Tag: Type 1 diabetes

Fuel for football: post-match recovery

Posted on by thediabetesfootballcommunity in Uncategorized

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition

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

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. 

Read time: 5-10 minutes

Introduction

The primary objectives for a footballer with type 1 diabetes after a match is to reduce the time needed to fully recover and to reduce the risk of developing a hypo later in the day. To meet both of these objectives, it is important to replenish the body’s carbohydrate stores which may have been (partially) depleted during exercise.

How much carbohydrate should I eat after exercise and when?

After exercise, muscle cells that have sustained a depletion in carbohydrate stores are metabolically primed for rapid carbohydrate repletion. In simple terms, glycogen use during exercise turns on glycogen synthesis during recovery. When carbohydrates are eaten soon after exercise, insulin sensitivity in muscle cells, glucose uptake from the blood by muscle cells, and the conversion of glucose to glycogen in muscle cells all increase. Collectively these responses provide the best physiological opportunity to replenish carbohydrate stores. Although the responses can be increased for up to 48 hours1,2, there is a golden window of opportunity shortly after exercise (within the first hour after exercise) where these responses are dramatically upregulated and carbohydrate stores will be replenished more quickly. Consuming 1-1.2 grams of carbohydrate per kilogram of body weight for the first hour after exercise will take advantage of these metabolic circumstances to stimulate high rates of carbohydrate storage. Continue to focus on carbohydrate intake for 24-48 hours after the game, aiming for 6-8 grams of carbohydrate per kilogram of body weight in the 24 hours following a game to ensure that carbohydrate stores are continuing to be replenished; don’t exceed 10 grams of carbohydrate per kilogram of body weight per day – beyond this level does not seem to confer any additional advantage and it may make insulin dosing difficult. Furthermore, simply overconsuming carbohydrate has been shown to be ineffective at preventing post-exercise hypoglycaemia – read this article about preventing post-exercise hypoglycaemia

 

Does the type of carbohydrate matter?

Carbohydrates with a high glycaemic index (i.e., those that easily digested and rapidly absorbed) tend to replenish muscle carbohydrate stores quicker than lower glycaemic index carbohydrates (those that are difficult to breakdown and are absorbed slowly)3. However, consuming large amount of high glycaemic index carbohydrates is not recommended for people with type 1 diabetes, because this can result in large blood glucose spikes which are difficult to control. However, one potential option to trial is changing type of carbohydrate consumed. Carbohydrates come in many different forms and their structure, composition, and delivery method all impact how they affect glucose levels. Glucose is a type of simple sugar that is easily and rapidly digested resulting in spikes in blood sugar. However, mixing glucose with other types of sugar – in particular fructose (which can be bought as a powder) results in a lower glucose spike whilst maintaining total carbohydrate intake4. Figure 1 shows data pooled from several different research studies investigating the effect of different types of carbohydrate consumed after exercise in people without type 1 diabetes. As shown in Figure 1A, changing the type of carbohydrate neither increased nor decreased the rate of muscle glycogen repletion. Interestingly however, most studies report lower insulin levels when glucose and fructose was taken together which implies that this has less of an impact on blood glucose levels. Furthermore, liver glycogen repletion rates were increased when glucose and fructose was taken together as compared to glucose alone. This is potentially important for people with type 1 diabetes, because repletion of liver carbohydrates stores reduces the risk of late-onset hypoglycaemia – read this article about late-onset hypoglycaemia.

Figure 1. The impact of different types of carbohydrates on restoring muscle and liver carbohydrate stores after exercise. Figure reproduced from Gonzalez at al5. GLU = glucose alone, GLU+FRU = glucose and fructose taken together, SUC = sucrose (table sugar).

 

Protein is also (very) important for post-exercise recovery

Sore muscles after exercise are a key indicator of muscle damage – tiny microtears in muscle fibres. To speed up the repair process, and also enhance physiological adaptions, 20-35 grams of high-quality forms of protein should be eaten at regular 3-4 hour intervals6,7. The aim of this is to increase muscle protein synthesis rates – the rate at which cells build and repair muscle. Although protein intake after exercise increases rates of muscle protein synthesis, this is a slow process. This means that protein intake should be increased to a minimum of 1.2-1.4 grams per kilogram of body weight in the days following a match or heavy training session and trying. Where possible, you should try and spread out the total amount of protein to be consumed over the day in the form of smaller but more regular meals. As described above, there is a ‘golden window of opportunity’ shortly after exercise (within the first hour after exercise) to coordinate nutrient intake with the upregulation of key metabolic processes. During this window, muscle protein synthesis rates are rapidly increased if easily digestible and rapidly absorbable protein is consumed. Alongside carbohydrate intake, 30-45 grams of leucine-rich protein (such as whey protein) can be taken to maximise muscle repair and recovery; whey protein can be bought in powered form and taken as a drink but other whole food sources rich in leucine are also available – cottage cheese is an excellent example. As well as lean meat, legumes, and fish, another excellent source of protein is milk which can be drank on its own or mixed with protein powders. The benefit of drinking milk in the post-exercise period is that this has been shown to reduce muscle soreness and quicken recovery8. Additionally, before sleep, a slowly digested and absorbed protein can be taken to provide a gradual and sustained availability of protein9. Aiming for around 30-60 grams of slow-releasing protein (such as casein which is found in milk and can be bought as a powder) as a bedtime snack will be effective in minimising muscle protein breakdown during the night9. Figure 2 shows the pattern of how muscle protein is built-up and broken-down during the day. Timing protein-rich meals to be consumed during periods of protein breakdown will improve muscle reconditioning, especially during long periods of protein breakdown such as sleep.

