by Michael G. Sabbeth
Tom Bryant exited the shooting cage and manipulated a small device hooked on his belt. “I was losing concentration,” he said. “My blood sugar was a little high.” He infused insulin from his pump into his tissue, then wished me well as I stepped into the cage. I’ve shot with Tom for years yet had not known he was a Type I Juvenile Diabetic.
Diabetes is a pernicious disease that requires constant vigilance. Because superb information is readily available on the Internet, I do not address the disease’s severe pathology. This article describes metabolic processes relevant to shooters and offers suggestions about how they can achieve peak performance through proper preparation and treatment during a shooting event.
Carbohydrates – sugars, starch and fiber – are our main source of energy. Digestion breaks them down into sugars called ‘glucose’ when in the blood stream. Insulin, a hormone, enables glucose to enter cells, primarily muscle cells, to be used for energy or to be stored as glycogen in the liver and kidneys for future energy use. Blood sugar is the sole energy source for the brain.
For most of us, insulin is produced in the pancreas and released into the blood as needed as the glucose level rises. However, the pancreas of a person with Type 1 diabetes cannot produce insulin and, thus, the diabetic cannot process glucose for energy. The Type 1 diabetic must inject insulin from an external source to prevent blood glucose from rising to levels that can be fatal and to process it for energy.
A person with Type 2 diabetes produces insufficient insulin or is resistant to insulin and, thus, does not process glucose efficiently. As opposed to the Type 1 diabetic, the Type 2 diabetic has available various and less drastic treatments –exercise, weight loss, medication, sometimes insulin injection –to more efficiently process glucose. Many people with Type 2 diabetes remain undiagnosed for years because the symptoms are common among non-diabetics.
Normal blood glucose levels range from 90 to 110 milligrams of glucose per deciliter of blood (90- 110 mg/dl). The challenge for the Type 1 diabetic is to infuse into the blood stream the amount of insulin appropriate for the blood glucose levels so that a normal blood glucose range can be maintained under an array of physical and mental conditions. Hypoglycemia occurs when excess insulin causes the blood glucose level to drop below the normal range. Hyperglycemia occurs when the glucose level rises above the normal range because insulin in the blood is inadequate. In either instance, significant consequences will occur that, in the extreme, can be life-threatening. Severe consequences of mismanaged diabetes – for example, foot numbness or ketoacidosis
(poisoning the blood when inadequate insulin causes fat to be burned for energy) – are beyond the scope of this article.
How I Feel and Why
Blood glucose levels affect every function of the body and mind. An array of symptoms become apparent when the glucose levels are out of metabolic alignment. I wrote previously that Br yant noticed he was losing his concentration. Loss of concentration and focus can result from one or more causes, and when causes compound, the consequences quickly become detrimental and substantial.
Low blood glucose levels prevent the cells, including the brain, from receiving adequate energy. The body thinks it is starving. The person will feel weak, lethargic and unfocused. High glucose levels, the result of inadequate insulin, indicate that glucose is not entering the cells and generating energy. Symptoms such a dizziness, compromised vision, thirst and excess urination result.
Relevant to shooters, high glucose levels affect the eyes and diminishes concentration. Dr. Boris Draznin, Director, Adult Diabetes Program at the University of Colorado School of Medicine, explains that elevated sugar impairs the small vessels in the eyes and gets into the lenses, drawing in fluid and swelling them. Light penetration and vascular oxygen levels are diminished, compromising their functions and causing inaccurate information to be sent to the brain. Mental stress caused by impaired eyesight, somewhat similar to that caused by chronic back pain, for example, compounds the physical causes of sub-optimal performance. Blood sugar levels play a key
role in shooting because focus and concentration are vital. Br yant told me his vision is best and, thus, he shoots best, when his glucose levels are between 110 and 120mg/dl. He begins to get shaky below 90 and loses focus, just as concentration is compromised at high glucose levels. Br yant said he can ‘shoot through’ when he is low on energy but he can’t fight through bad vision. He cannot see well when blood sugars are high and when low, vision is compromised because he sees spots and flashes.
Mark Haywood is a long distance cyclist, a superbly fit athlete and a Type 1 diabetic. He experiences excessive urination and thirst when glucose levels are high. These symptoms not only negatively affect performance but also affect preparation for performance.
