1. DIABETIC ATHLETES Sports Injury Management

2. There are two types of diabetes. Type I: deficiency of insulin Type I is treated with insulin (injections, etc.) Type II: malfunctioning of insulin Type II is controlled with diet and exercise

3. Exercise lowers blood sugar levels and improves the use of insulin. Exercise increases blood flow to the muscles and skin, increases the amount of insulin in the blood stream, and stimulates the liver to release glucose into the blood. ATHLETES may need to lower their insulin dose prior to exercise. Consult with their physician before making these adjustments.

4. Athletes should maintain a good balance of blood sugar during activity ( 70 – 180 mg ). Too much insulin → HYPOGLYCEMIA S/Sx: tachycardia, sweating, hunger, nervousness, dizziness, headache, tremors, blurred vision Too little insulin → HYPERGLYCEMIA S/Sx: nausea, dehydration, decreased cognition, sluggishness, frequent urination KETOACIDOSIS → S/Sx: fruity breath, rapid breathing

5. Signs and Symptoms LOW BLOOD SUGAR -Decreased physical performance -Variable mood -Paleness, tremor, headache -Sweating -Poor vision -Fatigue, hunger, dizziness HIGH BLOOD SUGAR - Sleepiness -Dry mouth - Frequent urination - Fatigue - EXTREME thirst

6. SAFETY TIPS for Diabetic Athletes * Check blood sugar before, after, and every 20-30 minutes during exercise, monitor more frequently in extreme heat / cold If under 100 mg/dL, eat grams of carbohydrates before exercise If excessive (>250 mg/dL for Type II, >200 mg/dL for Type I), postpone exercise until level is at acceptable level Know signs of hypoglycemia; be prepared by by having snacks available

7. SAFETY TIPS – con’t. Exercise 1-2 hours after meals Avoid exercise @ times of peak insulin activity, morning is best; people with Type I should avoid evening exercise (when are most FB practices?) Adjust insulin doses, if necessary. After prolonged exercise, athlete may need extra carbohydrate foods for up to 24 hours to refill starch reserves

8. SAFETY TIPS – con’t. Drink plenty of fluids; 1 pt. 2 hours before exercise, drink to replace fluids lost in sweat PAY ATTENTION TO DIABETIC ATHLETE’s FEET! Wear proper shoes and socks. Avoid alcohol (duh…) Wear ID in case of emergency (LAT / FR should already know this athlete’s condition!)

9. MANAGEMENT OF DIABETIC ATHLETE Ask diabetes related questions on the Pre-Participation Evaluation After a diagnosis, have Glycemic Control Exam 4x/year (especially if multi-sport athlete) Annual diabetes screening Diabetic Care Plan 1. Monitoring guideline; frequency and pre- exercise exclusion values 2. Insulin guidelines; Type, Dosage / Adjustment / Corrections 3. Additional medications 4. Hypo-/Hyperglycemia recognition, treatment 5. Contact Information

10. MANAGEMENT OF DIABETIC ATHLETE – con’t. On-Site Supplies 1. Diabetic athlete’s care plan 2. Glucose monitoring & insulin supplies 3. Hypoglycemia supplies (glucose tabs, sugar packets, glucagon injection kit) 4. Urine testing supplies 5. Sharps container 6. Spare batteries