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InsulinProblems
Dr. Larry W. McDaniel and Sara Olson review the issues related to
insulinproblemsforstudentathletescompetinginsports.

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[9]

According to Wishnietsky (2004) the education coordinator for the diabetes

care centre at the Wake Forest University, "diabetes is on the rise in the
United States costing us more than $132 billion in healthcare costs and lost
wages." The increase in the number of cases of diabetes includes surrounding
countries and other parts of the world. This paper will focus on the United
States. "There are approximately 125,000 students under the age of 19 with
diabetes in the United States."
Almost all students in high school participate in some kind of sport or required
physical activity classes, and need to know the necessities when taking care of
diabetes while exercising. Students with diabetes are more likely to have Type
I diabetes. "Students with Type I Diabetes will have to receive exogenous
insulin for the rest of their lives unless a cure is found." One of the most
important health concerns for student athletes with diabetes is low blood
sugar, or hypoglycemia. Low blood sugar results from having too much insulin
for the amount of glucose in the blood which may be caused by ingesting poor
food choices or attempting to plan insulin adjustments related to physical
activity.

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The segments of our population that exercises less than three times a week,
has a high risk of developing type two diabetes. People who do not exercise as
children have a low chance of developing exercise habits as an adult. Parents
who exercise may serve as a model for exercise and influence children to
participate in physical activity. Knowledge related to symptoms of an insulin
fluctuation is a crucial aspect for ones health and continued participation in
[9]
physical activities. (Wishnietsky 2004) .

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[6]

According to Berkowitz (2008) , "there are many symptoms concerning

diabetes that are noticeable in daily living that should get attention by a
physician." One of the symptoms includes constant thirst and frequent
urination. "When your kidneys cannot filter and absorb excess blood sugar,
you become dehydrated, so you drink more (and urinate more). Drinking a lot
and still being thirsty are pretty big signs." Other symptoms of diabetes
[6]
include weight loss and fatigue. Berkowitz (2008)
stated that "Without
insulin, sugar from food cannot reach cells, so muscle and fat stores shrink.
That can make you tired and irritable. If you are not performing at your peak,
something is wrong."

[6]

Berkowitz (2008)
stated blurred vision and tingling sensations in the limbs
may be signs of diabetes. Later stages of Diabetes may cause the loss of
limbs. "High glucose levels in the blood can damage the blood vessels in the
retina. If left untreated, this can cause dark spots, flashing lights, and
eventually, blindness. High blood sugar damages capillaries that nourish
nerves, especially in the feet, hands, and penis. The poor blood flow causes a
tingling sensation."

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Symptoms that occur during

physical activity are dizziness,
light headed feeling, and
shaking. These are warnings
that are telling the athlete to
get some insulin in their body
and take a rest. (Berkowitz
[6]
2008) .
Figure 1, designed by Lesley
Kirkwood (Kirkwood et al.
[5]
2007) , explains the effects of advice on dietary intake and/or physical
activity on body composition, blood lipids and insulin resistance following a
low-fat, sucrose-containing, high-carbohydrate, energy-restricted diet. All of
these factors have a major importance to diabetes.

ControllingBloodSugarLevels
There are numerous ways to prevent fluctuations of insulin levels. Rest may
be the most important. Knowing how much time to rest is difficult to
determine, but keeping blood sugars regulated is crucial. Waiting a few
minutes after levels are back to normal is important to facilitate insulin
stability. For teams that include athletes with diabetes glucose tablets and
PowerAde should be available at athletic events. Diabetic athletes will most
likely have decreased insulin levels from physical activity; which causes a
demand for PowerAde and glucose tablets. The glucose tablets and PowerAde
will assist in the process of normalizing insulin levels. Ingesting large
quantities of fluids may change insulin levels for some. Fixing insulin
fluctuations due to physical activity takes time and patience. As an Athletic
Trainer, staying calm and in control is a major positive reinforcement. When
insulin fluctuations occur, the athlete with diabetes is usually uptight and
nervous. Being around someone that is reassuring and positive will assist the
athlete with diabetes with the needed adjustments to insulin.

[1]

Fig. 2, designed by Julian Aucouturier (Aucouturier et al. 2008) , includes the

factors influencing the relative contribution of carbohydrate and fat to energy
expenditure. There are factors that increase CHO and decrease fat
contribution to energy expenditure. In addition to the factors that decrease
CHO and increase fat contribution to energy expenditure having diabetes may
cause a fluctuation in blood sugar percentages and could affect one's duration
of exercise and diet.

