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.

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.

Running can be an ideal form of exercise for people with diabetes as it helps improve the body’s sensitivity to insulin.

This can be especially useful for people with type 2 diabetes to help combat

insulin resistance

The great aspect of running that you don’t have with many sports is control, as running can be a form of exercise tailored to your demands, unless you are specifically entering races.

Running can improve your health and help with

losing weight

in an extremely manageable way for people with diabetes, while providing immense satisfaction and reward in the process.

General diabetes and running tips

You should always ensure you carry a more than adequate supply of sugar, either in the form of

glucose tablets

or sugary drinks.

Carrying

medical identification

is also essential if you are running for longer than a 60-minute period, as well as informing a loved one that you are going out for a run as

hypoglycemia

is always a risk. A running partner, alternatively, would be ideal.

Running in the summer months is much more tempting due to the brighter, warmer conditions, but the risk of dehydration can occur during this period.

If your

blood glucose levels

are too high to begin with, dehydration can occur, with runners urged to ensure they are at a stable level, somewhere between 7-10 mmol/l, before setting out.

As a reference point for diabetes management, the demands from running are around 50 per cent greater than from

cycling

, when comparing energy exertion.

Running with an insulin pump

Running is one form of exercise for which

wearing an insulin pump

is completely suitable and very helpful as it is unlikely to be knocked and risk the tubing being snagged.

Management for people at risk of hypos

People at risk of hypos include anyone on insulin, sulphonylureas and glinides. For all lengths, it is best to avoid running less than two-three hours after absorbing

quick acting insulin

so as to not complicate your blood sugar readings and risk hypoglycemia.

Short runs

Short runs of between 20-45 minutes can be conducted many times over a week, with relatively minimal effect on blood sugar levels. Ensuring your blood sugar is between 7-10 mmol/l and consumption of a small snack should provide suitable preparation for your run.

If your blood sugar is higher than this, this snack will not be needed, while if lower, you should consume sufficient sugar and wait for your blood sugar to stabilise before running.
Be sure to take glucose with you in case you start to feel low, with these symptoms often harder to spot in the middle of consistent exercise.

Reducing your quick acting insulin later in the day, or alternatively eating more, will prevent any night time hypoglycemia occurring.


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Long runs

A long run would generally be classed at around one to two hours, which will require a slower pace over an extended period. Long runs are only advised for runners with diabetes who have developed good routines and fitness from shorter runs, as straining your body for this duration without training can result in severe hypos.

Your preparation does not need to deviate too much from short runs, but additional hydration and glucose intake will be necessary.

Stopping on the hour mark for a brief rest, blood sugar level test and snack, such as a sandwich, will keep your energy levels high. You could consider omitting a dose of quick acting insulin with this food. Similar to short runs, you can reduce your night time insulin dosages, but this time by about 50 per cent for quick acting insulin when eating your main meal.


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Very long runs and marathons

Marathons are the culmination of intense training and should not be considered by people with or without diabetes that have not prepared accordingly.
Initial management can be the same as above, although reducing your

long lasting insulin

in the morning may be advised, especially if you running a marathon for the first time.

Consuming slightly more sugar beforehand, such as a chocolate bar, will also keep your blood sugar a little higher and prevent the risk of hypoglycemia affecting you early on.

Sugar boosts such as energy gels every five or six miles will keep your nutrition levels high, while hydration is again essential. Marathon runners with diabetes have found their bodies tend to settle in regard to hydration after an hour’s running, however, and the less you sweat, the less you will need to rehydrate.

The consumption of too much liquid makes digestion much harder, so hydrating often with little amounts is the best management for marathons.

Refuelling your muscles following the run will help your body recover and a big meal combined with a reduction in insulin throughout the day will prevent hypos later in the evening.


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Parkrun

Parkrun

is a series of 5k runs held on Saturday mornings around the UK which welcomes those looking to walk at a comfortable pace and those looking to get their personal best time each week.

Events are free to attend, and their growing popularity has led to doctors and low carb enthusiasts

recommending parkrun

to patients as an adjunct to eating a healthy diet.

Care for your feet

Taking care of your feet is essential when running, especially for regular runners, so you should

ensure your choice of footwear is as comfortable as possible

What do other people do when running?