Figure 2. The pattern of muscle protein breakdown (MPB) and build-up (MPS) during the day. Eating protein stimulates the build-up and repair of muscle protein and allows for net muscle protein accumulation (green areas). In between mealtimes (termed the post-absorptive state), rates of muscle protein breakdown exceed rates of muscle protein build-up, resulting in a net loss of muscle protein (red areas). As shown by Figure 1A, overnight sleep is the longest post-absorptive period of the day (expect for Ramadan for those who observe this). Figure 1B ingesting protein before bedtime stimulates overnight protein build-up rates thereby improving muscle reconditioning during the night. Figure adapted from Trommelen & Loon10.

 

What about supplements?

Vitamins and minerals are important for maintaining key physiological processes including the body’s repair mechanisms. You should try and obtain sufficient amounts of vitamins and minerals naturally through eating a well-rounded healthy diet. This is because dietary sources of vitamin and minerals are more effective than taking isolated vitamins and minerals in supplement form. One supplement which is recommended for most individuals is vitamin D – especially those in the northern hemisphere because most people who live in Northern regions are vitamin D deficient11. If taking vitamin D, this should be coupled with sufficient calcium intake as this helps vitamin D to be absorbed12. Vitamin D is important for several health outcomes, as well as reducing the risk of bone fractures which are common in football, and may contribute to improved muscle recovery13. In addition, dietary iron is important for muscle recovery and repair13. Iron-rich sources of food include red meat as well as green leafy vegetables, eggs, seafood and fortified breads and cereals. Iron-deficiency is common is women, because blood is lost during menstruation, vegans and vegetarians who may struggle to obtain sufficient amounts of iron through diet alone, and teenagers who have increased iron requirements during maturation14.

Some studies have shown that taking branch-chain amino acids can help with recovery14, however the overall effects are small and may make little contribution to the recovery process15. Consuming foods rich in antioxidants have been shown to reduce inflammation and accelerate muscle recovery in difference sports16, but more recent investigations in football failed to show an improvement in recovery or subjective muscle soreness. An issue with this is that certain foods (like beetroot) which are rich in antioxidants are typically found in boiled or pickled form which is known to reduce their antioxidant value meaning that these are large quantities of these foods are likely needed to have any effect. Also, reducing muscle inflammation, particularly with large doses of antioxidants (including vitamins C and E) may interfere with adaptative processes in muscle17, which, if taken after training may reduce the training adaptation. Therefore, based on the available evidence, antioxidant supplements are not recommended.

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. Burke LM, van Loon LJ, Hawley JA. Postexercise muscle glycogen resynthesis in humans. Journal of applied physiology. 2017;122(5):1055-1067.
  2. Mikines K, Farrell P, Sonne B, Tronier B, Galbo H. Postexercise dose-response relationship between plasma glucose and insulin secretion. Journal of applied physiology. 1988;64(3):988-999.
  3. Burke LM, Collier GR, Hargreaves M. Muscle glycogen storage after prolonged exercise: effect of the glycemic index of carbohydrate feedings. Journal of applied physiology. 1993;75(2):1019-1023.
  4. Fuchs CJ, Gonzalez JT, Van Loon LJ. Fructose co‐ingestion to increase carbohydrate availability in athletes. The Journal of physiology. 2019;597(14):3549-3560.
  5. 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.
  6. Koopman R, Saris WH, Wagenmakers AJ, van Loon LJ. Nutritional interventions to promote post-exercise muscle protein synthesis. Sports medicine. 2007;37(10):895-906.
  7. van Loon LJ. Role of dietary protein in post-exercise muscle reconditioning. In: Nutritional Coaching Strategy to Modulate Training Efficiency. Vol 75. Karger Publishers; 2013:73-83.
  8. Rankin P, Landy A, Stevenson E, Cockburn E. Milk: an effective recovery drink for female athletes. Nutrients. 2018;10(2):228.
  9. Kouw IW, Holwerda AM, Trommelen J, et al. Protein ingestion before sleep increases overnight muscle protein synthesis rates in healthy older men: a randomized controlled trial. The Journal of nutrition. 2017;147(12):2252-2261.
  10. Trommelen J, Van Loon LJ. Pre-sleep protein ingestion to improve the skeletal muscle adaptive response to exercise training. Nutrients. 2016;8(12):763.
  11. Holick MF. Deficiency of sunlight and vitamin D. In. Vol 336: British Medical Journal Publishing Group; 2008:1318-1319.
  12. Christakos S, Dhawan P, Porta A, Mady LJ, Seth T. Vitamin D and intestinal calcium absorption. Molecular and cellular endocrinology. 2011;347(1-2):25-29.
  13. Bello HJ, Caballero-García A, Pérez-Valdecantos D, Roche E, Noriega DC, Córdova-Martínez A. Effects of Vitamin D in Post-Exercise Muscle Recovery. A Systematic Review and Meta-Analysis. Nutrients. 2021;13(11):4013.
  14. Pasricha S-R, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. The Lancet. 2021;397(10270):233-248.
  15. Doma K, Singh U, Boullosa D, Connor JD. The effect of branched-chain amino acid on muscle damage markers and performance following strenuous exercise: A systematic review and meta-analysis. Applied physiology, nutrition, and metabolism. 2021;46(11):1303-1313.
  16. Drummer D, Pritchett K, Many GM, et al. Montmorency Cherry Juice Consumption does not Improve Muscle Soreness or Inhibit Pro-inflammatory Monocyte Responses Following an Acute Bout of Whole-body Resistance Training. International journal of exercise science. 2022;15(6):686-701.
  17. Peternelj T-T, Coombes JS. Antioxidant supplementation during exercise training. Sports medicine. 2011;41(12):1043-1069.

