Category: diabetes research

Fuel for football: half-time strategies for maintaining performance with type 1 diabetes

Posted on by thediabetesfootballcommunity in diabetes research

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition. Thank you to JDRF and Matt for the support in the creation of this content. For more information, support and resources from JDRF, click here

Author: Dr Matthew Campbell | PhD ACSM-CEP MIFST RNutr FHEA BSc hons.

Read time: 5-10 minutes

 Introduction

The two main nutritional considerations for football are eating enough carbohydrate and drinking enough fluid. Whereas this is important in the time leading up to a match, it is also important to take on additional energy and fluids during the match.

 What should I eat during exercise?

Research studies consistently show performance benefits during simulated football matches when carbohydrate is consumed during exercise at a rate of approximately 30-60 grams per hour (41-44), or up to 60 grams before each half (45). The 30-60 grams of carbohydrate can be taken after warm-up and again at half-time to meet these guidelines. Consuming 30-60 grams of carbohydrate in the form of food such as energy bars can sometimes be difficult and result in stomach upset. However, carbohydrate-based drinks and gels can often minimise potential stomach issues – it will also help with hydration as discussed below. A major consideration about carbohydrate intake immediately before and during exercise will be managing the impact of this on blood glucose levels. You will need to make a judgement about how best to manage your insulin dose to minimise blood glucose spikes, and, to ensure that you do not have excessive insulin ‘on-board’ during the game which could cause hypoglycaemia – read this article about insulin dosing strategies for exercise.

What should I do if I struggle to manage blood glucose levels when consuming carbohydrate during a match?

If controlling blood glucose levels is difficult for you during football and you’re worried that eating carbohydrate might make this worse there is another, rather strange, but very special technique to try – carbohydrate mouth rinsing. The body is equipped with specialised receptors within the mouth that can detect carbohydrate. This detection of carbohydrates sends signals to the brain that reduce the perception of effort1. Carbohydrate mouth rinsing, which involves rinsing, but not swallowing, the mouth with a carbohydrate-based solution – like you would with mouthwash – has been shown to increase self-paced jogging speed with likely benefits in sprint performance during intermittent types of exercise2,3. There is limited research investigating this technique within applied football settings, although it is logical to think that this strategy could be effective. Using the carbohydrate mouth rinsing technique during breaks in match play (like half-time periods, extra-time, injury stoppages, and medical breaks) could potentially improve performance in situations where eating carbohydrate is either impractical or likely to cause stomach upset or unwanted blood glucose spikes. If your glucose levels tend to be stable during the match and managing hyperglycaemia isn’t too much of an issue for you, then you can combine mouth-rinsing and swallowing. Swallowing a carbohydrate-based drink following a short (approximately 5 second) mouth rinse allows for both the activation of brain signals to reduce perceived effort and will provide extra fuel to the body. This type of strategy might be particularly effective towards the end of games where fatigue may start to impact decisions making processes.

How much fluid should I drink during a match?

Although you can buy isotonic sports drinks, you can also make your own by simply adding a little salt to some squash. It is well established that dehydration impairs both physical and mental performance4,5, although some people are more sensitive to the effects of dehydration than others. The amount of fluid your body requires during a match is determined largely by the amount that you sweat, which, differs from one person to the next, and is dependent on the intensity of exercise, external factors like humidity and temperature, and how well you are acclimatised to the conditions6. Sweat rates in male footballers have previously been reported to range from 0.5-2.5 litres per hour7-9, whereas lower values are generally reported in female players largely because women tend to be smaller than men and expend less energy during exercise10-12. As well as water, sweat also contains electrolytes – primarily sodium (salt) – the amounts of which, again vary from person to person9. As a general guide, footballers should aim to drink sufficient fluids to avoid a reduction of 2-3% of pre-match body weight during a match13 and avoiding gains in body weight to prevent over hydration. As a starting point, measure your weight before and after a match (or even better during training), if you have lost more than 2-3% of your starting body weight then you need to drink more during matches when you can!

 If you are interested in learning how to improve managing your type 1 diabetes around exercise book a consultation with the author, Dr Matthew Campbell: matt@t1dcoaching.co.uk

 About Matthew

Matthew is an internationally recognised research scientist specialising in exercise, diet, and type 1 diabetes. He also provides consultancy and diabetes coaching to people living with type 1 diabetes and those that support them.

Matthew has a PhD in nutrition and exercise metabolism, is author to over 150 research publications, and holds honorary titles with the University of Cambridge and University of Leeds. He is a certified clinical exercise physiologist accredited by the American College of Sports Medicine, a registered nutritionist, and a member of the Institute of Food Science and Technology. He also provides consultancy to professional bodies and professional athletes including NHS England, the World Health Organisation, and TeamGB.

