Nutrition For Athletes With Diabetes Flashcards
What are the American College of Sports Medicine and American Diabetes Association’s exercise recommendations for diabetics
150 minutes/week of moderate exercise
Aerobic intensity should be 40-70% VO2 max
Anaerobic exercise: minimum of one set of 10-15 reps of 8-10 resistance exercises
Define type I diabetes
An autoimmune disease in which the body’s immune system produces antibodies that attack the beta cells of the pancreas
Define type II diabetes
A progressive metabolic disease characterized by insulin resistance and decreased insulin secretion
What causes gestational diabetes
A failure to increase beta cell insulin production in response to the increased insulin resistance that typically occurs secondary to hormonal changes associated with pregnancy
What is LADA
Latent Autoimmune Diabetes in Adults
Classified as a slowly progressing variation of type i diabetes
People with LADA are typically over 35 and not obese
What is MODY and what is it caused by
Mature Onset Diabetes of the Young
Caused by any number of monogenetic gene mutations that limit the body’s ability to produce insulin but do not completely destroy the beta cells
What is PCOS
A metabolic disorder characterized by peripheral insulin resistance, menstrual dysfunction, hirsutism, and infertility
List the hormone effects of glucagon and growth hormone
Stimulates hepatic glucose production via glycolysis and gluconeogenesis
Stimulates lipolysis
Facilitates uptake of FFA
Inhibits insulin
List hormone effects of epinephrine
Stimulates muscle and some hepatic glycolysis
Mobilizes FFAs from adipose tissue
Stimulates hepatic gluconeogenesis
Inhibits insulin production
List hormone effects of norepinephrine
Directly stimulates lipolysis
Indirectly suppresses glucose utilization
Stimulates AA storage
List hormone effects of cortisol
Mobilizes AAs and glycerol as substrate for hepatic gluconeogenesis
Mobilizes FFAs as fuel source for muscles
Blocks glucose uptake into adipocytes and muscles
List hormone effects of insulin
Increase glycogen synthesis
Increases lipogenesis
Increase AA uptake
Increases potassium uptake
Decreases proteolysis
Decreases gluconeogenesis
Decreases renal sodium excretion
How does exercise get glucose into cells if it inhibits insulin production
Exercise activates glucose transporter type 4 (GLUT4) which migrates to the interior surface of the cell membrane to absorb glucose
Hormone response to onset of exercise and recovery
Glucagon
Epinephrine
Norepinephrine
Growth hormone
Cortisol
Insulin
Exercise Recovery
Glucagon ⬆️ ⬆️
Epinephrine ⬆️ ⬆️
Norepinephrine ⬆️ Nominal
Growth hormone ⬆️ Nominal
Cortisol ⬆️ Nominal
Only in heavy
Exercise
Insulin ⬇️ ⬆️⬆️
Blood glucose ranges for athletes with type 1 diabetes
120-180 mg/dL
What is a safe blood glucose range to begin exercise for diabetics
100-200 mg/dL 30-60 minutes after meals
In an athlete who takes insulin, what should they do if they find ketones in the blood
Athletes should check for ketones in blood if blood glucose is >250 mg/dL
They should avoid exercise and consume water or other non carbohydrate fluid
What is the most useful information obtained from a CGM
Direction and rate of change in blood glucose
Blood glucose alarm
Describe basal, bolus, and mixed insulin
Basal - long acting insulin designed to mimic the glycogenic response of the liver, providing a relatively stable baseline amount of insulin
Bolus - fast acting insulin taken specifically to keep blood glucose levels under control when food is consumed or to correct hyperglycemia
Mixed - a combination of both fast and slow acting insulin primarily given to type 2 diabetics
What is ICR and ISF
Insulin to Carbohydrate Ratio - estimates how many units of insulin per gram of ingested carbs are required for glycemic control
Insulin Sensitivity Factor - estimates how much 1 unit of insulin will decrease blood glucose independent of eating
List storage time and options of insulin
Insulin is stable at room temperature for up to 28 days
Best to refrigerate
Do not freeze as it decreases the effectiveness of insulin
What is the value and symptoms associated with mild, moderate, and severe hypoglycemia
Mild: <70 mg/dL
Urgency to eat, shakiness, nervousness, or excessive perspiration
Moderate: <55 mg/dL
Changes in mood (irritability, anxiety, restlessness, anger), confusion, difficulty concentrating, blurred vision, dizziness, headache, low energy, poor coordination, slurred speech, decreased communication
Severe: <35-40 mg/dL
Altered state of consciousness, coma, seizure, hypothermia
What are common symptoms of chronic hyperglycemia
Fatigue
Thirst
Frequent urination
Possible UTIs or yeast infections
How does DKA manifest
DKA is due to insufficient insulin to transport glucose into cells and results in metabolic acidosis, severe dehydration, and electrolyte imbalance
When is insulin sensitivity highest
Evening and post exercise
What is the recommended change in basal insulin pumps before, during, and after exercise
A 25-50% decrease
What is hashimoto’s disease
Autoimmune disorder characterized by chronic inflammation of the thyroid gland caused by antibodies attacking and damaging thyroid cells
How does one treat hashimoto’s disease
Hormone replacement therapy to compensate for the decreased production of thyroxin
What is Grave’s disease
An autoimmune disorder that results in hyperthyroidism
How to treat Grave’s disease
Anti thyroid medications are sometimes used
Most commonly treated by destroying or removing all or part of the overactive thyroid with radiiodine therapy or surgery followed by hormone replacement therapy if necessary
Explain the dawn phenomenon
Secretion of glucocorticoid typically increases before dawn and targets the liver to stimulate hepatic glucose production
When is exercise contraindicated in those with diabetes
Retinopathy - vigorous exercise can increase risk of vitreous hemorrhage or retinal detachment
Peripheral neuropathy - skin breakdown, infection, and Charcot joint destruction
Autonomic neuropathy - lowered cardiac responsiveness, postural hypotension, impaired thermoregulation
Albuminuria and nephropathy - exercise can increase urinary protein excretion
Should an athlete with diabetes stop during longer duration physical activity to test blood glucose and if so, when
Yes
Halfway through
When should insulin dependent athletes not exercise
When insulin is at its peak
Carbohydrate recommendations for diabetics:
Exercise lasting < 30 min
Exercise lasting >60 min
No adjustment for exercise lasting <30 min
Add 15g of carbohydrates every 30-60 minutes of activity (depending on intensity)
At what blood glucose level should carbs be ingested for pre exercise
Add carbohydrates if preexercise blood glucose levels are <100 mg/dL
Insulin dose changes to:
Moderate to strenuous activity >45-60 min
Prolonged vigorous exercise
Moderate to strenuous activity >45-60 min: decrease rapid or short acting insulin (1-2 U)
Prolonged vigorous exercise: may need a 15-20% decrease in total daily insulin
