The management of insulin treated diabetes and sport

People with insulin treated diabetes should be encouraged to exercise, and many will want to perform sports, some at a competitive level. Whilst cardiovascular and muscle physiology is normal in uncomplicated diabetes, the effects of insulin treatment and the various abnormalities in the endocrine response with exercise seen in diabetes may impact on glycaemic control and increase the risk of hypoglycaemia. At higher levels of performance, diabetes may impair maximum performance. Understanding normal physiology of exercise and the changes seen with diabetes enables the athlete and their health care professional to predict the pattern of change in blood glucose with various forms of effort, and thus with appropriate changes in insulin therapy and food intake to manage these changes so that hypoglycaemia is avoided and performance is normalised. Examples of outstanding performance from athletes with insulin treated diabetes are presented and the implications of the use of insulin in competitive sport are discussed. This article reviews these issues and suggests potential strategies for the management of insulin treated diabetes with sport. Copyright © 2005 John Wiley & Sons, Ltd.