Savannah’s Story – A TDFC Story

Posted on by thediabetesfootballcommunity in Uncategorized

A story from our community shared in the words of Natalie the mother of Savannah. We hope you can connect with their story and we want to thank them both so much for getting in touch to share what they’ve been through. It’s an incredibly powerful post and we hope you all can resonate with their experiences… Over to you Natalie:

“At the tender age of six, Savannah’s life took an unexpected turn when she was diagnosed with Type 1 diabetes. I remember the day like it was yesterday. Savannah was struggling to breathe, and her energy seemed to have vanished into thin air. With a call to 111, followed by a swift ride in the ambulance with those flashing blue lights, we found ourselves at Northampton General Hospital. The journey was frightening, but little did we know, it was also the beginning of Savannah’s incredible resilience and bravery.

In the children’s ward, surrounded by compassionate nurses and caring doctors, Savannah began her journey of understanding and managing her diabetes. Despite the challenges she faced, Savannah’s optimism shone through like a beacon of hope. I’ll never forget the relief on her face when she discovered that even with diabetes, she could still indulge in her favourite breakfast of pancakes and Nutella and still play football! That smile of hers could light up the darkest of rooms!

As we returned home armed with needles, insulin, and bags full of information, we knew that our journey was just beginning. Learning to navigate the intricacies of managing diabetes was like embarking on a rollercoaster ride full of highs and lows. From monitoring her food intake to keeping an eye on her activity levels, Savannah showed incredible maturity beyond her years.

There were bumps along the road, and we found ourselves back in the hospital a couple of times. But through it all, the unwavering support of the Northampton Diabetes team kept us going. Their 24-hour support line became our lifeline, even during family holidays when we called our dedicated nurse for guidance.

Despite the challenges, Savannah never lost her spark. She faced each day with determination and grace, bravely enduring the countless injections and finger pricks that became a part of her daily routine. As a parent, I couldn’t help but marvel at her resilience and strength.

Savannah’s zest for life knew no bounds. Despite her diagnosis, she continued to pursue her passion of football with unwavering enthusiasm. From scoring goals on the football field with NN29 Titans in Podington to representing MK Dons, Savannah’s spirit remained unbreakable. Her recent achievement of reaching 100 goals for the Titans club is a testament to her tenacity and dedication. Her goal is to become a professional footballer and she is well on her way at the tender age of 8!

 

As Savannah’s journey continues, I am filled with awe and gratitude for the incredible young girl she has become. She is not just my daughter; she is my inspiration, my hero. And with that infectious smile of hers, she reminds me every day that no matter what challenges life may throw our way, we have the strength and courage to overcome them together. ”

Thank you so much again to Natalie and Savannah for sharing your experiences with us, and if you want to share your story to feature on our website, please do get in touch with pictures and videos!

Team TDFC

 

2023 at The Diabetes Football Community

Posted on by thediabetesfootballcommunity in Uncategorized

Well what a year it’s been! We probably say that at the end of most years, but a year is a long time, and we get involved with so many projects across a year, as we bring the year to a close it always feels like our chance to take a breath and reflect on what’s happened!

This year, instead of writing up a blog post for you to read about what’s been going on, myself and Peachy brought back “The Diabetes Dugout Podcast” following a period of 622 days since our last episode! We’ve made a few changes behind the scenes to help us with virtual content and we’re now in a place to bring back the pod on a more regular basis! So, if you enjoy listening to me and peachy talk to guests and discuss Football and Diabetes, get ready for more episodes in 2024! We’d also really appreciate you getting in touch to let us know who you’d like us to speak to and what topics you’d like us to discuss. All feedback is useful!

