diabetes and are world champions at their sport.

• Diabetes won’t stop you playing sport.
• Some of the best sports players in the world have diabetes, like
  
  Sir Steven Redgrave
  

• The key thing to remember in diabetes and sport for children is to prepare.
• Preparation needs to be made for before, during and after sport for young people with diabetes.
• Your doctor will be able to tell you and your parents more about playing sport.

Playing sport

Playing sport increases the risk of something called hypoglycaemia.

This happens when the body isn’t producing enough insulin to function properly. Hypoglycaemia, or hypo, can be quite scary and dangerous.

Your doctor can tell you how to avoid getting a hypo, and also what to do if you think you are having a hypo.

• Diet plays a key role in sport for young people with diabetes. Children playing sport need to consider how the sport affects blood glucose, and how they will boost their blood glucose if need be.
• Some sports are not very suitable for young people with diabetes, including solitary pursuits. However, people with diabetes are surfing, hiking, climbing, diving and being involved in all sorts of sports, all over the world.
• When playing sports, peers and leaders such as teachers should be aware of diabetes and understand what to do in the event of recognising the signs of hypoglycaemia.
• Telling your teacher you have diabetes should be one of the things you do in preparing for sport.

Sports day can be very exciting for children, and while kids with type 1 diabetes will have more to consider, there is no reason that they cannot compete.

Exercise is extremely beneficial for children with diabetes. Not only will it improve their sensitivity to insulin, but physical activity provides an opportunity for social interaction and fun.

Primary and secondary school

Sports days at primary school are likely to be different to those at secondary school.

Events such as the egg & spoon race, sack race and three legged race feature at primary school sports day, which may involve a number of events back-to-back.

However, at secondary school, long running races and team sports could require more management. While your child may only be involved in one short event, such as a 100m or 200m sprint, this could still influence their blood glucose levels.

Meeting with the school

Before a sports day, you should make sure your child’s teachers and/or head teacher are informed of a plan to manage their diabetes on the day.

Among the considerations to be made include:

• 
  If your child can recognise hypos and know how to treat them
  
  – if they don’t, the free
  
  Hypo rogram
  
  can teach them, and their teachers, to recognise symptoms.
• 
  If your child can check their blood glucose levels
  
  – if your child is not old enough to do this, a teacher will need to help them with this, offering a place with privacy if your child requests this
• 
  Making sure they have ample supplies and know where they are kept
  
  – including glucose (such as Lucozade) for a hypo, insulin kept in a cool place – in case they are high – and water nearby, as your child may feel more thirsty.

Blood glucose levels

Physical activity can lead to reductions in blood glucose levels, as muscle movement results in greater sugar uptake from muscle cells.

However, short periods of strenuous exercise, such as sprints, can lead to stress hormones such as adrenaline being released. This can result in higher blood glucose levels for most people with type 1 diabetes.

Regarding your child’s blood glucose management, you should ensure that tests are done on your child before exercise, at regular interviews in-between events they are competing i, and upon exercise finishing.

Insulin management

You may consider taking precautions regarding your child’s insulin on a sports day. You should consult with your child’s diabetes healthcare team if you are thinking of altering your child’s insulin doses for a sports day.

This may, however, be dependent on how long your child will be exercising for. If they are competing in longer distance sports, or a greater a number of events, you may consider reducing their long acting insulin the night before. If your child uses an insulin pump, you could consider lowering their basal rate.

Conversely, a reduction may not be necessary if they are competing in a reduced duration of exercise, or a number of events that don’t involve much strenuous physical activity.

Changes to event schedules

If your child uses an insulin pump and switches off their basal insulin before an event, which is then delayed, their blood glucose levels could go too high during this time.

On the other hand, if your child has bolus insulin in their system and an event is brought forward, there could be an increased risk your child will have a hypo.

For this reason, changing event times could present difficulties in diabetes management. Making sure the organising teachers know about your child’s insulin requirements in advance is essential in case an event time is altered.

Hot weather

There are a few aspects to consider regarding

diabetes and hot weather

This is especially the case as most sports days are contested at the end of the school year, when the weather is likely to be much warmer.

You may consider reducing your child’s insulin levels if the weather is scheduled to be very warm, as this could lead to unpredictably low or high blood sugar levels.

If your child has been experiencing unusually high or low readings in hot weather, you should consult a member of their healthcare team prior to their sports day.

Additionally, your child should increase their intake of fluids during hot weather as dehydration can occur, with higher blood glucose levels exacerbating this risk.

New words to remember:



weather, insulin, blood glucose, having fun

The metabolism of people with diabetes differs to the metabolism of people without it. In type 2 diabetes, the effectiveness of insulin is reduced and in type 1 diabetes, insulin levels in the body are very low.

For this reason,

type 1 diabetics
require insulin delivery from other methods. Insulin resistance, most common in pre-diabetes.

metabolic syndrome
and type 2 diabetes, impairs the body’s ability to metabolise glucose.

Consequently

blood sugars
become elevated, weight gain is more likely and the resistance to insulin becomes greater.

What is metabolism?

Metabolism refers to the chemical reactions that take place inside the cells of living organisms which are essential for life. For the purposes of this guide, metabolism refers to the processes that occur in the body once food is eaten.

The metabolism process

The metabolism of people with diabetes is almost identical to the metabolism of people without diabetes. The only difference is the volume and/or effectiveness of the

insulin
produced by the body.

The

metabolism process

is as follows.

• Food is consumed
• 
  Carbohydrates
  are broken down into glucose – by saliva and the gut
• Glucose enters the bloodstream
• Pancreas responds to the presence of food by releasing stored insulin (phase 1 insulin response)
• Insulin allows glucose from the blood to enter into the body’s cells – where the glucose can be used for fuel
• Insulin also allows glucose to be stored by muscles and the liver as
  
  glycogen
• If needed, the stored glycogen can later by returned to the blood as glucose
• If there is glucose remaining in the blood, insulin turns this glucose into saturated body fat.
• Proteins in the meal also get broken down into glucose to some degreen, however, this is a much slower process than it is with carbohydrates.
• After the body’s initial release of insulin, the beta cells in the pancreas start to develop new insulin which can be released as well. This is known as the phase 2 insulin response.
• As mentioned above, if glucose is taken from the blood to the point where blood sugar levels start to approach a low level, the body releases glucagon.
• Glucagon works to change the stored glycogen into glucose which is released into the blood stream.

