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How to stay fit when you have Type 1 diabetes, like England rugby's Henry Slade

The Telegraph logo The Telegraph 05/02/2019 Madeleine Howell
BAGSHOT, ENGLAND - NOVEMBER 09:  Henry Slade looks on during the England training session held at Pennyhill Park on November 9, 2017 in Bagshot, England.  (Photo by David Rogers/Getty Images) © 2017 Getty Images BAGSHOT, ENGLAND - NOVEMBER 09: Henry Slade looks on during the England training session held at Pennyhill Park on November 9, 2017 in Bagshot, England. (Photo by David Rogers/Getty Images)

England’s defeat of Ireland at the Six Nations in Dublin last weekend marked a coming of age for Henry Slade – the Plymouth-born 25-year-old who scored two tries, and whose progress as a key player for England is speeding along at a rate of knots.

What makes his success on the pitch perhaps all the more impressive is that Slade is a Type 1 diabetic (a condition also known as as juvenile diabetes or insulin-dependent diabetes).

“Basically, I can’t control the blood sugars in my body," Slade explained in a recent video issued by England Rugby. "My pancreas doesn’t produce insulin so if I eat something I’ve got to inject my insulin, which you probably would produce yourself.”

TEDDINGTON, ENGLAND - MAY 28: Henry Slade of England poses for a portrait at The Lensbury on May 28, 2014 in Teddington, England.  (Photo by Steve Bardens - RFU/The RFU Collection via Getty Images) © 2014 Steve Bardens - RFU TEDDINGTON, ENGLAND - MAY 28: Henry Slade of England poses for a portrait at The Lensbury on May 28, 2014 in Teddington, England. (Photo by Steve Bardens - RFU/The RFU Collection via Getty Images) While he admits that the resulting blood sugar highs and lows “took a bit of getting used to”, the rugby star is adamant that the condition shouldn’t hold him or anyone else back when it comes to exercise.

“It’s not something that makes you run slower, or be able to lift less weight. Don’t ever think, oh, I’ve got diabetes – I can’t run this race, I can’t lift this weight, play that match. It shouldn’t affect your physical capabilities.

"It’s just all about keeping yourself ordered so your bloods are right. Keep testing yourself as much as you can and you’ll be sweet,” he advises.

Still, it took some calibration to get the balance right for Slade, who found that in training, a few sweets beforehand would suffice to keep his glucose levels stable – but that during a game, his blood sugars would spike due to adrenaline.

Now, he keeps a pot of jelly babies for half time (he jokes that fellow player Tom Waldron “would always be lurking round my spot trying to get his hands in the jar”).

According to Diabetes.co.uk, the home of the global diabetes community, this is a sensible plan: “Always carry a fast-acting carbohydrate food such as glucose tablets when exercising in the event blood sugar drops too low and hypoglycemia symptoms develop during exercise,” it advises.

England's Henry Slade during the International Friendly match at Twickenham Stadium, London   (Photo by David Davies/PA Images via Getty Images) © PA Images England's Henry Slade during the International Friendly match at Twickenham Stadium, London (Photo by David Davies/PA Images via Getty Images) Slade has also found that checking his blood sugar via an app has helped take the faff out of checking his bloods. “I’ve got a device that inserts into my arm so I don’t actually have to check it – every five minutes it sends a blood sugar result to my phone.

"If I’m going to go high or low in the next thirty minutes it gives me a little warning, if not it just leaves me be – it’s almost like being normal. Almost.”

Exeter Chiefs' Henry Slade (Photo by Daniel Hambury/PA Images via Getty Images) © PA Wire/PA Images Exeter Chiefs' Henry Slade (Photo by Daniel Hambury/PA Images via Getty Images) According to Diabetes.co.uk, if your blood sugar is low before exercise (less than 5.5 mmols/l (100 mg/dl), you should opt for a carbohydrate snack before hand. If it isn’t, you may need carbohydrates during or after – so, as Slade suggests, keep checking your blood to see if your blood sugar dips below 4 mmols/l (70 mg/dl). 

