Management of Athletes with Type 1 Diabetes
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What is the primary role for an athletic trainer when dealing with an athlete with diabetes?

  • Prescribing insulin dosages and dietary plans.
  • Providing medical diagnoses for diabetes-related complications.
  • Monitoring only the long-term health of the athlete.
  • Prevention, recognition, and immediate care of hypo- and hyperglycemia. (correct)

When should an athletic trainer be prepared to assist an athlete with a diabetes-related issue?

  • At all times as part of a team-wide protocol. (correct)
  • Only when the athlete reports having symptoms.
  • During scheduled exercise sessions only.
  • Only when a physician is not available.

What is considered the normal range for fasting blood glucose levels in a person without diabetes?

  • Less than 60 mg/dL (3.3 mmol/L)
  • Greater than 100 mg/dL (5.5 mmol/L)
  • Between 100 to 140 mg/dL (5.5 to 7.8 mmol/L)
  • Between 60 to 100 mg/dL (3.3 to 5.5 mmol/L) (correct)

Besides glucose and insulin levels, what other aspect of training should the athletic trainer assist the athlete with?

<p>Adjusting hydration and nutrition for exercise. (C)</p> Signup and view all the answers

What is the normal range for postprandial blood glucose levels 2 hours after a meal, in a person without diabetes?

<p>Less than 140 mg/dL (7.8 mmol/L) (C)</p> Signup and view all the answers

How often is basal insulin typically injected when using multiple daily injection (MDI) therapy?

<p>Once or twice a day (B)</p> Signup and view all the answers

What is a key difference between basal insulin delivery with MDI and insulin pump therapy?

<p>MDI delivers a fixed amount of long-acting insulin; pumps can vary basal rates (B)</p> Signup and view all the answers

What should athletes with diabetes do daily to help avoid foot problems?

<p>Inspect feet for any reddened areas (A)</p> Signup and view all the answers

When is initial screening for peripheral neuropathy recommended for individuals with diabetes?

<p>5 years after diagnosis (A)</p> Signup and view all the answers

What is a common symptom of autonomic neuropathy in athletes with diabetes?

<p>Hypoglycemic unawareness (C)</p> Signup and view all the answers

Which of the following is a recommendation for toenail care in individuals with diabetes?

<p>Cutting toenails straight across (B)</p> Signup and view all the answers

What is the typical duration of biological activity for basal insulin used in MDI therapy?

<p>18-24 hours (B)</p> Signup and view all the answers

In addition to carbohydrate content and current blood glucose, what other factor is considered when determining bolus insulin dosage for MDI users?

<p>Anticipated exercise (A)</p> Signup and view all the answers

What is a primary cause of hypoglycemia during exercise in individuals with type 1 diabetes?

<p>Impaired hepatic glucose production due to relative hyperinsulinemia. (A)</p> Signup and view all the answers

How long after the onset of exercise does hypoglycemia usually occur in individuals with type 1 diabetes due to relative hyperinsulinemia?

<p>20 to 60 minutes after the onset of exercise. (B)</p> Signup and view all the answers

What is a consequence of psychological stress before competition in athletes with type 1 diabetes?

<p>Increased blood glucose levels due to counter-regulatory hormones. (D)</p> Signup and view all the answers

What is a common management strategy for athletes with type 1 diabetes experiencing hyperglycemia on game days compared to practice days?

<p>Frequent blood glucose monitoring and adjusting insulin doses. (C)</p> Signup and view all the answers

What is NOT a specific requirement or consideration for a traveling athlete with type 1 diabetes?

<p>Specific travel insurance for diabetic athletes. (D)</p> Signup and view all the answers

Why might an athlete with type 1 diabetes experience impaired release of counter-regulatory hormones during exercise?

<p>After previous exercise or a hypoglycemic episode. (B)</p> Signup and view all the answers

What is the likely effect of relative hyperinsulinemia during exercise in an individual with type 1 diabetes?

<p>A reduction in blood glucose levels. (B)</p> Signup and view all the answers

What should be included in a letter from a physician for a traveling athlete with type 1 diabetes?

<p>An explanation of the need for diabetes medications. (D)</p> Signup and view all the answers

What physiological response is likely to cause elevated blood glucose levels in athletes during training or competition?

<p>Exaggerated increase in glucose counterregulatory hormones (D)</p> Signup and view all the answers

Which of the following is NOT a typical symptom of hyperglycemia in athletes?

<p>Increased alertness and focus (C)</p> Signup and view all the answers

An athlete experiencing ketoacidosis might exhibit which of these additional symptoms compared to typical hyperglycemia?

<p>Fruity odor to the breath and rapid breathing (D)</p> Signup and view all the answers

What is the primary reason for diabetic athletes to carry extra medication and supplies while traveling?