Metabolism in obesity-related type 2 diabetes mellitus

Overweight people with either

pre-diabetes
or

type 2 diabetes
most typically produce significantly more insulin than non-diabetic people resulting from a higher ratio of body fat to muscle.

The reason for this is insulin resistance, which means that the body can’t use its insulin effectively enough.

Therefore, it makes sense that the body should produce more insulin to compensate.

However, the strain of producing all this extra insulin means that the beta cells become over worked and over time will start to fail.

In addition, the increasing amounts of insulin in the body cause the body to become gradually more resistant to it – it can be viewed as being similar to how drug addicts can build up tolerances to drugs.

How does insulin resistance lead to higher blood sugar levels?

If insulin resistance exists, this therefore reduces the effectiveness of the

phase 1 insulin
response (as discussed in non-diabetics). The pancreas will release all the insulin it has but it likely won’t be enough because the insulin is less effective.

To cope with this, the body has to rely on its phase 2 insulin response, however, this takes some time and therefore in that time, without sufficient insulin available, blood sugar levels in the type 2

diabetic
or pre-diabetic are very likely to rise higher than normal.

If the next meal is sufficiently far away, the body may have time to catch up and produce enough new (phase 2) insulin to catch up and bring

blood sugar levels
back to normal.

However, as mentioned above, this puts strain on the beta cells which can fail therefore reducing the number of active insulin producing cells, this therefore further slows down the production capability of insulin which helps to escalate the problem further.

If the diabetic or pre-diabetic is used to consuming relatively generous amounts of carbohydrates then the effects of the problem are exaggerated further. Note also that higher sugar levels tend to make people feel both lethargic and more hungry as the less effective insulin means they are less able to get glucose into the cells which need the energy.

If a

larger amount of food
is eaten as a result, then the excess calories will start to get absorbed as additional body fat, which may contribute to further insulin resistance.

Metabolism in type 1 diabetes mellitus

In type 1 diabetes, the proper functioning of metabolism is reliant on the delivery of insulin, usually either from injection or a pump.

Short term (rapid acting) insulin
is intended to behave in a similar way to the phase 1 insulin response and the long term to act in a similar way to the phase 2 response.

If the correct amounts of insulin are delivered and the rapidity of the action of the insulin matches the rapidity at which glucose from the meal is absorbed, then a person with type 1 is able to quite well replicate the metabolism of a non-diabetic.

However, this is often difficult to do and therefore there will be times when high and

low blood sugars
will result, which have to be treated accordingly by the diabetic.

As insulin plays a part in body fat storage, people with type 1 diabetes can also build up insulin resistance, termed double diabetes.

When training to take part in competitio, you will want to keep your body in good health, injury free and able to achieve your peak performance.

Blood sugar levels
play an important part in achieving a high level of performance so we also look at the science of sports.

Check you are healthy before starting training

If you will be significantly stepping up the amount of exercise you will be taking part i, it may be worth requesting a physical examination from your GP to assess your fitness to take part in the training you have planned.

This is particularly recommended for people over 35 years old or those that have had diabetes for a long period of time as

exercise

Eating for training

It’s recommended that you leave about 2 hours between eating a meal and starting your training or competition.

Traditionally, pre-activity meals have been relatively high in

carbohydrate, moderate to high in protein and low in fat.

Some professional athletes without diabetes, however, have performed at high levels with moderate carbohydrate intakes.

If you are looking to tailor your diet to your training regimen, it is recommended that you discuss with your doctor or consultant before making any significant changes to the composition of your diet.

Keeping hydrated

The more we exercise, the more fluid we give off, through sweat and through our breath. It is important to stay

hydrated
Charity Diabetes UK recommends drinking around 150ml of fluid every 15 minutes.

Warming up

Warming up is highly recommended before taking part in physical activity. Dynamic stretching, a form of stretching carried out with movement, is a useful warming up technique which researchers have found to be beneficial for reducing injury.

Cooling down

After you have completed your training session, cooling down exercises and stretches will further help to minimise the risk of injury.

Continuing the exercise you have been doing at a slower intensity is a good way of cooling down. This can be followed by stretches of the muscles used in the training. When stretching, don’t be tempted to overstretch the muscles as this could lead to injury.

Maintaining peak performance

As you exercise your muscles will take in glucose from your blood for energy. The body can store a finite amount of sugar (known as glycogen) in the liver and muscles. When this supply of glucose is exhausted, your blood glucose levels will usually drop unless carbohydrate or glucose is taken on board.

To maintain peak performance, make sure your blood glucose levels are above 4 mmol/L.

High blood glucose levels
can also affect performance and can also lead to fatigue, so ideally it’s best to keep your sugar levels within a balance of not too high and not too low.

Those with type 1 diabetes may find this to be more challenging. Blood glucose testing in training can be a helpful way of monitoring how your sugar levels and performance respond throughout exercise. It is advisable to record your levels after each training session to help you to spot trends.

Blood glucose testing If you are on medication that can bring on

hypoglycemia, it is important to keep an eye on your blood glucose levels whilst training to prevent hypos from occurring. It is recommended to test before, during (where possible) and after exercising.

Physical activity can increase sensitivity to insulin for up to 48 hours so you may need to test your blood glucose levels more regularly following exercise and be wary of

hypos at night
A carbohydrate snack before bed may be required to keep blood glucose levels going too low following intense or prolonged exercise earlier in the day.

When taking part in competitio, it is possible that anxiety may increase your blood sugar levels. Taking short but intense sprints either before or during exercise may also prompt the body to release its own stored sugar into the bloodstream.

• Read more on
  
  blood glucose testing

Training and insulin

People on insulin may find that their insulin requirements are reduced during periods of training.

It may therefore be appropriate to lower your insulin dose when training. If you have any doubts as to how best to adjust your insulin, speak to your diabetes team who should be able to advise you.

It is important, if you are on insulin, that you have a good supply of glucose or sweets close by in case your blood glucose drops too low.

When people with diabetes participate in sport, whether they are children or adults, it is quite possible that they will experience low or high blood sugar levels.

If you are on blood glucose lowering medication (e.g. tablets or

insulin

) it is recommend to more frequently test your blood glucose levels during and after exercise to see how your sugar levels are responding.

