From Ohio, USA

My daughter, aged 18 (diagnosed at age 5), is currently playing college soccer. No amount of training seems to keep her from hitting the “wall” after about 20 to 25 minutes. Even when glucose levels are normal she seems to run out of gas. Is this normal? Is there some way to optimize diet to provide for longer term or slower carbohydrate conversion to help to keep her from needing to refuel so quickly? Sometimes this may happen after only 5 or 10 minutes, again with glucose levels looking normal.

The first possibility that comes to mind is fatigue. Fatigue that causes anyone with or without diabetes to stop exercising can be caused by a shortage of:

oxygen (the ability to take in transport and utilize oxygen is related to the degree of physical training);
fluid (related to nutrition); or
fuel (related to nutrition).

These shortages or deficiencies can occur separately or in a combination. You need to keep in mind that although all athletes will eventually need to replenish fuel for their exercising muscles, individuals with diabetes need to replenish fuel (carbohydrates) sooner.

Here are some important considerations for the individual with diabetes:

Total energy requirements,
The source and the amount of energy, and
Fluid intake.

The best way to determine caloric needs is to sit down with a dietitian and bring along a detailed nutrition history. Compare what is currently being taking in with the estimated caloric needs and develop a meal plan based on the nutrition assessment. Make sure your daughter monitors her weight and her appetite to evaluate her calorie requirements.

In general 60% of total energy for exercise should come from carbohydrate. An adequate intake of carbohydrate is necessary to maintain maximum muscle and liver glycogen stores. Low fat carbohydrate foods such as crackers, muffins, yogurt or soup rather than sugary sweets are good choices. Peanut butter and crackers, oatmeal raisin cookies, bread sticks are additional good choices.

Lastly, Always check blood glucose before, during and after exercise.

Guidelines for blood glucose before exercise:

If your blood glucose is less than or equal to 100 mg/dl, eat a snack before exercise.
If your blood glucose is over 100 mg/dl and less than or equal to 250 mg/dl, go ahead and exercise.
If your blood glucose is over 250 mg/dl, check for ketones. If ketones are present, do not exercise. Exercise will worsen your control.
If blood glucose is over 300 mg/dl, whether you have ketones or not, do not exercise.

PL