If you are interested in learning how to improve your type 1 diabetes management, contact Matthew at: matt@t1dcoaching.co.uk

References

  1. Carter JM, Jeukendrup AE, Jones DA. The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Medicine and science in sports and exercise. 2004;36(12):2107-2111.
  2. Rollo I, Homewood G, Williams C, Carter J, Goosey-Tolfrey VL. The influence of carbohydrate mouth rinse on self-selected intermittent running performance. Internatonal journal of sports and exercise metabolism. 2015;25(6):550-558.
  3. Rollo I, Williams C, Gant N, Nute M. The influence of carbohydrate mouth rinse on self-selected speeds during a 30-min treadmill run. International journal of sport nutrition and exercise metabolism. 2008;18(6):585-600.
  4. Mohr M, Krustrup P. Heat stress impairs repeated jump ability after competitive elite soccer games. The journal of strength & conditioning research. 2013;27(3):683-689.
  5. McGregor S, Nicholas C, Lakomy H, Williams C. The influence of intermittent high-intensity shuttle running and fluid ingestion on the performance of a soccer skill. Journal of sports sciences.1999;17(11):895-903.
  6. Smith JW, Bello ML, Price FG. A case-series observation of sweat rate variability in endurance-trained athletes. Nutrients. 2021;13(6):1807.
  7. Shirreffs SM, Aragon-Vargas LF, Chamorro M, Maughan RJ, Serratosa L, Zachwieja JJ. The sweating response of elite professional soccer players to training in the heat. International journal of sports medicine. 2005;26(02):90-95.
  8. Baker LB, Barnes KA, Anderson ML, Passe DH, Stofan JR. Normative data for regional sweat sodium concentration and whole-body sweating rate in athletes. Journal of sports sciences. 2016;34(4):358-368.
  9. Maughan R, Shirreffs S, Merson S, Horswill C. Fluid and electrolyte balance in elite male football (soccer) players training in a cool environment. Journal of sports sciences. 2005;23(1):73-79.
  10. Da Silva RP, Mündel T, Natali AJ, et al. Pre-game hydration status, sweat loss, and fluid intake in elite Brazilian young male soccer players during competition. Journal of sports sciences. 2012;30(1):37-42.
  11. Horowitz M. Heat acclimation, epigenetics, and cytoprotection memory. Comprehensive Physiology. 2011;4(1):199-230.
  12. Kilding A, Tunstall H, Wraith E, Good M, Gammon C, Smith C. Sweat rate and sweat electrolyte composition in international female soccer players during game specific training. International journal of sports medicine. 2009;30(06):443-447.
  13. McDermott BP, Anderson SA, Armstrong LE, et al. National athletic trainers’ association position statement: fluid replacement for the physically active. Journal of athletic training. 2017;52(9):877-895.

 

Fuel for Football: The Pre-Match Preparation

Posted on by thediabetesfootballcommunity in diabetes research

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition. Thank you to JDRF and Matt for the support in the creation of this content. For more information, support and resources from JDRF, click here

Author: Dr Matthew Campbell | PhD ACSM-CEP MIFST RNutr FHEA BSc hons.

Read time: 10 minutes

Introduction

Food is made up from a combination of macronutrients and micronutrients. Macronutrients are nutrients that the body needs in large amounts and include carbohydrates, fats, proteins, and fibre, whereas micronutrients include vitamins and minerals. Achieving the right balance of macronutrients and ensuring adequate intake of micronutrients is important for maintaining energy balance – i.e., meeting, but not exceeding the body’s energy demands – as well as maintaining normal physiological processes that are important for day-to-day and long-term health.

What fuels are important for football?

Our bodies preferentially and predominantly use carbohydrate and fat as fuel sources. The amount of energy used, as well as the proportion of energy derived from carbohydrate and fat is influenced by several factors including genetics, training status, as well as what fuels are available – all of these factors differ between individuals meaning that generic, one-size-fits-all recommendations are usually inappropriate1. One constant however is exercise intensity and duration2. At lower exercise intensities (about 60%-70% of maximum heart rate – calculate your maximum heart rate by subtracting your age in years from 220), the body predominantly uses fat. With increasing exercise intensity and duration however, your body will turn to carbohydrate, such that at very high intensities (90%-100% of maximum heart rate) your body will be utilising carbohydrate almost exclusively2.

Why is having enough carbohydrate on-board important?

Having enough carbohydrate available to the body is important during football because low levels of carbohydrate availability is a major cause of early fatigue, decreased performance, reduced concentrations, and hypoglycaemia, especially towards the later stages of a match, extra-time, or long or intense training sessions3. Because the body has only a limited capacity for carbohydrate storage4, it is important to eat enough carbohydrate in the time leading up to a match. Data from a number of research studies show that carbohydrate intake before (and during) a match can delay fatigue5, enhance the capacity for intermittent high-intensity activities6,7 (such as sprint speed and recovery), and prevent hypoglycaemia when insulin doses are adjusted too8. It’s not known how much of the body’s carbohydrate stores are depleted during football, although previous research has suggested that  about 50% of muscle fibres are empty or partially empty after a game9. Players who begin a game with lower muscle carbohydrate stores are known to cover less distance and much less at speed, especially in the second half and during extra-time periods, than those who have ensured adequate carbohydrate stores10.

How much carbohydrate should I eat?