Be wary of hypos

Low blood sugar, hypoglycemia

, can occur during or after exercise when the body has used a high level of its stored sugar (glycogen).

People taking glucose lowering medications should be aware of the risk of hypoglycemia that sport can present.

Sport can cause the body to be more sensitive to insulin for up to 48 hours after exercising and people on insulin may need to take this account, particularly when next going to sleep after exercise to avoid

hypos during the night

Hyperglycemia and sport

High blood sugar,

hyperglycemia

, can also occur during exercise, particularly after short bursts of strenuous activity.

Strenuous activity produces a stress response which sees the body producing glucagon to

raise blood sugar levels

to provide the muscles with energy in the form of glucose.

If your sugar levels are above 14 mmol/l, it may be advisable to do a

ketone test

as exercise can increase the production of ketones. If your ketone levels are high, it is advisable to do less strenuous activity such as walking.

Symptoms of high and low blood sugar

All diabetics taking part in sport need to be aware of the influence of

hypoglycemia

and

hyperglycemia

, as well as the symptoms of each.

Symptoms of hypoglycemia may include:

• Sweating
• Shakiness
• Lightheadedness
• Anxiety
• Hunger
• Headache
• Lack of concentration.
• In severe cases, fainting and seizures can occur.

Hyperglycemia or high blood sugar symptoms include:

• Dehydration
• The need to urinate more often
• Weakness or lethargy
• Blurred vision

How the body regulates blood glucose levels during exercise

When you start to exercise, glucose stores (glycogen) in the muscles are immediately mobilised and used as the body’s major fuel source. Take up of glucose by the muscles is closely balanced by the

release of glucose from the liver

However, the amount of glucose the liver can release is limited, and as a result, people with type 1 diabetes may become hypoglycemic during sustained exercise if carbohydrate is not taken or insulin is not reduced.

People with

type 2 diabetes

on certain medication (e.g. sulfonylureas and insulin) may also go hypoglycemic as a result of sustained physical training.

As you continue with your exercise, other sources of fuel become available. Fats are mobilised from the stores and can be used directly by the muscles.

They are also converted into

ketones

by the liver. However, if the muscles do not have enough oxygen, they cannot burn fats and other fuels, and this causes them to produce lactic acid.

How the body regulates blood glucose levels after exercise

Following exercise, the body will try to replenish its stores of

glycogen

by taking glucose out of the blood. This is one reason why blood glucose levels tend to be lower following a good session of exercise.

This can be particularly helpful for people with diabetes treated with tablets or lifestyle only treatment regimens, as it helps to reduce blood glucose levels following activity.

As noted above, people on insulin or insulin stimulating tablets may need to take care to prevent blood glucose levels going too low.

Speak to your healthcare team if you have any difficulty with

preventing hypoglycaemia

after exercise.

Effects of different types of sport on blood glucose levels

Different forms of sport may affect your

blood glucose levels

in different ways.

It is not uncommon for upper body exercise to have a different effect on your levels to lower body exercise.

How strenuous the exercise is can also make a difference to how much your sugar levels vary.

The best way to see how different activities affect your levels is to regularly test your blood sugar during (where possible) and after exercise.

Sport is commonly associated with an increased risk of hypoglycemia but this shouldn’t put you off taking part.

When taking part in sport or exercise, always keep a source of short acting

carbohydrate

such as glucose tablets to hand should you go hypo and test regularly including after having completed exercising.

The effects of exercise on the body, such as increases in heart rate and adrenaline and a keen focus on the activity at hand, can make hypoglycemia more difficult to spot, particularly if you have

reduced hypo awareness

Preventing hypoglycemia during exercise

Perform a blood test

before commencing exercise. If your blood sugars are low (under 4 mmols/l) you should wait until your sugar levels are stable again before commencing exercise.

Also, bear in mind that exercising with a

high blood sugar level

can initially increase your blood sugar levels, and could increase ketone production.

In general, moderate to intensive exercise should begin to lower blood sugar within 30 minutes of starting.

Before exercise

Before starting exercise, it is recommended that an appropriate amount of carbohydrate is taken to balance the expected drop in sugar levels from exercise.

Studies have shown that a short one minute burst of activity, such as sprints or running on the spot, can increase blood sugar levels without having to take carbohydrate on board.

However, individual reactions may vary and so it’s best to verify this by checking your blood glucose levels before the burst of activity and about 30 minutes after, to see how your body responds.

Be aware that if you strenuously exercise a muscle group shortly after having

injected

near to that area, this could cause the insulin to be absorbed more rapidly than usual, increasing the chances of hypoglycemia.

For example performing sit ups shortly after having injected into the abdomen. It is wise to test your sugar levels during as well as after exercise where possible.

Preventing delayed hypoglycemia after exercise

After a period of strenuous activity or a long period of exercise blood sugar levels can drop for up to 48 hours.

As a result you may need to reduce your insulin requirements over this period or take more carbohydrate.

The night time following a day of strenuous or prolonged activity is a period where you may experience

nocturnal hypoglycemia

Depending on your medication, you may be advised to reduce your dosage or take additional carbohydrate before bed.

Alcohol consumptio, following exercise on the same day, can exacerbate the problem and lead to severe hypoglycemia in some cases.

Your

healthcare team

can advise you on managing how to avoid hypoglycemia during this period of time after exercise.

Participating in a sport as a diabetic takes some planning. The following tips should help diabetics get ready to play sport, whether they are children or adults.

Before participating in sport or exercise, diabetics should make their doctors aware of their intentions and take notice of any advice.

Diabetes sports tips

Testing yourself is crucial. Diabetics taking part in sport should be able to test themselves and take advice from their doctor on

when to test blood sugar levels

Diabetics participating in sport may have to test before, during and after exercise. This is also known as

self-monitoring

In addition to this, diabetics may also want to:

• Secure your
  
  insulin pump
  
  Before playing sport, make sure that your insulin pump will not be disturbed by the activity. If you can’t play a sport because of your insulin pump, consult your doctor.
• Choose your food carefully.
  Your doctor will also be able to tell you what to eat as a diabetic taking part in sport.
• For instance, you may need extra snack food before, during or after playing sport.
• Make sure you carry snacks and water with you, wherever you are exercising.
• Take sufficient supplies.
• Take sufficient testing equipment, medication, emergency contact information.
• Choose your injection site wisely if you are planning to exercise. Don’t administer insulin to a part of the body about to be actively used in sport, as this can speed up the
  
  blood glucose
  
  lowering effect of the injection.
• Tell people. Don’t exercise with people that don’t know you are diabetic. There is nothing to be ashamed of, so don’t hide it, particularly from teachers or sports coaches.
  
