Helpful tips from a Sports Nutritionist
By Pamela M. Nisevich, MS, RD, CSSD, LD, a specialist in sports nutrition and a PowerBar
® Team Elite™ athlete. As a nutrition consultant with
SwimBikeRunEat.com she works with athletes of all ages, abilities, and conditions. As an elite athlete, she recently finished the 2009 Chicago Marathon with a PR of 3:09.
Starting an exercise program can be challenging at first — If you are a budding athlete, it can be difficult at first to get used to blood sugar fluctuations. Sometimes levels can go high due to the adrenalin response, while other times blood sugar plummets because of reduced glycogen stores. Also, when blood sugar is low before exercise, you need to consume carbs and then wait until your blood sugar is within a normal range. All of this can be inconvenient and sometimes frustrating when all you want to do is get started with or continue your workout. You can overcome these challenges with close monitoring of your blood sugar — testing before, during, and after exercise. Always keep testing supplies on hand. You should also monitor for dips in blood sugar following a new exercise regimen.
Safety precautions during exercise — Always bring quickly absorbed carb sources with you while exercising. PowerBar
® Gels and PowerBar
® Gel Blasts™ energy chews, as well as PowerBar
® Endurance sports drink, are excellent choices. I encourage the use of gels because if your blood sugar dips to a dangerously low level, the gel doesn’t need to be chewed. It’s also easily stored and portable. Another precaution is to avoid exercising alone.
Advice for improving exercise performance — By taking in carbs every 10–15 minutes during exercise, you can feel confident that your blood sugar level will not plummet. Also, the meal you eat before a practice, game, or workout is essential. Skipping out on this meal may cause your blood sugar to be too low when it comes time to exercise.
An Athlete's Perspective
Kerry White is an ultra-endurance athlete and a PowerBar® Team Elite™ member. She’s also had type 1 diabetes since the age of 11, but it certainly hasn’t slowed her down. In fact, Kerry has twice won the 3,042-mile transcontinental Race Across America bike race in the 4-women team division. And in 2007, she was the only competitor with type 1 diabetes to complete the arduous event in the solo division. Kerry offers the following insights into how she manages training, competing, and her diabetes.
Q: What type of insulin therapy are you on?
Kerry: I am on an intensive insulin regime including injections of long-acting insulin; an insulin pump for mealtime; and extended bolus and Symlin
® at mealtimes to help slow the food absorption, to help with my blood sugars post-meal, which tend to be very difficult to manage. I think I have a very high insulin resistance factor and as a result have to manage my diabetes with an intensive schedule with multiple injections and frequent blood sugar monitoring. My insulin regimen is, of course, my own — any active diabetic would want to work with their physician to help them fine-tune their insulin regimen to suit their individual needs.
Q: How frequently do you check your blood sugar — before, during, and after exercise?
Kerry: I usually check my blood sugar before exercise, once or twice during if it is a long session, and afterwards prior to refueling. Testing frequency is very dependent on how I feel and what my blood sugar levels are like before the activity. If it is in an acceptable range, then I don’t have to check as often. If I’m starting with a blood sugar that is higher, I check it more frequently to see how it is changing with the activity. Sometimes exercise can make your blood sugar rise dramatically in the first 30 minutes, due to stress and adrenalin. In other cases, blood sugar can drop dramatically in the first 30–45 minutes of exercise, depending on what you are doing. With the emergence of continuous glucose monitors, you can now keep tabs on your blood sugar up to the minute before a race starts, and during a race if all goes well. For some events, such as a triathlon, this type of monitor doesn’t always work; but you can definitely use it to monitor whether your blood sugar is rising or dropping pre-race. Continuous glucose monitoring is the technology of the future for athletes with type 1 diabetes who want to be at the top of their game while competing.
Q: What are the situations where it’s most difficult to manage your blood sugar, and how do you tackle the problem?
Kerry: For me the most difficult situation is coming into a race with a blood sugar above 300. I can test before breakfast with everything looking fine, eat a normal breakfast, have my short-acting insulin bolus, then check again an hour before race time only to find my blood sugar starting to rocket up. It’s not unusual in the 30–45 minutes before a race for me to test every 10 minutes and watch my blood sugar spiral out of control. This can happen even when I’ve eaten nothing! It is the effect of stress and adrenalin. Sometimes I try adjusting the timing and dose of my short-acting insulin, but that doesn’t always stop the rise in blood sugar. In that situation the key for me is to stay calm and know that I have insulin in my system, and that as soon as I start racing, my blood sugar will start to come back down. Of course, this means the first 45–60 minutes of a race can be quite unpleasant and I won’t feel good at all. Starting with a blood sugar just under 200 is more ideal, but if things are not perfect, I’ve learned that I can still at least try to give it a go.
Q: What do you eat as a pre-race meal?
Kerry: I don’t really have a single pre-ride meal, but usually for breakfast I’ll have coffee and three pieces of toast to get me started. Unlike athletes without diabetes, keeping blood sugar in check prior to training or racing is a difficult task. Carbo loading pre-race can sometimes cause me to start an event with a super-high blood sugar. So I try to stick with moderate carbs and a little more protein the night before. Soup and toast with some turkey and cheese seems to help keep my blood sugar in check the night before, and then my usual carb intake at breakfast before the race — not any additional — as the stress and adrenalin start to kick in. If needed, I may do additional bolus doses of short-acting insulin pre-race to keep my blood sugar in check. That way I’m not starting in the 300s and having to spend a large part of the race worried about getting my blood sugar down to a normal level. Rather than carbo load, it works better for me to start a race with a blood sugar below 200 and then to fuel during the race.
Q: How do you refuel during longer rides?
