Although type 1 diabetes usually occurs in adolescence and childhood, it is a chronic disease that can be seen at any age. In type-1 diabetes, the insulin-producing cells of the pancreas are damaged due to genetics and some unknown environmental factors, and as a result, insulin is produced insufficiently or not at all in the body. Lack of the insulin hormone, whose most important function is to reduce elevated blood sugar to normal, causes blood sugar to rise, that is, "hyperglycemia", which is the hallmark of diabetes. Inability to control blood sugar in individuals with diabetes; It reveals microvascular complications such as neuropathy, nephropathy, retinopathy and macrovascular complications such as cardiovascular diseases. Main treatment; It consists of intensive insulin therapy, exercise, self-monitoring of blood sugar, medical nutrition therapy and aims to avoid decreases in quality of life due to diabetes. The success of type 1 diabetes treatment is possible by providing appropriate glycemic control by protecting the individual from hypoglycemia, which is defined as too low blood sugar (<50 mg/dl), and thus preventing or delaying the complications of diabetes. In case of individualized nutrition therapy, compliance with physical activity recommendations and correct use of insulin, blood sugar can be controlled, complications can be delayed and individuals with diabetes can live a healthy life.
In addition to nutrition and insulin replacement therapy, exercise is recommended for individuals with Type-1 diabetes. It is also of great importance. Proper physical activity improves glucose metabolism and thus allows the insulin dose to be reduced. In addition, regular exercise helps treat diabetes by preventing other health problems. However, the requirements of some diabetes-specific situations, such as monitoring blood glucose, counting carbohydrates and other macronutrients, and adjusting insulin dosage in cases of stress and illness, may challenge athletes. This situation can be even more troublesome, especially for professional athletes with Type-1 diabetes who are exposed to heavy training conditions. Fortunately, individuals with Type-1 diabetes can continue exercising without complications if they follow the recommendations of experts in different disciplines.
Before starting any sports program, the blood of the diabetic individual The primary rule is to keep your sugar under control. It is not recommended for people with HbA1c levels of 9% and above to start sports in any branch. Additionally, the individual should be evaluated for complications related to diabetes. People with any comorbidities or complications of diabetes should be evaluated separately in terms of exercise program and appropriate diet. People with type-1 diabetes often experience hypoglycemia during endurance exercise due to increased insulin absorption, impaired glucagon release, and decreased catecholamine responses. Athletes who use insulin should take appropriate amounts of carbohydrates before and after exercise, as they are at risk of exercise-induced sudden or delayed hypoglycemia. However, if the exercise/training will last longer than 1 hour, carbohydrates should be consumed during the exercise. In addition, when adjusting insulin dosage, the type, intensity and length of exercise should be taken into account to prevent hypoglycemia. It is important to protect against hyperglycemia as well as hypoglycemia during sports. Since exercise stress can further increase blood sugar, exercise should not be started if there is significant hyperglycemia. Considering all these recommendations, it is clear that individuals with diabetes should monitor their blood sugar before, during and after exercise.
Exercise management in diabetes can be complicated because it causes hypoglycemia and hyperglycemia. Understanding the changes in physiology, especially during exercise, and following a nutrition program accordingly makes this process easier to manage. Compliance with nutritional recommendations improves performance and prevents hypoglycemia and hyperglycemia. Although no different macronutrient requirements have been defined for athletes with type-1 diabetes than healthy individuals, some issues need to be taken into consideration.
Insulin-dependent diabetic athletes focus on correct carbohydrate consumption to prevent hypoglycemia and ensure good performance. To keep blood sugar under control during exercise; In addition to the amount of carbohydrates, their quality and timing are also important. Essentially, the amount of carbohydrates to be consumed varies depending on the current blood sugar and insulin level and the type and intensity of exercise to be performed. However, when looking at general recommendations, exercise Adequate and low glycemic index carbohydrate sources should be consumed a few hours before, and 15-30 g of carbohydrates should be taken 1 hour before exercise. Even in those using rapid-acting insulin, if the time between meal and exercise is less than 2-3 hours, insulin is likely to be active during exercise. For this reason, in training lasting longer than 1 hour, 30-100 g/hour carbohydrate supplements should be given, depending on the intensity of the exercise. After exercise, 1.2-1.5 g of carbohydrates per body weight should be consumed for 4-5 hours. To ensure rapid replenishment of glycogen stores, the carbohydrate consumed after exercise may have a higher glycemic index. If the blood sugar level 1 hour before exercise is below 100 mg/dl, a snack containing 15-30 g carbohydrates should be consumed and blood sugar should be measured again after 30-60 minutes. If the blood sugar level before exercise is below 70 mg/Dl, exercise should not be started. In addition, it should not be forgotten that the risk of hypoglycemia after intense training can last up to 30 hours, and to protect from the most risky night hypoglycemia attack, a snack containing low glycemic index carbohydrates should be taken before going to bed. Another point that should be considered in athletes with diabetes is that stress hormones such as glucagon, adrenaline and noradrenaline, whose release increases as a result of competition stress, can lead to significant increases in blood sugar. In this case, the diabetic individual may avoid carbohydrate intake before exercise to prevent further rise in blood sugar, which may increase the risk of delayed hypoglycemia. Since such situations may lead to different reactions in different individuals, an individual evaluation should be made through trial and error under controlled conditions.
In conclusion, although the nutritional requirements of professional athletes with Type-1 diabetes are not much different from healthy individuals, some changes may be required to ensure glycemic control. These changes will vary individually. For this reason, athletes with type-1 diabetes should be followed by a nutritionist and know that diabetes does not constitute an obstacle to good performance if they follow the recommendations.
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