  Tell people you have diabetes
  

• Be prepared to stop. Quitting in sport is not usually encouraged, but with diabetes you have to be prepared to stop when your body’s telling you to. In some cases this may be just long enough to drink water, eat a snack or
  
  test blood sugar levels
  

Diabetes sports tips for children and parents

Diabetes experts indicate that no matter how closely children and parents stick to diabetes sporting advice from doctors, at some point children are likely to experience low blood sugar.

• Take advice.
  
  As a parent
  
  , make sure you take advice from a doctor or diabetic health care team before allowing your child to take part in sport. These experts should be able to provide you with clear advice about taking part in sport.
• Be prepared to make testing/medication changes. It may be likely that your child will need to vary their testing regimen, or insulin/
  
  medication dosage
  

• Adjust meals and snacks. For children in particular, being a diabetic and taking part in sport may need adjustment to meals and snacks. The diabetic health care team should be able to recommend suitable snacks and advice on when they should be eaten.
• Take snacks and water. Wherever your child is taking part in sport, make sure that they have snacks and water close to hand.
• Make sure that all equipment is packed. If your
  
  diabetic child
  
  is going away to play sport, make sure all of his or her equipment is packed.
• Tell teachers and coaches. Both teachers and coaches should know that your child is diabetic, and understand what this means, including how with
  
  high or low blood sugar levels
  
  , should they occur.
• Encourage your child. Taking part in sport is good both mentally and physically. If your child can stay fit and healthy, whilst still keeping a tight control on blood sugar levels, in the long run it will benefit his or her diabetes and overall health.

All diabetic children participating in sport should carry some type of medical identification which details

diabetic treatments

and provides contact details in event of emergency.

Golf is not a hugely demanding sport and requires minimal intensity, which makes it a very manageable sport for people with diabetes.

Food be can carried on your person and

blood glucose testing

can be done at any time, although certain variables will still influence the way you control your diabetes.

Courses with greater hills and longer holes will require greater energy. It is wise to study the course you are playing o, be it nine holes or 18 holes, in advance to prepare for how your blood glucose could be affected.

Celebrity golfers

Scott Verplank was diagnosed with type 1 diabetes at nine years of age, and has since gone on to become a five-time PGA Tour winner.  He uses a Medtronic MiniMed insulin pump to control his diabetes.

Playing golf with type 1 diabetes

Playing nine holes of golf with

type 1 diabetes

will require less management than 18 holes, which demands twice as much time and energy to complete.

Managing your diabetes for 9 holes can be adapted to playing 18 holes – blood tests and snacks should be doubled in volumen, while quick acting insulin can be further reduced with meals, or perhaps not given at all.


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Golfers playing in the morning will probably not need to alter their long lasting insulin dosages, but reducing your quick acting insulin by 25 per cent with breakfast will account for the walking you do.


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A

healthy breakfast

designed to keep you full and your blood sugars low may not even necessitate an injection of quick acting insulin. If you are to start playing in the afternoo, you can reduce your quick acting insulin by around 25 per cent with your lunchtime meal, which again should provide energy but not risk high blood sugars.


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Carrying glucose and snacks with you on the golf course, as well as regularly checking your blood sugars will be important to managing your blood glucose levels throughout.

If you find, when playing regularly, that you are continually having low blood sugars, you could reduce either your morning long lasting insulin or your evening dose from the night before.

Type 2 diabetes

Your normal dose of metformin, or other hypoglycemic agent, will be fine before a game at any time of the day, but extra snacks should be taken if you notice your blood sugar is falling.

If you are on hypo causing medication such as sulphonylureas or glinides, be mindful of

hypoglycemia

and test your blood glucose levels if there are any signs your blood sugar levels could be low.

Tips for golfers

Playing golf on your own can be dangerous if you were to suffer a hypoglycemic attack. You should always alert someone close to you what time you are playing and

carry medical identification

on you at all times.

You should also remember to take special care of your feet when playing golf, which will require a substantial amount of walking. Your choice of golf shoes should be comfortable throughout your game.
Playing regular golf will also require consistent

foot care

Playing golf with an insulin pump

Wearing your insulin pump when playing golf should not cause you any problems, and will allow for flexibility wherever your pump is positioned as it should not face any interference.

What does the Diabetes Forum say?

Members of the Diabetes Forum have previously

discussed issues with diabetes when playing golf

daveosman

, wrote: “

Hi everyone. I’m newly diagnosed type 2 and I have found that since going on a low carb diet I have lost weight but when I go and have a round of golf, which I do every weekend, I now feel really tired half way round. Is there any food I can eat the day before that will give me more energy?

”.

Who said that exercise has to be a chore? There is a wide range of activities that are not only enjoyable but are also great social opportunities too.

There are a number of dry

exercises
that aren’t always appealing for all of us, jogging and sit-ups come to mind, but you’ll see from our slideshow that there are ways to get out of breath without the worry of how long you’ve been running or whether you’ve done enough ‘reps’ (repetitions).

On insulin or at risk of hypos?

If you are on medication that can cause hypos,

be prepared for decreasing sugar levels
This may include taking some carbohydrate before exercise and you may need to

test your blood sugar
before, during and after exercise.

After a good period of activity, our muscles will steadily re-fuel their stores of glucose (glycogen), which means our blood glucose levels may decrease to low levels for up to 48 hours after exercise. You may therefore need to take less insulin or extra carbohydrate before bed to prevent

nocturnal hypos
occurring after a day or evening involving more exercise than usual.

Time to get started

Take a look at the slideshow and see which ones you can try out and add in to your exercise schedule.

1. Trampolining

Whilst a very simple concept, trampolining can be great fun and is one of those sports where you may only realise how much effort you’re putting in when start getting out of breath.

Trampolining can be enjoyed in your own garden or, to carry more sophisticated leaps including somersaults, look for a gym or sports centre running organised trampolining sessions.