ManagingBloodSugarProblems
[8]

Stewart & Getsinger (2008) , an Exercise Physiologist from the Decatur

Memorial Hospital Wellness Centre, emphasized that "cardiovascular and
resistance training go hand in hand, and those with diabetes can reap
benefits such as weight control, heart health, and improved blood sugar when
they participate in an exercise program with doctor's approval." "The heart is
a muscle, and like all muscles, if we don't train it or if we do not use it, it will
[8]
become weak," Stewart & Getsinger (2008)
said, emphasizing the
importance of cardiovascular health in diabetes control.
Paying attention to ones feet is important, and in addition to wearing some
type of medical identification. Maintaining fluid balance is an important
element in controlling diabetes.

One of the keys related to diabetes control and physical activity is to make
sure the bodies systems have adequate levels of fluid. Those with insulin
problems must be able to control levels of fluid and insulin and develop an
awareness fluctuating insulin levels. Planning regular meals is a critical
element in the process of managing blood sugar levels. According to Beaser &
[2]
Hill (1995)
""meal planning consists of the proper balance of foods and
nutrients that you need to maintain good health and manage your blood sugar
levels." If meals are planned regularly and have nutritious value, maintaining
blood sugar levels will be easier to control. Planning meals that are high in
nutrition will hopefully eliminate a portion of fast food eating which is not
healthy for those with diabetes.
[2]

Beaser & Hill (1995)

stated that by planning meals "It will also help you
manage the level of fats or "lipids" in your blood, which are frequently too
high in people with diabetes." Becoming familiar with nutrition values for
various types of foods may make it easier for some athletes to keep insulin
levels normal. "Your meal plan will also take into consideration the timing of
your meals in conjunction with your daily diabetes medications, goals you
may have for weight loss and the types of foods you like or dislike." When all
of these considerations are put together correctly and used efficiently insulin
testing will be easier.

[3]

The model in Fig 3, designed by Carol Horowitz (Horowitz et al. 2008) ,

represents individual factors that relate to your health. When looking into
most of these factors, such as your nutrition, physical activity, education,
social factors, and food marketing your chances at being diagnosed with
diabetes are at a higher risk when not taking these factors into consideration.

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InsulinPumps
Athletes that have been diagnosed with diabetes may have dilemmas where
their blood sugar level fluctuations during practices and games.
Considerations for athletes with insulin concerns range from exercise
rehabilitation to the use of an automatic insulin pump. The automatic insulin
pump is a small battery-operated device about the size of a pager. The pump
continuously delivers small doses of insulin into the body and can be
conveniently clipped to a belt, waistband, or carried in a pocket. Many
athletes have taken the advantage of using this device to assist with insulin
[7]
control. Sherr & William (2008)
at Yale University believes that using the
pump may improve insulin control. Using the insulin pump during rough

physical activity, such as playing football is not safe considering that a needle
is stuck in the side of your abdomen. The insulin pump assists in the process
of insulin regulation before and after practices to maintain desired insulin
levels. Frequently checking insulin levels while the athlete is participating in
practice or games is a requirement to prevent further injuries. The automatic
insulin pump has many features and positive aspects that would benefit most
diabetics. Below are some of the some of the conditions where an insulin
[7]
pump should be used according to Sherr & William (2008) .

Recurrent severe hypoglycemia

Wide fluctuations in blood glucose levels regardless of A1C
Suboptimal diabetes control (i.e. A1C exceeds target range for age)
Microvascular complications and/or risk factors for Macrovascular
complications
Good metabolic control but insulin regimen that that compromises
lifestyle
[7]

Sherr & William (2008)

also recognizes and shares ways where the insulin
pump would be beneficial.

Young children and especially infants and Neonates

Adolescents with eating disorders
Children and adolescents with a pronounced dawn phenomenon
Children with needle phobia
Pregnant adolescents, ideally before Conception
Ketosis-prone individuals
Competitive athletes