On the days leading up to a match, training is usually light or avoided completely. During this time and on match day itself, carbohydrate intake can be increased to about 6-8 grams per kilogram of body weight per day11 (for a 70 kilogram person this equates to approximately 490 grams of carbohydrate across the whole day). This sounds a lot, but it can be easily achieved by incorporating carbohydrate-based foods (bread, pasta, and potatoes) into each meal. If you are playing in a tournament with congested match fixtures then carbohydrate intake should be maintained at about 6-8 grams per kilogram of body weight per day11 whilst you’re between games in order to replenish carbohydrate stores that may have been (partially) depleted. Although carbohydrate intake in the hours before a game is important, try and avoid eating immediately before (within an hour) and chose easily digestible foods (low in fibre) to avoid exercise-induced stomach upset12.

Is there a way to increase the amount of carbohydrate stored?

Interestingly, although there is an upper limit to the amount of carbohydrate that the body can store, this varies from person to person and can be improved using the right training and feeding strategies. For example, research has shown that training with low muscle glycogen levels can lead to ‘supercompensation’ – i.e., an increase in the amount of carbohydrate stored above and beyond an individual’s normal baseline level13. The challenge for people with type 1 diabetes adopting this strategy, however, is managing glucose levels during exercise to avoid hypoglycaemia. You can also try manipulating the type of carbohydrate consumed which has been shown to increased carbohydrate stores in some tissues14

Does it matter what time I eat carbohydrates?

The timing of carbohydrate consumption is important and can be manipulated to optimise carbohydrate storage. Carbohydrate-rich meals can be consumed on heavy training days, or specific times in the day when stored carbohydrate levels are low. For example, at breakfast the liver has partially depleted its carbohydrate stores because it has been releasing glucose during the night to maintain blood glucose levels15. When carbohydrate stores are low, the body is metabolically primed to preferentially restore these supplies, meaning that less of what you eat will be stored as fat, or ‘burnt-off’ as extra energy. Conversely, when carbohydrate stores are full, the body will is unable to store excess carbohydrate and so some of this will be stored as fat and some will be ‘burnt-off’ as extra energy.

 Aside from carbohydrates, what else should I focus on?

Hydration is also key. Players should aim to start the match fully hydrated – you can tell if you are fully hydrated by the colour of your urine; anything darker than a pale-yellow colour and you need to drink more fluids. General recommendations are to drink 5-7 millilitres per kilogram of body weight in the 2 to 4 hours before kick-off (for a 70 kilogram person this equates to about half a litre. This allows sufficient time for excess fluid to pass through the system and achieve urine that is pale yellow in colour16. Make sure that your drinks are largely sugar-free (to avoid big glucose spikes) and try adding a pinch of salt (1 gram of table salt for every litre of water) as this helps increases hydration rates17.

If you are interested in learning how to improve managing your type 1 diabetes around exercise book a consultation with the author, Dr Matthew Campbell: matt@t1dcoaching.co.uk

 

About Matthew

Matthew is an internationally recognised research scientist specialising in exercise, diet, and type 1 diabetes. He also provides consultancy and diabetes coaching to people living with type 1 diabetes and those that support them.

 

Matthew has a PhD in nutrition and exercise metabolism, is author to over 150 research publications, and holds honorary titles with the University of Cambridge and University of Leeds. He is a certified clinical exercise physiologist accredited by the American College of Sports Medicine, a registered nutritionist, and a member of the Institute of Food Science and Technology. He also provides consultancy to professional bodies and professional athletes including NHS England, the World Health Organisation, and TeamGB.

References

  1. Venables MC, Achten J, Jeukendrup AE. Determinants of fat oxidation during exercise in healthy men and women: a cross-sectional study. Journal of applied physiology. 2005;98(1):160-167.
  2. Melzer K. Carbohydrate and fat utilization during rest and physical activity. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2011;6(2):e45-e52.
  3. Costill DL, Hargreaves M. Carbohydrate nutrition and fatigue. Sports medicine. 1992;13(2):86-92.
  4. Acheson K, Schutz Y, Bessard T, Anantharaman K, Flatt J, Jequier E. Glycogen storage capacity and de novo lipogenesis during massive carbohydrate overfeeding in man. The American journal of clinical nutrition. 1988;48(2):240-247.
  5. Holway FE, Spriet LL. Sport-specific nutrition: practical strategies for team sports. Journal of sports sciences. 2011;29(sup1):S115-S125.
  6. Phillips SM, Sproule J, Turner AP. Carbohydrate ingestion during team games exercise. Sports Medicine. 2011;41(7):559-585.
  7. Russell M, Benton D, Kingsley M. Influence of carbohydrate supplementation on skill performance during a soccer match simulation. Journal of Science and Medicine in Sport. 2012;15(4):348-354.
  8. Campbell MD, Walker M, Bracken RM, et al. Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial. BMJ Open Diabetes Research and Care. 2015;3(1):e000085.
  9. Krustrup P, Mohr M, Steensberg A, Bencke J, Kjær M, Bangsbo J. Muscle and blood metabolites during a soccer game: implications for sprint performance. Medicine and science in sports and exercise. 2006;38(6):1165-1174.
  10. Jacobs I, Westlin N, Karlsson J, Rasmusson M, Houghton B. Muscle glycogen and diet in elite soccer players. European journal of applied physiology and occupational physiology. 1982;48(3):297-302.
  11. Collins J, Maughan RJ, Gleeson M, et al. UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research. British journal of sports medicine. 2021;55(8):416-416.
  12. De Oliveira EP, Burini RC. Carbohydrate-dependent, exercise-induced gastrointestinal distress. Nutrients. 2014;6(10):4191-4199.
  13. Burke L. Fueling strategies to optimize performance: training high or training low? Scandinavian journal of medicine & science in sports. 2010;20:48-58.
  14. Gonzalez JT, Fuchs CJ, Betts JA, Van Loon LJ. Glucose plus fructose ingestion for post-exercise recovery—greater than the sum of its parts? Nutrients. 2017;9(4):344.
  15. Nilsson LH, Fürst P, Hultman E. Carbohydrate metabolism of the liver in normal man under varying dietary conditions. Scandinavian journal of clinical and laboratory investigation. 1973;32(4):331-337.
  16. Armstrong LE, Pumerantz AC, Fiala KA, et al. Human hydration indices: acute and longitudinal reference values. International Journal of Sport Nutrition & Exercise Metabolism. 2010;20(2).
  17. Pratama RY, Muliarta IM, Sundari LPR, Sutjana IDP, Dewi NNA, Griadi IPA. Provision of Coconut Water as Good as Packed Coconut Water and Isotonic Beverages on Hydration Status in Football Athlete. Journal of Physical Education Health and Sport. 2022;9(1):18-26.

