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National Athletic Trainers' Association Position Statement: Management of The Athlete With Type 1 Diabetes Mellitus
National Athletic Trainers' Association Position Statement: Management of The Athlete With Type 1 Diabetes Mellitus
12-2007
Matthew H. Corcoran
Lehigh Valley Hospital, Allentown, PA
James T. Crawley
Dominican College, Orangeburg, NY
Kimberly S. Peer
Kent State University - Kent Campus
Recommended Citation
Jimenez, C. C., Corcoran, M. H., Crawley, J. T., Hornsby, Jr., W. G., Peer, K. S., Philbin, R. D., & Riddell, M. C. (2007). National
Athletic Trainers’ Association Position Statement: Management of the Athlete With Type 1 Diabetes Mellitus. Journal of Athletic
Training, 42(4), 536-545. Retrieved from http://digitalcommons.wcupa.edu/spomed_facpub/18
This Article is brought to you for free and open access by the College of Health Sciences at Digital Commons @ West Chester University. It has been
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please contact wcressler@wcupa.edu.
Authors
Carolyn C. Jimenez; Matthew H. Corcoran; James T. Crawley; W. Guyton Hornsby, Jr.; Kimberly S. Peer;
Rick D. Philbin; and Michael C. Riddell
Objective: To present recommendations for the certified suring the long-term health and well-being of the athlete with
athletic trainer in the management of type 1 diabetes in the diabetes.
athlete. Recommendations: These recommendations are intend-
Background: In managing diabetes, the most important ed to provide the certified athletic trainer participating in the
goal is to keep blood glucose levels at or as close to normal management of an athlete with type 1 diabetes mellitus with
the specific knowledge and problem-solving skills needed.
levels as possible without causing hypoglycemia. This goal
Athletic trainers have more contact with the athlete with di-
requires the maintenance of a delicate balance among hypo- abetes than most members of the diabetes management
glycemia, euglycemia, and hyperglycemia, which is often more team do and so must be prepared to assist the athlete as
challenging in the athlete due to the demands of physical ac- required.
tivity and competition. However, effectively managing blood Key Words: hypoglycemia, hyperglycemia, insulin replace-
glucose, lipid, and blood pressure levels is necessary to en- ment therapy
E
ffective management of glycemic, lipid, and blood pres- training kits; preparticipation physical examination (PPE); rec-
sure control plays an important role in the health out- ognition, treatment, and prevention of hypoglycemia; recog-
comes of persons with diabetes mellitus. The primary nition, treatment, and prevention of hyperglycemia; insulin ad-
goal of diabetes management is to consistently maintain blood ministration; travel recommendations; and athletic injury and
glucose levels in a normal or near-normal range without pro- glycemic control.
voking undue hypoglycemia.1–5 Although several exercise
guidelines for persons with diabetes have been published Diabetes Care Plan
(American Diabetes Association’s ‘‘Physical Activity/Exercise
and Type 2 Diabetes,’’6 American College of Sports Medi- 1. Each athlete with diabetes should have a diabetes care
cine’s ‘‘Exercise and Type 2 Diabetes,’’7 and the joint state- plan for practices and games. The plan should include the
ment of the American College of Sports Medicine and the following:
American Diabetes Association, ‘‘Diabetes Mellitus and Ex- a. Blood glucose monitoring guidelines. Address frequen-
ercise’’8), none address issues of concern for athletic trainers cy of monitoring and pre-exercise exclusion values.
(eg, blood glucose management strategies during injury or the b. Insulin therapy guidelines. Should include the type of
effect of therapeutic modalities on blood glucose control). The insulin used, dosages and adjustment strategies for
following position statement and recommendations provide planned activities types, as well as insulin correction
relevant information on type 1 diabetes mellitus and specific dosages for high blood glucose levels.
recommendations for athletic trainers who work with patients c. List of other medications. Include those used to assist
with diabetes. with glycemic control and/or to treat other diabetes-
related conditions.
RECOMMENDATIONS d. Guidelines for hypoglycemia recognition and treat-
ment. Include prevention, signs, symptoms, and treat-
Based on current research and literature, the National Ath- ment of hypoglycemia, including instructions on the
letic Trainers’ Association (NATA) suggests the following use of glucagon.
guidelines for management of athletes with type 1 diabetes e. Guidelines for hyperglycemia recognition and treat-
mellitus. These recommendations have been organized into the ment. Include prevention, signs, symptoms, and treat-
following categories: diabetes care plan; supplies for athletic ment of hyperglycemia and ketosis.
Carolyn C. Jimenez, PhD, ATC; Matthew H. Corcoran, MD, CDE; James T. Crawley, MEd, PT, ATC; W. Guyton Hornsby, Jr, PhD, CDE;
Kimberly S. Peer, EdD, LATC; Rick D. Philbin, MBA, MEd, ATC; and Michael C. Riddell, PhD, contributed to conception and design;
acquisition and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article.
Address correspondence to National Athletic Trainers’ Association, Communications Department, 2952 Stemmons Freeway, Dallas, TX
75247. Address e-mail to cjimenez@wcupa.edu.
Fasting* blood glucose level is ⱖ250 mg/dL (13.9 mmol/L). Test urine and/or blood for ketones.
If ketones present, exercise is contraindicated.
If ketones not present, exercise is not contraindicated.
Blood glucose value is ⱖ300 mg/dL (16.7 mmol/L) and without Exercise with caution, and continue to monitor blood glucose
ketones. levels.
*Fasting is defined as 4 h or more after eating a meal.
Humalog (lispro; Eli Lilly and Co, Indianapolis, Rapid acting Bolus in MDI* 5–15 min 45–75 min 3–5 h
IN)
Novolog (aspart; Novo Nordisk Inc, Princeton, Basal and bolus in insulin
NJ) pump
Apidra (glulisine; Sanofi-Aventis, Bridgewater,
NJ)
Humulin (regular; Eli Lilly and Co) Fast acting Bolus in MDI 30 min 2–4 h 5–8 h
Novolin (regular; Novo Nordisk Inc) Basal and bolus in insulin
pump
Humulin N (NPH; Eli Lilly and Co)† Intermediate acting Basal insulin in MDI 1–2 h 4–10 h 14⫹ h
Novolin N (NPH; Novo Nordisk Inc)†
Lantus (glargine; Sanofi-Aventis)† Long acting Basal in MDI 1.5–2 h Flat 18–24 h
Detemir (levimir; Novo Nordisk Inc) †
*Indicates multiple daily injections.
†Indicates not used in insulin pump therapy.
Exercise of the injected area Exercise of injected area within 1 h of injection may increase the
rate of absorption.
Massage of the injection site Do not rub or vigorously massage injection sites within 1 h of
injection.
Thermal modalities Heat increases absorption, whereas cold decreases absorption.
Avoid using thermal modalities for 1 to 3 h postinjection.
Insulin dose Larger doses are associated with slower absorption rates.
Lipohypertrophy (accumulation of subcutaneous fatty lumps Injection into lipohypertrophic sites delays absorption.
caused by repeated injections of insulin into the same spot)