National athletic trainers' association position statement: Management of the athlete with type 1 diabetes mellitus

Journal of Athletic Training

Volumn 42, Issue 4, 2007, Pages 536-545

  Jimenez, Carolyn C ^a,h   Corcoran, Matthew H ^b   Crawley, James T ^c   Hornsby Jr , W Guyton ^d   Peer, Kimberly S ^e   Philbin, Rick D ^f   Riddell, Michael C ^g  

^a WEST CHESTER UNIVERSITY   (United States)

^b LEHIGH VALLEY HOSPITAL   (United States)

^c Dominican College   (United States)

^d WEST VIRGINIA UNIVERSITY   (United States)

^e KENT STATE UNIVERSITY   (United States)

^f Animas Corp   (United States)

^g YORK UNIVERSITY   (Canada)

^h National Athletic Trainers' Association   (United States)

Author keywords

Hyperglycemia; Hypoglycemia; Insulin replacement therapy

Indexed keywords

CATECHOLAMINE DERIVATIVE; GLUCAGON; GLUCOSE; HEMOGLOBIN A1C; INSULIN; INSULIN ASPART; INSULIN GLULISINE; INSULIN LISPRO; LIPID;

ARTERY DISEASE; ATHLETE; AUTONOMIC NEUROPATHY; BLOOD GLUCOSE MONITORING; BLOOD PRESSURE; DRUG ABSORPTION; GLUCOSE BLOOD LEVEL; GLYCEMIC CONTROL; HEART INFARCTION; HUMAN; HYPERGLYCEMIA; HYPOGLYCEMIA; INSULIN DEPENDENT DIABETES MELLITUS; KETOACIDOSIS; LIPID BLOOD LEVEL; PERIPHERAL NEUROPATHY; PHYSICAL ACTIVITY; PHYSICAL EXAMINATION; PRACTICE GUIDELINE; REVIEW; STROKE; WELLBEING;

DIABETES MELLITUS, TYPE 1; EXERTION; FACULTY; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; HYPOGLYCEMIA; PHYSICAL EDUCATION AND TRAINING; PROFESSIONAL COMPETENCE; SOCIETIES, MEDICAL; SPORTS; SPORTS MEDICINE; TOTAL QUALITY MANAGEMENT; UNITED STATES;

EID: 40749086403     PISSN: 10626050     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (91)