<p>To account for any potential loss or damage during travel (C)</p> Signup and view all the answers

Why might travel necessitate adjustments to an athlete's insulin therapy?

<p>Changes in eating patterns and time zones can impact regular insulin timing (C)</p> Signup and view all the answers

In addition to carrying extra supplies, what other key piece of information should athletes always have with them while traveling?

<p>A health insurance card with policy details and emergency contacts (A)</p> Signup and view all the answers

Why is it recommended that an athlete with diabetes carry prepackaged meals and/or snacks?

<p>To have food available if there are any delays in access to regular meals (C)</p> Signup and view all the answers

An athlete showing signs of rapid breathing, confusion, and sweet smelling breath is MOST likely experiencing:

<p>Hyperglycemia progressing to ketoacidosis (B)</p> Signup and view all the answers

Why might an athlete with type 1 diabetes intentionally compete in a hyperglycemic state?

<p>To avoid the risk of hypoglycemia. (D)</p> Signup and view all the answers

What risk is associated with competing in a hyperglycemic state?

<p>Potential for dehydration. (D)</p> Signup and view all the answers

What is the renal glucose threshold, and what happens when it is exceeded in athletes with diabetes?

<p>The point at which the kidneys start excreting glucose; leading to increased urination. (B)</p> Signup and view all the answers

Besides insulin adjustments, what might athletes need to increase during hyperglycemic periods?

<p>Noncarbohydrate fluid consumption. (D)</p> Signup and view all the answers

What should an athlete with type 1 diabetes do regarding travel plans?

<p>Discuss the plans with their diabetes healthcare team before departure. (D)</p> Signup and view all the answers

What does ADA provide for individuals with diabetes when traveling to non-English speaking countries?

<p>Translated medical identification cards (B)</p> Signup and view all the answers

Why might it be helpful for a person with diabetes to learn specific phrases before travelling?

<p>To communicate the need for medical assistance (B)</p> Signup and view all the answers

What is the primary result of trauma on glucose levels in individuals with diabetes?

<p>Dramatic increase in blood glucose levels (A)</p> Signup and view all the answers

For athletes experiencing postexercise late-onset hypoglycemia, how frequently should blood glucose levels be measured after exercise?

<p>Every 2 hours up to 4 hours (C)</p> Signup and view all the answers

If a blood glucose level is below what threshold should carbohydrates be consumed?

<p>100 mg/dL (5.5 mmol/L) (D)</p> Signup and view all the answers

What is the recommended timing for blood glucose measurement for athletes who experience nighttime hypoglycemia?

<p>Before sleep, once during the night, and immediately upon waking (A)</p> Signup and view all the answers

When might additional carbohydrate supplementation be necessary during exercise?

<p>For practices lasting more than 60 minutes when pre-exercise insulin dosage hasn't been reduced by at least 50% (B)</p> Signup and view all the answers

Besides postexercise late-onset hypoglycemia, what conditions may necessitate additional monitoring for an athlete?

<p>Exercising in extreme heat or cold (A)</p> Signup and view all the answers

How often should blood glucose levels be measured before exercise to determine glucose movement?

<p>2 to 3 times at 30-minute intervals before exercise (C)</p> Signup and view all the answers

What should athletes consume shortly after exercise?

<p>A snack and/or meal (B)</p> Signup and view all the answers

During exercise, how often should glucose levels be measured if possible?

<p>Every 30 minutes (C)</p> Signup and view all the answers

Flashcards

What is diabetes?

Diabetes is a chronic disease where the body can't regulate blood sugar effectively.

What is hyperglycemia?

Hyperglycemia means high blood sugar levels. It's a common sign of diabetes.

What is hypoglycemia?

Hypoglycemia is low blood sugar, which can be dangerous for people with diabetes.

What is the role of athletic trainers in managing diabetes?

Athletic trainers play a crucial role in managing diabetes in athletes by preventing, recognizing, and addressing emergencies.

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Why is communication important in diabetes management?

Good communication between athletic trainers and other healthcare professionals is important in managing a diabetic athlete.

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Basal Insulin

Insulin that works slowly and continuously throughout the day, typically injected once or twice daily.

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Insulin Pump Therapy

A method of delivering insulin using a small pump attached to the body. It allows more flexibility in adjusting insulin levels.

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Multiple Daily Injections (MDI)

Delivering insulin using injections throughout the day, typically with syringes or pens.

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Rapid-Acting Insulin

A type of insulin that works quickly, typically used before meals or to correct high blood sugar.

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Peripheral Neuropathy

Damage to the nerves, often affecting the feet and causing numbness, tingling, or pain.

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Autonomic Neuropathy

A type of nerve damage that affects the automatic functions of the body, like heart rate and digestion.

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Hypoglycemic Unawareness

The inability to recognize the signs and symptoms of low blood sugar, potentially leading to dangerous complications.