With all that being said, here is the podcast episode summarising 2023 below but to give you an idea of what we discussed, and in what order, here’s a few bullet points around the structure of our conversation, to help you with where you might want to tune in or pay particular attention to!

  • Our first Family day and Adult session.
  • Our first ever Women’s Team fixture.
  • DiaEuro 2023 in Poland. The Men’s team headed off to the European Futsal Championships for People with Diabetes again.
  • Our Diabetes Awareness Event in Essex. 
  • Our new merchandise with Harlequin Teamwear.
  • Our New director joining the organisation – Rhian Holland
  • The plans for 2024.

CLICK THIS LINK TO WATCH ON YOUTUBE.

We hope it’s an enjoyable listen and watch, and as always thank you for the continued support for everything we do. We couldn’t do it without the community backing our work!

And lastly, I just wanted to wish you all a happy end to 2023 wherever you are and a happy Christmas to all those celebrating!

See you in 2024.

Chris

 

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.

 

The 2022 Review – What’s been going on at TDFC?

Posted on by thediabetesfootballcommunity in Uncategorized

It’s been a little while since I’ve found the time to sit and reflect on all things TDFC but the end of a calendar year always presents me with that opportunity… But as we do in every year since our existence, we’ve tried our best in 2022 to provide a project that is progressive and a reflection of what the diabetes community want. We’ve had some amazing things going on this year and I just want to say a massive thank you to those who help lead on everything at TDFC and to those who commit to what we do and make all of this possible! It continues to motivate me to keep pushing the boundaries and to strive for more for our community.

There have been some significant changes in my own circumstances which have meant this year we’ve also transitioned to a situation where I’ve been a little less hands on with the day to day running of our project due to my new full time role working at JDRF UK. The prospect of working for the charity has been an amazing chance for me to continue my development more widely and learn more about the UK and global context that exists surrounding type 1 diabetes. I’ve really enjoyed it and the impact my role in the organisation has on supporting the community… Here’s hoping for more of the same in 2023! Despite the change in my world, the support for what TDFC does has never been greater as so many people recognise the importance of our work and are really stepping up to help myself and the directors with continuing to push what we do onto the next level. Together we are stronger and so is TDFC.

With this review of our year, I obviously wanted to run through some of the key things which have been happening in 2022 but this time round I’m going to do it in alignment with our strategic pillars of Educational improvements and increasing participation opportunities for people with Diabetes in Football.

So firstly, a look back on the developments we’ve made in Education in 2022:

The continuation of our podcast has led to some incredible episodes on the channel as we saw Adam Smith and Reece Parkinson share their stories of living with type 1 and working in the media industry. Whilst we also added a chat with Joe Wright (Current Millwall FC Goalkeeper) as he discussed life with type 1 as a professional player… We also got Lucy Wieland on the podcast to talk about something else I’ll come onto in a little while… (Can’t give all the key details away in the first few paragraphs haha!). The Diabetes Dugout still remains a great source of stories, information and support from those in our community, so if you haven’t checked it out yet click here and you can listen to all of the episodes we’ve released so far.

Alongside those all-important lived experience stories we’ve shared, we’ve also been able to help create a structured education programme called Active Minds in partnership with our friends at AJB Sports in Education. The idea was to utilise physical activity to educate on the differences between type 1 and 2 diabetes, as well as to educate on lifestyle to prevent the development of type 2 diabetes. In my opinion, educating the next generation on the condition will in future reduce the level of misinformation, stigma and stereotypes which are prevalent in society surrounding Diabetes. It’s been something that I’ve experienced regularly since I was diagnosed in 1999 and it’s an area which I’m extremely passionate about tackling… Education will make this happen, but it takes time to implement and there has to be a “carrot” for the mainstream to engage them in the conversation of raising awareness and learning more about Diabetes. As numbers rise and people see the condition more regularly day to day, many more people are receptive to the idea that society at large needs to know more about this condition… I think there will be many more developments like this in years to come and I’m really glad we’ve been able to co-produce a series of lessons to support with this education… Make sure you head over to our page to check out the Active Minds programme.

This year also saw the development of a piece of work I’ve been trying to create for over 4 years… To see it land was a big moment and something which I hope will help so many people across our community in the years to come. I am of course talking about the Coaches Guideline & Webinar co-produced by ourselves, JDRF UK, Diabetes UK and The Football Association of Wales (FAW). I’ve always felt that the organisers & coaches of our sport, haven’t had the support to help them with creating an environment and support system around a type 1 player as the condition hasn’t been well understood. So, to now have a guideline which coaches can utilise to help with the foundations of what a player with Diabetes goes through can only be a huge step forward. To have this supported by the 2 big patient charities and the FAW is also vital in seeing this rolled out more widely to the sporting community. More awareness and education for physical activity providers can only help with participation and the feeling of comfort in a sporting environment for those with the condition… A massive moment and if you haven’t seen these resources yet click here and take a look!