AthleticTrainersPerspective
Before an athlete participates in a sport, a physical and physicians approval is
required. If the athlete has been diagnosed with diabetes, the physician will
review numerous symptoms and facts with the patient. The Athletic Trainer
working with the athlete is notified and has been prepared for various types of
[4]
emergencies. According to Jimenez et al. (2007)
"Athletic Trainers
constantly deal with Type I diabetes". Jimenez is a member of the National
Athletic Trainers Association. "In managing diabetes, the most important goal
is to keep blood glucose levels at or as close to normal levels as possible
without causing hypoglycemia." If levels fluctuate, it is important normalize
the bloods' sugar content. Checking levels with a Blood glucose meter before
and after meals should be performed. "This goal requires the maintenance of
a delicate balance among hypoglycemia, euglycemia, and hyperglycemia,
which is often more challenging in the athlete due to the demands of physical
activity and competition."
Maintaining insulin balance before, during, and after physical activity is
important. The athlete with the assistance of an athletic training will continue
with insulin testing and regulating. If insulin levels do not return to normal, a
physician must be seen as soon as possible. Some of the items for athletic
trainers to keep on hand during practices and games include glucose tablets,
PowerAde, and water. Being aware of the symptoms of insulin fluctuation in
the athlete is important to prevent further damage to the athletes' body.
Athletic Trainers should be present during games and practices. They will be
aware of the symptoms and know what to do if blood sugar levels fluctuate.
[4]
(Jimenez et al. 2007) .

CoachesPerspective
In some setting, Athletic Trainers may not always be available for practices.
When this occurs the coach is responsible and must be prepared if insulin
problems occur. Sometimes athletes with blood sugar problems need
additional rest. Knowing how much time to rest when suffering insulin
problems during physical activities is important. Allowing the athlete with
insulin to return to the game or practice too early could cause further damage
and make it difficult to bring insulin levels to normal. Keeping blood sugars
regulated on the side during timeouts or breaks will assist with the consistent
regulation of stabilizing glucose levels. In addition to the head coach assistant
coaches should be well educated in this area. During competition, the head
coach will be more concerned with the game and what is happening on the
field placing more responsibility in this area to the assistant coach. The
assistant coaches will be able to tend to athletes and monitoring them during
the competition. All coaches should be required to have enrolled in and passed
course content related diabetes.

Conclusions
Most athletes with diabetes are capable of competing. How well the athlete
monitors insulin levels will affect the time needed to rest during games and
practices to regain normal blood sugar levels. Managing insulin levels takes
time. Regardless of the type of athletic participation, investing in an automatic

insulin pump may be an excellent choice. Insulin management may be

improved for athletes who study and research information related to diabetes
and physical activity.

References
1. AUCOUTURIER, J. et al. (2008) Fat and Carbohydrate Metabolism during
Submaximal Exercise in Children. Sports Medicine, 38 (3), p. 213
2. BEASER, R. and HILL, J. (1995) A Program for Managing your
Treatment: The Joslin Guide to Diabetes. New York: A Fireside Book: By
Simon and Schuster
3. HOROWITZ, C.R. et al. (2008) A Model for Using Community-Based
Participatory Research to Address the Diabetes Epidemic in East Harlem.
Mount Sinai Journal of Medicine, 75 (1), p. 13-21
4. JIMENEZ, C. et al. (2007) National Athletic Trainers' Association Position
Statement: Management of the Athlete With Type 1 Diabetes Mellitus.
Journal of Athletic Training, 42 (4), p. 536-545
5. KIRKWOOD, L. et al. (2007) Effects of advice on dietary intake and/or
physical activity on body composition, blood lipids and insulin resistance
following a low-fat, sucrose-containing, high-carbohydrate, energyrestricted diet. International Journal of Food Sciences & Nutrition, 58
(5), p. 383-397
6. BERKOWITZ, K. (2008) COULD DIABETES SIDELINE YOU? Men's Health
(10544836) 23 (7), p. 60
7. SHERR, J. and WILLIAM, V. (2008) Past, Present, and Future of Insulin
Pump Therapy: Better Shot At Diabetes Control." Mount Sinai Journal of
Medicine, 75 (4), p. 352-361
8. STEWART, M. and GWTSINGER, A. (2008) Exercise can help control
diabetes. Herald & Review (Decatur, IL) (27 Feb. 2008)
9. WISHNIETSKY, D. (2004) Helping Students with Diabetes Management.
Bloomington, Indiana: Phi Delta Kappa Educational Foundation

PageReference
If you quote information from this page in your work then the reference for
this page is:
McDANIEL, L. and OLSEN, S. (2009) Insulin Problems [WWW] Available
from: https://www.brianmac.co.uk/articles/article051.htm [Accessed
3/11/2016]

AbouttheAuthors
Dr. Larry McDaniel is an associate professor and advisor for the Exercise
Science program at Dakota State University, Madison SD USA. He is a former
All-American in football (USA) and Hall of Fame athlete & coach.
Sara Olson is an outstanding student enrolled in Exercise Science and student
athletic trainer at Dakota State University, Madison, SD USA.

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