Table Of ContentType 1 Diabetes
Clinical Management of the Athlete
Ian Gallen
Editor
Type 1 Diabetes
Clinical Management of the Athlete
Editor
Ian Gallen
Diabetes Centre
Wycombe Hospital
High Wycombe
UK
ISBN 978-0-85729-753-2 e-ISBN 978-0-85729-754-9
DOI 10.1007/978-0-85729-754-9
Springer London Dordrecht Heidelberg New York
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This book is dedicated to my parents Louis
and Barbara for their lifelong love,
encouragement and support, to my wife Susan
for our happy life together and to our children
Robert and Hannah who make my life
meaningful. I thank all my outstanding and
inspirational medical teachers, the many
colleagues with whom I have been privileged
to work and the people with diabetes who
have trusted me to help them.
Foreword
I was diagnosed with diabetes at the start of training for the 2000 Sydney Olympic
Games, having won gold medals in rowing events at the previous four Olympic
Games. The diagnosis was a shock, and I felt my sporting world was over. I had a
grandfather who had the condition in his late 60s, and even though I was very young
at the time and didn’t know very much about diabetes, I felt I knew enough to know
that I wouldn’t be able to carry on my sporting path. I was sent up to my local dia-
betic center where my diabetes was confi rmed, and I was taught to inject insulin and
all the life-changing routines and dietary adjustments that needed to be implemented
immediately. At the end of the consultation when I was expecting to be told that this
was it, my sporting career was over, my consultant said to me, “I can’t see any rea-
son why you can’t still achieve your dreams in 3 years time by competing at the
Sydney Olympics in 2000.” This was a bigger shock to me than being told I wouldn’t
be able to compete. All my instincts and limited knowledge as a newly diagnosed
diabetic told me otherwise. He did say it would be a tough path, but immediately I
thought if he thinks I can do it, I will give it my best shot.
The path over the next few months was very traumatic. Firstly, of coming to
terms with the condition and, secondly, as an athlete with a certain pride in your
performance at the highest level is about consistency within training and racing. In
the early days of my diabetes, it was the consistency that had gone. The main issue
was not actually the controlling of the diabetes; it had more to do with the refueling
of my body. To compete in rowing at Olympic level, you have to train somewhere
in the region of 18–24 sessions a week, averaging about 1½ h a session of intensive
endurance work, splitting these sessions between three and four a day. There is very
little time to regain the energy when you are limited to the insulin you can take
because of the fear of hypoglycemia. I was put onto the normal diabetic diet, and
session after session I was not gaining the energy to perform. The way I felt after
each session was convincing me I was never going to be the athlete that I was.
Over time, my consultant changed the patterns of refueling. In fact, this meant going
back to my old diet. He knew that I had been successful on this before, but he had to
come up with a regime that allowed me to eat 6–7,000 cal a day and still control my
diabetes. When you are fi rst diagnosed, you are given so much information, and this is
vii
vviiiiii Foreword
so diffi cult to take on board – even as an athlete when you need to have the freshness
of mind to adapt to your needs. I feel that if you could be drip-fed information
over time, this would be a better process. There wasn’t any information for athletes to
achieve at the highest level, and books like this really do help the athlete and give the
consultants a good foresight. Since I was diagnosed in 1997, the world looks at diabetes
and elite sport in a very different way, and there are so many more diabetic athletes
achieving their dreams now. With all the help I was given, I decided very early on that
diabetes was going to live with me, not me live with diabetes.
I very much welcome this book, in which leading experts highlight the many
advances in the understanding of the effects of diabetes and insulin treatment during
and following exercise, and on how diabetes management can be optimized. This
will help clinicians in turn help those people with diabetes who want to play sport,
and even for some like me achieve the highest level of sporting success.
Sir Steve Redgrave
Preface
In this year of the London Olympic Games, our attention is drawn to sport and
physical performance. Type 1 diabetes is initially a disorder of the young, and in this
age group and for many older people physical activity is a very important compo-
nent of lifestyle. Whilst it is of undoubted importance for physicians to optimize
insulin therapy programs and other treatments to avoid or treat the chronic compli-
cations of type 1 diabetes, people with diabetes also seek to normalize their life-
style. Some will want to advance their sporting ambitions, and the examples of
outstanding sportsmen with diabetes, such the rower Sir Stephen Redgrave, or the
Rugby Union player Chris Pennell, show us that type 1 diabetes per se is not a bar-
rier to maximum physical performance in sport. These examples encourage people
with type 1 diabetes to engage in all types of physical activity, and they will seek
best advice on how to manage their diabetes with exercise.
There are some signifi cant barriers for people with type 1 diabetes performing
sports and exercise. They are likely to experience marked fl uctuations in blood glu-
cose control and frequent hypoglycaemia with exercise. The occurrence of hypogly-
caemia may seem both unpredictable and inexplicable to the person with diabetes,
which may force the response of excess replacement of carbohydrate before and
following exercise, with resultant hyperglycaemia, adding to the burden of dysgly-
caemia. Perhaps of more concern to people with diabetes is the risk of hypoglycae-
mia during and nocturnal hypoglycaemia following exercise. When hypoglycaemia
is severe, requiring assistance from another person, it may cause embarrassment to
people with diabetes, and is likely to cause concern to parents, teachers and coach-
ing staff as to the safety of physical activity. Excessive fatigue and weakness during
prolonged exercise compared with peers without diabetes may be experienced, and
this may reduce the wish to continue in sport. For the outstanding athlete with dia-
betes, there is potential that diabetes and insulin treatment may cause loss of maxi-
mum physical performance, which also may discourage progression in sport. We
now know many of the causes of impaired physical performance and how these may
be rectifi ed through augmented diabetes management strategies.
Evidence from people with type 1 diabetes suggests that advice from healthcare
professionals to people with type 1 diabetes on the management of physical exercise
ix
xx Preface
may be simplistic. Over the last decade, we have established a specialist clinic to
help sportspeople and athletes manage their diabetes and physical activity success-
fully to reduce dysglycaemia with and following exercise, and to normalize physical
performance. Athletes and sports people explained in our clinic what problems they
had found during exercise, and how they had tried to overcome those diffi culties.
This experiential evidence has produced many effective clinical strategies. These
are now strongly supported by the growth in the clinical research knowledge base of
the effects of diabetes on the physiological response to exercise, on the effect of
exercise on the response to hypoglycaemia and on effective dietetic and insulin
management of diabetes during and following exercise. There have also been sig-
nifi cant technological improvements in the support of the management of type 1
diabetes with continuously infused insulin infusion pump therapy and continuous
sub-cutaneous glucose monitoring equipment.
People with type 1 diabetes will seek to be effectively supported in any sporting
ambition, presenting an interesting challenge to healthcare professionals. This book
aims to provide the evidence on the management of type 1 diabetes and exercise,
bringing together outstanding clinical science, clinical practice from experts in the
fi eld and the evidence of the real experts, the athletes themselves. The book outlines
potential dietetic and therapeutic strategies which may be employed to promote
these aims. Our aim is that if applied, the evidence will equip the healthcare profes-
sional with the knowledge base to support the development of clinical skills to sup-
port any person with type 1 diabetes perform physical activity safely and for some
talented individuals to pursue their sporting ambitions to the highest level.