Running is a topic discussed frequently in the

Diabetes Forum

Ad Infinitum wrote: “

I’m looking for some advice on long distance running and BS management. I’m having major problems with my BS, no matter how much I reduce my Lantus the evening before a run of >1 hr or regardless of what I eat/drink before and during exercise I just can’t keep my BS high enough to avoid hypo

”

An increasing number of people with diabetes mellitus are turning to yoga in an effort to keep their condition under control and improve overall quality of life.

It is well known that regular practice of yoga can help reduce levels of stress, enhance mobility,

lower blood pressure
and improve overall wellbeing.

It is these benefits that many health experts believe can improve diabetes management and protect against other related medical conditions such as

heart disease

What is yoga?

Yoga is a series of mental, physical and spiritual disciplines that originated in ancient India over 5,000 years ago.

The practice of yoga helps to co-ordinate the breath, mind and body to promote relaxatio, develop breath awareness and provide a sense of inner peace.

It involves various body postures and movements (known as asanas), breathing techniques and

meditation, which are all designed to promote physical comfort and mental composure.

There are several forms of yoga, but in the west the most widely taught form is Hatha Yoga.

Benefits of yoga

Most, if not all, people who undergo regular yoga training experience improvements in their mental and physical health.


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These benefits can include:

• 
  Better sleep
• Reduced anxiety and
  
  depression
• Enhanced feelings of well-being
• Relief from chronic illnesses
• Improved digestion, circulation, and immunity
• Improved posture, flexibility and strength
• Enhanced concentration and energy levels
• Enhanced function and efficiency of respiratory, neurological and
  
  endocrine organs

Benefits for people with diabetes

Yoga is considered to be a promising, cost-effective option in the treatment and prevention of diabetes, with data from several studies suggesting that yoga and other mind-body therapies can reduce stress-related hyperglycemia and have a positive effect on

blood glucose control

Controlling mental stress (stress management) is one of the keys of

diabetes treatment
When we’re stressed, our blood sugar levels increase and elevated blood sugar levels increase the chances of serious complications such as heart disease.

Using controlled breathing techniques, meditation and body postures, yoga and other mindfulness-based programmes train participants to invoke a relaxation response.

This response helps regulate cortisol and other stress hormones, which increases blood pressure and

blood glucose levels
Both play a big role in the development of

type 2 diabetes
and related complications.

Yoga can also treat diabetes, or in the case of type 2 diabetes, prevent the disease from developing by:

• 
  Rejuvenating pancreatic cells
  
  – Yoga postures that aid relaxation (asanas) stretch the pancreas, which can stimulate the production of insulin-producing beta cells.
  
  
  ^[73]
  
• 
  Exercising the muscles
  
  – Like other forms of exercise, yoga increases glucose uptake by muscular cells, which in turn, helps to lower blood sugar levels, improve circulation and reduce the risk of cardiovascular disease.
  
  
  ^[74]
  
• 
  Promoting weight loss
  
  – Exercising through yoga can reduce weight and improve weight control, both of which are essential for protecting against conditions such as type 2 diabetes, cancer and heart disease, as well as diabetes management.
• 
  Improving your mental attitude
  
  – Regular yoga practice can help to focus the mind and create the right mental approach to dealing with diabetes.
  
  
  ^[75]
  

Whilst the benefits of yoga therapy have been demonstrated in several studies, it is not medically approved in the UK as a form of diabetes treatment. Before starting any yoga classes, you should consult with your doctor and diabetes healthcare team and continue with your conventional diabetes care plan.

Skiing generally requires medium to high anaerobic activity over a period of short durations, but good diabetes control can be achieved with the right preparation.

For regulars, skiing intensity may be enhanced, but for those with diabetes looking to ski as a one-off, there are some specific notes to be taken to assist in your management.

Celebrity skiers

Kris Freema, an American cross-country skier, has

type 1 diabetes

and competed in three Winter Olympics. He performs wearing a small, wireless insulin pump on his arm.

Skiing with diabetes

Blood sugar levels should be monitored frequently while skiing. Tests should be made before and after each event you participate in and glucose should be carried on you at all times.

