My son is 15 years old and was diagnosed Type 1 diabetes when he was 10 years old. He currently participates in high school football, wrestling and baseball. The football and wrestling programs both have a regimented lifting program. Our physician suggested using very low weights due to the blood pressure/flow in relationship to his eyes, looking to prevent problems down the road. Should we be concerned with his weightlifting at this time and have his program adjusted?

Congratulations for encouraging and supporting your son’s participation in school sports! Your question concerns activity limitations regarding weight training with a complication of diabetes known as “diabetic retinopathy”. It is not clear to me from your letter whether your son has received this diagnosis, so please allow me to make some general recommendations. The American Diabetes Association’s (ADA) Clinical Practice Recommendations state that “patients over the age of 10 with Type 1 diabetes should have an initial dilated/comprehensive eye exam by an ophthalmologist or optometrist within 3-5 years after the onset of diabetes” and at least annually thereafter, as a screening for diabetic retinopathy. The degree and type of retinopathy will affect exercise guidelines. Ask your son’s eye specialist to detail his situation for you.

For people with no retinopathy present, there are generally no limitations regarding exercise. In fact, there have been a number of studies on resistance exercise in those with Type 1 diabetes in which weight training was done without complication and demonstrated beneficial effects. We do know that intensive insulin therapy reduces the risk of the development and progression of retinopathy. To my knowledge however, there is no data to suggest that limiting weight training in persons without signs of retinopathy will prevent complication down the road.

For people with active and progressive retinopathy, strenuous exercise which dramatically increases blood pressure may cause retinal detachment or increased bleeding within the eye. We “risk stratify” the degree of retinopathy, and make appropriate individual recommendations based on clinical status. Generally, we tell these individuals to avoid intense exercise which involves straining, or jarring (such as power lifting, boxing) and may even extend the limitations to include jogging, racquet sports and high-impact aerobics if the retinopathy is advanced enough. You will find a summary of these considerations in the ADA position statement on Diabetes Mellitus and Exercise on-line at their website.

Meanwhile, I encourage you to return to your son’s physician for a more detailed description of your son’s retinopathy situation. More information will assist you both in guiding his exercise participation.

DMW