What are the contraindications and management strategies for individuals with Insulin-Dependent Diabetes Mellitus (IDDM) participating in high-intensity sport camps?

From the Guidelines

Individuals with Insulin-Dependent Diabetes Mellitus (IDDM) should not participate in high-intensity sport camps if they have uncontrolled blood glucose levels, recent severe hypoglycemic episodes, diabetic ketoacidosis, or untreated diabetic complications such as retinopathy or neuropathy. For safe participation, management strategies include:

• Frequent blood glucose monitoring (before, during, and after exercise) 1
• Adjusting insulin dosages (typically reducing pre-exercise bolus insulin by 10-20% depending on intensity and duration) 1
• Consuming appropriate carbohydrates (15-30g for every 30-60 minutes of activity) 1 Athletes should:
• Carry fast-acting glucose sources like glucose tablets or juice 1
• Wear medical identification
• Ensure coaches understand diabetes management and can recognize hypoglycemia symptoms Hydration is crucial, as dehydration affects blood glucose control. A personalized plan developed with an endocrinologist should include specific insulin adjustment protocols, target glucose ranges (ideally 126-180 mg/dL before exercise), and recovery strategies 1. Continuous glucose monitors can provide real-time data during activities. These precautions are necessary because exercise increases insulin sensitivity and glucose uptake by muscles, which can cause hypoglycemia during or after activity, while high-intensity exercise can sometimes trigger temporary hyperglycemia due to stress hormone release. It is also important to follow a meal planning approach to quantify carbohydrate intake and match mealtime insulin to carbohydrates consumed 1. Treatment of hypoglycemia includes the use of glucose tablets or carbohydrate-containing foods or beverages, with a commonly recommended dose of glucose being 15–20 g 1.

From the FDA Drug Label

Adjustment of dosage of any insulin may be necessary if patients change their physical activity or their usual meal plan. Hypoglycemia As with all insulin preparations, hypoglycemic reactions may be associated with the administration of LEVEMIR. The time of occurrence of hypoglycemia depends on the action profile of the insulins used and may, therefore, change when the treatment regimen or timing of dosing is changed In patients being switched from other intermediate or long-acting insulin preparations to once- or twice-daily LEVEMIR, dosages can be prescribed on a unit-to-unit basis; however, as with all insulin preparations, dose and timing of administration may need to be adjusted to reduce the risk of hypoglycemia

The main contraindications for individuals with IDDM participating in high-intensity sport camps are:

• Hypoglycemia: High-intensity sports may increase the risk of hypoglycemia, and individuals with IDDM should be aware of the signs and symptoms of hypoglycemia and take steps to prevent it.
• Changes in physical activity: Changes in physical activity, such as those that occur during high-intensity sport camps, may require adjustments to insulin dosage to prevent hypoglycemia or hyperglycemia.

Management strategies for individuals with IDDM participating in high-intensity sport camps include:

• Monitoring blood glucose levels: Frequent monitoring of blood glucose levels is necessary to adjust insulin dosage and prevent hypoglycemia or hyperglycemia.
• Adjusting insulin dosage: Insulin dosage may need to be adjusted based on changes in physical activity and meal plans.
• Education and awareness: Individuals with IDDM should be educated on the risks and management of hypoglycemia and hyperglycemia, and should be aware of the signs and symptoms of these conditions 2.

From the Research

Contraindications for IDDM Individuals in High-Intensity Sport Camps

• Individuals with Insulin-Dependent Diabetes Mellitus (IDDM) participating in high-intensity sport camps are at risk of experiencing severe hypoglycaemia, a potentially life-threatening condition, both during exercise and for up to 31 hours of recovery 3.
• Mild hypoglycemia can markedly reduce sports skill performance and cognition in young athletes with IDDM 4.
• Nocturnal hypoglycemia is a common occurrence in individuals with IDDM, lasting an average of 84 minutes, and can be detected using continuous real-time blood glucose monitoring systems 5.

Management Strategies for IDDM Individuals in High-Intensity Sport Camps

• Adjusting the dosage of self-administered exogenous insulin and nutritional intake can help manage the risk of exercise-induced hypoglycaemia 3.
• Supplementing carbohydrate before and after exercise, as well as during exercise for events lasting longer than 1 hour, can help prevent hypoglycemia 6.
• Adjusting insulin dosing based on planned exercise intensity is another strategy to prevent hypoglycemia 6.
• Monitoring blood sugar closely before, during, and after exercise is crucial for individuals with IDDM 6.
• Significant hyperglycemia before exercise should preclude exercise, as the stress of exercise can paradoxically exacerbate hyperglycemia and lead to ketoacidosis 6.

Additional Considerations

• Individuals with IDDM should be evaluated for complications of long-standing disease before beginning an exercise program, and exercise should be modified appropriately if complications are present 6.
• Athletes with IDDM should be aware of hypoglycemia symptoms and have rapidly absorbable glucose available in case of hypoglycemia 6.
• Intense exercise can produce sustained postexercise hyperglycemia in individuals with IDDM, and different therapeutic strategies may be required for intense compared with moderate exercise 7.