1. Wasserman DH, Davis SN, Zinman B. Fuel metabolism during exercise in health and diabetes. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002:63-100.
2. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.
3. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.
4. Ludvigsson J, Nordfeldt S. Hypoglycaemia during intensified insulin therapy of children and adolescents. J Pediatr Endocrinol Metab. 1998;11(suppl 1):159-166.
5. The Diabetes Control and Complications Trial Research Group. Hypoglycemia in the Diabetes Control and Complications Trial. Diabetes. 1997;46:271-286.
6. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:1433-1438.
7. Albright A, Franz M, Hornsby G, et al. American College of Sports Medicine position stand: exercise and type 2 diabetes. Med Sci Sports Exerc. 2000;32:1345-1360.
8. American College of Sports Medicine and American Diabetes Association joint position statement: diabetes mellitus and exercise. Med Sci Sports Exerc. 1997;29:i-iv.
9. Molitch ME, DeFronzo RA, Franz MJ, et al. Nephropathy in diabetes. Diabetes Care. 2004;27(suppl 1):S79-S83.
10. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28:956-962.
11. Fong DS, Aiello L, Gardner TW, et al. Retinopathy in diabetes. Diabetes Care. 2004;27(suppl 1):S84-S87.
12. Berger M. Adjustments of insulin and oral agent therapy. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002:365-376.
13. Schiffrin A, Parikh S. Accommodating planned exercise in type I diabetic patients on intensive treatment. Diabetes Care. 1985;8:337-342.
14. Schiffrin A, Parikh S, Marliss EB, Desrosiers MM. Metabolic response to fasting exercise in adolescent insulin-dependent diabetic subjects treated with continuous subcutaneous insulin infusion and intensive conventional therapy. Diabetes Care. 1984;7:255-260.
15. Riddell MC, Perkins BA. Type 1 diabetes and exercise, part I: applications of exercise physiology to patient management during vigorous activity. Can J Diabetes. 2006;30:63-71.
16. Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH. Physical activity/exercise and diabetes. Diabetes Care. 2004;27(suppl 1):S58-S62.
17. Wright DA, Sherman WM, Dernbach AR. Carbohydrate feedings before, during, or in combination improve cycling endurance performance. J Appl Physiol. 1991;71:1082-1088.
18. Kalergis M, Schiffrin A, Gougeon R, Jones PJ, Yale JF. Impact of bedtime snack composition on prevention of nocturnal hypoglycemia in adults with type 1 diabetes undergoing intensive insulin management using lispro insulin before meals: a randomized, placebo-controlled, crossover trial. Diabetes Care. 2003;26(1):9-15.
19. Zinman B. Insulin pump with continuous subcutaneous insulin infusion and exercise in patients with type 1 diabetes. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002:377-381.
20. Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabetes. 1997;46:440-443.
21. Francescato MP, Geat M, Fusi S, Stupar G, Noacco C, Cattin L. Carbohydrate requirement and insulin concentration during moderate exercise in type 1 diabetic patients. Metabolism. 2004;53:1126-1130.
22. Franz MJ. Nutrition, physical activity, and diabetes. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002:321-338.
23. Wasserman DH, Zinman B. Exercise in individuals with IDDM. Diabetes Care. 1994;17:924-937.
24. Franz MJ, Bantle JP, Beebe CA, et al. Nutrition principles and recommendations in diabetes. Diabetes Care. 2004;27(suppl 1):S36-S46.
25. Brubaker PL. Adventure travel and type 1 diabetes: the complicating effects of high altitude. Diabetes Care. 2005;28:2563-2572.
26. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26:1902-1912.
27. Bolli GB. How to ameliorate the problem of hypoglycemia in intensive as well as nonintensive treatment of type 1 diabetes. Diabetes Care. 1999;22(suppl 2):B43-B52.
28. American Diabetes Association. Preventing and treating severe hypoglycemia. Available at: http://www.diabetes.org/preventing.jsp. Accessed September 10, 2007.
29. American Diabetes Association. Hypoglycemia. Available at: http://www.diabetes.org/type-1-diabetes/hypoglycemia.jsp. Accessed September 10, 2007.
30. Perkins BA, Riddell MC. Type I diabetes and exercise: using the insulin pump to maximum advantage. Can J Diabetes. 2006;30:72-79.
31. Berger M, Cuppers HJ, Hegner H, Jorgens V, Berchtold P. Absorption kinetics and biologic effects of subcutaneously injected insulin preparations. Diabetes Care. 1982;5:77-91.