Then we’ve also seen the foundations laid for the inclusion of Peer Support as part of the recognised treatment pathway for those living with Type 1 Diabetes within the NHS in England… A monumental step in chronic health support and a move that we at TDFC have been championing for a long while. I was invited to be involved in the group of people who have helped shape the principles of Peer Support in conjunction with the NHS England team and the patient charities (Diabetes UK & JDRF UK). The process of shaping “what good looks like” collaboratively has taken just over a year and it’s been brilliant to see the release of those principles on World Diabetes Day… As someone who’s personally seen the impact of peer support changing my own life, and others through our work, this is a HUGE moment. It’s been my belief for the last few years that good peer support deserves its place within the healthcare structure for the contribution it can make to health outcomes for those with type 1 diabetes. I’m now excited to see where these principles will take us as we now focus on the delivery and growth of peer support… Keep your eyes peeled for more from the NHS Diabetes Programme and if you haven’t checked out the principles yet take a look here

To build on this further, the research conducted into the development and creation of The Diabetes Football Community will be included within an academic publication for the first time in the early part of 2023. This was always a huge goal of mine following the conclusion of my masters degree programme in 2020. I wanted to ensure the lessons I’d learned from developing our project could go onto help us and others in continuing to develop projects/communities/groups which are reflective of how society and a sub-cultures like sport (football in this case!) operate. I feel the key to creating positives connections to the condition lies in the link to the areas of interest we have within our lives, to positively re-frame some of the identification with the condition. By doing this, identification with the condition may grow and healthcare outcomes improved as a result… It’s a topic of conversation I’m hoping the research opens up further, as we look to see how we can supplement the development of diabetes technological advancements, with further understanding upon the impact that society & culture has on those living with the condition. I’m sure there will be lots more to come in this area, and if you’d like to see the book where the research will be published, please click here whilst you can also check out the blog post I wrote on the research here . A big shout out to Professor Gyozo Molnar who has played a huge role in guiding all of the work on this research!

So, from an education perspective this year we’ve been pretty busy… But we weren’t done there! Our participation work has also been progressing…

Participation:

Because for the first time since we were created in 2017, we’ve been able to host an all-women’s training day, in the same year that the England National Women’s team won the European championships! 2022 has been a huge year for us and for Women’s football in the UK. In making this team we’ve also been able to link in with the incredible HerGameToo campaign to help us champion women’s participation in our sport. It was brilliant to welcome Caz May, one of the founders to a session to meet the team, as they continue to provide support for what we do. A huge thank you for the donations you’ve provided, which have helped us in developing the sessions and funding our first kit! As you’ll see from the images, alongside our new women’s kit, we’ve got an updated Men’s kit supported by Air Liquide, which we hope, will be worn at DiaEuro 2023 (The European Futsal Championships for people with Diabetes)… It’s looking likely that this will take place in Poland in June and we’re busy planning behind the scenes to try and get a UK team back in the tournament for the first time in 4 years! I also want to shout out our friends in Ukraine, who hosted us and the tournament in 2019, who have been going through an unthinkable year with the Russian invasion of their nation. My thoughts are with you all!

Whilst our teams are a great opportunity to represent country and condition, they’re also an incredible opportunity to raise awareness of type 1 diabetes more widely in society… We take that on as one of the primary objectives of the team, alongside the support it offers the players, so to have BBC MOTDX attend a session to showcase T1D in Football was incredible! If you haven’t seen the feature yet, please do check it out here , in what was a great day for our men’s and women’s team. Awareness in mainstream TV makes a big difference to us all when it’s accurately portrayed, and with having Reece involved it gave Football a real insight into what our lives look like when tackling the sport whilst living with T1D.

 

 

 

 

 

 

 

 

The magic of what makes our community great has also been recognised in 2022 with our TDFC London team awarded with a QIC (quality in care) award for all of their amazing work across this year. It’s thoroughly deserved, and the team continues to go from strength to strength as they grow their numbers and look to win another league title in 2022, after winning one of the London Futsal League North iterations previously! They’re a brilliant group and I’d urge anyone in the south east/London to get in contact with them to find out more about what they’re up to…

Not only do these teams serve a purpose on the court but away from it as well… Because most of the players within them have originally come through one of our peer support WhatsApp groups to help continue the discussions and support in football surrounding T1D after the full-time whistle sounds too… We now have a WhatsApp group for men, women and we’ve recently introduced one for parents of children living with Diabetes. As with the men’s and women’s groups, we now hope we can take the support online into a physical session and team in the future for kids with type 1. We’ve had discussions about this within the group and keep a look out on our social media for any developments coming in 2023… We’re excited about this!

Sooooo, what a year it’s been! We’ve faced changes, we’ve adapted, and we’ve grown. Our community is special. It’s coming up to 6 years since TDFC started and as the community’s founder it always amazes me what we’re able to achieve collectively… It’s an honour to still be doing this and while the need is still there for us, I’ll be there helping to push what we do forward…

Thank you so much for taking the time to read my musings and for all of the support this year, I hope you’ve enjoyed a great festive period with families and friends, and I wish you an amazing 2023…

We will be there with you, when you need us…

Happy New Year!

