A Diabetes Primer

Diabetes is a chronic disease diagnosed in over 20.8 million U.S. children and adults. Those diagnosed with diabetes have high blood glucose levels (blood sugar) and they’re bodies are either unable to make insulin or the insulin they produce cannot be used.

Insulin is a hormone produced in the pancreas. It is needed to convert sugar, starches and other food into the energy required for daily life. Essentially, it “unlocks” the body’s cells, allowing glucose (sugar) to enter the body’s cells and be converted into energy.

With diabetes, sugar does not enter the cells. Instead, it builds up in the blood stream, starving the body’s cells of energy. Long-term high blood sugar levels can damage organs and body systems resulting in blindness, cardiovascular disease, loss of circulation and/or kidney failure.

The cause of diabetes has not been determined. Genetics and environmental factors such as obesity and lack of exercise appear to play a role.

Because this is a growing segment of our population and because an individual who properly manages his/her diabetes has no limitations on his or her activity, its important for public service providers to understand the disease, recognize the warning signs and work to avoid problems – whether that be in our recreation centers, on our ball fields or in our parks. It’s not our job to manage our citizen’s disease, but it sure is helpful to recognize diabetic related complications to exercise or recreation and know how to react to them if needed.

So, here’s more than you probably ever wanted to know about diabetes.

Types of Diabetes

Type I diabetes is when the pancreas fails to produce insulin. An individual with Type I diabetes requires daily insulin either through a shot or insulin pump. Insulin shots are usually given two to three times per day at regular times. An insulin pump delivers a steady flow of insulin to the body. This type occurs most often in children and young adults but it can occur at any age. Approximately five to ten percent of individuals diagnosed have Type I diabetes.

Type II diabetes is when the pancreas produces insulin but the body does not utilize it properly. This type was previously referred to as adult-onset diabetes but unfortunately, children as young as six years of age are now being diagnosed. Oral medication and proper diet are needed to treat this condition. A proper diet and exercise are often all that is necessary to manage, and even prevent, Type II diabetes. Most individuals diagnosed have Type II diabetes.

Warning Signs

Typical warning signs of Type I and Type II diabetes, as provided by the American Diabetes Association, are outlined in the following table. Persons with Type II diabetes sometimes have symptoms that are so mild that they go undetected.

Warning Signs - Type I Diabetes

Frequent urination

Excessive thirst

Extreme hunger

Dramatic weight loss

Irritability

Weakness and fatigue

Nausea and vomiting

*Symptoms usually occur suddenly

Warning Signs - Type II Diabetes

Recurring or hard-to-heal skin, gum, or bladder infections

Drowsiness

Blurred vision

Tingling or numbness in hands or feet

Itching

*Symptoms usually occur gradually

Diabetes Complications That Require Immediate Medical Attention

It is very important for individuals with either type of diabetes to monitor and maintain desirable levels of blood sugar. Two complications that require immediate attention can occur without proper monitoring and maintenance.

Hypoglycemia, or low blood sugar, is often referred to as an insulin reaction. It is a result of too much insulin in the blood stream. Symptoms appear rapidly and must be treated quickly. If untreated, an individual may become unconscious. It usually occurs in people who have not eaten or when they have engaged in excessive exercise. Hypoglycemia is more prevalent in individuals with Type I diabetes.

Hyperglycemia,or high blood sugar, results from too much sugar and not enough insulin in the blood stream. It is often due to too much food being eaten or not enough insulin being taken. Illness or emotional stress can also lead to hyperglycemia. Ketoacidosis, or diabetic coma, may result if hyperglycemia is untreated. If the imbalance between insulin and blood sugar level is extreme, ketones accumulate in the blood. Ketones are toxic acids that collect in the blood and urine when the body uses fats instead of glucose (sugar) for energy. Ketones are a sign that an individual’s diabetes is not in control. Hyperglycemia is also more likely to occur in individuals with Type I diabetes.

The symptoms and recommended treatments for hypoglycemia and hyperglycemia, as provided by the American Diabetes Association and the Juvenile Diabetes Research Foundation International, are provided in the table below. Both children and adults vary in the nature of signals indicating hypoglycemia and hyperglycemia. Individuals also vary in their willingness to monitor blood sugar and may ignore early warning signs that if recognized, could avoid medical problems.

Hypoglycemia (Insulin Reaction)

Symptoms (rapid):

Pale, moist skin

Dizziness

Irritability, crying

Fast pulse

Weakness

Headaches

Hunger

Eventual loss of consciousness

Treatment:

If conscious, ingest fast acting sugars such as honey, fruit juice, or nondiet soda pop. Within 10 minutes, improvement should be evident. If not, seek immediate medical attention.

