A Nutrition
  B Sports
A. Nutrition   
1. Do I need a special diet ?

No, but I must have a healthy nutrition.
2. What does a healthy nutrition mean ?

I should have 3 main meals and 2 snacks.
It would be good to consume 3-5 portions of fruit and vegetables.
The meals should consist mainly of carbohydrates, one part of proteins and a small amount of fat.
3. Must all kind of food be compensated by insulin ?

No, I must only count the cardohydrates.
I count approximately in grammes every meal by using a carbo schedule.
In Germany, people use the “Broteinheit” which means “bread unit”. One BE corresponds to 12 grammes of carbohydrates.
In most countries, we use the carbohydrate unit, 1 KE = 10 grammes of carbohydrates.
I don’t have to count every single carbohydrate but these schedules should help me and my parents evaluate approximatequantities.
4. What are carbohydrates ?

You can find carbohydrates in 4 groups of food:

1.Bread group (cereals)
-bread
-noodles
-rice
-potatoes
-starchy food

2.Fruit group
-all kinds of fruit

3.Milk product group
-whole milk, semi-skimmed milk
-yoghurts

4.Vegetable group
Only very few vegetables count but they contain only small amounts of carbohydrates!
-sweetcorn
-cooked carrots
fresh peas
-pumpkin
-carrot juice
5. Which food does not count ?

Animal proteins :
-meat
-fish
-poultry
Vegetable proteins:
-butter
-cheese
-cream
-white cheese
-nuts
6. Which drinks count ?

-All kinds of lemonade consist of big amounts of sugar. They are not healthy and they should only be consumed for special occasions or if your blood sugar is too low.
-Milk: whole milk and semi-skimmed milk
-Mineral water, sparkling water, tea and coffee don’t have sugar
-Processed fruit juice contains carbs and most of them have even had sugar added to them. That’s why it’s better to drink fresh fruit juice.
-Light drinks don’t have sugar at all or only a little because they are sweetened with artificial sugars (ex: aspartam). I must always check the exact amount of carbs on each bottle. I should not drink too much of these products.
7. Does every type of food have the same influence on my blood sugar ?

No, there are “rapid” and “slow” carbohydrates.
The action speed depends on the constitution of the sugar.
There are 3 different sorts of sugar:

1.Simple sugar
-glucose in fruit and vegetable
-fructose in fruit
-galactose in milk

2.Double sugar
-saccharose in the common sugar
-lactose in milk products
-maltose in beer

3.Complexe sugar
-starch in cereals, potatoes

Simple sugar raises the blood sugar very quickly and complex sugar raises it much more slowly.
8. What does glycemic index mean ?

The glycemic index informs us about the speed of the rise in the blood sugar level.
Food that makes it go up slower is healthier for diabetic and non-diabetic people.
9. What influences blood sugar ?

quick rise
-simple sugar
-boiled food
-less proteins
-less fat
-less fibres
-liquid food

slow rise
-complex sugar
-raw food
-many proteins
-much fat
-much fibres
-solid food
10. Which food makes the blood sugar rise slowly ?

-fruit and vegetables of our region: apples, pears…
-milk products
-whole bread
-whole rice
-whole noodles
-spaghetti
-starchy food: peas,lentils…

This kind of food is digested slowly because the sugar is not absorbed so quickly by the intestine.
11. What can I eat at a birthday party ?

I am allowed to eat birthday cake like the other children but I have to adjust my insulin dose.
I should not have any sweet drinks or eat any other sweets.
My parents must inform the people who invited me about my diabetes and give them some advice so that the party goes well for me.
B. Sports    
1. Am I still able to pratice sport ?
Yes, sport is possible even if I am diabetic. It’s healthy for everyone.
But, I have to adjust my insulin dose and my food accordingly to the effort to avoid a hypoglycemia.
2. What’s an ideal blood sugar before starting a physical exercise ?
My blood glucose should be a little higher before an effort, so that I have a “security zone” at my disposal. To avoid an hypoglycemia too quickly, my blood sugar should not be situated under 150mg/dl.
If my blood sugar is over 250mg/dl, I must absolutely do a keton test. If this test is positiv, I cannot start an exercise otherwise effort will make it worse.
3. What’s the risk by doing sport ?
As my blood glucose falls during the effort, I risk an hypoglycemia. The usual symtoms of a hypo are more difficult to detect as I am concentrated on my exercise and my body changed because of the effort.
4. Why does my blood glucose change during a physical effort ?
By doing an effort my muscles have to work hard.
On one side, the insulin sensitivity increases and on the other side the muscles need energy which they get as glucose.
My body consumes first the absorbed glucids in the blood. My blood sugar sinks.
If my blood glucose continues to fall as the effort is important, the sugar reserves of the muscles, the liver and finally the lipids are tired out.
5. What is glucagon ?

Glucagon is a hormon, which is produced by the alpha-cells of the pancreas of a non-diabetic person. The role is to rise the blood glucose; it’s the opponent of insulin.
It starts acting when there is a lack of sugar in the blood, like a “starving sign”.
The sugar reserves of the liver return to the bloostream. The stored glyogen is transformed back into glucose and the blood glucose rises again.

6. What should I pay attention at while doing efforts ?
-test the blood glucose
-reduce the insulin dose
-eat more glucids
-drink more
-always carry quick sugar
-keep glucagonset close to you
-test ketons if the bloodsugar is over 250mg/dl
7. Why do I need less insulin while doing sport ?
As the blood glucose falls while doing a physical effort, the non-diabetic person automatically produces less insulin to avoid a hypoglycemia.
Because of this low insulinlevel ,the liver is able to to return his sugar reserve back to the blood and the muscles can have more energy by using fats. The blood glucose stays constant.
8. How do I adapt my insulin dose to the exercise ?
How much less insulin I need depends on:
-how big the effort is
-how long the effort lasts
-which kind of sport I practice
-how athletic I am
-at what time I do my sport (as the insulin sensitivity changes during the day)
-what kind of insulin I use (analog or NPH)
-how much time between the meal and the effort
9. Why does my blood glucose continue to fall even after stopping the effort ?
After a physical effort, my muscles fill up their stock. Glucose is transfered from the blood to the liver and the muscles to refill their glycogen reserves.
It’s called “muscle rebuilbing effect”. The bigger the effort, the longer this period of time will last.
That’s the reason why I have to be extremely careful not to do a hypoglycemia during the night.
10. What kind of food is favorable when doing a phycical effort ?

-Rapid glucids such as dextro-energy, juice, sweet sodas ( Coke…), glucose gel are adapted to counter a hypoglycemia but after a short time, the blood sugar sinks again.
-Comlpex glucids such as bread, pasta, rice and especially food with fibres (wholemeal) help to keep the blood glucose constant for several hours.
-isolated glucids act on my glycemia for the first 1-2 hours
-additional proteins act for the next 2-4 hours
-additional fat acts for the next 4-6 hours

I should adapt my meal accordingly to the kind of exercise.