Diabetes Care

In recent years, detailed guidelines were published by the American Diabetes Association (ADA), which included suggestions to manage diabetes for athletes. These comprised various position statements, technical reviews and consensus statements.

Recommendations for adolescents and children also covered a small portion of these documents. The objective of this research was to determine the influence of frequency and intensity of gymnastics in children with Type 1 Diabetes Mellitus (Gunasekera & Ambler, 2006). Children suffering from diabetes can manage their illness better by taking part in physical activities, but they need to work out at a certain level of intensity and frequency to reap the rewards of good health. Children have variable characteristics that would dictate the standards of nutritional care they receive. Hence, an activity will be programmed for the training level of the child. Eating specific sports nutrition can enhance an athlete’s performance during competitive events and practices (Boland et al.

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, 1999). This research will review two case studies; one to determine the impact of high intensity activities on T1DM management and the other to evaluate the impact of frequent exercises on T1DM. Furthermore, it will also illustrate the nutritional requirements to achieve an optimum physique, analysis of the physiological requirements for gymnastics, practical problems arising from interference with nutritional intake and training patterns of gymnasts (Zuppinger, 1990). Aims and Objectives The aim of this research is to determine the impact of frequency and intensity of exercise on children with Type 1 Diabetes Mellitus. The primary objectives of this research are to evaluate the following: Can intensive exercises manage illness for children suffering from Type 1 Diabetes Mellitus? Training patterns for the gymnastics. Nutritional strategies for gymnasts with this condition.

Practical issues which interfere with optimum eating practices. Hypotheses There are two hypotheses for this research paper. They are: H0- Increase in frequency and intensity of gymnastics (exercise) will help patients with T1DM disease to manage their illness. H1- Increase in frequency and intensity of gymnastics (exercise) will have no effect on patients with T1DM disease, who are trying to manage their illness. Methodology The methodology adopted to conduct this research document is to use credible secondary sources of information. Reasons for choosing Secondary Analysis This research makes use of over forty different secondary sources of information, which include books, journals, articles and official statistics.

The author of this document evaluated them in order to determine the impact of intensity and frequency of exercise on children with Type 1 Diabetes Mellitus. Hence, to achieve the objectives of this research, sources have been carefully selected to include evaluation studies, statistics and research publications. All of the secondary sources were assessed through available literature and the Internet. A number of documents were analysed before they were selected for this research. Advantages of Secondary Analysis This method of research provides researchers with a credible alternative to conducting primary research. Even though very few scholars and researchers explored the research topic of this document, there is still enough literature available to form a decisive hypothesis regarding the research topic.

The biggest advantage of using secondary sources of information is that the researchers are far more experienced than the author of this document. Furthermore, the selected studies were not limited by time or money constraints. Disadvantages of Secondary Analysis There are some disadvantages associated with using secondary research. The most notable one among them is the lack of familiarity of the researcher with the research topic. Primary research is a more impersonal method to conduct research.

Furthermore, secondary sources of information can be very complex and extensive. Hence, it is sometimes difficult to interpret the data available in these research papers and extract the relevant information. Training patterns for Gymnasts The significance of preparation and technical ability is very high in a gymnast’s training. The techniques of a gymnast are determined by the power, strength, flexibility and anaerobic capacity of an athlete. The training patterns of a gymnast take into account these factors and aim to enhance the capabilities of the athlete (Guelfi, Jones & Fournier, 2005). The most significant training pattern for a gymnast is power training, which enables him to apply maximal strength in the shortest duration.

This is a key measure of a gymnast’s performance. Power training involves completing traditional weight lifting activities as quickly as possible. Gymnasts also need strength to perform well. The muscles of torso and trunk help stabilize the pelvis, spine and shoulder girdle. This strength allows a gymnast to have a solid base and can move the limbs with control. Using simple equipment like the medicine ball and stability ball can enhance the strength of a gymnast (Porter et al.

, 1997). Another important training pattern for a gymnast is flexibility training. Flexibility is defined as the variety of motions performed about a joint during a passive movement. Flexibility plays a vital part in the movements of an athlete. Dynamic stretching can make an athlete more flexible.