32. Gossain VV. Insulin analogs and intensive insulin therapy in type 1 diabetes. Int J Diab Dev Ctries. 2003;23:26-36.
33. U.S. Department of Homeland Security Transportation Security Administration. Hidden disabilities: travelers with disabilities and medical conditions. Available at: http://www.tsa.gov/travelers/airtravel/specialneeds/ editorial_1347.shtm. Accessed September 10, 2007.
34. Gavin JR, Alberti KGMM, Davidson MB, et al. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20(7):1183-1197.
35. American Diabetes Association. All about diabetes. Available at: http://www.diabetes.org/about-diabetes.jsp. Accessed September 10, 2007.
36. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003. Available at: http://www.cdc.gov/diabetes/pubs/factsheet.htm. Accessed September 10, 2007.
37. American Diabetes Association. Medical Management of Insulin-Dependent (Type I) Diabetes. 2nd ed. Alexandria, VA: American Diabetes Association; 1994.
38. Siminerio LM, Koerbel G. A diabetes education program for school personnel. Practical Diabetes Int. 2000;17:174-177.
39. Khan MA, Longley J. Psychosocial aspects of diabetes: the diabetologists' perspective. Semin Clin Neuropsychiatry. 1997;2:94-98.
40. American Diabetes Association. Care of children with diabetes in the school and day care setting. Diabetes Care. 1999;22:163-166.
41. Jimenez CC. Diabetes and exercise: the role of the athletic trainer. J Athl Train. 1997;32:339-343.
42. Stoller WA. Individualizing insulin management: three practical cases, rules for regimen adjustment. Postgrad Med. 2002;111: 51-54,59,60,63-66.
43. Brink SJ. How to apply the experience from the diabetes control and complications trial to children and adolescents? Ann Med. 1997;29:425-438.
44. The Diabetes Control and Complications Trial Research Group. Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial. Diabetes Care. 2001;24:1711-1721.
45. Kollipara S, Warren-Boulton E. Diabetes and physical activity in school. School Nurse News. 2004;21:12-16.
46. Katz G, Strain GW, Rodriguez M, Roman SH. Influence of an interdisciplinary diabetes specialist team on short-term outcomes of diabetes at a community health center. Endocr Pract. 1998;4:27-31.
47. Kanner S, Hamrin V, Grey M. Depression in adolescents with diabetes. J Child Adolesc Psychiatr Nurs. 2003;16:15-24.
48. Draznin MB. Type 1 diabetes and sports participation: strategies for training and competing safely. Physician Sportsmed. 2000;28(12):49-56.
49. Hopkins D. Exercise-induced and other daytime hypoglycemic events in patients with diabetes: prevention and treatment. Diabetes Res Clin Pract. 2004;65(suppl 1):S35-S39.
50. O'Connor DP. Clinical Pathology for Athletic Trainers: Recognizing Systemic Disease. Thorofare, NJ: Slack Inc; 2001.
51. Ciccone CD. Pharmacology in Rehabilitation. 2nd ed. Philadelphia, PA: FA Davis; 1996.
52. Skinner JS. Exercise Testing and Exercise Prescription for Special Cases: Theoretical Basis and Clinical Application. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
53. Schneider SH, Shindler D. Application of the American Diabetes Association's guidelines for the evaluation of the diabetic patient before recommending and exercise program. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002:253-268.
54. Nathan DM, Singer DE, Hurxthal K, Goodson JD. The clinical information value of the glycosylated hemoglobin assay. N Engl J Med. 1984;310:341-346.
55. American Diabetes Association. Standards of medical care in diabetes, 2006. Diabetes Care. 2006;29(suppl 1):S4-S42.
56. Lebovitz HE, Austin MM, Blonde L, et al. ACE/AACE consensus conference on the implementation of outpatient management of diabetes mellitus: consensus conference recommendations. Endocr Pract. 2006;12(suppl 1):6-12.
57. Aiello LP, Wong J, Cavallerano JD, Bursell S. Retinopathy. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002:401-413.
58. Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005;28:164-176.
59. Waxman S, Nest RW. Cardiovascular complications. In: Ruderman N, Devlin JT, Schneider SH, Kriska A, eds. Handbook of Exercise in Diabetes. Alexandra, VA: American Diabetes Association; 2002:415-432.
60. Heinemann L. Variability of insulin absorption and insulin action. Diabetes Technol Ther. 2002;4:673-682.