One time especially to check your blood sugar is when getting on a chairlift. Having a hypoglycemic attack on a chairlift can be a frightening experience and you should not get on to one if you feel any

symptoms of a hypo

When pricking your finger, you may find that cold weather makes obtaining blood tricky. It is wise to move inside somewhere warm to test, and if your glucometer reports error messages, you can hold it under your armpit for a few minutes for warmth and try again.

Insulin

Casual skiers will attest that skiing is not as energetic as some may think, although a reduction of your long lasting insulin by 10-20 per cent in the morning is still advised for first timers.


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However, there are exceptions where energy usage is considerably higher, two of which are snowboarding and cross-country skiing.

Snowboarders often spend time falling down and getting up, which requires greater energy. For those planning a snowboarding session, morning insulin doses could be further reduced to between 40-50 per cent. Cross-country skiing, meanwhile, is far more demanding and occurs over a much longer time period. Long lasting insulin doses could be reduced to a similar degreen, with regular snacks or glucose portions taken throughout the day.


^[114]

The body burns more calories when shivering in the cold, which can result in lower blood sugars.

For those skiing over a period of several days, it is advised to monitor trends of your blood sugar readings and consider decreasing your evening and morning long lasting insulin doses if you are consistently going low.

Staying hydrated

When skiing at high altitude, you will need to remain additionally hydrated, as uncontrolled diabetes can put you at high risk of dehydration.

The higher you are above sea level, you more will you will exhale and perspire additional moisture as a result. The body rids sugar from the body using water, so drinking water before, during and after will prevent dehydration, especially if your body is trying to eliminate extra sugar from

high blood glucose

Tips for skiing in cold weather

Your

blood glucose meter

may not work in freezing conditions and should be stored with your insulin in a backpack or pouch on your body.
Carrying your meter closer to your body will keep it warmer, with an inner pocket on your clothing an ideal place to ensure that it works throughout the day.

Insulin pumps

Falling down is a risk for your insulin pump while skiing, but if positioned in a place of the body, such as the arm, where the tubing won’t get snagged then wearing your pump should be fine when skiing.
For more information on wearing an insulin pump during sport, read about

exercise and insulin pumps

The effects of blood sugar levels from playing squash can vary, which may surprise some due to the intense nature of the sport.

Many may expect

blood sugar levels

to fall during and following a squash match, but the predominance of upper limb movements and changes in body position results in relatively low energy expenditure.

As a result, glucose use is also quite low, with glucose production subsequently higher which can lead to blood sugar levels rising during a game if not carefully managed.

Managing diabetes when playing squash

If you take medication that can cause hypos then managing your diabetes when playing squash can be tricky, especially if you are a first-time or very infrequent player. There are two factors worth considering before you play.

The first is the adrenaline rush that arises from squash, which is much greater than other sports due to its rapid speed. This is another reason why glucose production from the liver is quite high.

The second is that there is much less potential for

hypoglycemia

later in the evening, which will alleviate the need to reduce your quick acting insulin later in the day.

Match day

With rising blood sugar posing a threat during the game, you will probably not need to dose up on carbohydrate or glucose drinks before you start. This is not to say that these items should not be on your person at all times though.

Reducing insulin before your game is also not advised, although a small injection during the game, if you notice your blood sugar rising, may be necessary.


^[116]

If you are playing for the first time, it is best to eat and inject as normal before playing. You will then be able to gauge during and after the game how your blood sugar levels are affected.

Be sure to test before, after and during your game so that you can monitor any patterns that may develop.
Rising blood glucose levels may be an issue following the game, in which case you can either take a small insulin dose without food or reduce your insulin amount with your next meal.


^[116]

Hypo causing tablets

If you take tablets that can lead to hypos, such as

sulphonylureas

or glinides, you may find that a longer or more energetic session makes you more susceptible to hypos.

Testing your blood glucose levels regularly

– to check how your blood glucose levels respond – can allow you to take measures such as consuming carbohydrate if your sugar levels begin to drop below 5 mmol/l. This will prevent hypos from occurring.

If your sugar levels drop too low when playing sports, speak with doctor about whether to lower your dose prior to playing squash.

Tips for when playing squash

Squash is a notoriously tiring sport and you may struggle to recognise signs of high or low blood sugar.

Medical identification

must be worn should an emergency occur such as a

hypo

and people are trying to help you.