2. Swimming

Swimming is a sport which has a very low impact on our joints and can therefore be a great activity for those of us who are no longer as sprightly as we used to do.

Swimming is another activity that can be practised alone or can be enjoyed as a social activity.

3. Juggling

Activities involving forms of juggling, including hula hooping and keepy uppy, require a bit of patience to get started but once you get a hang of the basic technique, you have not just an exercise but a way to impress your friends as well.

4. Team sports

Team sports are a great way to burn off calories.

From 5 a side football to netball, basketball or even a game of frisbee, team sports are a great way to spend time with friends, indulge your competitive side and get those muscles moving.

5. Racket sports

If getting a larger team together is tricky, racket sports are ideal.

Once a game warms up, racket sports such as tennis, badminton and squash, tend to become an intense session before you know it.

For a less demanding but just as fun work out, table tennis can be a good alternative option.

6. Dancing

Dancing can be a great social activity, whether it’s during an evening out or as part of dance classes.

Throwing shapes to your favourite music in the comfort of your, or someone else’s, home also counts as counts as exercise so feel free to get carried away!

7. Exergaming

If you have a console such as a Wii Fit, Xbox 360 Kinect or PlaystationMove, then this is one of the easiest ways to take part in exercise.

Exergaming is where the gaming console picks up on movements of the body, allowing us to physically control game play, which can range from dancing and sports to a plethora of games in fantasy environments.

Exergaming makes physical activity fun and you can take part alone or with others.

8. Skate sports

Earn extra style points for taking part in skating sports such as skateboarding, rollerblading or ice skating.

As well as helping you to be the epitome of cool, skating sports make for good social activities and, once you have the equipment, present a flexible and cost free form of transport too.

9. Rock climbing

Rock climbing makes for a great work out of the upper body.

Most cities will have an indoor climbing wall and for additional thrill value, you can take part in organised outdoor rock climbing sessions.

10. Paintballing

Not for the faint-hearted, paintball is a sport that can get your heart racing even before you get moving.

We’ll be honest, paintballing can hurt but once you get into the thick of a game, the adrenaline starts to take over and many people are surprised by how invigorating a session of paintball can be.

While similar, hiking and trekking are two different activities, but both require similar management for people with diabetes.

Hiking occurs on trails in beautiful natural environments, with pre-charted paths setting the way. These can occur at day or overnight.

Trekking, meanwhile, number lasts a number of days on unchartered paths in challenging environments that include hilly or mountainous land.

In terms of managing your diabetes, there are several aspects to consider in specific detail. However, differences between hiking and trekking are primarily based on how long you planned trip is to last.

Storing insulin

Hot weather

Insulin will last roughly a month at room temperature, but in hot weather and mid-summer trips, insulin can spoil much quicker.

If the insulin is overheated, it may look normal but not actually function. This will eventually lead to the insulin becoming cloudy when it should be clear, however, the exception is NPH insulin which is cloudy in appearance.

If hiking or trekking on warm days, keep your insulin out of direct heat and sunlight by storing it in the coolest places of your backpack. There are also a variety of

cooling wallets

available that can keep your insulin out of the heat.

Cold weather

When hiking or trekking in cold weather which is around or below freezing, keep your insulin in a jacket, trouser or coat pocket to keep it warm.

Insulin can freeze as well as overheat and will similarly fail to function as a result. Keeping insulin close to your body will prevent this from happening.

Needles

Be sure to take enough injection needles to last the duration of your trip, as well as a suitable box or

storage facility

for used needles to be placed.

Needles should not be reused, as a single injection can cause noticeable damage to the tip of the needle, making a second injection considerably harder and more painful when entering your skin.

Food

You may need to eat more carbohydrates than normal during your trip, with strenuous treks requiring around double your carbohydrate intake to handle the demand placed on your body.

Eating whole grain foods, such as bread, pasta and breakfast cereals provide a longer lasting energy boost than snacks that rely on sugar for quick doses of energy.

Whole grains digest more slowly

, providing a more stable energy level on your trip, while fibre is also recommended as it slows down the absorption rate into your cells.

Protein is also invaluable for longer treks. This can help your body maintain and build muscle mass as well as provide something else for your body to digest besides carbohydrates, which will help your blood sugar levels.

Medication

People hiking and trekking with diabetes will find, most likely from trial or error, what form of medication management works for them. Assessing a general plan can be hard, as one may not be applicable to all. However, there are some basic tips for first timers than can prove helpful.

Insulin changes

Once you have made healthy changes for your trip, you will probably find that cutting back on your insulin doses will keep your blood sugars more stable.


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If you are not used to hiking, you should consult your doctor before making drastic changes to your insulin routine, with trial and error necessary for many to find their own method of medicating.

You should also not attempt a hike or trek for the first time by yourself, especially if you have been cleared to make radical insulin changes.

Low blood sugar

People with diabetes, on either insulin, sulfonylureas or glinides, will find that strenuous days of burning calories can result in regular battles with low blood sugar that can require many breaks to correct.

Exercising with low blood sugar can be challenging on a longer trek and lead to exhaustion as the days go by. Given the amount of calories you’ll be burning, you will generally not need as much insulin.

You should also test your blood sugars frequently, as recognising

high and low blood sugar symptoms

can be harder when exercising at a relatively constant level.

Hydration

Keeping hydrated and drinking plenty of water will help you maintain all your endocrine functions (including insulin and glucose) a little easier.

This can help your body keep things under control, with better production and absorption also fending off side effects, such as extreme thirst and dizziness, that dehydration can cause.

High altitudes

Hiking or trekking in high altitudes can present different issues that people with diabetes will need to consider before their trip commences.


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Blood testing

Some

blood glucose meters

can under-read at altitude, particularly those dependent on a glucose oxidase reaction, while there is also a possibility of blood thickening at high altitude due to dehydration.

It is therefore important to keep your meter and test sticks warm, which can be achieved by using insulated pouches worn under clothing and near to the skin.

Cold hands can also make blood testing difficult, so keep your hands warm throughout your trip and try to use a large drop of blood to prevent rapid drying on the test strip.

If you do not believe your reading is correct, warm your meter up by holding it under your armpit for a few minutes and try again. Alternatively, test your urine for glucose, as meters may be unreliable at altitude.