61. Koda-Kimble MA, Carlisle BA. Diabetes mellitus. In: Koda-Kimble MA, Young LY, eds. Applied Therapeutics: The Clinical Use of Drugs. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:48-51.
62. Roy B, Chou MC, Field JB. Time-action characteristics of regular and NPH insulin in insulin-treated diabetics. J Clin Endocrinol Metab. 1980;50:475-479.
63. Frohnauer MK, Woodworth JR, Anderson JH. Graphical human insulin time-activity profiles using standardized definitions. Diabetes Technol Ther. 2001;3:419-429.
64. Kang S, Brange J, Burch A, Volund A, Owens DR. Absorption kinetics and action profiles of subcutaneously administered insulin analogues S (AspB9GluB27, AspB10, AspB28) in healthy subjects. Diabetes Care. 1991;14:1057-1065.
65. American Diabetes Association. Insulin administration. Diabetes Care. 2004;27(suppl 1):S106-S107.
66. Binder C, Brange J. Insulin chemistry and pharmacokinetics. In: Porte D, Sherwin RS, eds. Ellenberg and Rifkin's Diabetes Mellitus. Stamford, CT: Appleton and Lange; 1997:689.
67. ter Braak EW, Woodworth JR, Bianchi R, et al. Injection site effects on the pharmacokinetics and glucodynamics of insulin lispro and regular insulin. Diabetes Care. 1996;19:1437-1440.
68. Camacho RC, Galassetti P, Davis SN, Wasserman DH. Glucoregulation during and after exercise in health and insulin-dependent diabetes. Exerc Sport Sci Rev. 2005;33:17-23.
69. Zinman B, Murray FT, Vranic M, et al. Glucoregulation during moderate exercise in insulin treated diabetics. J Clin Endocrinol Metab. 1977;45:641-652.
70. Riddell MC, Bar-Or O, Ayub BV, Calvert RE, Heigenhauser GJ. Glucose ingestion matched with total carbohydrate utilization attenuates hypoglycemia during exercise in adolescents with IDDM. Int J Sport Nutr. 1999;9:24-34.
71. MacDonald MJ. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care. 1987;10:584-588.
72. McAulay V, Deary IJ, Frier BM. Symptoms of hypoglycaemia in people with diabetes. Diabet Med. 2001;18:690-705.
73. 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.
74. Mitchell TH, Abraham G, Schiffrin A, Leiter LA, Marliss EB. Hyperglycemia after intense exercise in IDDM subjects during continuous subcutaneous insulin infusion. Diabetes Care. 1988;11:311-317.
75. Hargreaves M, Angus D, Howlett K, Conus NM, Febbraio M. Effect of heat stress on glucose kinetics during exercise. J Appl Physiol. 1996;81:1594-1597.
76. Cox DJ, Kovatchev BP, Gonder-Frederick LA, et al. Relationships between hyperglycemia and cognitive performance among adults with type 1 and type 2 diabetes. Diabetes Care. 2005;28:71-77.
77. Hornsby WG Jr, Chetlin RD. Management of competitive athletes with diabetes. Diabetes Spectr. 2005;18:102-107.
78. American Diabetes Association. Traveling with diabetes supplies. Available at: http://www.diabetes.org/advocacy-and-legalresources/ discrimination/public_accommodation/travel.jsp. Accessed September 10, 2007.
79. Dewey CM, Riley WJ. Have diabetes, will travel. Postgrad Med. 1999;105: 111-113,117,118,124-216.
80. Bia FJ, Barry M. Special health considerations for travelers. Med Clin North Am. 1992;76:1295-1312.
81. White CB, Turner NS, Lee GC, Haidukewych GJ. Open ankle fractures in patients with diabetes mellitus. Clin Orthop Relat Res. 2003;414:37-44.
82. Jani MM, Ricci WM, Borrelli J Jr, Barrett SE, Johnson JE. A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int. 2003;24:838-844.
83. Bibbo C, Lin SS, Beam HA, Behrens FF. Complications of ankle fractures in diabetic patients. Orthop Clin North Am. 2001;32:113-133.
84. Young ME. Malnutrition and wound healing. Heart Lung. 1988;17:60-67.
85. Hotter AN. Physiologic aspects and clinical implications of wound healing. Heart Lung. 1982;11:522-531.
86. Cooper DM. Optimizing wound healing: a practice within nursing's domain. Nurs Clin North Am. 1990;25:165-180.
87. Goodson WH III, Hunt TK. Wound healing in experimental diabetes mellitus: importance of early insulin therapy. Surg Forum. 1978;29:95-98.
88. Flynn JM, Rodriguez-del Rio F, Piza PA. Closed ankle fractures in the diabetic patient. Foot Ankle Int. 2000;21:311-319.
89. Bagdade JD, Walters E. Impaired granulocyte adherence in mildly diabetic patients: effects of tolazamide treatment. Diabetes. 1980;29:309-311.
90. Pierre EJ, Barrow RE, Hawkins HK, et al. Effects of insulin on wound healing. J Trauma. 1998;44:342-345.
91. Clement S, Braithwaite SS, Magee MF, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553-591.