Match play demands: how does football impact blood glucose levels?

Posted on by thediabetesfootballcommunity in diabetes research

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition. Thank you to JDRF and Matt for the support in the creation of this content. For more information, support and resources from JDRF, click here

A REMINDER – this blog post is written by a healthcare professional but no changes should be made to the treatment of your condition without consultation with your own Diabetes team. 

Author: Dr Matthew Campbell | PhD ACSM-CEP MIFST RNutr FHEA BSc hons.

Read time: 10 minutes

 

Introduction

During a football match, you will find yourself walking, jogging, running, sprinting, jumping, dribbling, striking the ball, changing direction, as well as coming into contact with the opposition (and possibly arguing with the referee). This places a significant demand on our body’s physiological energy systems as it tries to cope with repeated changes in exercise intensity1.

 

How does the body use blood glucose during exercise?

The body requires energy to exercise, and this is generated by breaking-down various fuels. The main fuels used for exercise are carbohydrate and fat. Everyone (including professional footballers) has enough fat stored away to the meet the body’s fat-derived energy requirements for a football match. However, for higher intensity exercise the body relies more on carbohydrate but has only a limited storage capacity. Carbohydrate is stored in the form of glycogen – bundles of individual glucose molecules packaged together. During exercise, muscles convert stored glycogen into glucose which is then converted into energy. Muscles are also able to extract glucose directly from the blood to help meet their energy demands, and as exercise intensity and duration is increased more and more glucose from the blood is pulled into muscle – this can cause low blood glucose levels, even in people without type 1 diabetes.

 

Why do people with type 1 diabetes have an increased risk of hypoglycaemia during exercise?

In people without type 1 diabetes, insulin levels are regulated and are reduced in response to exercise. This enables two things; firstly, it limits muscle tissue from extracting excessive amounts of glucose from the blood; secondly, lower insulin levels allow the liver to release more glucose into the blood2. Think of this as trying to fill a bucket with a hole in the bottom… if the liver can release enough glucose into the blood to meet the rate at which glucose is being removed by muscle (and other tissues) then blood glucose levels will remain stable. If the rate at which glucose is removed from the blood exceeds the rate at which blood glucose is being replaced, then fatigue, reduced performance, and potentially hypoglycaemia will ensue. Importantly, in type 1 diabetes, insulin levels are the result of the previously administered dose and/or background insulin. This means that once in the body, insulin is unregulated and does not decrease in response to exercise. This results in two things; firstly, higher insulin levels promote excessive glucose removal from the blood; secondly, higher insulin levels prevent the liver from releasing sufficient glucose into the blood to meet demand. This will result in hypoglycaemia.

 

Does playing football mean I will have a hypo?

Although most people associate exercise in type 1 diabetes with hypoglycaemia3 – i.e., the ability of exercise to lower blood glucose to potentially dangerous levels – not all forms of exercise lower blood glucose acutely4-8. Whereas continuous or prolonged aerobic-based exercise (like running a 10K or half-marathon at a steady pace) carries with it a heightened risk of hypoglycaemia8, high-intensity types of exercise (like lifting weights or sprinting) often cause a short-term rise in blood glucose levels4,6,9. Intermittent types of activity which involve repeated bouts of high-intensity activity interspersed with lower and moderate intensity activities, like football, tend to produce more stabilised glucose levels during the activity5,10-13. For example, Figure 1 below illustrates the average change in blood glucose levels during 45-minutes of a simulated match in people with type 1 diabetes. Compared with running (red trace), a simulated first half of football (blue trace) tends to, on average, induce a lower drop in blood glucose levels even when the total amount of energy used (termed energy expenditure) is similar5. Note however, the long bars that stretch above and beyond each data point – this illustrates the amount of variability around the mean response; in other words, it demonstrates how much people can vary in their response to the average…. It’s quite a bit!

