Archery and Diabetes

By Kate Trickett
I was diagnosed with insulin-dependent diabetes at the age of 15. It’s never been a particularly easy relationship, but my diabetes and I do eventually settle into a routine before the next challenge comes along to make it more interesting! I’m now 32, and after 17 years it still finds new ways to surprise me!
I’m currently on 4 injections a day – a basal dose of 18 units of Lantus at 9.30pm and between 8 and 12 units of Novorapid before each meal, depending on what my blood sugars are and how much carbohydrate I’m about to eat. I know that my insulin to carbohydrate ratio varies throughout the day (I need much more in the mornings), but I’m still in the process of working with my diabetes team at the hospital to figure out what exact ratios are needed for each meal.
I took up Archery about 18 months ago when I realised that I did precisely none of the recommended hours of exercise per week! At the time it seemed an easy way to spend more time in the outdoors with a bit of gentle exercise thrown in for good measure – I didn’t realise that it would become so addictive or that it would have such an impact in my blood sugars!
I’ve seen some sports websites dismiss Archery as requiring only “low levels” of fitness – this amuses me immensely! ‘Low impact’ I would have to agree with, but shooting up to 12 dozen arrows over the course of a day requires not only the strength to pull the bow 144 times (I shoot a 30lb Recurve bow, so this is about the weight I pull with each arrow), but the stamina to ensure that the last 6 arrows are shot with the same skill and accuracy as the first 6 – I wouldn’t exactly call that a ‘low fitness’ requirement, it’s exhausting! All day shoots have been known to reduce my basal insulin requirement by 2 units for up to 48 hours just to avoid hypos during the night. Lantus isn’t handling these frequent short-term adjustments very well, so I am talking with my diabetes team about switching to Levemir (insulin detemir) instead to see if that works any better (Insulatard and I ‘fell out’ before I took up Archery so I’m not going back there again!).
I train between 2 and 3 times a week – one or two evenings during the week and Sunday afternoons depending on work and other commitments. My main struggle has been around balancing my insulin and carbohydrate intake with the amount of exercise I do during the session. Indoors the amount of exercise is fairly consistent – shorter distances within 4 walls and a ceiling and the time isn’t restricted by the amount of available light or the weather. Outdoors there are longer distances and no walls or ceiling, so there is greater potential for more arrows to go astray and bury themselves so far into the grass that they can only be ‘seen’ with a metal-detector! As we shoot on a school field these missing arrows have to be found before the next end is shot so everyone has to get involved in the search. Coupled with fading light in the evening and the ever-present ‘British weather’, it’s almost impossible to predict how much energy you will use outdoors.
This uncertainty makes reducing my insulin before the training session pretty much counterproductive! Unless I use as much energy as I’d planned as quickly as I’d planned to, my blood sugars shoot up into the high teens and leave me feeling pretty rough, so unable to perform as well as I could. Conversely, making no adjustment at all pretty much guarantees me a hypo. My focus is the first thing to go when I go hypo and clearly, not being able to see where you are pointing the arrow is something best avoided for everyone’s benefit! Hydration is a big problem for all archers, so the obvious thing to try was additional carbohydrate in liquid form. Sports drinks and ‘normal’ squash were too quick acting, but 500ml of a ‘homemade’ isotonic drink in the form of 1 part orange juice to 4 parts water with a pinch of salt gives me enough carbohydrate (approx 10g) to get me through a 2 hour training session. It’s not quite enough fluid to keep me going, but diluting the orange juice any further makes it taste disgusting, so I have another bottle of plain water with me for when I’ve finished the orange mixture. I take a drink after each end of 6 arrows, which means if I don’t shoot many arrows, I don’t have the whole amount of carbohydrate – it’s not an exact science and it certainly isn’t foolproof, but it seems to work quite well most of the time.
At the end of the training session I have a cereal bar (about 20g of carbohydrate) to replace the energy used and to keep my blood sugars up overnight. The quick acting carbohydrate of the orange juice mixture isn’t enough to keep me level after the session even when it was used in a higher concentration. My blood sugars were higher at the end of the session (18+), but I would still wake up at 2.30am the following morning with blood sugars below 2 (I could almost set my clock by it!). By removing some of the extra carbohydrate from the orange juice mixture and replacing it with a longer acting source at the end of the session, I can finish training on a normal blood sugar, sleep through the night and not wake up feeling like I’ve been hit by a bus!
Competition Days
I have the exact opposite problem. The stress and anxiety of competing means my blood sugars run high (15-22) from the moment I wake up right up until about an hour after I stop shooting. Until I learn to control this anxiety, all I can do is increase the insulin doses, replace the orange mixture with plain water and keep an eye on when my blood sugars start to drop so I can start to stock up on the longer acting carbohydrates.
It’s a steep learning curve and there is still a long way to go, but I have a great deal of support from my coaches and my diabetes team. Between us, we hope to get to the stage where I don’t have to worry about what my diabetes is doing; I can just relax and enjoy myself (i.e. the reason I took it up in the first place!). I see my diabetes as a positive – an added incentive for me to keep healthy. Combining Archery and Type 1 Diabetes is certainly a challenge, but if the long-term effects prove beneficial, it has to be worth it.!

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