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In Brief An effective management plan for an athlete with type 1 diabetes must consider the energy demands of intense competition and training, the athlete''s endurance sports that emphasize low body weight, such as distance running, or aesthetic sports, such as gymnastics, figure skating, cheering, and ballet.14,15 A study of weight control practices in type 1 diabetes reported unhealthy weight control in 37.9% of adolescent females and found that methods used included skipping insulin or taking less insulin in an effort to control body weight.16 The topic of eating disorders in adolescent girls and young women with type 1 diabetes has been explored in depth, and it is clear that the problem is fairly common and is associated with poor metabolic control.17 Anyone managing female athletes with diabetes, especially those involved in sports having a high prevalence of the female athlete triad, should be sensitive to prevention and early identification and treatment of this problem.
Omission of insulin is a common practice for athletes with diabetes who compete in sports having weight categories, such as wrestling, boxing, and weightlifting. Practices frequently used by athletes without diabetes to “make weight” include dehydration through perspiration, use of laxatives, diet pills, and diuretics, as well as vomiting.18 Even though the National Collegiate Athletic Association and most state high school leagues have implemented programs to reduce unhealthy weight loss in the sport of wrestling, the practice of significantly reducing weight before competition with subsequent weight gain after the event still persists.19 Athletes with diabetes quickly discover they can rapidly lose weight by withholding insulin until after weighing in. Metabolic control is obviously poor during the time that insulin is omitted, and there is always the serious risk of ketoacidosis. This is a difficult problem because the practice obviously works, and athletes with type 1 diabetes are often willing to take the associated risks.
Athletes with or without diabetes require adequate amounts of macronutrients to support their training and sustain performance during competition. A joint position statement issued by the the 1 last update 15 Jul 2020 ACSM, the American Dietetic Association, and the Dietitians of Canada summarized general nutrient requirements for competitive athletes.20 These included:Athletes with or without diabetes require adequate amounts of macronutrients to support their training and sustain performance during competition. A joint position statement issued by the ACSM, the American Dietetic Association, and the Dietitians of Canada summarized general nutrient requirements for competitive athletes.20 These included:
Carbohydrate consumption ranging from 6 to 10 g/kg of body weight/day to maintain blood glucose and replace muscle glycogen during activity. It was stated that a specified amount was dependent on the individual''s Guide to Diabetes and Exercise. Alexandria Va., American Diabetes Association,1995