Kerry: Pretty simple — my primary refueling source for longer rides is PowerBar
® Performance Energy bars. They provide a quick fuel source if my blood sugar is getting low, and they help sustain me for long rides. I usually stick to water for hydration during training rides or a sugar-free electrolyte drink to help manage my blood sugar and stop it from spiking too quickly. During long races, such as 24-hour events, I carry Performance Energy bars along with PowerBar
® Endurance sports drink and water. That way I can choose my fluid source depending on how I feel and whether my blood sugar is rising or dropping. A liquid fuel source such as the Endurance sports drink helps bring my blood sugar up quickly if it is dropping fast and I need fuel to be absorbed quickly. That combined with half of a Performance Energy bar will keep my blood sugar more stable and help sustain my energy. The key to longer rides for me is to fuel frequently but to avoid taking in too much. My body has a hard time absorbing the carbs if I take in too much fuel at once. I find that half of a Performance Energy bar and/or half a bottle of Endurance sports drink at a time works best. Putting more than 45 grams of carbohydrates into my system at one time is too much when I’m working hard. It is better to eat small amounts more frequently than to wait until the tank is empty and then have to stress my body to absorb food quickly. Also, when I’m in the loop transition area during a longer race, I eat traditional foods. Again, the formula is simple — bagels, peanut butter, chicken noodle soup, the occasional piece of licorice, and usually salted peanuts or whole grain crackers. I don’t stray from the things that I know will work. When the eating routine works, I stick to it and don’t try anything new — especially during a race.
Q: What is your recovery strategy?
Kerry: My weak point is that I have a tendency to overtrain. This makes recovery even more important. My approach includes using foods that promote recovery such as a PowerBar ProteinPlus
® protein bar after exercise, getting at least 8 hours of sleep a night, and varying my exercise schedule so I don’t get injured from too much repetition of the same activity. Ultra-endurance competition requires extensive training time, but I have to be smart so that overuse injuries do not occur. Varying my activities helps avoid this. Recovery from cycling is definitely faster than from running and nordic skiing, so depending on the season, I try to pace myself and not overdo it as I am working into whatever sport is coming into season.
Q: How do you manage hypoglycemia?
Kerry: Hypoglycemia is inevitable when you are an athlete with type 1 diabetes. The key is knowing the signs and addressing them quickly when they appear. I’ve found with experience that different types of physical activity induce different hypoglycemic symptoms, so it’s a matter of trial and error in identifying the low blood sugar indicators for each sport. When I swim, the signs are a tingling sensation in my hands and jaw and losing focus on lap counting. When I ride, I know it is hypoglycemia when I get a headache, my cadence drops dramatically, and my hands go numb. A big obstacle that people with diabetes face in terms of exercise and hypoglycemia is fear of what will happen. With trial and error over time, I have learned the telltale symptoms and I am much more self aware. So now it’s rare for me to develop extreme hypoglycemia during exercise. My problems tend to occur in new situations that I’m not so familiar with. My advice is to learn to read your body and to quickly react to any low blood sugar symptoms that occur. Once you know the symptoms, be proactive and manage your food intake to prevent the symptoms from worsening. Also, managing low blood sugar during exercise is a little different than managing it when you’re not active. I find that eating 15 grams of carbs and testing in 10 minutes is usually not enough. When I’m “hypoing” during exercise, 30 grams of carbs or possibly more may be necessary at first. I then test my blood sugar 15 minutes later and eat more carbs if it is still low. I continue eating every 15 minutes if I’m still exercising, and I test more frequently so that I know what my blood sugar is doing.
Q: What safety precautions do you recommend to athletes with type 1 diabetes?
Kerry: Always take more food than you think you can possibly eat, as there are times when your body does unusual things. Make sure you tell your friends and/or family where you are going, and go with a partner whenever you can. If you do go out alone, make sure you have your blood sugar monitor, more food than you think you will need, and a cell phone for emergencies. If you’re in a situation where you are alone, and you feel your blood sugar dropping, stay calm, eat carbs that are quickly absorbed, and then give it 10–15 minutes to work. Sometimes the fuel takes longer to be absorbed than you think it should, but don’t panic. Instead, slow your exercise pace to one of self-preservation until you start to feel better.
Q: How do you incorporate PowerBar® products into your regimen?
Kerry: I use Performance Energy bars as my main fuel source in all my exercise activities. I have them tucked into my back pockets and the pockets of my bags. I also keep an emergency supply with me everywhere I go. Performance Energy bars have been an incredible boost to my confidence. I know from experience that when my blood sugar is dropping, if I eat a bar it will work within 5–10 minutes, and then I can get back on pace. Endurance sports drink is also great during long races for keeping me hydrated and my electrolytes in balance. Small amounts of the sports drink and water together help keep my blood sugar balanced. After long rides and workouts I usually have a ProteinPlus protein bar for recovery. Finally, I love the bite-sized PowerBar
® Gel Blasts™ energy chews when I’m nordic skiing. They’re great because they don’t freeze, and in small increments they keep me fueled, but they don’t cause my blood sugar to spike too quickly.
References:
MacKnight JM, Mistry DJ, Pastors JG, Holmes V, Rynders CA. The Daily Management of Athletes with Diabetes. Clin Sports Med 2009; 28: 479–495.
Australian Institute of Sports. Diabetes and Sports Nutrition. http://www.ausport.gov.au/ais/nutrition/factsheets/special_diets2/diabetes_and_sports_nutrition.
Brown L, Wilson D, Cooper G, Deakin V. Special Needs: The Athlete with Diabetes. In: Burke L, Deakin V. Clinical Sports Nutrition. 3rd ed. McGraw-Hill, 2006: 677–697.
American Diabetes Association. Physical Activity/Exercise and Diabetes. Diabetes Care 2004; 27 (Suppl 1): S58–S62.
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