You should also remember to take special care of your feet when playing squash, as blisters can easily develop if your trainers are not a comfortable fit.
Playing regular squash will require consistent foot care.

Playing squash with an insulin pump

Wearing your insulin pump when playing squash should not cause you any problems, although it is not wise to attempt any dives to the ground that could damage your pump.

Swimming is a great way of improving cardiovascular fitness, with constant moving allowing for blood and oxygen to be pumped more efficiently.

Unlike sports such as football, rugby and golf, swimming does not strain your joints by having you expend energy and then rest.

It also uses upper and lower body muscles at the same time, which could benefit people with

diabetic neuropathy

, who suffer from numbness.

Intensity will vary, depending on your motivation for swimming, but per hour it can burn 350-420 calories and caution should be taken for beginners as

hypoglycemic

attacks can occur without proper preparation.

Celebrity swimmers

Gary Hall Jr, a five-time Olympic gold medallist, was diagnosed with type 1 diabetes in 1999. His 50m time of 21.76 seconds set a new American record at the 2000 U.S. Olympic Trials.

In 1996, Scott Coleman became the first insulin-dependent diabetic to cross the English Channel at the age of 42.

Managing diabetes when swimming

Swimming can require dedicated management for people with diabetes who are insulin-dependent. Please note the following advice may not be appropriate for people on other medications.

Swimming casually

Swimming once or twice a week should not require excessive management, depending on how many lengths you swim per session.

Keeping your blood sugar level above 12 mmol/l is necessary, however long you are planning to swim, as

blood sugars

lower than this can lead to early hypos.

If your blood sugar is lower, consuming

glucose tablets

or several sips of a glucose drink can provide you with a necessary sugar boost. When your session is finished, consume more sugar immediately and a big meal later on to prevent hypos further in the day.

Starting up regular swimming

People at risk of hypoglycemia looking to take up swimming on a regular basis are urged to see their doctor beforehand to assess their current health state and outline initial goals.

If you are unfamiliar with consistent swimming, the intensity of an hour-long session can lead to hypos during and after a session. For this reason, it is unadvised for beginners to swim alone, especially if you cannot identify

symptoms of high and low blood sugars

Once you have found a routine that works for you, and feel confident managing your diabetes, you can eventually start swimming on your own.

Swimming regularly

Whether professionally, training for an event or to improve fitness, regular swimming will require frequent blood testing and keeping plenty of glucose on you at all times.
Training days can require reductions of

quick acting insulin

and

long lasting insulin



^[115]


, whereas match days, such as a marathon open water events, may require you to consult your doctor see how much insulin you could decrease your injections by.

When training, glucose should be consumed every 30 minutes, but this may not be possible when performing in a race with a set time or distance that lasts longer.


^[115]


This is why for longer, intense events, a more dramatic decrease in insulin could be necessary in the build-up to the event.

Swimming do’s and don’ts

You should also never swim without

medical identification

if you are at risk of suffering hypos. Keeping something worn around your wrist is the best way of establishing that you have diabetes should you require help in the water.

Protective footwear

should also be worn if you are planning to swim in the ocean, where rocks or broken shells could cut your feet and potentially cause complications.

Insulin pumps and swimming

Swimming with an insulin pump can be done with certain waterproof pumps

, although you should not swim wearing your pump unless you know it is suitable for swimming.

Most insulin pumps cannot be used for diving or swimming deep under the surface and will have to be disconnected beforehand.

What does the diabetes community say about swimming?

Members of the Diabetes Forum have previously asked questions about swimming and the energy it consumes. Member

dickgarrard

, asked: “

I swim between 80 and 100 lengths and find that I run out of energy during the swim and want to get some extra energy from something, what do you suggest?

”

Playing tennis as a one-off can be managed relatively comfortably, but playing regularly or professionally requires much more consistent

management of blood glucose levels

However, that is not to say that it cannot be achieved and people with diabetes can have very successful tennis careers.

Tennis is an intense

sport

that can vary in time depending on how quickly games pass. Aerobic endurance is required over long durations, especially if five sets are played, which can take at least three hours or sometimes well over.

Celebrity tennis players

Billy Jean King


won 12 Grand Slam singles titles during her career before being diagnosed with type 2 diabetes. She is actively fighting to raise awareness about diabetes and has been the spokesperson for the Face of Change campaign.

