By Melanie Carroll
Melanie
is 32 years old and has been doing karate for at least 10 years and
reached to very high levels, training for the World Championships and
currently studying for third Dan. She has had type 1 diabetes for 8
months, and want to optimise her performance.
Martial Arts versus Sports
Martial
arts, whilst being "sporty" activities, have quite different roots and
mindsets to sports. Training in a Martial Art should be seen as a
priviledge and competition is an optional extra; whilst it's nice to
have shiny medals in your trophy cabinet and travel the world to fight,
you are defined by what you wear around your waist. In good traditional
schools, a peaceful and spiritual moral code should be promoted and
followed, with the training coming first before any other priority you
may have. This may explain why I class competition as "easy" compared
to Dan gradings and possibly why Martial Arts leaves such a huge gap
that sport can't fill when it's suddenly necessary to stop.
There
is an ethic that, if you are unwell or unable to give 100% in a class,
you shouldn't turn up to a class. You should never therefore break the
ranks in class for any reason, which is why I say I'm lucky insofar as
my instructor is willing to make an exception for me and my diabetes
and I'm allowed to do what I need to. Other students may not be so
lucky, I guess, although I'm sure even the most monstrous Sensei will
be lenient, so long as the class isn't unduly disrupted.
Martial Arts
Martial
Arts fall mainly into one of two categories - Striking or Grappling
styles. Requirements and physical demands for both are quite different
and it is rare for one individual to be equally proficient in both.
Striking arts are such as Karate, Tae Kwon Do - Boxing/kickboxing are the nearest sports
Grappling
arts are such as Judo, Jujitsu - Wrestling is the nearest sport - but
not WWF! Olympic styles are very close to Judo etc
Some
styles are a mix of both, such as Kung fu (t'ai chi), and some are
unique in their application such as Aikido, the whole point of which is
to use your attacker's energy and conserve your own. Others are weapons
orientated, such as Iado which is a purely sword drawing style. All
should be hard physical and mental training régimes and students will
at some point be pushed to their own limits to prove their worth. To be
considered competent in a Martial art and gain a black belt, you should
have completed a minimum of four years training ; although less
reputable schools will promise you quicker results than this, it
generally shows in the standard of their students.
Your
style will govern the development of your physical, mental and
spiritual development; eventually you will become so rooted in a style
it would be difficult to switch to another.
Striking Styles
I'll take Karate to discuss for the striking arts, because this is my speciality.
A
traditional karate school should value Karate as an art form above all
other considerations. Unlike sports, the competitive side is less
important than the progression through the art itself, that is in
continually pushing yourself towards the ultimate goal of perfect
execution.
Karate is so physically demanding because it places
high physical demands on all the major muscle groups and is both an
endurance and a dynamic activity, requiring high levels of stamina,
suppleness and speed.
A typical mixed grade Karate class is typically structured as follows:
First,
a Cardio warm up - maybe varied speed jogging/running, star jumps,
shadow boxing, anything to get both feet off the floor and raise the
core temperature for the stretch. This would last around 15 mins,
longer on very cold days. This should be very intense, with the
emphasis on keeping the body and muscles relaxed to avoid injury.
Then
a stretch, which starts off as passive stretching using the body weight
sympathetically and gradually increases in intensity through to dynamic
stretching, such as holding very uncomfortable strength building
techniques until the muscles begin to tremble and slightly beyond. This
is vital to build the strength required for the application of karate.
Although the stretch is hard work of sorts, it is low in intensity,
either seated or standing still to allow the body to take oxygen on
board to avoid cramp.
Next would be a very short period of meditation, usually about 5 minutes.
Then
the class would start working on individual techniques, usually
standing static. These would progress from single blocks/punches/kicks
to combinations of up to ten techniques. They are performed as a class,
responding to the instructor shouting to test reaction time. A slow
response is typically seen as a lack of effort and punished by means of
press ups so, although the feet are flat, the effort in each technique
is immense, so I would class this as high intensity. This would go on
for about 15 minutes and then progress to technique with increased
movement "on the toes", constantly changing position and increasing the
effort whilst maintaining the quality of the techniques, as there is a
right and wrong way to do everything. This is the most intense part of
the class as the student is being constantly scrutinised and cannot
take a rest or reduce the effort. This would probably go on for about
half an hour, during which time you lose a large amount of fluid.
Sometimes
this is performed striking large kick pads, held by a partner, which is
even more hard work as each strike has to be executed with the maximum
force, or small kick pads for fast focused techniques in a combination
(typically arm - arm - leg - leg - arm). Again pad work lasts about 30
minutes.
Then would come the sparring which is semi-contact
fighting, to show the application of the techniques with a partner. The
aim is to make contact in such a way as to cause no injury, so you are
not fighting full pelt. This is about med to low intensity in a mixed
class but should be med to high in a pure black belt or competition
class. This would last about half an hour. This is the time when the
adrenalin is at it's highest and any injuries sustained when sparring
do not present until the end of the sparring - even snapped tendons and
broken bones.
