League of Diathlete Symposium: Exercise Around the World

My favorite session so far was the League of Diathlete’s Symposium on exercise around the world. A panel of 7 speakers shared their experiences about exercise and diabetes management, risks and benefits of exercise, mental health and access.

Gavin Griffith from the UK, who started the League of Diathletes, introduced the organisation and the speakers. He then talked about exercise and education, before asking the panel several questions.

Chris Bright, a keen football and international futsal player spoke to us about the impact of diabetes technology on exercise. He explained how exercise caused a lot of worry before the use of cgm and other diabetes technology, whereas having access to something that is constantly accessing glucose levels had a huge impact. Not only does it reduce worry and stress from a physical point of view, but it also allows for more peace of mind, more mental space to actually focus on sport, rather than being completely consumed by managing diabetes. Thanks to technology, the trends and patterns can be reviewed and can be applied for the next training session or the next game. This analytical side of diabetes technology also leads to greater consistency in performance which is something that is difficult to achieve with just fingerprick testing. 

The use of diabetes technology can also have a positive impact on HbA1c and in Chris Bright’s case it helped him train better, recover quicker and ultimately led to better performances in his sport.

Next up, Daniela Rojas, originally from Costa Rica talked about access to diabetes technology. In Costa Rica, there is no access to cgms and pumps via the healthcare system, but are able to self fund technology. They only have one option for cgm, flash monitors and pumps, so there is not only an issue in regards to cost, but also in regards to actual availability.

Daniela also spoke about the impact of education. Being an avid hiker who loves to work out, she had to learn by herself how to manage her diabetes during exercise. Whether using technology or MDI (multiple daily injections), it is important to adapt to what your body needs. For this, education on how to use technology is paramount. Daniela explained how she often works with parents and children who may have access to diabetes technology but lack the proper education on using it or how to work with their own data to improve their diabetes management. 

Linking into this, Paula Chinchilla who also came from Costa Rica, talked about how her view on exercise and diabetes management has changed when she used different technology after moving to the UK. 

When she was younger, she was very motivated to exercise. During contact sport, she would disconnect her pump, resulting in higher blood sugar after exercise. This was very demotivational for her, ultimately causing her to move away from the pump back to MDI. Although she had access to a doctor, there wasn’t a fully fledged diabetes team to properly support and educate her on how to best manage her blood sugar before, during and after exercise. Paula also maintained that what she learned from all of this was that as long as you have the right support and motivation to use the tools you have access to, you can exercise well.

The next speaker was Mohammed AlBahar from Kuwait, who talked about exercise, mental health and finding his motivation. Having done karate, weight lifting and swimming in the past, but without the proper diabetes education on how to handle exercise, he shared how it is a completely different situation when you accept your diabetes diagnosis and work with it instead of against it. People do amazing things with diabetes, they don’t need to use diabetes as an excuse not to do anything.

Mental health, however, is still expensive and difficult to access in Kuwait, that is why a community and reaching out are very important. After several injuries during exercise, Mohammed went back to weight lifting, worked with a coach and attended camps to learn more. Sharing knowledge helps to increase education about diabetes management and technology, it is a great way to learn and share tips and trying out new things.

He emphasised that if you need help, whether that’s with diabetes, nutrition, exercise or mental help, reach out and ask for help.

Jyotsana Rangeen from India was up next and talked to us about the time she was diagnosed and the difficulty she faced as a young 21 year old adult having to suddenly cope with this life changing disease. She found her passion for dance and realised what a great influence it had on her diabetes management. This passion helped her to not only accept her diagnosis, but also gave her strength mentally and helped her to realise that it is possible to live a strong and healthy life. It also helped her to free up space in her mind and improve her mental health. There was also another silver lining of bringing so many people together and finding a community to support and encourage her.

Leonor Marchand in France then told us how the first diabetics she met were in the T1 running team. Sport can bring people together, helps everyone to connect and can inspire people, especially newly diagnosed people, by showing them that there is no limit. Sport is not only good for physical health and connecting with people, but it also helps with mental health and actually accepting diabetes by showing people what they can achieve.