Figure 1. The impact of different types of exercise on blood glucose levels during and immediately after a simulated first half of football running (blue trace) and continuous running (red trace) in people with type 1 diabetes. Hashed area indicates exercise period. Figure reproduced from Campbell at al14.

 

Ok, but how are glucose levels maintained or even increased during football?

Although insulin is a very important hormone for blood glucose regulation, other hormones also play important roles. Intense activity produces a marked increase in the release of stress-hormones9, like adrenaline, noradrenaline and cortisol which can help preserve (or even increase) glucose levels during, and for a short-time after, exercise. This is illustrated in Figure 2 where cortisol levels were shown to be elevated in response to 45-minutes of a simulated match (blue trace) compared to continuous running (red trace) in people with type 1 diabetes. Cortisol – which is produced and released by the adrenal glands on top of the kidney – as well as adrenaline, is also partly responsible for those glucose rises that you might see with pre-match nerves or a poor night’s sleep15.

Figure 2. The impact of different types of exercise on blood cortisol levels during and immediately after a simulated first half of football running (blue trace) and continuous running (red trace) in people with type 1 diabetes. Hashed area indicates exercise period. Figure reproduced from Campbell at al14.

 

How do stress hormones increase glucose?

These stress-hormones stimulate the body to break down stored glycogen into glucose2. In the muscle, glycogen broken down into glucose is simply converted into energy because this tissue lacks a special enzyme that prevents glucose being released into the blood. The culprit for increased blood glucose levels is the liver. Unlike muscle, the liver has a special enzyme that enables the conversion of glycogen to glucose for release into the blood. With high levels of stress hormones circulating, the liver is stimulated to increase its release of stored glucose2. In contrast to football, continuous moderate-intensity activity achieves only achieves a modest increase in stress-hormones5 meaning that they have only a minor impact on glucose levels.

 

How long will the effects of stress hormones last?

Although these hormones can have dramatic effects on blood glucose levels, they are usually very short lasting – for example, adrenaline is usually cleared from the blood within 5-10 minutes16. Importantly however, the hormonal and metabolic responses during repeated intense bouts are additive when recovery intervals are short17. This means that in a typical football match (especially those that are physically demanding, and for certain positions like wingers or attacking wingbacks) that there is likely insufficient time for full clearance of these hormones from the circulation before the next high-intensity bout. This means that you could see a gradual rise in glucose levels over each playing half.

 

How long will it take my glucose levels to normalise after football?

Hormones act for a relatively short time meaning that once levels drop, their influence on glucose levels will also be short-lasting. Although football might confer a lower risk of hypoglycaemia during and immediately afterwards, there is still an increased risk of developing hypoglycaemia later after exercise, so much so that the risk of developing late-onset hypoglycaemia seems to be comparable to other forms of exercise like running or lifting weights5. Read our other article to learn more about post-exercise hypoglycaemia and how to avoid it.

 

Are there other factors that can affect blood glucose levels during exercise?

Yes. Lots. Of course, with all aspects of type 1 diabetes, blood glucose responses to any form of exercise will to some extent vary from person to person, and from match to match. Your own physical fitness, technical ability, playing position, tactical role, style of playing, as well as ball possession of the team, quality of the opponent, importance of the game, seasonal period, playing surface, and environmental factors like humidity and temperature18 (to name but a few) will all influence both performance and diabetes management. As such, careful planning of training, nutrition, and insulin dosing strategies are required in preparation for training and match days in optimise performance and manage diabetes effectively and safely.

About Matthew

Matthew is an internationally recognised research scientist specialising in exercise, diet, and type 1 diabetes. He also provides consultancy and diabetes coaching to people living with type 1 diabetes and those that support them.

Matthew has a PhD in nutrition and exercise metabolism, is author to over 150 research publications and holds honorary titles with the University of Cambridge and University of Leeds. He is a certified clinical exercise physiologist accredited by the American College of Sports Medicine, a registered nutritionist, and a member of the Institute of Food Science and Technology. He also provides consultancy to professional bodies and professional athletes including NHS England, the World Health Organisation, and TeamGB.

If you are interested in learning how to improve your type 1 diabetes management around exercise, contact Matthew at: matt@t1dcoaching.co.uk