Common stretching exercises include kicking an imaginary ball, twisting from side to side and holding ones’ leg while resting on a chair (Prasek et al. 1995). Analysis of the physiological requirements of competition Gymnasts are required to perform a lot of repetitive physical movements. These patterns are carefully built in the brain pathways of an athlete. A performance sequence by gymnasts can automatically become their habits.

Researchers have analysed that if gymnasts are performing well and constantly trying to improve their sequence, the neutral pathways in the brain recognize it as a positive habit (Huttunen et al., 1989). Scholars have introduced the concept of muscle memory for gymnasts. This concept states that the movements of the athlete should be so firmly locked into one’s mind that one should be able to perform them while concentrating on different things. Coaches use mirrors, videos and other visuals to enforce the muscle memory concept (Huttunen et al., 1989).

The psychological requirements for gymnasts are very intensive. Familiarity plays a crucial role in the mental upbringing of an athlete. They need to be trained from an early age by their instructors, who are aware of the implications of neural pathways habits. The choices of instructor, gym, training routine and nutrient strategies have a determining impact on the psyche of the athlete and ultimately on his or her performance. Gymnasts do not react too well to changes, as it would result in the need to develop a new habit (Ludvigsson, 1980). Analysis of Nutritional strategies The diet plan for young gymnasts should provide enough nutrients to aid the athletic performance and the normal adolescent growth.

The most important nutrients for gymnasts are proteins, carbohydrates, minerals, vitamins and liquids. A balanced diet plan that contains all these nutrients would result in an athletic and healthy physique in teenage gymnasts (Salvatoni et al., 2005).. Proteins This sport requires a lot of muscular strength, flexibility and power from an athlete who depends on an appropriate dietary protein.

In contrast to adult gymnasts, a young gymnast has a relatively higher requirement of protein intake. Researchers have concluded that a protein diet should contain between one and two grams of protein per kilogram of the athlete’s body weight. An average American diet meets this requirement. The most popular protein choices among athletes and their coaches are the low cholesterol and saturated fat products, such as white meat, egg whites, fish, lean meats, low-fat dairy products and beans (Salvatoni et al., 2005).

Carbohydrates The intake of carbohydrates for a gymnast or any athlete is important as it is the primary source of energy for the body. The need for young gymnasts to consume carbohydrates is even more imperative than for adult gymnasts as they are more active and are still physically growing. According to the research by the National Heart Lung Blood Institute (NHLBI), active teenage girls and boys should consume 24,00 and 3,000 calories respectively in a day, and carbohydrates should form about sixty per cent of these calories. Taking carbohydrates before starting an exercise would help gymnasts maintain good energy levels during their performance and taking carbohydrates after exercise would help them replete their energies (Salvatoni et al., 2005 & Larsson et al.

, 1999). Vitamins and Minerals All adolescents need vitamins and minerals to grow. However, there are certain vitamins and minerals that immensely benefit young gymnasts. Vitamin D and calcium are very important for bone mineralization. These can be found in dairy products.

Bone mineralization leads to stronger bones, which give gymnasts the required strength to reduce the risk of skeletal injury. Iron is another significant mineral that increases the performance of an athlete as it helps carrying oxygen to various body tissues during a workout. Furthermore, Vitamins B are essential for protein metabolism and energy production (Salvtoni et al., 2005 & (Levin et al. 2003). For a gymnast, it is vital to keep his or her body hydrated to achieve optimal performance.

Even though gymnasts are not required to perform in high temperatures, minimal sweating can result in fatigue and dehydration. Research shows that young gymnasts usually drink between nine to sixteen ounces of liquids before and after an event. Researchers have mentioned that gymnasts should drink about seven ounces of liquids every fifteen minutes during strenuous exercise. Athletes should also avoid liquids which cause dehydration, such as tea or coffee (Salvatoni et al., 2005).

Nutritional Strategies to Achieve Optimum Performance There are a number of factors that should be considered before choosing an activity for an athlete. Gymnasts would require a quick dissolving carbohydrate, such as candy or fruit juice (containing sugar), to be available to them during the exercise. Furthermore, they should also have access to slowly digested edibles, such as raw a whole-wheat product, corn starch or a slice of whole-grain bread, in case there is a potential a risk of nocturnal hypoglycemia. There is no exact figure on the quantity of carbohydrates required to balance euglycemia while performing as this amount is dependent on the frequency and intensity of exercise and can only be determined after constant monitoring by the coaches. (Sackey & Jefferson, 1996 & Aaron et al., 2002).