While Slade tends to exercise with a team, if exercising alone, it’s also recommended to wear a form of ID which identifies you as having diabetes. That way, others may help you appropriately in the event something unexpected happens.

Slade is right to pursue his sport regardless of the condition: according to the experts, exercise with type 1 diabetes is not only possible, but it’s also beneficial to managing the condition.

That said, it's crucial that people with Type 1 diabetes always consult a health professional before undergoing new exercise regimes.

“People with diabetes are encouraged to exercise regularly for better blood sugar control and to reduce the risk of cardiovascular diseases. The reason for this is that muscles which are working use more glucose than those that are resting,” states Diabetes.co.uk.

Of course, people with diabetes have to take careful precautions to avoid a hypo (when blood sugar levels fall under 4 mmol/L) or a hyper (when the blood sugar level is too high, which means above 11.1 mmol/l).

But muscle movement leads to greater sugar uptake by muscle cells and overall lower blood sugar levels – so it's a valuable aid to optimum health. 

a screenshot of a cell phone: At a glance | What to avoid when exercising with Type 1 diabetes © Provided by Telegraph Media Group Limited At a glance | What to avoid when exercising with Type 1 diabetes

According to Dan Farrow, the Senior Manager of Community Engagement and Volunteering at the type 1 diabetes charity JDRF (the Juvenile Diabetes Research Foundation), it’s always best to speak to your healthcare team to find the right plan that works for you before, during and after exercise.

He points out that it’s also important to be aware that different kinds of exercise will have a different effect on you.

He also offers some general guidelines to follow to help maintain good type 1 diabetes while enjoying an active lifestyle. 

Before you exercise

“Having too much active insulin before you exercise can cause a hypo, as it reduces the amount of glucose the liver can add to blood. Exercising with too little insulin stimulates glucose production from the liver, which can cause a hyper. So you may need to reduce your insulin before you exercise, depending on what you’re doing and how long you’re doing it for.”

Carbohydrate intake before exercise

"Whether you need to eat carbohydrate immediately before exercise will depend on your blood glucose level, the type of exercise you plan to do, its duration and its intensity. Everyone’s carbohydrate requirements for exercise are different so checking your blood glucose before, during and after exercise will help you develop your own plan."

During exercise

"In general, sustained and moderate exercise (like hiking) will result in a slow drop in blood glucose levels. Intense, sprint-like exercise that really gets your heart pumping (like a game of football or netball) might cause your blood glucose level to rise. This is because your body releases high levels of adrenalin that trigger your liver to break down stored glucose and release it into your bloodstream. It will be exaggerated if your insulin levels are too low at the time of exercise."

© Jovanmandic Carbohydrate intake during exercise

"If you are exercising intensely or over an extended period of time you’re likely to need extra carbohydrate during exercise. Less carbohydrate is required the longer it was since your last insulin injection."

After you exercise

"Be aware the around eight to 12 hours after you exercise, your blood glucose level could drop too low. This is because your adrenalin levels drop and your muscles and liver will start to take up extra glucose to replace their stores. You will need to take this into account when estimating your insulin dose prior to, or immediately after, exercise.

"Checking your blood glucose before and then every few hours after exercise, and recording what exercise you do and food you’re eating, will make it easier to see trends and assist you and your healthcare team to develop good ways of managing it.

" © AMR Image If you exercise in the late evening after dinner, it may increase the risk of a hypo overnight, often around 2-3am. To reducing the risk of this, you might need to take less evening insulin or eat a low GI snack before bed.

"In general, if your insulin levels during exercise were sufficient, your blood glucose should be back down to your pre-exercise level within three to six hours, without additional insulin."

Carbohydrate intake after exercise

"If your blood glucose level is normal to low immediately after exercise, you may need to eat some carbohydrate as your body will continue to cause a slow drop in blood glucose levels. You may also like to consider consuming additional low GI food to protect against delayed post-exercise hypoglycaemia."

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