Skiing

It’s that magical time of year when some lucky people are planning a trip to the mountains, so here is some advice on how to manage diabetes during the trip.We have some amazing content from a young English woman who went to the Turin 2006 games to enter the Super G! The first thing to do before you go is to check with your doctor whether you have and damage to the nerve to your feet (peripheral neuropathy) of reduced circulation to the feet. If you have neuropathy, the bane of skiers’ lives, ill-fitting and uncomfortable boots can lead to unrecognised foot damage and foot ulceration. If you have neuropathy, you can still ski, but have to be very careful about your foot care and footwear, and stop skiing if you develop any sore patches on your feet. Get properly fitted boots, and don’t hire. If the circulation to your feet is reduced, you will need to have a specific consultation with your doctor, to be sure that you are not at risk of loss of blood supply to the foot an frostbite or other damage
Elizabeth M, Para-olympian
Elizabeth who went to the Winter Paralympics in Turin in 2006, developed type1 diabetes at the age of 8 but unfortunately she had to have a left below knee amputation in 1997 due to a compartment syndrome in relation to a fracture.
She has the following major problems:
First of all, she finds it impossible to work out what is happening to her blood sugars, and she finds that her blood sugars rise erratically with her short Slalom Super G races, but falls quickly during her aerobic training. She is worried about her weight and she also finds it difficulty to control her blood sugar at altitude when in Winterpark (which is over 9000 feet).
Training
Her summer training here in England is that she does at least 45 minutes of aerobic exercise 5 days per week. During these periods she notices that her blood sugar falls fairly steadily, although she does not suffer from hypoglycaemia. In her winter training she wakes typically at 6 o’clock in the morning and following breakfast she does 10 minutes of cycling, followed by 10 minutes of balance exercises to warm up. She then goes out to do 2 brief training runs taking approximately 2 minutes each, followed by 2-2½ hours of gate work. This consists of runs of 2 minutes, followed then by 10 minutes standing around or waiting in chairs. In the afternoons, they do 2 hours of general ski training which may be followed by weights. She notices that her blood sugars rise during the sprint training and while doing weights in the gym but otherwise falls. She also notices that her blood sugar rises whilst at altitude and she finds that she has to increase her Glargine dose from 26 units to 40 plus units to maintain normal glycaemia.
She is not troubled by hypoglycaemia. She is not counting her carbohydrates and although she does adjust her insulin dose for carbohydrate content, it does not seem to be in a very organised fashion.My thoughts on her case are that she will need to regularise her carbohydrate intake and try not to take extra carbohydrates on training days, and the carbohydrate contents should be roughly the same at each meal and supported by appropriate bolus insulin.During training and events days, she will need to check her blood sugars before and after each event. If she finds that her blood sugar is rising during events, she may need to take a small dose perhaps 1-2 units of quick acting insulin before the event. On more prolonged training such as her running. She will need to check her glucose before, during and following, and if she notices that her blood sugars fall, to take approximately 30 grams of glucose in the form of Dextrosol tablets, Jelly Babies, Lucozade or a prepared drink in 10 mg portions, evenly spaced at approximately every 10-15 minutes. This should stop excessive fall in glucose during the event.
She will be going to Winterpark to help her in her preparation for the Olympic Games where I hope that she will do very well.
Skiing for the Rest of Us!
Is not quite as energetic for most people as they imagine, and all that is required usually is a reduction in daytime insulin dose by 10-20%, and to have some glucose with you. However, there is some exception where energy use is a bit higher. Snowboarders learning spend a lot of time falling and getting up, and they may use a lot of energy. Ski safaris with long days skiing and quite a bit of uphill work also can use a lot of energy. In this situation, the daytime insulin doses will need to reduce further (perhaps by 50%).
Cross-Country Skiing
Is a different matter altogether. It can be one of the most energetic exercises, and daytime insulin doses have to be reduced substantially, and regular glucose or carbohydrate snacks taken throughout the day.
Lastly be aware of the effects of alcohol après-ski, and the risks of nighttime hypoglycaemia. Go easy on the booze; a bad hypo will spoil your expensive trip!
If there are any competitive skiers with diabetes, we would really love to hear from you!

Skiing

By Chris Priest
I have been diabetic for 8 years now, having been diagnosed at the age of 12. I control my diabetes using a routine of four injections each day, three short acting injections of Humalog and a final longer acting one of Humulin I prior to bed. This routine for me seems to work well and has resulted in me being able to control my sugar levels and diabetes as a whole. I first went skiing at the age of 14 and as such have never encountered the sport without the worry of diabetes, however I have been several times since and have never experienced any serious problems.
There are issues to be concerned about when skiing and being diabetic however: ensuring that your feet are in good condition and always having a supply of glucose on you as the last thing you want to happen is for a hypo to come on when you are at the top of a mountain!! I personally found that reducing my dosage of insulin by roughly 20% on each of the four injections enabled me to have enough energy to ski without incident for the majority of the day, however i never went onto the slopes without a couple of chocolate bars in my pocket should anything happen.
I am not fortunate enough to own my own pair of ski boots either and as such have always hired from shops at the resort. This may not be an ideal situation, and no ski boot is ever going to be comfortable, but I have always found them to be fine.
The most important thing to do is to make sure that whoever you are skiing with knows that you are diabetic and knows exactly what to do should something happen to you whilst on the slopes. Dont feel that you can't tell anyone as people really would rather know and if you need to stop and have a chocolate bar half way down a piste then just do it, there is absolutely no need to push yourself.

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