Take control of your blood sugar while continuing
to safely train.
It is well established that diabetes mellitus
alters the metabolic response to exercise, thus runners who have
diabetes must pay special attention to how they train and what they
eat. Therefore, it is necessary to follow several precautions to
avoid adverse reactions during exercise.
With well-controlled Type I diabetes (insulin
dependent) and Type II diabetes (non-insulin dependent, usually
adult onset), excessive amount of insulin in the blood stream can
result in increased muscle glucose uptake and diminished liver glucose
production. This results in decreased blood glucose levels. On the
other hand, with poorly controlled Type I diabetes, there can be
diminished muscle glucose uptake and increased liver glucose production
owing to inadequate insulin in the blood stream. This results in
increased blood glucose.
Symptoms of hyperglycemia (high blood sugar/inadequate
insulin available) are typically gradual in onset and include, but
not limited to, polyuria (frequent urination), glucouria (sugar
in urine), thirst, lethargy, blurred vision, confusion, flushed
face, nausea, “fruity” breath, and deep sighing (Kussmaul)
breathing. In severe cases, diabetic coma is a medical concern.
Symptoms of hypoglycemia (low blood sugar/excessive
insulin present) are typically sudden in onset and include, but
not limited to, shakiness, sweating, trembling, confusion, irritability,
hunger, weakness, lethargy, headaches, and pale moist skin. In severe
cases, insulin or hypoglycemic shock (below 60 mg/dL) is a medical
The optimal range for blood sugar levels while exercising is between
150-180 mg/dL. The following are some guidelines for exercise in
relation to blood sugar levels, but should always be reviewed with
Below 70 mg/dL: Do not exercise. Eat 25-50g of
carbohydrates (CHO) and
recheck in 20 minutes.
70-100 mg/dL: Eat 25-50g of CHO before exercise and 10-15g every
100-170 mg/dL: Eat 10-15 g of CHO every hour of exercise.
170-300 mg/dL: Monitor glucose after an hour of exercise.
Above 300 mg/dL: Hold exercise and check for ketones in urine.
Some general tips for the diabetic athlete include:
Never exercise alone
Carry I.D. that identifies you as diabetic
Have fast acting glucose available (for hypoglycemia)
Monitor glucose levels before, every hour during, and after exercise
Allow proper warm-up and cool-down
Pay close attention to footwear
Avoid exercise at peak insulin times
Regularity of exercise is important to minimize glucose instability
Injections should be done approximately 1 hour before exercise in
Avoid injections in large muscle groups (e.g., thigh muscle)
Eat 10g of CHO every 30-60 minutes
Regularity of exercise is extremely important
in minimizing glucose instability and providing the opportunity
for appropriate adjustment in insulin dosages in the Type I diabetic.
If hypoglycemia repeatedly occurs during regularly scheduled exercise,
the appropriate insulin component should be reduced as necessary.
The Type I diabetic exercising regularly may require as much as
a 10-20 unit reduction inn daily dose.
Frequent glucose testing and individual modifications to this plan
are necessary. Guidelines should be considered a starting point,
not a complete treatment guide. Particularly for the River Bank
Run, changes will likely need to be made every 1-2 weeks as the
intensity of workouts increases.
Continued consultation with your medical doctor is necessary. Despite
the medical concerns associated with diabetes, individuals who properly
manage their condition are able to exercise efficiently and safely,
and be able to maintain a level of fitness consistent with their
Landry GL, Allen DB: Diabetes mellitus and exercise.
Clin Sports Med 1992; 11(2):403-418
Zachazewski JE, Magee DJ, Quillen WS. Athletic
Injuries and Rehabilitation. 1996; Saunders Company; 832-833
Overtraining occurs when athletes try to improve
performance and train beyond their body’s ability to recover.
What are the signs of overtraining?
· Mild soreness and achiness.
· Pain in muscles and joints.
· Feeling tired, drained, lack energy.
· Sudden drop off in ability to run normal distances, a drop
off in time.
· Headaches, insomnia.
· Not able to relax.
· Lower resistance to common illness.
Flexibility is a joint’s ability to move
through a full range of motion. Flexibility is a key component of
a balanced fitness program.
Working regularly on your flexibility will help prevent injury,
increase your range of motion, promote relaxation, and improve performance
Use Static Stretching
Static stretch involves a slow, gradual and controlled elongation
of the muscle group through full range of motion, held for 15-30
seconds in the furthest comfortable position (without pain).
Always warm up before stretching
A warm muscle is more easily stretched that a cold muscle. Get the
blood circulating throughout the body and into the muscles. The
warm up should last about 5 to 10 minutes of low intensity (slow
jog or stationary bike). Once the muscles are warm, you can now
Stretch before and after exercise
It is recommended that you stretch before and after exercise, each
for different reasons. By stretching before activity you can improve
dynamic flexibility and reduces chance of injury. Stretching after
exercise ensures muscle relaxation, facilitating normal resting
length, circulation to joint and tissue structures, removal of unwanted
waste products, thus reducing muscle soreness and stiffness.
Begin with a general warm up period, which may consist of 5 to 10
minutes of slow jogging, or riding on a stationary bike. The general
warm up increases heart rate, blood flow, deep muscle temperature,
respiration rate, viscosity of joint fluids and perspiration. Remember
that a warm muscle exhibits a greater amount of flexibility.
After the general warm up, incorporate 8 to 12
minutes of a specific warm-up. Use movements similar to the movements
of your sport. The more power necessary for the sport or activity
the more important the warm up.
Treating an Acute Injury
Listen to your body. Pain is a warming sign of injury. As athletes
we tend to want to work through the pain but often this increases
our chance of injury.
If you suffer an acute injury, such as strain or pull, immediately
stop activity and use the RICE method of treatment. RICE stands
for Rest, Ice, Compression and Elevation.
· Rest will prevent further injury and allow for healing.
· Ice will stop the swelling as it constricts injured blood
vessels and limits the bleeding in the injured area.
· Compression further limits swelling and supports the joint
· Elevation uses gravity to reduce swelling in the injured
area by reducing blood flow.
When a Sport Medicine Doctor can help
You should call a Physician if you experience the following:
· You have severe pain, or if pain persists for more then
2 weeks in a joint or bone.
· Pain radiates to another area of the body.
· You have ‘point tenderness.’ That is, you can
cause pain by pressing on a specific area, but pain is not produced
at the same point on the other side of the body.
· You have any injury to a joint that produces significant
swelling. If left untreated, joint injuries can become permanent.
· You cannot move the injured part.
· There is persistent numbness, tingling, or weakness in
the injured area.
· You have an infection with pus, red streaks, a fever, or
swollen lymph nodes.