Fueling the Athlete with Type 1 Diabetes

  • Carin Hume


Evidence-based guidelines exist to advise athletes on the appropriate amount, composition, and timing of food intake required to optimize training and performance [1–3]. The nutrition goals and guidelines for training and competition for athletes with and without T1DM are similar, yet there are special considerations for the athlete with T1DM. Maintenance of glycemic control remains an important goal for the athlete with T1DM so as to limit the progression of long-term complications from diabetes [4].


Glycemic Index Continuous Glucose Monitoring Insulin Bolus High Glycemic Index Muscle Glycogen Store 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Burke LM. The IOC consensus on sports nutrition 2003: new guidelines for nutrition for athletes. Int J Sport Nutr Exerc Metab. 2003;13(4):549–52.PubMedGoogle Scholar
  2. 2.
    Rodriguez NR, Di Marco NM, Langley S. American College of Sports Medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc. 2009;41(3):709–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Burke LM, Hawley JA, Wong SH, Jeukendrup AE. Carbohydrates for training and competition. J Sports Sci. 2011;29:S17–27.CrossRefGoogle Scholar
  4. 4.
    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(14):977–86.CrossRefGoogle Scholar
  5. 5.
    Franz MJ, Powers MA, Leontos C, Holzmeister LA, Kulkarni K, Monk A, et al. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc. 2010;110(12):1852–89.PubMedCrossRefGoogle Scholar
  6. 6.
    Hawley JA, Schabort EJ, Noakes TD, Dennis SC. Carbohydrate-loading and exercise performance. An update. Sports Med. 1997;24(2):73–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Bussau VA, Fairchild TJ, Rao A, Steele P, Fournier PA. Carbohydrate loading in human muscle: an improved 1 day protocol. Eur J Appl Physiol. 2002;87(3):290–5.PubMedCrossRefGoogle Scholar
  8. 8.
    James AP, Lorraine M, Cullen D, Goodman C, Dawson B, Palmer TN, et al. Muscle glycogen supercompensation: absence of a gender-related difference. Eur J Appl Physiol. 2001;85(6):533–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Jeukendrup A, Brouns F, Wagenmakers AJ, Saris WH. Carbohydrate-electrolyte feedings improve 1 h time trial cycling performance. Int J Sports Med. 1997;18(2):125–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Carter JM, Jeukendrup AE, Jones DA. The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Med Sci Sports Exerc. 2004;36(12):2107–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Smith WM, Zachwieja JJ, Peronnet F, Passe DH, Massicotte D, Lavoie C. Fuel selection and cycling endurance performance with ingestion of (13C) glucose: evidence for a carbohydrate dose response. J App Physiol. 2010;108(6):1520–9.CrossRefGoogle Scholar
  12. 12.
    Jentjens RL, Jeukendrup AE. High rates of exogenous carbohydrate oxidation from a mixture of glucose and fructose ingested during prolonged cycling exercise. Br J Nutr. 2005;93(4):485–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Burke LM, Collier GR, Hargreaves M. Muscle glycogen storage after prolonged exercise: effect of the glycemic index of carbohydrate feedings. J Appl Physiol. 1993;75(2):1019–23.PubMedGoogle Scholar
  14. 14.
    Howarth KR, Moreau NA, Phillips SM, Gibala MJ. Coingestion of protein with carbohydrate during recovery from endurance exercise stimulates skeletal muscle protein synthesis in humans. J Appl Physiol. 2009;106(4):1394–402.PubMedCrossRefGoogle Scholar
  15. 15.
    Burke LM, Collier GR, Davis PG, Fricker PA, Sanigorski AJ, Hargreaves M. Muscle glycogen storage after prolonged exercise: effect of frequency of carbohydrate feedings. Am J Clin Nutr. 1996;64:115–9.PubMedGoogle Scholar
  16. 16.
    Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34(3):362–6.PubMedGoogle Scholar
  17. 17.
    Stevenson E, Williams C, Nute M. The influence of the glycaemic index of breakfast and lunch on substrate utilisation during the postprandial periods and subsequent exercise. Br J Nutr. 2005;93(6):885–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Donaldson CM, Perry TL, Rose MC. Glycemic index and endurance performance. Int J Sport Nutr Exerc Metab. 2010;20(2):154–65.PubMedGoogle Scholar
  19. 19.
    Burke LM, Claassen A, Hawley JA, Noakes TD. Carbohydrate intake during prolonged cycling minimizes effect of glycemic index of preexercise meal. J Appl Physiol. 1998;85(6):2220–6.PubMedGoogle Scholar
  20. 20.
    Blom PC, Hostmark AT, Vaage O, Kardel KR, Maehlum S. Effect of different post-exercise sugar diets on the rate of muscle glycogen synthesis. Med Sci Sports Exerc. 1987;19(5):491–6.PubMedGoogle Scholar
  21. 21.
    Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007;39(2):377–90.PubMedCrossRefGoogle Scholar
  22. 22.
