Martial Arts

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.

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