After the introductions there were several questions all the panelists discussed. The role of the healthcare provider was discussed and what they can do to personalise their advice and guidance to motivate a person living with diabetes to go out and exercise again.

Healthcare professionals should protect people in regards to the relationship they have with their diabetes. Not everyone has the same education, access and understanding of diabetes and diabetes management. Without proper companionship and support, people living with diabetes often become fearful of exercise and hypoglycemic events, so they try and avoid it at all times.

If healthcare professionals would ask how their patients are feeling in regards to exercise, what motivation do they have to exercise, what exercise do they like, they would be able to understand people living with diabetes better, understand their motivation and would be able to personalize their advice and support. For the best outcome, the whole diabetes team (including dietician, psychologist, nurses, etc.) would work together so people can feel empowered and secure when exercising.

There was quite a discussion in regards to a multidisciplinary diabetes team and the influence they have on exercise. This includes nurses, psychologists, dieticians, doctors, PE teachers, personal trainers, as well as family members etc working as a team to motivate and support a person living with diabetes, however it isn’t always realistic or possible to work with a full team.

In India, for example, Jyotsana had a difficult time at the beginning to learn and see how her diabetes management was affected by dance and exercise. In the absence of a full diabetes team, she had to learn by trial and error and was able to connect with people online and abroad to learn and share tips.

Dieticians and psychologists are often not readily available, but instead, new communities and organisations are springing up to bridge the gap between healthcare professionals and people living with diabetes. These organisations are helping with carb counting sessions, work on removing stigma, encourage people to try exercise and support people as a community. Education and access, however, is still a far fetched dream and there is still a long way to go.

The last question of the panel was in regards to sporting challenges and achievements.

Chris Bright talked about 2 big achievements; number one being bringing a community together through exercise. There is a big difference in how people access technology and insulin. People would often come in to play football or futsal and after some discussion time, they’d realise that they’ve been using older or mixed insulin when there are newer and better insulin types readily available to them. The same applies to people playing sports using fingerpricks and lacking the trend data information a cgm can provide. Chris’ team would look into the option of a cgm, if access was possible. As such, he is supporting the community to understand, educate and find access to the technology that is available. Having diabetes-specific sporting events in the community also helps to see what people expect, how they prepare for it, do they have hypo treatments with them, and so forth.

His second achievement was becoming an international futsal player. Chris also commented that  no matter what we face on a daily basis, if we have the right access, the right tools and management, there are no limits to what we can achieve.

Leonor in France told us about her marathon she did 2 years after diagnosis. She wanted to prove to herself that nothing was impossible, but what she really needed was to regain control over her body. She needed something positive to come out of this diagnosis, and what the marathon really taught her was that we all go through difficult things but that sport is a great way to overcome this and that with rigor, passion and drive people can achieve amazing things.

Mohammed talked to us about a 3 day trek he did in Costa Rica and having to adjust to the different terrain, humidity and climate. Coming from a dry flat climate to humidity and mountains showed him that diabetes is unpredictable and we always need to learn again when we are faced with a new situation. With access to technology there is better peace of mind, he was able to trust his team and felt the support around him.

He also advised us to try to be hungry and eager, to be fascinated about things we want to learn, if we are keen to try out new sports like swimming, dancing, hiking, we should be willing to learn about it.

At the end of the symposium, all panelists were asked for one word to describe diabetes and exercise. The words given were:

Commitment, rollercoaster, unpredictable , passion, defiance, teacher, life

I really enjoyed this symposium, hearing these stories and I loved to see the social media impact it had as well as a few people discussing their stories and what they took away from this discussion.

A recording of the whole panel can be viewed again here, even without ISPAD2021 access:

https://cloud.t-e-m.de/nextcloud/s/foo5BwrMmyAt5w8

Exercise has such a huge effect on me as a person too, both physically and mentally, it is part of who I am and it has helped me to adapt to my diagnosis so much quicker too. Seeing organisations like the League of Diathletes has also encouraged me and given me hope that I can live a healthy, active life too.

Published by KyeorugiTiger

Just me, learning to adapt.

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