As the athletes prepare a stable routine of exercise regimens, performances and nutrients requirements, they will master the glycemic response of their body to a specific training program. Hence, these athletes would not be disrupted by health emergencies and will complete a more normal workout (Kohl & Hobbs, 1998). According to studies, the ideal pre-exercise level of blood glucose is in the range of 130 to 180 mg/dL. If a gymnast has a blood-glucose concentration level of over 200 mg/dl and ketones filled urine, or a blood-glucose concentration level of more than 350 mg/ dL, irrespective of the status of ketones, he should delay his activity and consume supplementary insulin. The study also suggested that patients with a blood-glucose level of less than 100 mg/dL should take a carbohydrate snack before starting to exercise, regardless of the intensity of the exercise planned for them ( Kitzler, 1998). Optimum Exercise Intensity and Duration Gymnasts are subjected to different kinds of exercises.

Some of them are of high intensity and others with a low intensity, designed to initially test the effects on their glycemic levels. These exercises can be later used to enhance their performances. Different kinds of exercises employed by coaches, and their procedures would be briefly explained below (Campaigne et al., 1984). Short-term exercise These are exercises, which are not too tiresome. Examples of short-term exercises include table tennis, walking, golf, calisthenics and dancing.

Before starting these exercises, it is recommended to have a quick absorbable carbohydrate. For these exercises, reduction in the quantity of insulin is not suggested by researchers (Campaigne et al., 1984). Vigorous competitive activity These exercises are characterized as medium intensity activities. The duration for these activities should be less than one hour and can include cardio-related activities, like playing running sports, time calisthenics, cycling, and swimming. The pre-exercise protocol for these exercises requires a reduction of 25 per cent in insulin, and 25 grams of quickly absorbed carbohydrate should be consumed half an hour before the activity is started (Levin et al.

2003). Strenuous activity This is regarded as a high-intensity exercise. The duration for these exercises lasts for more than one hour and is endurance-based. Examples of these exercises include backpacking, marathon running, downhill skiing and triathlon. These exercises require a thirty to eighty per cent reduction in the insulin dose and a consumption of 125 calories (of fruits) after every 30-minute time duration.

The chances for exacerbating the hypoglycemic effect are more while performing a high-intensity exercise, as compared to a moderate level one (Campaigne et al., 1984 & Larsson et al., 1999). Unanticipated exercise This exercise is designed by the coaches and is employed to surprise the athletes and their internal physical system. These can be of low, mild or high intensity but the calorie intake for each level of exercise would change.

The calorie requirements are 30 for low, 50 for moderate and 120 for high-intensity exercises after an interval of thirty minutes (Gottlieb, 1985). Another crucial subject that physicians and coaches should stress on is to respond sympathetically to a gymnast’s pre and post- competition anxiety. This response is also likely to trigger hypoglycaemia. In order to differentiate between anxiety and hypoglycaemia, spot blood glucose test should be carried out to determine blood glucose levels.(Heere, 1980 & Caspersen et al.

, 2000)). Common Nutrition Problem and Prevention Common nutrition problem in this sport for T1DM patients arise when their eating practices are interrupted, leading to hypoglycaemia. Researchers have suggested using spot blood glucose test to differentiate between anxiety and hypoglycaemia, as both have similar symptoms for an observer. In case these levels are under 100 mg/dL or if the gymnast has received short-acting insulin within ninety minutes of the start of his or her exercise, supplementary pre-exercise carbohydrates should be taken. As a general rule, fifteen grams of carbohydrate would result in increasing the blood-glucose levels by 45 mg/dL (Selam et al.

, 1992 & US Department of Health and HUman Services, 2000). A variation in the level of physical activities (exercise) can potentially change the patients’ daily insulin requirements. Hence, to maintain a balanced level of blood glucose, coaches should consider changing the intensity of exercises. If a balance between counter regulatory hormones and insulin action is not attained while performing aerobic exercises, it will lead to hyperglycemia (Levin et al., 2003 & Kim & Keen, 1999).