References

  1. Dolci F, Hart NH, Kilding AE, Chivers P, Piggott B, Spiteri T. Physical and energetic demand of soccer: a brief review. Strength & Conditioning Journal. 2020;42(3):70-77.
  2. Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation: implications for diabetes. Diabetes. 2002;51(suppl_1):S271-S283.
  3. Cockcroft E, Narendran P, Andrews R. Exercise‐induced hypoglycaemia in type 1 diabetes. Experimental physiology. 2020;105(4):590-599.
  4. Turner D, Luzio S, Gray B, et al. Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scandinavian journal of medicine & science in sports. 2015;25(1):e99-e109.
  5. Campbell MD, West DJ, Bain SC, et al. Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic responses in T1DM patients. Scandinavian journal of medicine & science in sports. 2015;25(2):216-222.
  6. Yardley JE, Kenny GP, Perkins BA, et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes care. 2012;35(4):669-675.
  7. Hasan S, Shaw SM, Gelling LH, Kerr CJ, Meads CA. Exercise modes and their association with hypoglycemia episodes in adults with type 1 diabetes mellitus: a systematic review. BMJ Open Diabetes Research and Care. 2018;6(1):e000578.
  8. Campbell MD, Walker M, Trenell MI, et al. Large pre-and postexercise rapid-acting insulin reductions preserve glycemia and prevent early-but not late-onset hypoglycemia in patients with type 1 diabetes. Diabetes care. 2013;36(8):2217-2224.
  9. Fahey A, Paramalingam N, Davey R, Davis E, Jones T, Fournier P. The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus. The Journal of Clinical Endocrinology & Metabolism. 2012;97(11):4193-4200.
  10. Guelfi K, Ratnam N, Smythe G, Jones T, Fournier P. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. American Journal of Physiology-Endocrinology And Metabolism. 2007;292(3):E865-E870.
  11. Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes care. 2005;28(6):1289-1294.
  12. Bussau V, Ferreira L, Jones T, Fournier P. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia. 2007;50(9):1815-1818.
  13. Bussau VA, Ferreira LD, Jones TW, Fournier PA. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes care. 2006;29(3):601-606.
  14. Campbell MD, West DJ, Bain SC, et al. Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic responses in T1DM patients. 2015;25(2):216-222.
  15. Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetology & metabolic syndrome. 2015;7(1):1-16.
  16. Goldstein DS, Eisenhofer G, Kopin IJ. Sources and significance of plasma levels of catechols and their metabolites in humans. Journal of Pharmacology and Experimental Therapeutics. 2003;305(3):800-811.
  17. Bogardus C, LaGrange BM, Horton ES, Sims E. Comparison of carbohydrate-containing and carbohydrate-restricted hypocaloric diets in the treatment of obesity. Endurance and metabolic fuel homeostasis during strenuous exercise. The Journal of clinical investigation. 1981;68(2):399-404.
  18. Al‐Qaissi A, Papageorgiou M, Javed Z, et al. Environmental effects of ambient temperature and relative humidity on insulin pharmacodynamics in adults with type 1 diabetes mellitus. Diabetes, Obesity and Metabolism. 2019;21(3):569-574.

Zak Brown reviews 2020… Happy New Year Everyone!

Posted on by thediabetesfootballcommunity in diabetes research

Another leading member of The Diabetes Football Community and a veteran of the UK Diabetes Futsal squad wanted to share his views on 2020. Zak has been living a long way from home, with the pandemic unfolding in a completely different way in the country of his birth, to the country he’s been living in…. A really interesting insight from Zak and we want to wish you all a Happy New Year wherever you are in the world and thank you for all of your support. Over to you Zak:

“It’s obvious that many people will be glad to see the back of 2020. However, reflection is an important part of every cycle or transition to a new period.

And with any reflection, it is important to acknowledge the positives of the year just passed.

Despite challenging circumstances, I have seen so many friends on social media starting up a side-business this year, whether it be selling hand-made gifts, homemade cakes, or launching a company they had been thinking about for years, and had finally been given the time to turn a vision into action.

Secondly, I have seen some seriously impressive 5km, 10km and further run times from people who had barely ran those distances before. The ability to get out in the fresh air and to explore the local environment will always be free, and for that we should be grateful. It also shows how quickly we can improve at something if we just put the time and effort in.

My situation is different to most right now, as I moved to New Zealand at the end of 2019 from Sydney, where I had been working on an overseas visa for the previous three years. The events that were about to unfold meant that it turned out to be a fortunate decision in many ways, with New Zealand containing the virus for much of 2020. However, despite the relative freedom, it still affects me in a similar way to others as I don’t know when I can next fly home to see my family and friends (I was due to see them this Christmas).

The main challenge for me this year has actually been diabetes-related. The health care system here isn’t quite as advanced as in the UK, meaning diabetes care options are much more limited. For example, only one type of long-acting insulin is government funded (Lantus) and CGM is mainly self-funded here too. Due to my current visa status, I am not eligible for any discount on prescriptions. The full price of insulin, the thing that keeps me alive on a day-to-day basis is eye-watering at times, and certainly makes me feel some empathy for our friends across the Atlantic in USA, who deal with similar battles over the cost of their diabetes.

Despite these hurdles, I have taken a positive outlook and tried to address how I can combat this challenge. To save some money, I decided to cut back on a couple of other “luxury” expenses. However, I made sure I did not cut back on my diabetes care, as health is so important, therefore I tested as much as I usually would, despite the extra costs. This yielded a positive result, with my HbA1c resulting in 42 at my last check-up; the lowest it has been since diagnosis 14 years ago. I remain hopeful that my new visa will come through soon and that I can then access my insulin, test strips etc. at a more reasonable cost.

