Q: My husband has type 1 diabetes and is training to ride in a 65-mile bicycle race. How can he best control his blood sugar levels during and after this race? His levels sometimes crash a few hours after training.
A:First, I would like to congratulate your husband on having the remarkable discipline such an activity requires. This is long and strenuous exercise. I am assuming that he has been evaluated and cleared by his doctor to participate in such physical activity, so I will focus on glucose control. When engaging in arduous exercise, people who have diabetes should be vigilant about preventing both high and low glucose levels.
The risk of low sugar levels is more intuitive to understand than high sugar levels because the body uses so much energy from glucose during exercise. In addition, after exercising, the body tries to replenish the energy stores of the muscles and the liver, which can also lead to abnormally low blood sugar levels.
High sugar levels can develop because the body considers long and strenuous exercise a form of stress. Any type of stress triggers the production of adrenaline and other hormones that inhibit insulin and increase the production of glucose. Here are some general guidelines.
Before training begins, your husband should have his diabetes controlled very well with intense insulin therapy, either with three or more injections a day or with an insulin pump. This allows for better flexibility during his training and race.
During his training weeks or months, your husband should monitor his glucose levels both before and after meals. He should also track the amount of insulin he injects, his dietary intake, and the duration of each exercise or training session. He should also check his glucose levels at 2 a.m.
Before he starts his training sessions, he should determine his glucose level. The ideal glucose level is 100 to 250 mg/dl. If it is below 100 mg/dl, then he must eat a snack containing carbohydrates. If it's above 250 mg/dl, he should also check for the presence of ketones in his urine. Ketones are the by-product of fat energy metabolism. The body reverts to this process when it lacks sufficient amounts of insulin. If he has urine ketones, he should refrain from exercising until the insulin deficiency is corrected. If his sugar is above 300 mg/dl, he must postpone his training session until his levels are corrected.
While he's training, your husband should check his glucose level frequently. He should also carry drinks that contain carbohydrates, or sugar tablets, to compensate for low levels. Having a "map" of his sugar levels (see step 2) will provide him a reference to base his insulin requirement on as well.
After exercising, your husband's body will try to restore the glucose in his muscles and liver, so it will continue to remove glucose from the bloodstream. This leads to low sugar levels even hours after he's through exercising. Your husband must check his glucose level immediately after exercising and several times later, for up to 12 hours afterwards.
Based on the records he has kept on his glucose levels, he may need to reduce his insulin dose by more than 50 percent.
It is best to exercise at least 30 minutes after injecting insulin to limit the effect of exercise on insulin absorption. If your husband exercises in the afternoon or evening, he might find his glucose level to be abnormally low in the middle of the night — his bedtime or evening insulin doses would have to be adjusted accordingly. If your husband is on NPH, the evening dose should be given at 10 or 11 p.m. Your husband will probably need to increase his carbohydrate intake in the evening to prevent low blood sugar levels in the middle of the night.
It is also generally recommended that diabetic athletes have a meal two to six hours before exercising. It should contain 83 to 200 grams of carbohydrate, a small amount of protein, and fat.
Showing posts with label diabetes and prediabetes whats the difference. Show all posts
Showing posts with label diabetes and prediabetes whats the difference. Show all posts
Thursday, March 15, 2012
Wednesday, December 21, 2011
Stop the Progress of Prediabetes
You can prevent this precursor to type 2 diabetes from developing into full-blown disease.
Nearly 24 million American adults are living with diabetes, according to figures released last month by the International Diabetes Federation. But what may be even more alarming is that there are also about 79 million Americans with a condition known as prediabetes — and many aren't aware of it.
Prediabetes means that while your blood sugar levels are higher than normal, that level isn’t high enough to warrant a diabetes diagnosis. However, a prediabetes diagnosis means it is time for action to prevent diabetes.
"In simple terms, there is a gap between what we call diabetes, which is a fasting blood sugar of 126 and above, and normal, which is less than 100 fasting," explains Vivian Fonseca, MD, a professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans. "In between, you have impaired fasting glucose. If you do a glucose tolerance test, and you are in the gap, you have prediabetes. You are at risk for getting diabetes in the future and you are also at risk for heart disease."
Research has also found that prediabetes may be more common in men than in women.
Type 2 Diabetes: Prevention
If you are told your blood sugar is abnormally high, you’ve just had a red flag waved in front of you. You’re being warned that unless you make some changes in your life today, your future will probably include a diabetes diagnosis.
"Walking 30 minutes a day and reducing weight by 5 percent can decrease the risk [of getting type 2 diabetes] by 60 percent over three years," says Dr. Fonseca. While there are medications that have the same effect, lifestyle change is less expensive and has fewer side effects, Fonseca says.