Taking a back-up meter and batteries is advised as well as a larger amount of test strips than you think you would need.

Hypoyglycemia

High altitudes can increase the need for

carbohydrate

, while the cold can suppress the usual mechanisms required for fat breakdown.

Both situations can result in hypoglycemia, which is dangerous enough, but can also result in your body suppressing shivering, a normal reaction to the cold.

This can increase the risk of hypothermia, which is when your body-core temperature is lower than 35°C.

Type 2 diabetes

Those with

type 2 diabetes

who are treated by diet, exercise and the oral medication, metformin, are very unlikely to suffer a hypo while hiking or trekking.

However, people on drugs such as sulphonylureas and glinides will be at increased risk of hypos. There are two options; one is to increase your carbohydrate intake before and at intervals during the walk, while the other is to reduce your dose before hiking or trekking.

You should speak to your doctor and get their agreement before making any changes to your medication dose.

Hiking tips

Taking care of your feet is essential

when hiking or trekking, so you should ensure your choice of footwear is as comfortable as possible.

Having diabetes won’t stop you from building muscle. However, it’s wise to follow a few precautions when it comes to gaining muscle.

There are many different types of exercise and one of the most popular is strength or power training, which is very effective for building strong bones and muscles.

Strong muscles collect oxygen and nutrients from the blood much more efficiently than weak ones, meaning that any physical activity you do will require less cardiac work and put less strain on your

heart

As well as being good for the heart, they also improve weight control and help the body remain sensitive to the hormone insulin, which is vital for keeping blood sugar levels in check and preventing or controlling type 2 diabetes.

Here are some tips on how you can build strong, lean muscle, without affecting your diabetes:

Load up on protein

Protein intake is vital for building muscle.

However, your body constantly drains its protein reserves for other uses such as producing hormones, resulting in less protein available for muscle building.

To counteract this, you need to build and store new proteins faster than your body breaks down old proteins.

You should look to consume about

1 gram of protein per pound of body weight
, which is roughly the maximum amount your body can use in a day.

Good

sources of protein
include:

• Chicken
• Tuna
• 
  Eggs, milk and cottage cheese
• Protein shakes (see below for more about shakes)

Remember, the more protein your body stores (protein synthesis), the larger your muscles grow.

Have a protein shake before your workout

Protein shakes are very effective for improving strength.

While many trainers have a post-workout shake, research has shown that drinking a shake containing at least 6 grams of amino acids – the muscle-building blocks of protein – and 35 grams of

carbohydrates
30-60 minutes before exercising increases your protein synthesis more than drinking the same shake after training.

“Since exercise increases bloodflow to your working tissues, drinking a carbohydrate-protein mixture before your workout may lead to greater uptake of the amino acids in your muscles,” says Kevin Tipto, PhD, an exercise and

nutrition researcher
at the University of Texas.

Good quality whey-protein powders usually contain at least 30 grams of protein per serving, as well as a healthy supply of vitamins and minerals.

Other liquid supplements such as weight-gain powders can also provide a lot of high quality protein and nutrients in each serving, but they also tend to be extremely high in calories, carbohydrates and sugar.

While this is sufficient for most weight lifters, it is not ideal for those with conditions such as type 2 diabetes, for whom

weight loss
may be a key goal.

Work your biggest muscles

If you’re new to weight lifting or strength training, just about any workout will be intense enough to increase protein synthesis and build muscle.

However, if you’re experienced with weights, you’ll see the biggest and fastest results by focusing on the large muscle groups, like the back, legs and chest.

The best exercises for these body parts are squats, dead-lifts, bench press, leg press, pull-ups, bent-over rows, shoulder press and dips. Add two or three sets of 8 or 12 repetitions to your workout, with about 60 seconds’ rest between sets.

Eat a high-quality meal after training

Post-workout meals or snacks should be high in carbohydrates and protein. Carbohydrates are needed to fuel exercise. As well as being a vital energy source they also play a

role in the release of insulin, which regulates levels of blood sugar and is also the body’s most potent anabolic hormone.

However, people with diabetes are generally advised to limit their carb intake to keep their blood sugar levels under control as their bodies struggle to produce insulin or don’t use the insulin produced effectively.

The problem with this though is that a lack of stored carbs can result in the body using protein for energy production, thus leaving less protein for building muscle.

The key is to cut out

bad

carbs such as. refined, processed carbohydrates found in white bread, potatoes, pasta and rice  from your diet and replace them with

good
, unprocessed carbs from fruit and vegetables, beans, nuts, seeds and whole-grain versions of bread, pasta and rice.

Foods with good carbs generally have a lower glycemic index (GI), which means they tend to break down slowly to form glucose.

Low GI foods
also have a high nutritional value and provide prolonged release of energy.

Drink plenty of water

Adequate water consumption is one of the most overlooked factors in exercise. Water comprises up to 70% of the human body and if you’re

dehydrated, your muscle size suffers as well. The other way of looking at it is that one pound of muscle can hold up to three pounds of water.

Rest

Rest is another hugely overlooked factor in building strong, lean muscle.

The simple fact is that after an intense workout, the body needs the proper nutrients and recovery time to grow bigger and stronger.

In fact, your muscles grow when you’re resting, not when you’re working out.

If you’re a beginner, do a full-body workout followed by a day of rest. Alternatively look at setting aside at least 3 days of rest each week.

Consume good fats

A common misconception among the general public is that all types of fat are bad for you. While saturated fats and

trans fats
(i.e.

bad

fats) increase

cholesterol
and your risk of certain diseases, monounsaturated fats and  polyunsaturated fats can have the opposite effect and benefit your overall physical and

mental health

They are also important for muscle growth.

Good sources of healthy fats such as omega-3 fatty acids include:

• 
  Fish
  – salmon, tuna, mackerel, herring, trout and sardines
• Avocados
• Olives and olive oil
• Nuts – almonds, hazelnuts, pecans, walnuts, cashews and macadamia nuts
• Peanut butter
• Tofu
• Sunflower, sesamen, and pumpkin seeds, and flaxseed

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Hockey is a popular sport that requires a substantial amount of exercise, but can be very successfully managed by people with diabetes. Its pace is similar to games of

football

and

rugby

Light to moderate intensity is involved, depending on how frequently you play and what your role is on the team.

