Last October, the International Diabetic Athletes Association (IDAA-USA) met in Phoenix, Arizona, for its annual meeting. At the conference, 60 active men and women shared information on methods of integrating a vigorous lifestyle with diabetes. Most of the speakers were athletes and health professionals who spoke of diabetes and exercise from personal experience.
The IDAA is an international organization, but the membership of the United States branch is unique. In Europe, most members of the IDAA are doctors, but in the United States, the majority of the members are active people or athletes with diabetes. Some of these active people are also diabetes health professionals.
Paula Harper is a nurse, CDE, and the founder and president of the IDAA. She has lived with insulin-dependent diabetes for nearly 20 years. In the winter edition of the Juvenile Diabetes Foundation magazine, Countdown, Harper notes, “A lot of the answers regarding exercise come from trial and error. These [IDDA] athletes are helping other diabetics by sharing their experiences-sharing knowledge they’ve gained from a lot of guesswork.” Even certified experts say much of diabetes management involves doing daily experiments with food, medication, and exercise to see what works for you and your life with diabetes. However, it helps to get advice from experienced health professionals and it helps to use the right tools.
One tool used by many of the insulin dependent IDAA members at the conference is intensive insulin therapy. This consists of either using multiple injection routines with an intermediate or long-acting insulin for a basal dose (about 50-60% of the total daily insulin) and a pre-meal bolus of regular insulin, or using an insulin pump. There were many members using pumps and a few who had used pumps previously but later switched back to multiple injections.
Among those members using multiple injections, there was a general disfavor towards using human ultralente as basal insulin. The IDAA meeting keynote speaker, Dr. John Hunt, stated he used animal ultralente for many of his diabetes patients. In his experience with many active people with diabetes in Canada (including Ironman Triathlete Adrian Marples), he found that the human ultralente insulin was highly unpredictable. However, Dr. Hunt did not encourage patients who had never been previously exposed to animal insulin to start using it. He thought another human intermediate-acting insulin or an insulin pump were better alternatives.
Physician’s Assistant John Walsh, another insulin-dependent CDE, gave a lecture and several workshops on carbohydrate counting and insulin reduction for exercise of 60 minutes or longer. For exercise between 30 to 60 minutes, Walsh recommended experimenting with small insulin reductions, and if your blood sugar gets low after exercise, carbohydrates should be increased. For exercise of 30 minutes or less, adjustments may be unnecessary for many people, but increasing carbohydrate is easiest for most people doing short duration exercise.
Carbohydrate counting is easy if you do your homework. Using body weight, math formulas, and charts, an individual can figure out how many grams of carbohydrate 1 unit of regular insulin will cover (usually 10-15). Counting the total carbohydrate grams in any meal and dividing that total by the number of grams covered by 1 unit of regular insulin will yield a precise calculation of how many units of insulin to take for that meal.
There is a similar method for calculating how many points your blood sugar will drop for 1 unit of insulin (anywhere from 25 mg/dl to 50 mg/dl). This is a great tool for those who like precise control of blood sugar (most athletes with diabetes do). Carbohydrate counting works well for those on insulin pumps and multiple injections. However, insulin routines of less than three injections a day are less flexible for applying this tool.
Despite the precision of this method, there are many variables affecting blood sugar which are difficult to calculate or predict, such as stress. John Walsh spoke of one occasion where, after giving a lecture to a room full of people, his blood sugar shot up to 300 mg/dl. His breakfast meal carbohydrate calculation proved inadequate due to the unforeseen effect of stress hormones. He adjusted his pre-lunch insulin bolus by using his blood glucose point drop calculation method and counting lunch carbohydrates. He waited a half hour longer to eat lunch, allowing the insulin bolus more time to work, and a few hours after lunch his blood glucose was back to normal.
The IDAA-USA isn’t just for athletes. Any active person with diabetes can be a member. Benefits include support and information provided by peers and health professionals focused on the exercise component of diabetes management. For more information, write to the IDAA-USA, 1931 East Rovey Ave., Phoenix, AZ 85016, or call (602) 230-8155. Cassette tape recordings of the lectures at the 1992 IDAA-USA annual meeting are available from Brad Hepfer, 930 Letort Road, Washington Boro, PA 17582, (717) 872-9344.
The author, James Hill, will be leading a group of hikers with diabetes on a 25 day trip down California’s famous John Muir Trail in July ’93. For information, call (707) 769-9323.