Hyperglycemia, as defined by the ACSM, for training is BG’s of 250 mg/dL or above with ketones present in urine or 300mg/dL or above. Symptoms include increased thirst and urination, ketones in urine (observed with a test strip), weakness, nausea, abdominal pain, vomiting, blurred vision, and labored breathing. A lack of sufficient insulin before training may impair glucose transport into the muscles, limiting its availability for muscular fuel and causing BG to rise. To compensate, the body will use free fatty acids in great abundance for muscular fuel, which generates ketones in the urine as a waste product. Ketones are very difficult for the kidneys to process and excrete. This physiological state of “ketosis” is what drives a diabetic’s increased thirst and urination, which helps to flush the ketones from the body. Also, without glucose entering the cells for energy production when training is initiated, the liver, a storehouse for glucose, is signaled to secrete glucose into the blood for energy. However, this response ends up making the BG higher and hyperglycemia worse. Which is the opposite of what would be expected because the athlete’s activity should be using BG for energy, creating a lower BG value after training/competition. Also, as a person’s BG rises, the blood’s consistency gets thicker and thicker, creating the potential for blood clot formation and making the heart work harder at any level of exertion affecting physical performance. So, even if the athlete says they feel well, the guidelines for safe BG ranges must be enforced.

A safety checklist of items that should always be in the Type 1 diabetic athlete’s gym bag include: