Nutrition For Athletes With Diabetes

Question 1

What are the American College of Sports Medicine and American Diabetes Association’s exercise recommendations for diabetics

Answer 1

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

Question 2

Define type I diabetes

Answer 2

An autoimmune disease in which the body’s immune system produces antibodies that attack the beta cells of the pancreas

Question 3

Define type II diabetes

Answer 3

A progressive metabolic disease characterized by insulin resistance and decreased insulin secretion

Question 4

What causes gestational diabetes

Answer 4

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

Question 5

What is LADA

Answer 5

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

Question 6

What is MODY and what is it caused by

Answer 6

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

Question 7

What is PCOS

Answer 7

A metabolic disorder characterized by peripheral insulin resistance, menstrual dysfunction, hirsutism, and infertility

Question 8

List the hormone effects of glucagon and growth hormone

Answer 8

Stimulates hepatic glucose production via glycolysis and gluconeogenesis

Stimulates lipolysis

Facilitates uptake of FFA

Inhibits insulin

Question 9

List hormone effects of epinephrine

Answer 9

Stimulates muscle and some hepatic glycolysis

Mobilizes FFAs from adipose tissue

Stimulates hepatic gluconeogenesis

Inhibits insulin production

Question 10

List hormone effects of norepinephrine

Answer 10

Directly stimulates lipolysis

Indirectly suppresses glucose utilization

Stimulates AA storage

Question 11

List hormone effects of cortisol

Answer 11

Mobilizes AAs and glycerol as substrate for hepatic gluconeogenesis

Mobilizes FFAs as fuel source for muscles

Blocks glucose uptake into adipocytes and muscles

Question 12

List hormone effects of insulin

Answer 12

Increase glycogen synthesis

Increases lipogenesis

Increase AA uptake

Increases potassium uptake

Decreases proteolysis

Decreases gluconeogenesis

Decreases renal sodium excretion

Question 13

How does exercise get glucose into cells if it inhibits insulin production

Answer 13

Exercise activates glucose transporter type 4 (GLUT4) which migrates to the interior surface of the cell membrane to absorb glucose

Question 14

Hormone response to onset of exercise and recovery

Glucagon
Epinephrine
Norepinephrine
Growth hormone
Cortisol
Insulin

Answer 14

Exercise Recovery
Glucagon ⬆️ ⬆️
Epinephrine ⬆️ ⬆️
Norepinephrine ⬆️ Nominal
Growth hormone ⬆️ Nominal
Cortisol ⬆️ Nominal
Only in heavy
Exercise
Insulin ⬇️ ⬆️⬆️

Question 15

Blood glucose ranges for athletes with type 1 diabetes

Answer 15

120-180 mg/dL

Question 16

What is a safe blood glucose range to begin exercise for diabetics

Answer 16

100-200 mg/dL 30-60 minutes after meals

Question 17

In an athlete who takes insulin, what should they do if they find ketones in the blood

Answer 17

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

Question 18

What is the most useful information obtained from a CGM

Answer 18

Direction and rate of change in blood glucose

Blood glucose alarm

Question 19

Describe basal, bolus, and mixed insulin

Answer 19

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

Question 20

What is ICR and ISF

Answer 20

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

Question 21

List storage time and options of insulin

Answer 21

Insulin is stable at room temperature for up to 28 days

Best to refrigerate

Do not freeze as it decreases the effectiveness of insulin

Question 22

What is the value and symptoms associated with mild, moderate, and severe hypoglycemia

Answer 22

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

Question 23

What are common symptoms of chronic hyperglycemia

Answer 23

Fatigue

Thirst

Frequent urination

Possible UTIs or yeast infections

Question 24

How does DKA manifest

Answer 24

DKA is due to insufficient insulin to transport glucose into cells and results in metabolic acidosis, severe dehydration, and electrolyte imbalance

Question 25

When is insulin sensitivity highest

Answer 25

Evening and post exercise

Question 26

What is the recommended change in basal insulin pumps before, during, and after exercise

Answer 26

A 25-50% decrease

Question 27

What is hashimoto’s disease

Answer 27

Autoimmune disorder characterized by chronic inflammation of the thyroid gland caused by antibodies attacking and damaging thyroid cells

Question 28

How does one treat hashimoto’s disease

Answer 28

Hormone replacement therapy to compensate for the decreased production of thyroxin

Question 29

What is Grave’s disease

Answer 29

An autoimmune disorder that results in hyperthyroidism

Question 30

How to treat Grave’s disease

Answer 30

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

Question 31

Explain the dawn phenomenon

Answer 31

Secretion of glucocorticoid typically increases before dawn and targets the liver to stimulate hepatic glucose production

Question 32

When is exercise contraindicated in those with diabetes

Answer 32

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

Question 33

Should an athlete with diabetes stop during longer duration physical activity to test blood glucose and if so, when

Answer 33

Yes

Halfway through

Question 34

When should insulin dependent athletes not exercise

Answer 34

When insulin is at its peak

Question 35

Carbohydrate recommendations for diabetics:

Exercise lasting < 30 min

Exercise lasting >60 min

Answer 35

No adjustment for exercise lasting <30 min

Add 15g of carbohydrates every 30-60 minutes of activity (depending on intensity)

Question 36

At what blood glucose level should carbs be ingested for pre exercise

Answer 36

Add carbohydrates if preexercise blood glucose levels are <100 mg/dL

Question 37

Insulin dose changes to:

Moderate to strenuous activity >45-60 min

Prolonged vigorous exercise

Answer 37

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