Looking ahead to 2021, our CEO at Sport Wellington summed it up quite well by wishing for a “dull and boring” 2021! With uncertainty set to continue for a while, “prepare for the worst, hope for the best” may be a good mantra to live by. For me personally, the current situation just re-iterates how happiness and health are essential to our livelihoods. So, I would encourage everybody to think about what makes them most happy? And think of how you can achieve this in whatever circumstances are thrown at you. And when we think about health, as people with Diabetes we have that extra aspect to think about; but remember that health is holistic and not just physical – mental, emotional, social and spiritual health are all contributors to our overall wellbeing.

Take care everyone and wishing you all a Happy New Year.

Zak Brown”

 

The Impact of Stigma on Identity Formation within a Diabetes Football Community… A Research Project

Posted on by thediabetesfootballcommunity in diabetes research

For the last 3 and a half years The Diabetes Football Community has been doing its best to be a leader of peer support for sporty people with Diabetes and those specifically with a passion for Football….. As we’ve seen growth, an increase in engagement and increase in awareness there has been widespread acceptance that there is a need for this group to come together, to provide help for a population of people who felt under-supported before TDFC arrived. However, a big question loomed for me from the off…. Why has it taken until now for this group of people to feel supported? And why has the community continued to develop?

In the pursuit of these answers I decided I needed to expand my knowledge and investigate the issue. So, just under 3 years ago I took the decision to study for a master’s degree in Socio Cultural Studies of Sport and Exercise. By choosing this particular path it allowed me to create my own research project which followed the degree’s subject, but in a field I was passionate about. This gave me the opportunity to search for the answers in the hope that I could glean insight which may help alter the narrative that people with type 1 Diabetes have been up against in Football throughout my entire life.

So, I’m really delighted to say that I’ve now completed my degree and am awaiting the final results. It’s been an incredible 3 year journey which has taught me a lot, but in this blog post I want to give a bit of background and discuss some of the reasons why I feel it’s a hugely important step for the community, as well as the concepts and findings which have been presented within the conclusions of the study.

The Why?…

I wanted to provide academic foundations for why this incredible community continues to grow, support and enhance the lives of those who are involved. Academic research remains at the forefront of change globally and I felt this was the right way to try to influence leaders across the globe, into considering how the narrative for Diabetes care should not be completely focussed upon medical enhancements and technology, in improving the lives of those with T1D.

The How?…

The research I conducted involved analysing some of the online content of blog posts, Facebook posts and tweets as well as interviewing several type 1 members of the community who had volunteered their time to support with the project. This allowed me to collect a substantial amount of data to analyse and compare with previously written academic literature.

What was found…

So, the really important bit…. What were the findings? What did the analysis show about our community and how stigma impacts on members of our Diabetes football Community living with Type 1.

Well… there’s plenty to choose from.

As most people would expect stigma towards Diabetes was shown again to impact the lives of those interviewed, whilst also driving the success of particular online content, as posts which were uplifting, dispelled stigma and provided education against it, were all highly viewed and extremely important to community.

I don’t think that would come to the surprise of many involved in TDFC, however the strong feelings of discontent surrounding type 2 related stigma imposed upon those living with type 1 was an area which I was a little surprised by. The feelings demonstrated were strong and it may have something to do with the particular field the study was focussed in, Football. With Football an unforgiving sport, where weakness is often exploited and ostracised you can potentially see why some of the participants felt strongly towards a stigma bestowed upon them which doesn’t actually represent what they live with. Yet, in their eyes it affects how they could go about their business on a Football pitch or Futsal court.

But it’s there on that very Football pitch or Futsal court where one of the most surprising findings from the study really comes to fruition…

As I’ve already mentioned, the show no weakness culture, masculinity and macho approach that’s embedded in Football really pushes players to hide anything that could be perceived as a weakness by fans, players, coaches or the media. This is why for example there’s not a single player in any professional Football league in England who has come out as gay for example… It’s a perceived weakness which goes against the image of masculinity and strength within the sport so therefore must be hidden. In all other parts of society that stigma is beginning to break but in Sport it still remains, and I believe that it forms the basis of why those in our community, who strongly identify themselves as a footballer, hide the fact they live with T1D. In using secrecy as a coping mechanism for avoiding stigma, academic research has demonstrated that this may increase the likelihood of poorer self-management and thus health outcomes. This is a highly significant finding because for the first time I’m suggesting, with support from the research, that the culture of the sport I’ve grown up with may have a detrimental impact on my health, as a result of the culture within Football, which depicts difference as weakness and ultimately attaches it with negative stigma.

So, with greater identification towards football, you’re more likely to hide your condition, and in hiding your condition you’re less likely to do the right things to self-manage it. With this academically evidenced throughout this study it’s a finding which really needs much more investigation to test its transferability. Nonetheless, when I consider my own experience as young person growing up with the condition, this finding resonates very closely to my experience. I love the sport I’ve played but I now question the impact that it’s had on my mental health, choices and behaviours.

However, there are also questions that stem from this which could really open the door for some interesting exploration. For example, is this just as a result of the Football culture, a team sport surrounded by mainstream players, traditionally with a working class – middle class background? Does it differ with other team sports such as Cricket or Rugby, where the tradition of the game may encourage a different culture and demographic background? Could we also consider a difference between Men’s Football and Women’s Football? Is there a cultural difference between the genders?

