Endocrinology and the Athlete. Objectives

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1 Endocrinology and the Athlete Paul Thornton, MD Medical Director Endocrinology Objectives Overview of type 1 diabetes Impact of type 1 diabetes on athletic performance Management of type 1 diabetes daily and during sports Impact of hyperthyroidism, growth hormone deficiency and late puberty on athletic performance Dr. Sheri Colberg 1

2 What is type 1 diabetes Autoimmune condition Destruction of insulin producing cells in the pancreas Progressive loss of body s ability to make insulin High blood sugar and body starvation Administered insulin corrects the acute metabolic imbalance First type 1 diabetes Patient treated with insulin Symptoms of uncontrolled Type 1 Diabetes High glucose Polyuria and polydipsia Leads to thirst and dehydration and poor performance Irritation and moodiness Leads to poor performance and bad sportsmanship Dr. Sheri Colberg 2

3 Symptoms of uncontrolled Type 1 Diabetes Hypoglycemia Poor concentration, confusion, irritability, lethargy, seizure and coma Leads to poor performance and death Mild forms lead to bad sportsmanship and behavior Treatment of type 1 diabetes Blood sugar checks Insulin treatment Carbohydrate counting Dr. Sheri Colberg 3

4 Diabetic Athlete There are many diabetic athletes worldwide competing even at elite levels Adam Morrison (NBA basketball) Jay Cutler (NFL football) Michelle McGann (LPGA) Gary Hall, Jr. (Olympic swimming) Goals of Exercise Management Prevention of hypoglycemia during and after any physical activity Rapid management of hypoglycemia caused by exercise Prevention of hyperglycemia Maintain hydration Dr. Sheri Colberg 4

5 What is the Zone for Exercise? Most athletes perform best with levels of Some start out higher, but few lower Each individual has his/her starting point but majority are 150mg/dl Glucose Use during Exercise glucose falls in 2 ways: Insulin-mediated Muscle uptake during exercise So, the amount of insulin that is active in the athlete s body will change the speed at which blood glucose drops during exercise. But glucose doesn t always fall during exercise Dr. Sheri Colberg 5

6 Hormones and Blood Glucose Levels Insulin Adrenaline Cortisol Growth Hormone Glucagon Some insulin is needed to moderate the effects of glucose-raising hormones: Adrenaline Glucagon, cortisol, and growth hormone Cortisol and GH are higher during morning exercise Hormone release is intensity-dependent (more adrenaline at higher workloads) Factors Affecting Blood Glucose Response during Exercise Exercise intensity, duration, and type Carbohydrate supplementation Initial blood glucose levels Insulin dose before and/or during exercise and insulin peak times Training effects on fuel use Timing of exercise bout Physical fitness level Dr. Sheri Colberg 6

7 High Adrenaline Activities Raise Blood Sugars Quickly Sports w/ intense bursts Sprinting of any type Heavy weight lifting Scary activities (e.g., hang gliding or downhill skiing) Intense competition (mental stress) Changes for Exercise Increase carbohydrate intake for the activity to prevent low blood glucose Adjust insulin doses before, during, and after activities Try to prevent acute and delayedonset hypoglycemia, which can occur for up to 48 hours after exercise Dr. Sheri Colberg 7

8 Diet Management Eat gram carbohydrate snack with fat/protein before sustained exercise Consume extra rapidly-absorbed carbs during exercise to prevent hypoglycemia Carbohydrate Intake (Grams) Exercise Duration 30 min Exercise Intensity BG <100 BG BG Low None BG >200 None Mod High Low min Mod High Adapted from Colberg, S. The Diabetic Athlete, 2001 Dr. Sheri Colberg 8

9 Diet Management Consume carbohydrates for 2-3 hours after sustained aerobic exercise to rapidly restore muscle glycogen Diet Management Consume adequate fluids to prevent and correct dehydration. 2 bottle system Water and Gatorade Glucose <150 Gatorade Glucose >150 water Dr. Sheri Colberg 9

10 Blood Glucose Checks Check blood sugars at minimum before and after exercise Let blood glucose levels guide choices on carbohydrate intake or insulin dosing. Insulin Management For exercise done 1-2 hours postmeal, reduce meal short-acting insulin dose or give free carbs Insulin pumpers may do reduction in basal insulin or disconnect the pump during sustained activity Dr. Sheri Colberg 10

11 Duration Insulin for Exercise Low Intensity Moderate Intensity High Intensity 30 min None 10-20% 10-30% 60 min 10-20% 20-40% 30-60% 90 min 15-30% 30-55% 45-75% 120 min 20-40% 40-70% 60-90% 180 min 30-60% 60-90% % Adapted from Colberg, S. The Diabetic Athlete, 2001 Hypoglycemia Hypoglycemia (Glucose of 70 or lower is the most immediate risk during and after exercise Access to liquid carbs, gels, or glucose tablets Glucagon emergency kits should also be available, especially for longer activities Dr. Sheri Colberg 11

12 Pumping Insulin and Athletics Advantages Better control No need for injections during activity Disadvantages Attached to body Damage/loss Short time period before high blood sugars Site insertion National Athletic Trainers Association Guidelines Dr. Sheri Colberg 12

13 National Athletic Trainers Association Guidelines Want to Learn More? es/42.4/i pdf Dr. Sheri Colberg 13

14 Hyperthyroidism Caused by excess thyroid hormone in the body Risk for heat stroke with hyperthyroidism and exercise Rare risk for severe hyperthermia and heart failure Hyperthyroidism Findings Annual incidence around 1-3 per 100,000 per year Girls are three times as likely as boys to have the condition Dr. Sheri Colberg 14

15 Hypothyroidism A deficiency of thyroid hormone in the body Causes weight gain, short stature, and fatigue Severe hypothyroidism can cause exercise intolerance and heart failure Want to Learn More? Dr. Sheri Colberg 15

16 Growth Hormone Deficiency Difficult to diagnose Kids are short for many reasons Subtle impact on athletic performance Most cases are idiopathic Risk factors: Severe head trauma, history of brain tumors, history of radiation therapy to brain or spine Growth Hormone and Sports Participation Growth hormone treatment does not exclude participation in athletics Children treated with growth hormone should be monitored for safety and effectiveness of the treatment by a pediatric endocrinologist Dr. Sheri Colberg 16

17 Delayed puberty Delayed puberty cause kids of same age to be smaller and less muscular Often select sports based on physique Do not abandon as they will grow Training should be appropriate to physical maturity not age A 16 yr old Tanner 2 boy should not be doing high weight low repeat exercises Delayed puberty Treatment is giving Testosterone Need to be declared on medical form to be considered if drug testing Just because they are late bloomers does not mean they will not be some one else's best athlete Dr. Sheri Colberg 17

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