Many professional hockey players with diabetes have established medication routines which enable them to perform without worrying about their blood sugar levels.

There are two particular variables to consider when managing your diabetes for playing hockey; how much energy you expect to use and the time of day in which you play.

Managing different positions

Midfielders generally exert much more energy due to the demanding role of simultaneously defending and attacking.

Playing in goal, however, will be much less taxing, while centre and defence positions are focused on attack and defence respectively.

If you have diabetes and play midfield then you should expect to manage your diabetes more vigilantly given the

enhanced likelihood in which hypoglycemia can develop

Rolling substitutions can also influence your involvement. If you know you are going to be playing a full game, a sugar top-up will be required during the game. However, playing less due to substitution will not require this.

Different playing times

A big meal should be consumed between two and three hours before training or a game, and a reduced dose of quick acting insulin can be given by around 25 per cent.


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This time frame will allow the insulin to have worked thoroughly with limited effects on your blood sugar as a result while playing.

Morning or early afternoon games will require another big meal after the game to prevent a hypo later in the night. This could again be accounted for with a reduced insulin dose.

The policy of big meals before and after sessions should still be followed for evening games or training, but you could consider reducing your long lasting insulin on the night. This can be discussed with your doctor prior to playing.

This may work for casual players, but regular players may find that they do not have to adjust their long lasting insulin either before or on the day of playing.

Blood testing

Blood testing should be done frequently on match days, especially if you are looking to establish a routine.
Testing before, during and after matches will be required, as well as later in the evening when your blood sugar is prone to dropping.

Foot care

You should remember to take special care of your feet when exercising. Your choice of hockey footwear should be comfortable throughout.
Playing regular hockey will require consistent

foot care

Insulin pumps

It is best to learn how to play hockey without your insulin pump, as damage can be done to the device given the nature of the sport. Pumps can sometimes break upon contact with a stick or a ball.

Some players, particularly young ones, may find it easier at first to

wear their pump to establish a routine

in which they can then learn to play without it.

Interval training is a flexible form of training that has also been shown to be particularly beneficial for people with type 2 diabetes.

High intensity interval training has made positive headlines thanks to research showing that relatively small amounts of interval training can be as beneficial to health as longer periods of conventional cardiovascular exercise, such as continuous jogging.

A key advantage of interval training is that it can be fit into the day before work, before lunch or any convenient free moment, even for those of us that lead busy lifestyles.

What is interval training?

Short bursts of activity with rest breaks in between each bout of exercise. The activity periods should increase in intensity with each new session. Each bout of exercise should

work the heart
and leave you breathing deeper.

One form of High intensity interval training is the PACE routine. PACE stands for Progressively Accelerating Cardiopulmonary Exertion ad was designed, by American Physician Al Sears, to be beneficial for the heart and metabolism.

Who is HIIT for?

High intensity interval training is suitable for most people, from those that have not exercised in years through to athletes.

HIIT has been found to be a useful and effective form of exercise for people with type 2 diabetes or with

heart disease

If you haven’t been exercising regularly, or have a chronic health condition in addition to your diabetes, check with your doctor before commencing interval training.

Benefits

As with any good exercise routine, HIIT has benefits for your heart,

blood glucose levels
and mental well being.

The following benefits are particularly associated with interval training:

• Can be undertaken in as little as 10 minutes
• Is very flexible – a wide range of exercises can be chosen
• 
  Is suitable for people that currently have a low level of fitness
• Can be as effective as much longer periods of continuous exercise

How to follow HIIT

The idea is to tire your body during each burst of activity and then you have a short rest period before another bout of activity. During the rest period, try to keep moving but not intensely. For example, if you’ve been sprinting for the burst of activity, ease down to a jog and then walk for your rest period.

By the end of each active burst, you should notice your heart rate has risen considerably and your breathing has become deeper.

The length of time you exercise for can vary from one type of HIIT to another. Typical examples vary between 10 and 20 minutes.

Examples of high intensity interval training include:

• 
  For a beginner try a 30 seconds bout of activity
  with 90 second rest periods in between.
• If well accustomed to interval training, you may try 3 minutes of exercise followed by 1 minute of rest.

Whilst the training aims to get your heart working faster, do not attempt to work yourself too hard before your body is ready. Start off at a gradual pace and increase the intensity gradually with each new exercise session.

Which exercises are involved?

One of the great aspects of interval training is that you can choose from a wide range of exercises

Can choose which exercises you do

• Running
• Cycling
• Squats
• Lunges
• Push ups
• Weights

You can even combine two different types of exercise in one activity bout. Such as a set of squats followed by a set of push ups and then your rest period. Even walking can be used if the options above are too challenging to start with.

Safety

Ensure your body is warmed up before you start the session.

If you have not exercised recently or have another chronic health condition, in addition to diabetes, you should consult your doctor for advice starting HIIT.

If you take medication that puts you at risk of hypoglycemia, it’s important to take precautions to prevent low blood glucose levels from occurring. Read more on

sport and preventing hypos

Some people may notice that blood glucose levels rise immediately following interval training. This is because short bursts of activity can commonly prompt the liver to release stored glucose (glycogen). However, blood glucose levels will usually tend towards lower values over the next 24 to 48 hours.

Science

Research has shown that high intensity interval training can lead to improvements in blood glucose levels and improved muscle mass.

One study reviewed the blood glucose levels of 8 patients with type 2 diabetes before and after 6 sessions of interval training set out over 2 weeks.

Each training session included 1 minute bouts of cycling with 1 minute breaks in between each of the 10 bouts of cycling.

The participants average blood glucose levels over a 24 hour period had been 7.6 mmol/l before the training.

Blood glucose levels through 324 hours were later taken between 48 and 72 hours following the last training session and

average sugar levels had dropped 6.6 mmol/l

In addition to improving blood glucose levels, the participants showed increased skeletal muscle.


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Interval training and intermittent fasting

Combining interval training with an intermittent fasting diet has gaining popularity amongst people actively looking to improve their health and fitness.

Both interval training and

intermittent fasting
have been shown to be particularly effective in

combating insulin resistance

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A small study, carried out by the University of Leuve, showed that exercise carried out in a state of fasting is associated with improved insulin sensitivity compared with participants that took a carbohydrate-rich breakfast 90 minutes prior to training.