But then what about individual sports? Is this an issue which disappears or lessens in individual sports because there isn’t the need to hide from teammates, coaches, referees and opposition players what you need to go through to get out and play? Would we see a different view from a T1D Tennis player, Golfer, Badminton player, runner or cyclist etc?

Although the evidence of the study suggests a significant challenge for those with T1D accessing a sporting culture where weakness is shunned, I do think we’ve seen an opportunity in the findings to help alleviate some of that strain. It’s not all bad news!

This mechanic we’ve created through TDFC has helped to bridge the gap in identification for this population. Building identity with diabetes is important, it helps psychologically, socially and with the eventual medical outcomes for the condition. The research is out there evidencing this but in what we’ve created we’ve potentially helped people identify with T1D who otherwise may not have done. Those people have been so keen to keep it secret because of their life’s interests and passion in Football specifically, that actually by linking their passion to the condition we might have helped gain their attention enough to identify themselves with T1D, seek out others with their condition and ultimately receive help which betters their self-management.

Combining this with the use of Social Media as our prominent tool for communication actually increases this likelihood too. Through Social Media you can view content, see what people are up to and get support from posts without anyone else knowing you’re looking. This ability to temporarily and intermittently identify with T1D is something I would guess has happened a lot. In these moments the individual can see the benefits they may get from associating with the community, talking to others who share their passion within it and begin to develop their identity with the condition that in the long run, I certainly believe and so does the academic literature, will impact positively on self-management.

It’s no secret the positive impact that peer support has for people with T1D, this has been evidenced for years with strong support for it in this study too. However, if you have no inclination to seek out others, or no reason to identify with your condition because your favourite thing in life actively tells you not to, how on earth would you find it? You wouldn’t. So, this study really for the first time suggests we need to create a positive affiliation to draw people to their condition and break down some of the stigma for those who find it hard to identify with T1D. Without that, peer support is not able to cut through to those who may need it the most. It has a hugely significant impact on people who partake in this kind of support but why isn’t everyone doing it if that’s the case? I think this is an area and idea which may help to uncover some of that why….

Peer support is an incredible tool that buffers against stigma but another area that comes through strongly in the study is the idea that personal experiences in life and of stigma are a key driver in identification with T1D. I think for this population of people they are more likely to experience stigma as a result of their decision to put themselves in an environment where their condition is far from embraced, actually actively shunned. Only 2 weeks ago did I experience a pretty obvious stigma related slur, and in the last year I’ve experienced stigma on 3 different occasions all of which were related to Football/ Futsal. I don’t think it’s a coincidence.

This population struggles to come to terms with their condition in the face of it. Which is why TDFC has grown, expanded and continues to do the good it does. Because it tackles and dispels stigma whilst providing a positive view of our condition, which for the first time in our lives is celebrated rather than shunned. THIS is why TDFC has been successful. I knew the reasons deep down but now I’ve taken the time to research it and understand it from a social and cultural perspective, I believe my view of our direction is far clearer for the future, whilst I really hope it can help to influence decision makers within Diabetes care to look at niche populations in greater detail, and more importantly on the impact of stigma on self-management. I’d like to appeal to the Diabetes academic community to really consider this area in the future…. The below link shows a recent poll I ran to get a feel for how it’s affecting behaviour/choices and I think the results speak for themselves:

https://twitter.com/chrisbrighty1/status/1295416282695770116?s=21

With only really the Australian Centre for Behavioural Research in Diabetes (ACBRD) focussing in on this area globally, it needs more. I might add they’re doing a fantastic job with it and a number of their papers heavily influenced my thinking, but they can’t be the only institution driving this.

Evidenced in my study and on the TDFC website is the impact the community has had on altering behaviour positively. We’ve achieved identification with T1D for the first time in this population. Which I firmly believe has resulted in an upturn in the psychological and Hba1c measures that have been achieved within this population. This wasn’t achieved through the traditional models of care provided by Doctors and Nurses but through a new innovation which championed a new way of looking at the condition. Now this is not to diminish the contribution of our incredible Diabetes teams but rather to say, there’s more we can achieve, if we work closer together.

The overall outcomes of a condition determined by self-management is far more holistic than looking only to the medical professionals who support us for the answers. Sometimes, the answers come from ourselves, our choices and our behaviours…. Which may have been influenced.

I hope the blog gives some real insight into what I’ve been working away on in the background to try to drive change for our community as well as raising awareness of why TDFC is a special project.

Throughout all of this it’s important to know that TDFC stands right there beside our NHS and healthcare workers across the globe in trying to make life easier for people with Diabetes. We couldn’t do it without you and I hope we can help you more greatly in the future.

I must say a huge thank you to those who have shared the last 3 years of my journey and the research, projects and teams I’ve been a part of at the University of Worcester. Whilst I can’t forget the contribution of both the University itself and my supervisor Dr. Gyozo Molnar. Without their support it would not have been possible.

If anyone would like to discuss the study with me, its findings or any future collaborations with TDFC please do get in touch via email:

thediabetesfootballcommunity@gmail.com

Thanks for reading,

Chris