Chris Bright

Founder of The Diabetes Football Community

 

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.

Insulin dosing strategies before Football

Posted on by thediabetesfootballcommunity in Uncategorized

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 minutes

Introduction

The objective of adjusting insulin doses before exercise is to prevent hypoglycaemia during a match whilst minimising hyperglycaemia during the run up to kick off. Important factors to consider are the insulin dose, where insulin is administered, the blood glucose level before exercise, the type, amount, and timing of the last meal or snack eaten, the intensity and duration of the match (difficult opposition? Will you play a full 90 minutes?), as well as recent hypos1.

What is the best blood glucose level to have during football?

Blood glucose levels are individual; some people feel (and perform) worse with higher glucose levels before exercise, whereas others don’t. The consensus amongst the medical research community is that a reasonable starting range for most footballers would be between 5-10 mmol/L depending on whether blood glucose levels usually decrease, stay stable, or increase as well as the expected difficulty of the match and the likely duration of play (are you a super-sub?). This range generally balances performance considerations against the risk of hypoglycaemia, although achieving and maintaining glucose levels in this range can be very challenging.  If starting exercise below 5 mmol/L it is recommended that you eat 10-20 grams of glucose beforehand and delay (if possible) the start of exercise until glucose levels are more than 5 mmol/L. If glucose levels are between 5-10 mmol/L then most people will be ok to start playing football, although some people may see a rise in glucose levels during the match. If glucose levels are above target (10-15 mmol/L) most people will expect a further rise in glucose during a game. Importantly, if glucose levels are above 15 mmol/L it is recommended to check blood ketone levels; if ketones are elevated up to 1.4 mmol/L then a small correction dose might be needed; if ketones are elevated over 1.4 mmol/L then exercise should be suspended and glucose management should be initiated rapidly.

What should I do if I struggle to avoid a hypo during a game?

People who tend to develop hypoglycaemia during exercise will usually turn to eating carbohydrates as a technique to avoid it. There is an issue with this, however. Firstly, if you find yourself eating lots of carbohydrate to prevent glucose lows the extra calories eaten might contribute to unwanted weight gain in the long-term. Secondly, eating carbohydrates does not necessarily tackle the underlying cause of a hypo.

The reason for the fall in glucose during exercise is at least partly due to high insulin levels. Whereas insulin levels fall in people without type 1 diabetes (in order to preserve blood glucose), in people with type 1 diabetes insulin levels are the result of the previously administered insulin dose or the rate of insulin being infused by an insulin pump. Irrespective of the method of insulin delivery, once insulin is in the body, it is unregulated and does not decrease in response to exercise; this results in excessive glucose removal from the blood. Even if individuals with insulin pumps half their basal insulin rates up to an hour before exercise, circulating insulin in the body does not decrease sufficiently before the start of exercise. Moreover, insulin levels tend to increase during exercise even when insulin pump rates are reduced because of changes in blood flow2. Although aggressively lowering insulin levels through reducing insulin administration or skipping an insulin dose can prevent hypoglycaemia during exercise3,4, this often causes hyperglycaemia and raises ketone levels before and during exercise5. For people using insulin pumps, a basal rate reduction, rather than a suspension can be attempted 60-90 minutes before the start of a game. An 80% basal reduction at the onset of exercise helps to mitigate hyperglycaemia after exercise more effectively than basal insulin suspension and appears to reduce the risk of hypoglycaemia both during and after the activity. For individuals treated with insulin pens, mealtime insulin dose can be reduced by about 50% when taken with a carbohydrate-based meal around 1 hour before the start of a game3. However, it must be stressed that people respond very differently to any strategy and there is no one-size fits all approach.

What should I do if struggle to avoid hyperglycaemia during a game?

High blood glucose levels can raise ketone levels, increases the perception of effort, and reduces performance. As discussed elsewhere, carbohydrate intake before a game is important for both performance and managing the risk of hypoglycaemia. If hyperglycaemia is an issue prior to a match, try eating earlier in the day and maintaining a normal mealtime insulin dose; most mealtime insulins peak in strength by 2-3 hours meaning that a normal insulin dose can be administered with an earlier meal and taking a small snack before exercise omitting insulin – this may reduce the risk of starting exercise with high glucose levels whilst ensuring adequate carbohydrate availability and lowered insulin levels for the game. If hyperglycaemia is a continual issue, starting glucose management preparations earlier in the day gives a longer window to achieve glucose targets. Unless glucose levels are above 10 mmol/L it is not recommended to take a correction dose of insulin because of the increased risk in developing hypoglycaemia.