Managing diabetes and playing tennis

The following advice is primarily aimed at people on insulin. Further down the article we will discuss

management for people on tablets, including sulphonylureas or glinides

Playing tennis casually

Tennis can be played at all times of the day, so managing your insulin consumption beforehand will depend on when you are playing.

If you are playing in the morning, or early afternoo, you could reduce your long lasting evening injection the night before.

If your tennis game is scheduled for late afternoon or the evening, there should be no need to reduce your long lasting insulin, but instead reduce your quick acting insulin with your most recent meal.


^[109]

There can be a temptation to consume glucose immediately before playing tennis, however, this is counterproductive to managing your blood sugar levels.

The high counter regulatory response seen in upper limb exercise makes it likely that blood glucose rises in the first hour, and then falls rapidly.
Blood sugar levels should be checked at hourly intervals, with glucose drinks consumed during the second and third hours of play.

Upon completing your game and having an evening meal, insulin doses for food can stay the samen, but long lasting insulin could be reduced to lessen the chances of hypoglycemia later in the evening.


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Playing regularly or professionally

Playing professionally can incorporate many of these practises, but training across tennis, running and weightlifting, among other exercises, will require additional management.

Inevitably, competitions will dictate match times,

leaving other forms of exercise

to fall at different times of the day.

It is important to keep a stable blood sugar reading of between 5-7 mmol/l when exercising on a consistent basis, with high blood sugars leading to lethargy and a poorer performance among people with diabetes.

When exercising,

testing your blood sugar levels

within 20 minutes, and then every 50 minutes will allow you to spot trends and manage any falls with glucose drinks.

Being able to successfully count carbohydrates will also be important. Knowing how much insulin should be consumed with food portions will allow you to alter dosages up or down, depending on your blood sugar, and plan exercise management for the rest of the day.

Playing in extremely warm weather is also something to be accounted for, especially for professionals playing abroad in warmer climates.

Hot conditions can result in enhanced insulin absorption and potential hypoglycemic attacks. If playing in the su, insulin should be reduced further with meals before playing.

Playing tennis when on tablets or oral medication

People on medicines such as

sulphonylureas

or glinides should be wary managing their diabetes when playing tennis as hypos can occur.

If you are on these tablets, you may need to reduce your dose prior to long periods of playing to decrease the risk of developing low blood glucose levels. Check with your doctor prior to playing to see if reducing your dose is appropriate.

An alternative to lowering your dose is to take carbohydrate before and during your game or training.

It is advisable to test your blood glucose regularly before, during and after playing. You should test your blood sugar levels before going to bed and take carbohydrate if there is a risk that your blood sugar may drop too low over night.

Tennis tips

You should also remember to take

special care of your feet when playing tennis

, as blisters can easily develop if your trainers are not a comfortable fit.

Playing tennis with a pump

Wearing your insulin pump when playing tennis should not cause you any problems, although it is not wise to attempt any dives that would bring your pump into contact with the ground.

Competing in a triathlon with

type 1 diabetes

is arguably the biggest challenge that sport can pose to your blood sugar levels.

Triathlons take place over a long duration and require severe intensity and aerobic endurance, which will necessitate vigilant monitoring of your diabetes.

owever, your diabetes is no reason for you to not be able to compete in a triathlon.

A triple threat of

swimming

,

cycling

and

running

may sound hard to manage, but it can be done, mostly through a period of trial and error to find a routine that works for you.

Wearing a

continuous glucose monitor

(CGM) can be hugely beneficial when competing, especially as some will function in water. This can allow you to check your blood sugar at any time of the race.

Celebrity triathletes

Gary Blakie was diagnosed with type 1 diabetes when he was 12. He went on to represent the United Kingdom in the World Triathlon Age Group Championships.

At the age of 21, Blakie was one of the youngest competitors in the 2005 World Triathlon Championships, which involved a 1.5k swim, 40k bike ride and 10k run all in one day.

Diabetes management when triathlon training

Please note, the information below on

managing diabetes

when training or taking part in a triathlon is written for people with insulin-dependent diabetes.

Training

Training for a triathlon can incorporate over three miles of swimming, 150 miles of cycling and 25 miles of running per week for some. For others, this level of intensity may be different.