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Orthostatic Hypotension

A condition where the body's blood pressure drops when moving from a lying or sitting to a standing position.

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Diabetes and Training Environment

Athletes with diabetes may experience increased blood sugar levels when training or competing in certain environments due to heightened counter-regulatory hormone production.

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Hyperglycemia Symptoms in Athletes

Symptoms of high blood sugar in athletes with diabetes can include nausea, dehydration, reduced cognitive performance, slow reaction time, and fatigue.

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Hyperglycemia with Ketoacidosis

In severe cases of high blood sugar, athletes may show additional signs like rapid breathing, fruity breath odor, unusual fatigue, sleepiness, loss of appetite, increased thirst, and frequent urination.

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Diabetes and Travel

Traveling with diabetes requires extra planning and preparation due to potential disruptions in meal schedules, access to food, and medication availability.

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Food Preparation for Travel

Athletes with diabetes should carry pre-packaged meals and snacks to avoid delays in eating.

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Insulin Adjustment for Time Zones

Insulin therapy might have to be adjusted during travel due to time zone changes and altered activity patterns.

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Travel Medication

Athletes with diabetes should carry twice the amount of medication and supplies they need for a trip.

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Health Insurance Card

Athletes with diabetes should carry a health insurance card with relevant information for emergency situations.

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Relative hyperinsulinemia in type 1 diabetes during exercise

When insulin levels don't decrease during exercise in people with type 1 diabetes, it leads to higher-than-normal insulin levels, impairing the liver's ability to produce glucose and potentially causing dangerously low blood sugar.

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Hypoglycemia during exercise in Type 1 diabetes

Low blood sugar (hypoglycemia) can occur during exercise in people with type 1 diabetes because the body can't efficiently release counter-regulatory hormones, like glucagon and catecholamines, needed to raise blood sugar levels.

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Psychological stress and hyperglycemia in type 1 diabetes

The body's natural response to stress, like competition, can cause an increase in counter-regulatory hormones, which can lead to high blood sugar (hyperglycemia) in athletes with Type 1 diabetes.

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Managing blood sugar in Type 1 diabetic athletes

Regularly monitoring blood sugar levels and adjusting insulin doses are important strategies for managing blood sugar in type 1 diabetic athletes during training and competition.

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Type 1 diabetes management in hot and humid environments

Diabetic athletes need to consider the impact of hot and humid weather on their blood sugar control, as it can increase glucose levels and make it harder to manage diabetes.

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Travel with Type 1 diabetes

Athletes with type 1 diabetes often require special medications for travel, including insulin and other medications, along with documentation explaining their needs.

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Safe disposal of used syringes

Syringes used by athletes with type 1 diabetes should be safely disposed of in a sharps container, which helps prevent injuries and contamination.

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Insulin allergies

Insulin can cause allergic reactions, so it is important to be aware of signs and symptoms and seek medical attention if necessary.

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Why is competing with high blood sugar risky?

Competing with high blood sugar (above 180 mg/dL) can cause dehydration, reduced performance, and potential ketosis.

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How to manage insulin during hyperglycemic exercise?

The ADA provides guidelines for exercise during hyperglycemia. Athletes should work with their doctors to adjust insulin before, during, and after exercise.

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What happens to the body when blood sugar is very high?

When blood sugar exceeds 180 mg/dL, the body excretes excess glucose through urine, leading to increased fluid loss.

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What should athletes drink during hyperglycemia?

Athletes with diabetes should drink more non-carbohydrate fluids to combat dehydration during periods of high blood sugar.

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Why is communication crucial for diabetic athletes traveling?

Athletes with type 1 diabetes should communicate their travel plans with their healthcare team to plan for insulin adjustments and potential emergencies.

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Monitoring blood glucose in athletes

Athletes exercising in extreme conditions (heat, cold, high altitude) or experiencing postexercise late-onset hypoglycemia may require additional monitoring of blood glucose.

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Why is medical identification important for diabetic travelers?

People with diabetes should wear or carry medical identification, particularly while traveling, for emergencies.

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Blood glucose monitoring before exercise

Blood glucose levels should be measured 2-3 times before exercise at 30-minute intervals to understand how blood sugar is changing.

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Carb supplementation during exercise (long duration)

During exercise lasting over 60 minutes, athletes may need additional carbohydrates, especially if their pre-exercise insulin dose was not lowered by at least 50%.

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How does trauma affect blood sugar?

Trauma triggers the release of stress hormones like cortisol and glucagon, leading to a surge in blood sugar levels.

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How can the ADA help diabetic travelers communicate?

The ADA provides translated identification cards for international travelers with diabetes to facilitate communication with medical personnel.

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Carb needs during exercise (peak insulin)

Athletes exercising at the peak of insulin activity may require additional carbohydrates.