There is an extreme level of energy and physicality expanded during rugby, which requires aerobic endurance of moderate intensity across a long duration.

Playing rugby as a one-off can be managed with the right preparation, while regular players will need to keep a detailed log of their

blood glucose

trends.

Taking frequent tests during training and matches will enable you to assess how your blood sugar can be managed on a regular basis.

Celebrity rugby players

Chris Pannell, of Worcester Warriors, is a England international, having been diagnosed with type 1 diabetes aged 19.

Other current players include Brett Stewart, an Australian fullback, while Alun Davies, who also has type 1 diabetes, spent 20 years playing rugby before becoming the Welsh Rugby Union’s player welfare manager.

Building strength

Depending on your position, rugby can require that you have vast physical strength, which is developed through a starchy diet and frequent anaerobic exercise.

This is certainly the case for forwards and, whilst less essential in backs, strength is still a desired quality.

For those playing regularly, and therefore working out frequently while eating additional carbohydrates, further management will be required.
Read the guide to

going to the gym

for more on how to manage diabetes when building your muscle mass.

Insulin management in training

For morning rugby training, a minimal injection of insulin with a large breakfast is advised, or perhaps none at all.


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However, these are both dependent on the intensity of your planned session.

If your blood sugar is within 6-9 mmol/l at lunchtime, an afternoon session may not require any insulin after consuming lunch or a smaller portion of carbohydrate.

Sugar such as energy drinks, tablets or small snacks can help regulate your blood glucose levels during sessions, in which blood tests should be taken every 30-45 minutes.

Insulin management on match days

Match days will be quite similar to training in terms of the amount of insulin and food portions you absorb before the game begins.

However, Exeter Chiefs fly-half

Henry Slade explained in an interview

with Diabetes.co.uk that adrenaline can be a factor necessary of consideration on match day.

“I was often higher because of adrenaline. If my blood sugar was 7 or 8 mmol/L before I went out for a training session, I’d have a couple of jelly babies which would last me up to an hour and a half. Although, if I was to do that before a match I’d come in with a higher blood sugar. So I had to adapt little things like having an insulin jab before a match or at half-time to compensate for the adrenaline.”

Blood tests before, during half time and after the match will enable you to assess trends of your blood sugar.

If you test high, you will know for next time then you could consider injecting a reduced insulin dose before the game, while if low, sipping glucose drinks such as Lucozade during stoppages of play will initially be necessary.

If this continues at any point of the game, you should lower the nightly or morning doses of your long lasting injections before match days going forward.

Type 2 diabetes medication

If you are on insulin stimulating medications, such as sulphonylureas or glinides, you will either need to increase your carbohydrate intake or have a reduced dose of those medications. You should speak to your doctor before making any changes to your medication.

Test your blood glucose levels regularly during and after training and games to monitor for any

low blood glucose levels

Tips for when playing rugby

You should remember to take special care of your feet when exercising. Your choice of rugby boots should be comfortable throughout a game and also strong to protect your feet from the studs of other players.
Playing regular rugby will require

consistent foot care

Insulin pumps

Rugby is an excessive contact game and wearing an insulin pump is not advised for this sport. Read more on

exercising with an insulin pump

What do other people say about playing rugby?

Members of the Diabetes Forum have previously discussed

issues with diabetes when playing rugby

Community member

tbcgaz

, wrote: “

I stumbled across the forum searching online about low carbohydrate diets and diabetes as I am a type 1 diabetic who plays rugby and I am looking to bulk up. A few of the guys at my club are on low carb, high protein diets and I wasn’t sure how this would affect me

”.

Walking may be one of the most basic forms of exercise but it’s also a very effective form of activity for helping to reduce blood glucose levels.

We take a look at how walking can help, the evidence provided by research, and provide tips on how you can get more strides into your day.

Walking off stubborn high sugar levels

Walking can also be useful for lowering blood sugars that are staying

stubbornly high as a result of stress
or

mild illness
such as colds.

If you are on insulin
and find it difficult to reduce blood glucose despite increasing your insulin doses, you may find that a period of walking is helpful for getting your glucose levels back closer to normal levels.

Note that if you are on insulin, you

should test your sugar levels regularly
after walking to ensure your blood sugars do not go too low.

Walking more

Rather than thinking about walking as an inconvenience, it’s better to view walking as a convenience – that is a convenient way to keep our metabolism active.

Whilst many of us may feel

we have difficulty in getting enough physical activity into each day, getting more activity into our day is often a matter of adjusting priorities.

Here are some simply ways to increase the amount of walking you do:

• Deliberately park your car further away from the shops
• For shorter journeys, walk instead of using the car or other transport
• Use stairs where possible
• Get off the bus, tram or tube train a stop or two early
• Take a break from your computer every hour for a short stroll –
  
  even a short break to stretch your legs has been shown to be better than nothing
  
  
• 
  Take walks after meals, particularly if your after meal glucose results are often on the high side
• Move around, where possible, during phone calls
• Move around during TV breaks or, better still, take a walk instead of watching TV
• 
  Make walking a regular family activity
• Make a point of regularly visiting local parks or attractions

Research on the effects of walking on diabetes

Research studies have shown that walking can be beneficial in bringing down blood glucose and therefore improving diabetes control.


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In a study

involving people with type 1 diabetes, participants were assigned to either take a 30 minute walk after eating or have the same meal but remain inactive.

The results showed that participants who walked after meals experienced around a 4.5 mmol/l peak increase in glucose levels. By comparison, the participants that did not walk after meals experienced around 7 mmol/l peak increase after meals. The peak results occurred between 1 and 1.5 hour after eating.

A reduction in post meal glucose levels was also experienced in non-diabetic participants and so people with other types of diabetes, such as type 2 diabetes or gestational diabetes, can also expect to experience significantly improved glucose levels following a period of walking.

Parkrun

Parkrun
is a series of 5k runs held on Saturday mornings around the UK which became extremely popular in the mid 2010’s. Olympians, juniors and those just looking for a social walk are welcome equally, and events are free to attend.

Doctors and low carb enthusiasts are recommending parkrun to patients as an adjunct to eating a healthy diet, with Dr Simon Tobin from Norwood Surgery Southport in Merseyside claiming parkrun is a “

win-win situation
” because his patients are healthier and happier and less likely to develop diabetes-related complications.