If you are interested in learning how to tailor strategies like the ones presented to your own individual requirements, contact Matthew at: matt@t1dcoaching.co.uk

References

  1. Bally L, Laimer M, Stettler C. Exercise-associated glucose metabolism in individuals with type 1 diabetes mellitus. Current opinion in clinical nutrition & metabolic care. 2015;18(4):428-433.
  2. McAuley SA, Horsburgh JC, Ward GM, et al. Insulin pump basal adjustment for exercise in type 1 diabetes: a randomised crossover study. Diabetologia. 2016;59(8):1636-1644.
  3. West DJ, Morton RD, Bain SC, Stephens JW, Bracken RM. Blood glucose responses to reductions in pre-exercise rapid-acting insulin for 24 h after running in individuals with type 1 diabetes. Journal of sports sciences. 2010;28(7):781-788.
  4. 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. 2013;36(8):2217-2224.
  5. Berger M, Berchtold P, Cüppers H, et al. Metabolic and hormonal effects of muscular exercise in juvenile type diabetics. Diabetologia. 1977;13(4):355-365.

 

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.

Award Winning TDFC London: The Power of Peer Support

Posted on by thediabetesfootballcommunity in Uncategorized

TDFC London – Quality In Care Diabetes Award Winners 2022. I can’t quite believe it. It’s been a huge team effort and after a few weeks to let it settle in, I thought I’d share mine and the team’s journey.

I was diagnosed with type 1 diabetes over ten years ago, and needless to say it was quite a shock! There was so much to get my head around, but one of my biggest concerns was being able to get back playing football. I went years before meeting a fellow type 1 and it took a long time to work out how to manage the condition while playing sport.

And then there was a breakthrough moment. I came across a fledgling initiative called The Diabetes Football Community (TDFC). I signed up to one of their first ever meet-ups, and what a journey it’s been since.

Suddenly I was playing competitive matches against other people with type 1 diabetes. In between games, team members exchanged insights about new glucose tracking technologies, different methods of delivering insulin and practical tips on managing diabetes whilst playing football. After just one match I picked up so much useful advice and diabetes life-hacks that I wouldn’t have known otherwise.

At DiaEuro 2018 we realised that there was the enough players to potentially set a team based in London and if we did so we’d be the first ever all-type 1 diabetes team to compete in a mainstream league. Hence TDFC London was formed, with the aim of providing open and inclusive football-based meet-ups for people with type 1 diabetes, and to help show that the diagnosis doesn’t need to be a barrier to participation. This diverse group celebrates each individual as their own entity. We’ve helped each other gain access to diabetes technology and referred individuals to health services they were unaware of prior to joining.

COVID-19 put a long pause on the group meeting up, but the peer support element of the project really kicked in, with teammates all sharing support and guidance in dealing with the dreaded ‘COVID-type 1 combo’ via WhatsApp. Post-pandemic, we came back even stronger, going on a winning streak to eventually fulfil our goal of becoming champions of the North London Futsal League 🏆

https://twitter.com/TDFCLondon/status/1482765960637468674?s=20&t=MfnsfwlVLra3I1_4tKtDwQ

 

I work at the Royal College for Paediatrics and Child Health alongside a great team as part of the National Diabetes Quality Programme. We see first-hand the issues around drop-out rates when transitioning from paediatric to adult services. I’m convinced that projects like TDFC can directly support diabetes services in enabling self-management and help to signpost people back into diabetes services to ensure things like technology access.

My teammate Muhammed Ismail has been an amazing ambassador for the project and secretly submitted our team’s concept and achievement for this year’s Quality in Care Diabetes Awards. To our amazement, we won the Unsung Heroes award! The judges commented:

“TDFC London was an inspirational, heart-warming and feel-good entry that has offered support to a group of young Type 1s. This could be replicated nationwide. It is a great example of peer support, ingenious and particularly focusses on young men – a notoriously difficult group to connect with and an often-overlooked group.”

 

 Much like my glucose levels, there’s been lots of ups and downs over the years since being diagnosed. However, I’m very grateful to have stumbled across TDFC and my experience with this group has been a standout highlight.

Peer support is a powerful tool for empowering those with long-term conditions. Sport is a powerful vehicle for bringing people together. Combining the two has so much potential!

 Bryn White

TDFC London Manager

Diagnosed at 34 and trying to adapt to Football again…

Posted on by thediabetesfootballcommunity in Uncategorized

It’s been a little while since we shared a blog on the website, so we thought it was a great opportunity to share the story of one of our newest members to the community… Thank you Tom for sharing what you went through upon diagnosis and we hope that your story will provide comfort and support to those who may face this in the future… No more words from us, over to you Tom to talk us through what happened.

“Football was the first sign

The last game of the 2021/2022 season was a mid-week evening fixture on the 20th April, away in a small village outside of Lincoln. A very scratchy 11 players were put together with a couple of late stragglers turning up to fill the subs bench after work and family commitments… Sunday league football in England at it’s finest. Playing at centre half, the dream of being a marauding midfielder has long been forgotten since turning 30! After around 70 minutes something happened which I had never experienced in my whole-time playing football, as I had excruciating pain in both of my calves as they cramped up. At the time, through lack of awareness and a large chunk of denial about my own health, I convinced myself that age had finally caught up with me and I wasn’t as fit as I once was! I struggled on for 10 more minutes before giving up and giving the gaffer the dreaded arm roll signal above the head to indicate I needed to come off. To add to the dismay of being subbed off, we managed to throw away a two-goal lead and concede two late goals to draw the game and consign ourselves to rock bottom of the 1st division after a long tough season! Unfortunately, our collective lack of footballing ability wasn’t the only thing to become apparent after this game.