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Blood glucose monitoring after exercise (late-onset hypoglycemia)

Athletes who experience postexercise late-onset hypoglycemia should monitor their blood glucose levels every 2 hours for up to 4 hours after exercise.

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Blood glucose monitoring at night (hypoglycemia)

Athletes experiencing nighttime hypoglycemia should measure blood glucose before bed, during the night, and upon waking.

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Carb supplementation before exercise (low blood sugar)

Carbohydrate supplementation before exercise depends on the athlete's blood glucose level. If blood glucose is below 100 mg/dL, carbohydrates should be consumed.

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Post-exercise snack/meal

After exercise, athletes should have a meal or snack to replenish energy stores and prevent hypoglycemia.

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Study Notes

National Athletic Trainers' Association Position Statement: Management of the Athlete With Type 1 Diabetes Mellitus

  • Objective: To provide recommendations for certified athletic trainers in managing type 1 diabetes in athletes.

  • Background: Maintaining blood glucose levels near normal is crucial, balancing hypoglycemia, euglycemia, and hyperglycemia, especially during physical activity and competition. Effective management of blood glucose, lipids, and blood pressure is critical.

  • Recommendations:

    • Diabetes Care Plan: Each athlete with diabetes needs a plan for practices and games, including:
      • Blood glucose monitoring frequency and pre-exercise exclusion values.
      • Insulin therapy, including insulin type, dosage, adjustments based on activity, and correction doses for high blood sugar.
      • List of all medications for glycemic control or related conditions.
      • Hypoglycemia recognition, prevention, and treatment guidelines, including glucagon use.
      • Hyperglycemia and ketosis recognition, prevention, and treatment guidelines.
    • Supplies for Athletic Training Kits: Kits should include:
      • Diabetes care plans.
      • Blood glucose testing equipment and supplies (check expiration dates).
      • Hypoglycemia treatment supplies (sugary foods, fluids, glucagon kit).
      • Urine/blood ketone testing supplies.
      • Sharps containers.
      • Spare batteries/infusion sets (for pumps).

  • Preparticipation Physical Examination (PPE):

    • Glycosylated hemoglobin (HbA1c) assays every 3-4 months to assess long-term glycemic control. However, HbA1c is not used for daily decisions.
    • Annual eye, kidney, nerve, and foot (sensory function and reflexes) exams.
    • Cardiovascular disease screening intervals as determined by the athlete's endocrinologist or cardiologist.
    • Athlete's physician determines exercise limitations related to complications.

  • Hypoglycemia Recognition, Treatment, and Prevention:

    • Strategies include blood glucose monitoring, carbohydrate supplementation, and insulin adjustments.
    • Athletes need to discuss with their doctor specific carbohydrate types and quantities and insulin reduction during exercise.
    • Trainers should know signs, symptoms, and treatment of mild and severe hypoglycemia. Severe cases require glucagon.

  • Hyperglycemia Recognition, Treatment, and Prevention:

    • Athletes and trainers should follow American Diabetes Association (ADA) guidelines to avoid exercise during hyperglycemia.
    • Consult with the physician if hyperglycemia occurs during intense or stressful exercises.
    • Drink non-carbohydrate fluids if blood glucose levels exceed 180 mg/dL (10 mmol/L) to avoid dehydration.

  • Insulin Administration:

    • Subcutaneous insulin administration into the abdomen, upper thigh, and upper arm. Avoid intramuscular injections.
    • Avoid heat and cold applications near injection sites for several hours after rapid-acting insulin injections.
    • Insulin pump users should replace infusion sets regularly to reduce irritation.
    • Extreme temperatures can affect insulin action, so monitor blood glucose levels frequently.

  • Travel Recommendations:

    • Review TSA and ADA recommendations for airline travel.
    • Carry sufficient diabetes supplies, including prescriptions, for the duration of the trip.
    • Avoid storing insulin in the cargo hold.

  • Athletic Injury and Glycemic Control:

    • Trauma can cause hyperglycemia.
    • Develop an individualized blood glucose management protocol for injury recovery, including monitoring frequency.

  • Diabetes Management Team:

    • Team approach is important for managing diabetes in athletes, involving school nurses, coaches, and administrators (for school-aged athletes). In adults, more health professionals may be involved.

  • Disclaimers: The recommendations are not exhaustive and should be considered in the context of individual athletes and institutional guidelines.

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National Athletic Trainers' Association Position Statement: Management Of The Athlete With Type 1 Diabetes Mellitus PDF

Description

This quiz focuses on the best practices for certified athletic trainers dealing with athletes who have type 1 diabetes. It covers essential recommendations for creating diabetes care plans, monitoring blood glucose, and managing insulin therapy during physical activity. Understanding these guidelines is crucial for maintaining athletes' health and performance.

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