Athletes, coaches and physicians need to do a lot of planning to prevent hypoglycemia. The planner should have a thorough knowledge of injection timings and the impact of the insulin being used. For instance, hypoglycemia could be experienced if the insulin injection is inserted into an exercising limb; due to over-absorption of insulin. The timing of the competitive gymnastic event and the insulin evaluation is also a significant determinant of the performance of the athlete. Researchers have observed that for the most effective performance by athletes with diabetes, their level of blood glucose should be between 75 and 140 mg/dL. Lastly, caloric augmentation and dietary strategies are employed to prevent hypoglycemia can also be a determining factor for a successful workout (Horgan, 2005 & Dahl-Jorgensen et al.

1980). The symptoms of hypoglycemia differ between children and adults. The former are not so significantly affected by hypoglycemia as the latter. As this research is specific for children, the neuroglycopenic symptoms would be discussed, which most commonly are experienced by children suffering from T1DM (Devlin, 1992). Supplements which may promote optimum performance this sport The use of supplements is growing in all sports, and gymnastics is witnessing a similar trend.

Most of the literature available on athletes taking supplements is focused on adults. That literature would be used to analyze the extent of supplement use in this sport (Mcdowall, 2007). A research by Froiland et al. (2004) concluded that 89 per cent of university athletes used supplements. The use of supplements by gymnast is well documented.

Researchers observing the Canadian Gymnastic team found that 54 per cent of team members used supplements in the Atlanta Olympic Games. In another research by Erdman et al, (2006) the authors concluded that the use of a dietary supplement is very common among elite athletes. Types of supplements used A number of researches have been conducted to determine the types of supplements used by gymnasts. These researches employed different methodological sequences to determine the most frequently used supplements among adolescent, but they all determined that mineral and vitamin supplement is most commonly used. Among these categories, athletes choose Vitamin C, iron, multivitamins and calcium (American Diabetes Association, 2004). Bell et al (2004) conducted a study on adolescent athletes and found out in addition to minerals and vitamins, energizers, creatine and proteins are also used.

However, a research by O’Dea (2003) contradicted the findings of Bell et al. The researcher concluded that young athletes mostly consume sports drinks, herbal supplements, mineral/ vitamin tablets, protein milk supplement and guarana (Roberts et al., 2001). These dietary supplements are considered to be safe as they are generated from naturally-occurring compounds and are advertised to be healthy and safe. However, not all of these supplements have been tested by the Food and Drug Administration (FDA).

Therefore, Metzl et al. (2001) suggested that it would be unwise to comment on the reliability of these supplements. Reasons for Use A research by Burns at al. (2004) conducted a research to investigate the reasons given by young athletes for using nutrient supplements. Their research found that athletes recovering from injuries use vitamin and mineral supplements, as it has the highest impact on a quick reccovery. Other supplements, like proteins and creatine, are used for improving performance.

Gymnasts put a lot of stress on their joints and bones, so they are more likely to injure themselves than athletes of other sports. Hence, taking vitamins and minerals makes their bones stronger and helps them recover faster. Other popular reasons for using supplements are to increase strength, health, muscle mass and prevent nutritional deficiencies. Young athletes are much focused and under pressure from coaches to perform exceedingly well. Under these circumstances, they might be tempted to use supplements (Calfee and Fadale, 2006 & Austin et al. 1993).

Case Study 1: How Frequency of Physical Activities helps manage the illness of children with Type 1 Diabetes Mellitus – A report by Valerio et al. (2005) This section will help illustrate the impact of frequency of activities performed by children suffering from T1DM. The chosen case study has investigated the relation between management of T1DM disease and sporting activities in children. In the research conducted by Valerio et al (2005), 138 adolescents and children (71 girls and 67 boys) with T1DM were asked to participate. The average age of the participants was 13.

6 years with an average duration of diabetes of 6.2 years, which is very suitable for the topic of the research. The subjects were treated with three doses of insulin (combined total of 0.87 U/Kg) and their glycaemic control was monitored. The selection of participants was designed to include patients with average body mass index (BMI) and was free of diabetic complications.