Each exercise can have a different effect on

blood sugar levels

and require different approaches, especially if you train in all sports on the same day. Swimming can drastically reduce your blood glucose levels, so it advised to start a session with a blood sugar of over 12 mmol/l.

When training, especially as a beginner, you should stop swimming every 30 minutes and test your blood sugar. Eating some carbohydrate or consuming sugar during and after the swim will prevent your blood sugar falling.

Running can have different effects on people, but testing your blood sugar before and after a session will be necessary. A reduction in your insulin may not be, providing you do not run when insulin is working at its optimum performance time – which is normally two-three hours after absorption for

quick acting insulin

Cycling, meanwhile, can require breaks to adjust blood sugar levels. This is especially important if you are cycling as your third consecutive sport of the day, in which case fatigue will impact your energy levels.

Race day

Stopping during your triathlon and testing your blood sugar may be problematic, if not wearing a CGM, especially when competing with others as stop times can hinder your time. However, if not wearing a CGM, there are moments where checking your blood sugar will be essential.

Regimes obviously differ depending on race lengths, but starting with a small

breakfast

is generally advised, which will not require any quick acting insulin.

Eating a little and often is best, as you do not want to be exercising on a full stomach and this can help keep your glucose levels up throughout the race.

However, if your blood sugar goes too high, you will feel tired and thirsty, leading to your heart rate increasing and your energy decreasing. Moderation is therefore important.

Swimming

For swimming, starting with blood sugars of over 14 mmol/l will allow your blood sugar to drop at a manageable rate. You will need to have this slightly over the previous recommendation of 12 mmol/l to account for the extra exercise throughout the day.

Tucking a small sachet of glucose, or other form of sugar in your wetsuit can account for any emergencies. If you feel low, check your levels if possible, but otherwise go with your gut feeling and consume the sugar.

Many triathletes report getting out of the water following their swim and finding the transition to cycling physiologically hard. At this time you should assess your levels and consume some sugar, such as

dextrose tablets

Cycling

Using your CGM can allow you to keep an eye on your levels in real time and consume more sugar as needed, allowing you to focus solely on the ride.

Otherwise, taking the equivalent of a dextrose tablet every 10 minutes, placed conveniently somewhere on your bike, such as taped to your handlebars, can keep your levels up.

Some triathletes with diabetes have also been known to tape their

blood glucose testing kits

to their bikes to allow for quicker testing, which may be very useful for long distance events where stopping could be a hindrance.

However, this is quite a risky method of blood testing and safety should be your optimum priority if you choose to adapt this approach.

Running

Sugar doses may need to be increased during this stage, with your energy levels dropping in likelihood and your blood sugar potentially falling as well.

Eating additional carbohydrates

of around two or more glucose tablets every 30 minutes and stopping to test your levels, if you feel low, will be necessary.

Post-race

Following the race, you will need to check your levels every one-two hours for the rest of the day, with hypos likely to arise given the increased activity that your body has exerted.

Eating normally will help you refuel with your afternoon or evening meal, and here you could consider a reduced injection of insulin with your food.

Keeping your blood sugar slightly higher than normal throughout the evening and during the night can stop rapid drops from occurring.

Triathlon tips

A triathlon can take you over a long distance, and

medical identification

must be worn should an emergency happen and people are trying to help you.

You should remember to take special care of your feet when exercising. Your choice of footwear should be comfortable throughout.

Competing in a triathlon will require

consistent foot care

as even a minor injury could hamper efforts.

Can I wear my insulin pump whilst taking part in a triathlon?

Swimming

with an insulin pump can be done with certain pumps, but most will have to be disconnected before you begin swimming.

For cycling, falling down is a risk for your insulin pump, but if positioned in a place of the body, such as the arm, where the tubing won’t get snagged, then wearing your pump should otherwise be fine.

There should not be any issues wearing your insulin pump while running.

What do other people say about triathlon training?

A number of Diabetes Forum members have posed questions in

regards to triathlon training

christiearras

wrote: “

I have been recently diagnosed with type 2 and am preparing for a mini triathlon in September. I’ve asked people what they eat (squeeze goop, chocolate, etc.) and wonder what would be recommended for a diabetic

”.