    Nakagawa K. Effect of vitamin D on the nervous system and the skeletal muscle. Clin Calcium. 2006;16(7):1182–7.PubMedGoogle Scholar
  23. 23.
    Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. American College of Sports Medicine position stand: the female athlete triad. Med Sci Sports Exerc. 2007;39(10):1867–82.PubMedCrossRefGoogle Scholar
  24. 24.
    DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ. 2002;325(7367):746.CrossRefGoogle Scholar
  25. 25.
    Wolever TM, Hamad S, Chiasson JL, Josse RG, Leiter LA, Rodger NW, et al. Day-to-day consistency in amount and source of carbohydrate intake associated with improved blood glucose control in type 1 diabetes. J Am Col Nutr. 1999;18(3):242–7.Google Scholar
  26. 26.
    Canadian Diabetes Association. Guidelines for the nutritional management of diabetes mellitus in the new millennium. Can J Diabetes Care. 2000;23:56–69.Google Scholar
  27. 27.
    Connor H, Annan F, Bunn E, Frost G, McGough N, Sarwar T, et al. The implementation of nutritional advice for people with diabetes. Diabet Med. 2003;20(10):786–807.PubMedCrossRefGoogle Scholar
  28. 28.
    Perlstein RWJ, Hines C, Milsavlevic M. Dietitians Association of Australia review paper: Glycaemic Index in diabetes management. Aust J Nutr Diet. 1997;54:353–5.Google Scholar
  29. 29.
    Ryan RL, King BR, Anderson DG, Attia JR, Collins CE, Smart CE. Influence of and optimal insulin therapy for a low-glycemic index meal in children with type 1 diabetes receiving intensive insulin therapy. Diabetes Care. 2008;31(8):1485–90.PubMedCrossRefGoogle Scholar
  30. 30.
    O’Connell MA, Gilbertson HR, Donath SM, Cameron FJ. Optimizing postprandial glycemia in pediatric patients with type 1 diabetes using insulin pump therapy: impact of glycemic index and prandial bolus type. Diabetes Care. 2008;31(8):1491–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Nansel TR, Gellar L, McGill A. Effect of varying glycemic index meals on blood glucose control assessed with continuous glucose monitoring in youth with type 1 diabetes on basal-bolus insulin regimens. Diabetes Care. 2008;31(4):695–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009;21(1):CD006296.Google Scholar
  33. 33.
    West DJ, Stephens JW, Bain SC, Kilduff LP, Luzio S, Still R, et al. A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus. J Sports Sci. 2011;29(3):279–89.PubMedCrossRefGoogle Scholar
  34. 34.
    West DJ, Morton RD, Stephens JW, Bain SC, Kilduff LP, Luzio S, et al. Isomaltulose improves postexercise glycemia by reducing carbohydrate oxidation in type 1 diabetes mellitus. Med Sci Sports Exerc. 2011;43(2):204–10.PubMedCrossRefGoogle Scholar
  35. 35.
    Rabasa-Lhoret R, Bourque J, Ducros F, Chiasson JL. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care. 2001;24(4):625–30.PubMedCrossRefGoogle Scholar
  36. 36.
    Martin DD, Davis EA, Jones TW. Acute effects of hyperglycaemia in children with type 1 diabetes mellitus: the patient’s perspective. J Pediatr Endocrinol Metab. 2006;19(7):927–36.PubMedCrossRefGoogle Scholar
  37. 37.
    Jenni S, Oetliker C, Allemann S, Ith M, Tappy L, Wuerth S, et al. Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus–a prospective single-blinded randomised crossover trial. Diabetologia. 2008;51(8):1457–65.PubMedCrossRefGoogle Scholar
  38. 38.
    Jeukendrup AE. Carbohydrate and exercise performance: the role of multiple transportable carbohydrates. Curr Opin Clin Nutr Metab Care. 2010;13(4):452–7.PubMedCrossRefGoogle Scholar
  39. 39.
    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(9):1126–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Davis SN, Galassetti P, Wasserman DH, Tate D. Effects of antecedent hypoglycemia on subsequent counterregulatory responses to exercise. Diabetes. 2000;49(1):73–81.PubMedCrossRefGoogle Scholar
  41. 41.
    MacDonald MJ. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care. 1987;10(5):584–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Beelen M, Burke LM, Gibala MJ, van Loon LJ. Nutritional strategies to promote postexercise recovery. Int J Sport Nutr Exerc Metab. 2010;20(6):515–32.PubMedGoogle Scholar
  43. 43.
    Kalergis M, Schiffrin A, Gougeon R, Jones PJH, 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 bed. Diabetes Care. 2003;26:9–15.PubMedCrossRefGoogle Scholar
  44. 44.
    Gallen IW, Ballav C, Lumb A, Carr J. Caffeine supplementation reduces exercise induced decline in blood glucose and subsequent hypoglycaemia in adults with type 1 diabetes (T1DM) treated with multiple daily insulin injection (MDI). ADA 70th Scientific Sessions, June 25−29, 2010, 1184−P.Google Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  • Carin Hume
    • 1
  1. 1.Department of Nutrition and DieteticsBuckinghamshire Hospitals NHS TrustHigh Wycombe, BuckinghamshireUK

Personalised recommendations