If unconscious, seek immediate medical attention

Hyperglycemia & Ketoacidosis

Symptoms (gradual):

Dry, hot skin

Drowsy, lethargic

Fruity-smelling breath

Labored breath

Loss of appetite

Extreme thirst

Nausea, vomiting, abdominal pain

Eventual loss of consciousness

Treatment:

Seek immediate medical attention

Monitoring Blood Sugar

Periodic monitoring of blood sugar throughout the day is encouraged. In the past, urine tests were used but they are now considered obsolete. Recently, accurate and reliable home tests, or glucose meters, have been developed that read a small drop of blood. This typically involves drawing a small sample of blood from a pinprick. Services providers should discuss with individuals with diabetes their specific method for monitoring blood sugar levels and how often in order to provide assistance as needed. Blood sugar levels are measured in milligrams per deciliter of blood (mg/dl). A goal blood sugar level for a person with diabetes generally falls between 90 and 130 mg/dl.

Nutrition

Nutrition is an important consideration for individuals with diabetes, especially if they are physically active. The diet recommended by the American Diabetes Association consists of 60% carbohydrates, 30% protein, and 10% fat.If physically active, there is a greater need for carbohydrates in the diet and extra carbohydrates are recommended prior to strenuous exercise. Physical activity lowers blood sugar levels so adjustments to diet may be need to maintain the proper balance.

A short bout of mild intensity physical activity such as a 20 minute hike on easy terrain may require a rapidly absorbed carbohydrate such as a piece of fruit prior to the activity. Longer duration and higher intensity activity, such as playing an entire basketball game, might require carbohydrates every 30 minutes or between periods of the game. For all day activities, such as a golf or wrestling tournament, the individual’s physician should be consulted regarding diet modifications.

Midmorning and afternoon snacks should be allowed as needed. Service providers should always have sugar readily available. Individuals with diabetes should be encouraged to carry some form of quickly absorbable sugar with them and to act when recognizing symptoms. Examples of sugars to keep available include fruit juice, nondiet soda pop, sugar cubes, and hard candy. Individuals with diabetes should drink plenty of fluids. Dehydration can adversely affect blood sugar levels.

Exercise and Physical Activity

The American College of Sports Medicine recommends regular exercise and physical activity for individuals with diabetes. With proper diet and insulin levels, an individual can participate in any level of physical activity. Individuals who exercise regularly require less dosages of insulin to maintain their blood sugar levels. In both Type I and Type II, exercise has been shown to improve insulin sensitivity, thus making it easier for the body’s cells to receive glucose (blood sugar) for energy. A person who has diabetes should not avoid exercise and physical activity. It is a reason to be active! The value of regular exercise and physical activity cannot be overstated.

The highest risk factor is hypoglycemia, but this is easily avoided by monitoring blood sugar levels before, during, and after exercise and physical activity.

The following guidelines apply for individuals with diabetes:

Blood sugar level should be between 100 to 200 mg/dl before exercise

If blood sugar level is less than 100 mg/dl, carbohydrates should be ingested before exercising

If blood sugar level is greater than 250 mg/dl, exercise should be avoided until lowered to the 100 to 200 mg/dl range

If blood sugar level is less than 100 mg/dl 30 minutes after completion of exercise, a carbohydrate snack should be ingested

Skin Care

Service providers need to encourage proper foot care. Children and adults with diabetes often experience circulatory issues that can cause problems with foot health and general skin care. It is not recommended for individuals with diabetes to participate in physical activity barefoot. Socks, water slippers, and other types of footwear are available for physical activities such as sand volleyball and martial arts where footwear is optional. This lessens the risks of cuts, blisters, and other foot injuries that will take longer to heel due to circulatory problems. Wearing high-quality supportive shoes and self-checking feet are also recommended.

As you know, individuals with diabetes can lead an active, healthy life if diabetes is properly managed. Service providers need to be knowledgeable about both Type I and Type II diabetes and should talking with patrons about their individual needs and characteristics. As you can see from some of these charts, many warning signs are difficult to identify and you can’t directly control them so cooperation and communication is important. I urge you to take the time, to be aware of and be able to recognize early warning signs in order to prevent life threatening situations as well as offer a safe and enjoyable environment.

Rebecca Woodard, Ph. D., is the Physical Education Undergraduate Coordinator for the Department of Health, Physical Education and Recreation at Missouri State University in Springfield, Mo. You can contact her at rebeccawoodard@missouristate.edu.

Resources:

For more information about all aspects of diabetes visit the American Diabetes Association website at www.diabetes.org

For more information specific to children and young adults with diabetes visit the Juvenile Diabetes Research Foundation International website at www.jdrf.org

For more information about exercise and diabetes see Barnes, Darryl, E. (2004). Action Plan for Diabetes: Your Guide to Controlling Blood Sugar. American College of Sports Medicine Action Plan for Health Series. Human Kinetics: Champaign, IL.