The results showed that 67 of the participants spent on average 2.51 hours on physical activity, and the rest did not take part in intensive physical activity. The data collected from the two groups of participants, included gender, age, BMI, education of parents and diabetic status. This data was simulated using a regression model. The results of the simulation showed very little differences in terms of BMI ratios, cholesterol levels and daily insulin dosage of the two groups. However, the levels of triglyceride serum were remarkably lower for the group that participates in sporting activities.

This group also showed a good metabolic control. Furthermore, it also demonstrated that boys are healthier than girls as they take part in physical activities more than girls. The research indicated that moderate to high intensity of physical activity can be associated with health benefits for children suffering from T1DM. However, children with this condition should regularly monitor glucose levels and take appropriate dietary management measures before starting an exercise. Case study 2: How Intensity of Physical Activities help manage the illness of children with Type 1 Diabetes Mellitus – A report by Salvatoni et al.

(2005) The objective of this study is to determine the impact of intensive physical exercises on young patients suffering from T1DM. In order to conduct this study, researchers selected sixty-nine T1DM participants. Among them twenty-six were girls and forty-three were boys, with a mean duration of the disease of 8.1 years. This research was conducted over a seven year period (1996-2003). All sixty-nine patients were given two shots of short and/or long acting insulin.

The assessment of the patients comprised a strict monitoring of blood-glucose levels, BMI, glycosylated hemoglobin and an evaluation of pubertal stage. The extent of physical activity performed was evaluated by asking the participants to fill a questionnaire after every three months. After every evaluation, a decision was made about changing the physical activity to make it more or less intensive for the participant, by changing the sports. Once a set of variable values was collected, regression model was used to evaluate the co-relation between intensity, health and performance. The patients were divided into three groups, determined by the duration of their disease. Group A was comprised of patients with 2-5 years of illness, Group B with 5-10 years of illness and Group C with more than ten years of illness.

ANOVA was employed using the SPSS software to process the data. The results of boys and girls were classified separately and compared. According to the data collected, the amount and intensity of physical exercise performed by girls was significantly less than that of boys. Group B showed a significantly lower glycosylated Hemoglobin measurement but apart from that, no significant differences were observed in terms of weight excess, blood pressure, blood-glucose requirements and heart rate. Hence, this research did not observe long-term effects of intensive physical exercise on the glycemic control in T1DM patients.

Furthermore, this study also found out that the same activity (such as gymnastics) requires to be performed with variable intensities to improve the performance of the patient. Summary This research paper highlights the impact of intensity and frequency of physical exercise on children suffering from T1DM. The exercise chosen for this is gymnastics as it requires the athlete to be in a good physical condition. The paper reviewed a number of secondary sources of information to gain credible knowledge about training methods, psychological requirements, nutritional strategies and supplements that can enhance the performance of a young athlete. The primary objective of this research paper was to evaluate the role of intensity and frequency on illness (T1DM) management in children. The paper included two researches as case studies, which assessed the role of intensity and frequency of exercises by monitoring a number of research participants for a significant duration of time.

A record of insulin dosage, number of hours of physical activity, BMI, background and blood glucose levels was kept. From the review of the study conducted by Salvatoni et al. (2005), it was found that high intensity exercises can lead to short-term glycemia control for the patient but there are no definite signs of long-term benefits. Even though, the results were not conclusive, the researchers recommended high intensive exercises for patients with T1DM. The other research, conducted by Valerio et al.

(2005), conclusively determined that frequency of exercises performed has a positive impact on the health of children suffering from T1DM. The research paper has met its objectives and highlighted the benefits of intensive and frequent exercise, along with proper dietary management to control the glycemia of patients (athletes). Limitations There are a number of limitations, which have to be acknowledged by the researcher in preparing this research paper. Firstly, most of the publications used in this paper relied on questionnaires to assess the impact of intensity and frequency of exercise on a young athlete’s performance. Secondly, there was very little literature available that focused on the research topic. Most of the researches used adult gymnasts as test respondents.

Lastly, there was not enough literature on specific supplements used by athletes suffering from T1DM. Summarized Table The summarized table includes all the nutritional recommendations for gymnasts and the T1DM disease with their considerations and causes.