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Created with Fabric.js 1.4.5 Diabetes and ExerciseWhat do Athletes Have to Do? Preparation Before During Afterwards PRE-EXERCISE CARBOHYDRATE MEAL - Eat or drink an appropriate carbohydrate-rich snack, meal or fluids one to three hours prior to the exercise- Pre-exercise meal and fluids should contain 15 grams of carbohydrates per 30 minutes of moderate-intensity exercise. - The requirements will be higher as intensity increases PRE-EXERCISE INSULIN DOSE- Inject insulin at least one hour before exercise- Decrease the dose of insulin so that the peak activity of circulating insulin does not occur during exercise- Only inject insulin into the areas where it won't be used, as exercise increases the effects of insulin Nutritional guidelines for athletes with diabetes should be no different to those without it. However, they should still measure the blood glucose concentration to determine how well it is under control. IF BLOOD GLUCOSE IS: <5mmol/L, extra carbs are recommended 5-15mmol/L, extra carbs may not be required if short exercise duration >15mmol/L, delay exercise and measure urine ketonesIF URINE KETONES ARE:Negative - exercise can be performed. Extra carbs are not required Positive - take insulin and delay exercise until ketones are negative Foods and Fluids containing 15 grams of carbohydrates:- 1 slice of bread- 1 banana- 1 1/2 Vita Brits- 1/2 cereal or sports bar- 1/2 cup cooked pasta- 1/3 cup cooked rice- 1 potato- 1 glass of juice/milk- 250ml sports drink If exercise is prolonged and intense, frequent carb intake is required to prevent low sugar levels- monitor blood glucose during exercise sessions- aim to minimise fluid losses during exercise - if moderate to high intensity exercise is prolonged, use extra carbohydrate feedings during exercise - general carbohydrate requirements based on maximal glucose uptake during exercise are 60-80 grams per hour or ~1 gram per kilogram of body weight per hour - Drinks that contain rapidly absorbed carbohydrates and electrolytes are excellent in helping to avoid hypoglycemia and plasma volume depletion- A sports drink such as Gatorade is ideal, providing fluid, electrolytes, and 60 grams per litre of rapidly absorbed carbohydrate- Other foods or fluids containing 30 grams of carbohydrates suitable during exercise: - 500ml Gatorade - 1 cereal or sports bar - 2 bananas - 1-2 sports gels The recommended principles of recovery such as carbohydrate, protein, and fluid replacement also apply for athletes with Type 1 Diabetes. During recovery muscle glucose uptake continues to replace muscle glycogen stores. Insulin sensitivity also remains elevated for several hours. Therefore the athletes with Type 1 Diabetes need to pay special attention to recovery strategies to avoid delayed hypoglycemia. These include to:- Monitor blood glucose levels, including overnight- Reduce insulin dose to decrease the immediate and delayed actions of insulin- Avoid alcohol consumption after exercise- Ingest an appropriate amount of carbohydrate on a daily basis
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