Cutting your weight is crucial. "One of the links with obesity is that fat induces a mild low-grade inflammation throughout the body that contributes to heart disease and diabetes," Fonseca explains. Without making any changes, you could develop type 2 diabetes within 10 years of first developing prediabetes.
Type 2 Diabetes: Who Should be Tested?
Prediabetes is a "silent" condition, says Fonseca. While some people may experience symptoms of diabetes such as fatigue or increased urination, most people’s blood sugar rises without any outward signs at all. This means you might not know you need to be tested for prediabetes — and even if you are screened, your doctor might not give you all the information you need to prevent it.
For these reasons, diabetes experts developed criteria for those who should be tested. The American Diabetic Association recommends that any adult age 45 or older should be tested for diabetes and prediabetes.
The ADA also recommends that any adult under age 45 who is overweight and has at least one of the following risk factors should be tested:
Family history (especially parent or sibling with diabetes) Physically inactive lifestyle Native American, African-American, or Hispanic heritage Prior gestational diabetes diagnosis Birth of a baby over nine pounds in weight High blood pressure or treatment for high blood pressure Polycystic ovarian syndrome (PCOS) diagnosis Dark, velvety rash around the armpits or neck History of heart disease If your test reveals that you have prediabetes, you should be tested again in one to two years, depending on your doctor’s recommendations.
Type 2 Diabetes: Types of Tests
There are two tests used to screen for diabetes and prediabetes:
Fasting plasma glucose: a test of your blood after you haven’t eaten for eight hours (usually overnight) Oral glucose tolerance test: a comparison of your blood taken first after eight hours without food (fasting) and then two hours later after you have consumed a sugary drink given to you by the lab technician. If you fit the screening criteria listed above, make an appointment to get tested as soon as possible. It could be the first step toward preventing the development of type 2 diabetes.
Nearly 24 million American adults are living with diabetes, according to figures released last month by the International Diabetes Federation. But what may be even more alarming is that there are also about 79 million Americans with a condition known as prediabetes — and many aren't aware of it.
Prediabetes means that while your blood sugar levels are higher than normal, that level isn’t high enough to warrant a diabetes diagnosis. However, a prediabetes diagnosis means it is time for action to prevent diabetes.
"In simple terms, there is a gap between what we call diabetes, which is a fasting blood sugar of 126 and above, and normal, which is less than 100 fasting," explains Vivian Fonseca, MD, a professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans. "In between, you have impaired fasting glucose. If you do a glucose tolerance test, and you are in the gap, you have prediabetes. You are at risk for getting diabetes in the future and you are also at risk for heart disease."
Research has also found that prediabetes may be more common in men than in women.
Type 2 Diabetes: Prevention
If you are told your blood sugar is abnormally high, you’ve just had a red flag waved in front of you. You’re being warned that unless you make some changes in your life today, your future will probably include a diabetes diagnosis.
"Walking 30 minutes a day and reducing weight by 5 percent can decrease the risk [of getting type 2 diabetes] by 60 percent over three years," says Dr. Fonseca. While there are medications that have the same effect, lifestyle change is less expensive and has fewer side effects, Fonseca says.
Cutting your weight is crucial. "One of the links with obesity is that fat induces a mild low-grade inflammation throughout the body that contributes to heart disease and diabetes," Fonseca explains. Without making any changes, you could develop type 2 diabetes within 10 years of first developing prediabetes.
Type 2 Diabetes: Who Should be Tested?
Prediabetes is a "silent" condition, says Fonseca. While some people may experience symptoms of diabetes such as fatigue or increased urination, most people’s blood sugar rises without any outward signs at all. This means you might not know you need to be tested for prediabetes — and even if you are screened, your doctor might not give you all the information you need to prevent it.
For these reasons, diabetes experts developed criteria for those who should be tested. The American Diabetic Association recommends that any adult age 45 or older should be tested for diabetes and prediabetes.
The ADA also recommends that any adult under age 45 who is overweight and has at least one of the following risk factors should be tested:
Family history (especially parent or sibling with diabetes) Physically inactive lifestyle Native American, African-American, or Hispanic heritage Prior gestational diabetes diagnosis Birth of a baby over nine pounds in weight High blood pressure or treatment for high blood pressure Polycystic ovarian syndrome (PCOS) diagnosis Dark, velvety rash around the armpits or neck History of heart disease If your test reveals that you have prediabetes, you should be tested again in one to two years, depending on your doctor’s recommendations.
Type 2 Diabetes: Types of Tests
There are two tests used to screen for diabetes and prediabetes:
Fasting plasma glucose: a test of your blood after you haven’t eaten for eight hours (usually overnight) Oral glucose tolerance test: a comparison of your blood taken first after eight hours without food (fasting) and then two hours later after you have consumed a sugary drink given to you by the lab technician. If you fit the screening criteria listed above, make an appointment to get tested as soon as possible. It could be the first step toward preventing the development of type 2 diabetes.
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