CHAPTER 32 • ENDOCRINE CONSIDERATIONS 191(6) Skin care
(7) Meal planning and CHO counting- Complications present
(1) BP, neurology, mobility, opthalmology, blood
lipids, nephropathy, microalbuminuria, PVD,
proliferative retinopathy, autonomic neuropa-
thy, thermoregulation
(2) Graded exercise test recommended if >35 yoa
or >25 yoa with diagnosed type-1 diabetes for
15-year duration.
- Consider sports participation
(1) Heavy-weight training should be avoided to
avoid high ocular pressures.
(2) Practice and game times, duration and intensity
levels
(3) Travel time
(4) Meal planning
(5) Do coaches, athletic trainers, and others have
adequate knowledge of needs?
(6) Is support-staff prepared for emergency situa-
tion?
(7) Consider high-risksports; mountain climbing,
scuba diving and the like.
(8) Consider complications, i.e., athletes with
peripheral neuropathy should avoid weight
bearing exercise.
(9) Consider environment (hot or cold)–may expe-
rience problems with thermoregulation.
PARTICIPATIONGUIDELINES
Before Exercise
- Estimate intensity, duration, and kilocalories of event.
- Eat 1–3 h prior to event.
- Inject insulin more than 1 h before exercise.
•Inject away from an exercising muscle. - Decrease insulin dosage that may peak within activity.
- If blood glucose <100 mg/dL, ingest CHO snack.
- If blood glucose >250 mg/dL, postpone exercise,
ketone measurement, and add insulin. - Delay exercise until stable control is established.
During Exercise
- Supplement caloric expenditure with CHO supple-
mentation—30 g per 30 min of exercise.
1.<130 mg/dL, two CHO exchanges (120 kcal) per
35 min with exercise <60% VO2max, three
exchanges (180 kcal) with >70% VO2max(heavy ex)
2. 130–180 mg/dL, 1 CHO (60 kcal) per 30 min of
light, and two CHO exchanges with heavy exercise
3. 180–240 mg/dL, no food before exercise; if pro-
longed, intense exercise retake glucose levels
during exercise
4.>250, postpone exercise; ketone measurements;
may need increased insulin- Replace fluids.
- Monitor glucose levels with prolonged exercise.
Post-exercise- Monitor blood glucose, delayed hypoglycemia is
common. - Increase caloric intake for 12–24 h after activity, CHO
ingestion immediately after. - Reduce insulin if necessary.
- Proper foot care.
- Proper rehydration.
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