Diagnosis

My ‘diaversary’, as I have often affectionately seen it referred to on social media, is 18th May 2022. The usual sore muscles and cramping up in the night after a football game occurred, which I attributed to dehydration from the game that evening. I also attributed my constant thirst and then spending most of the night getting up to go to the toilet to this! I felt could explain all these things with a plausible causality to feelings after a tough game so thought nothing more of it. I carried on my usual daily routine after this, a little bit tired and run down, still thirsty and still weeing a lot! I was a teacher, and we were coming to the end of a school year, and I told myself I must be ready for a break and ploughed on through, although the symptoms never went away. I always tell people never to google your symptoms, but you never follow your own advice and one word kept coming up whenever I put them into the NHS website……. DIABETES. I was 34, fit, healthy, a good weight, no family history anywhere of Diabetes, I was sure it wouldn’t be that. I couldn’t deny that I wasn’t well for much longer and finally succumbed to pressure from my partner to book a doctor’s appointment. Casually dropping off a urine sample and having some bloods taken at the doctors before setting off on my way to work. I received a phone call about an hour later containing lots of words such as: ‘DKA’, ‘Diabetes’ and ‘A&E’. Within an hour I was sat in A&E on a drip with more bloods being taken, more meetings with doctors and no more idea what was going on! A very long and scary night at home alone followed this and a phone call from the doctor in the morning confirming Diabetes and directing me straight to Clinic 1 at the hospital. I was greeted by Diabetes Specialist Nurse and walked out an hour later with a blood glucose monitor, 2 pens of insulin and a lot of leaflets. I had never felt more overwhelmed in my life!

Getting back to football

I am never ashamed to admit I cried for most of that evening. The gravity of what a lifetime of diabetes means really is something which is quite incomprehensible at times. I was convinced footballing life was over and I was going to be confined to a life of golf! I had no idea how playing sport whilst managing diabetes worked and it was one of my first questions in my follow-up with my diabetes nurse the next week. As always seems to be the way with diabetes, it could not have been anymore inconvenient, with a house move and job move all scheduled for June! It did however afford me a summer break to get my head around living with diabetes and my body’s responses to exercise. My first experience of getting back into sport was an attempted cricket game in early June. As could be expected this went terribly and after having a very sweaty, dizzy and shaky moment whilst batting, I spent most of our turn to field eating a banana and various sweets from my pocket – there was a lot to learn! I was luckily given a libre 2 sensor around 3 weeks after diagnosis and this made the start of preseason in late June a lot more successful. I’m sure I did over 30 scans in my first session! I turned up armed with chocolate bars for some sugar beforehand, enough Haribo for a kid’s party and more water than any one person would ever need. At any opportunity I would nip off to tap my arm with my phone and check my levels. After a 90-minute session with some highs and lows it was overall a positive result. Maybe this wasn’t the end of the road for me after all! I managed to negotiate most of pre-season training and matches without too many wobbles, although the heat nearly did me a couple of times if it wasn’t the diabetes. However, after every session, there was always advice and support to fall back on from the TDFC community if things had gone wrong with people always happy to answer any questions or offer advice.

TDFC

I stumbled across Chris whilst searching out other people with Diabetes on twitter, looking for insight, inspiration, advice and general empathy from people going through something similar to me. I found the TDFC twitter page and dropped it a message before carrying on my mindless scrolling and forgetting all about it. The next day I got a reply from Chris and before long he had introduced me to the TDFC community and added me to the WhatsApp group. To find a place where people had experienced the same thing or going through similar situations was a comfort and motivator. Being able to ask questions and get answers from people all over the country and beyond was brilliant. Not just on football topics but every life experience with diabetes you can think of! I am yet to make a TDFC training session and join in a kick about but look forward to hopefully making one and sharing synchronised glucose checking and hypo snacks!

From speaking to others about diabetes I realise that it is a marathon not a sprint and no one ever truly masters it. You are thrown in at the deep end on day one and must quickly adapt to the basics but with the pace at which things are moving with diabetes and technology there is so much more to learn. I recently listened to a discussion on Twitter speaking about exercise and my mind was blown listening to people talk about open and closed loop systems, basal rates, adjustments and insulin sensitivity. I’m sure it will all make sense to me one day and I am not the only newly diagnosed diabetic trying to make sense of it all.

Today

Game one of the season has just gone without a hitch (a boring 0-0 draw) and 90 minutes at centre half was successfully negotiated. This is thanks to some of the advice and routines I have put in place with advice from the TDFC group chat and the post which Chris had done on the TDFC website which helped a lot. I’ve managed to keep my sensor on which I thought would never happen and have had great support from my teammates! I’m hoping I have a few years left in me yet……”

 

Thank you for sharing your story so openly Tom and If you’ve enjoyed reading this blog and want to share your own story with us please do get in contact with us…