Then comes the kata training, which is possibly
the most difficult to explain. Because of the history of Japan, at one
point all bearing or arms by Japanese citizens was at one time
forbidden by the occupying Chinese forces, which is why so many unarmed
systems of combat exist. Kata was invented to train the skills to the
Japanese people which are necessary for combat and was heavily
disguised so to avoid punishment; Kata are a set pattern of movements
which depicts a fight against an imaginary opponent. They mix in every
aspect of the training and requires a great deal of strength and
stamina but also grace, balance and, unfortunately, memory. A kata can
range from 4 moves to 100 but regardless of this, the effort put in to
each technique should be such that the student is breathless at the
end, so it is very physically demanding. They are also typically
performed in front of the entire class, to demonstrate the student's
knowledge and deserving of their grade. For these reasons, I would
class this as equal to sparring at med to high intensity; a high
ranking black belt can be expected to perform their most advanced
forms, which are very demanding indeed.
Then the
class would be wrapped up with some stamina work such as sit-ups and
press-ups, about 500 of each. Again the instructor is watching so
there's no room for missing any out without earning even more. This I'd
rank as med intensity.Then the class would meditate again to close the
session, for about 15 minutes and would be followed by a
warm-down.My 2nd Dan grading was structured very much like this, except
each section lasted much longer and there were only 5 people in the
class to a ratio of 5 very senior Dan grades assessing, which is why
these events are such hard work. The general ethos is that, if you are
still able to stand at the end, you've probably not put enough effort
in and so will fail. The panel are looking for you to push yourself
beyond your own boundaries - which is why black belts are so difficult
and the grade is so highly respected.
Grappling Styles
I'm
no expert in these styles, but I did study the Police Grappling
syllabus for two years which is based on a style called Taiho-jitsu
The
class was actually structured exactly as a striking class, but of
course the nature of the techniques was completely different as were
the physical demands of the art.
When grappling, you are in
constant contact (and combat) with your opponent, there is no way you
can relax. Our style started a bout with the students back to back and
knelt. The aim was to get your opponent to submit by any means within
the rules, using arm locks, throws and pressure point attacks, but at
least one knee had to remain in contact with the floor throughout. When
I was studying this art, I was at the top of my karate game and very
fit, yet I would be exhausted within about two minutes (compared to
virtually unlimited karate based sparring). These styles favour
strength and technique over a happy balance of power (focused into a
single strike), speed and technique. Again all major muscle groups are
used, but completely differently and for much longer periods of
anaerobic style exercise. Whereas a karate bout lasts typically for
three two minute rounds even at top levels, a grappling bout can last
for over an hour.
The amount of fluid lost is immense. I would be very interested to hear how diabetic judo students get on.
Management of Her Diabetes
Melanie is treated with Novorapid 7 units of insulin three times a day and Insulatard at night.
She
suspects that you are having some nocturnal hypoglycaemia. The main
problems are difficulty in controlling blood sugar during your
training, following training and more importantly after training. She
is reaching a wall in performance. This latter symptom is very common
in athletes who experience a loss of fuel supply during endurance
sports.
There are 3 different sets of activities.
- The
first a typical training class 15-50 minutes of cardiovascular work,
which raises heart rate, followed then by 15 minutes of low intensity
work, which consisted of stretching, then followed by your class, which
was 20 minutes of standing exercises, followed then by 20 minutes of
moderate intensity work, followed by 45 minutes of high intensity
sparring or kata. During these exercises, blood sugar was typically
7-10 on starting and then half way through was about 7, and then fell
to 3-4 during the intense part of the exercise.
- She also runs
at 4.30 in the morning and training for your next DAN level, which will
involve 5 hours of high intensity exercise.
- During your world championship events, you explained that these events are very short in duration and were ‘easy’.
As
far as her food intake is concerned, she is a vegetarian on a high
carbohydrate diet, taking 40 grams of carbohydrate in the form of
cereals with your breakfast, 60 grams in the form of a bar at 11.30, 40
grams with an evening meal and an occasional 20 grams with supper.
Suggested Management
- It
is likely that in the first 20 minutes of her exercise, blood sugar
rises quite rapidly and if checked blood sugars after the first 20
minutes, these were likely to be in the teens. Blood sugar fall is
therefore likely to be rapid, falling from this high level down to 3-4
during your aerobic exercise. This period will lead to the block on
performance. There is already a sufficient gap between the quick
acting insulin and exercise, and the Isophane insulin will have
certainly run out by the evening. Therefore it seems sensible to take
30-60 grams of a glucose containing drink in the form of PPS 22 or
Lucozade Sport every hour during the aerobic exercise.
- Do not
take the glucose during your high intensity cardiovascular exercise but
wait until you have demonstrated that your blood sugar is falling.
- Immediately
after exercise, take a further amount of glucose 30 grams, possibly
with 2 or 4 units of Novorapid, but you should reduce overnight insulin
by 2-4 units on days when if there has been a particularly intensive
training day.
- There is a problem with running at 4.30 in the
morning, as there will be significant amounts of Isophane insulin still
present and there is a significant risk of hypoglycaemia
- If
there is significant hypoglycaemia on the preceding day, think
seriously about whether you should be doing any exercise on the
following day, as hypoglycaemia is far more likely.
- Further
suggestions are that Insulin Detimer as your basal insulin to be taken
at night-time. This has a smoother action of profile which will make
it less likely to have nocturnal hypoglycaemia, help control morning
blood sugars, give better basal insulin in the daytime but whose action
is much reduced if you do your sports in the evening. Insulin pump
therapy, is also likely to help.