Dr. Shari Fox, a Denver endocrinologist, explains that at
high glucose levels, excess glucose overwhelms the kidneys and enters the urine. Osmotic pressure in this abnormal metabolic state pulls water from cells into the urine, increasing the need for urination and creating dehydration. A person feels thirsty because the osmotic pressure from high sugar concentrations signals sensors in the brain that there is not enough available water in the blood.
Another deleterious consequence of dehydration is decreased blood volume makes blood thicker – a higher concentration of red blood cells – and more resistant to flow, leading to poor circulation. The thirst and urination that result from hyperglycemia the night before a shooting event will affect sleep and concentration and undermine shooting performance.
With an understanding of the endocrinology of the disease, the diabetic shooter can now better understand why trying to reduce thirst and, perhaps, fatigue, by drinking a sugary energy drink will exacerbate rather than reduce the diabetic symptoms. Thirst and fatigue will increase because the blood sugar will spike. More insulin will be required to counter the high sugar levels, which then risks low glucose levels from excess insulin, continuing the destructive cycle.
Mark Haywood emphasizes the need for ‘tight control,’ the ability of the diabetic to keep glucose at normal or near-normal levels at all times. Tight control enhances a person’s sensitivity to small changes in glucose levels, enabling the diabetic to take small actions to achieve normal glucose levels rather than dramatic ones, thereby reducing the risk of a trampoline effect of repeatedly bouncing from high to low.
Doing and Attitude
All calories are not equal. They have different effects on insulin production in the non-diabetic and different insulin process requirements for all persons. Thus,diabeticshootersshould become familiar with the Glycemic Index (GI), a sliding scale that ranks how different carbohydrates influence insulin production. Knowing the insulin response of a food helps predict blood sugar responses to insulin.
In the non-diabetic, foods and drinks with a high GI trigger a significant insulin response from the pancreas. In the diabetic, high GI carbohydrates require more insulin to be injected in order to process them.
In general, food with a low GI, and thus, a lower insulin response, are preferable for diabetics because they can be processed into energy with smaller amounts of insulin.
This results in a more normal metabolic state, sustained energy and consistent mental alertness.
Here’s how to apply the GI to the diabetic shooter. As a snack, it is preferable to eat the same amount of carbohydrates in the form of a peach (GI 28) than jellybeans, (GI 80). Similarly, if thirsty, it is preferable to drink water than a sugary energy drink.
A consistent disciplined routine is key to the diabetic’s success in life generally and in shooting sports specifically. Preparation is important, as illustrated by the need to control glucose levels the night before a shooting event. Mark Haywood takes notes on his blood sugars before, during and after every athletic event and reviews them to replicate all the variables that were successful in controlling his glucose levels. He then can make adjustments for future treatment.
Tom Bryant’s food intake is routinized and consistent. In the morning he eats a peanut butter and honey sandwich and drinks coffee – always with the same amount of sugar. “If I take too much insulin in the morning,” Bryant said, “I tank bythetimeIgettotheshoot.”
Bryant integrates many variables into his pre-shooting and shooting routines – how many hours he must travel to the range, whether he will walk or use a cart, whether the shoot is half a day or a full day. He starts a shoot with his blood sugar a little high, knowing it will drop into normal range as he walks around.
He brings snacks of dried fruit, granola bars (low GI) and commercial low-carbohydrate drinks containing electrolytes. He checks his blood sugar level several times during the day and carries about fifteen grams of a high GI carbohydrate – glucose tablets, candy – just in case he miscalculates and goes low.
The insulin pump has been a blessing for Bryant because it keeps the glucose levels smooth and additional insulin is easy to infuse. He told me, “I am a master of no will power! Now I can eat whatever I want and just shoot up a little more.” He’s been a diabetic for more than half a century, but, he told me, “I’m better than I’ve ever been and having more fun. The pump has made it possible to compete at a higher level. I’m thankfulforwhatIhave.”
Colleague Steve Bieringer is a Type 1 diabetic, a cyclist and part of the legal staff of the American Diabetes Association. He emphasizes the importance of a positive attitude. He ignores the dismal advertisements of the dangers of diabetes. He’s motivated by positive reinforcement derived from the success of people despite their diabetes. He told me, “We’re ordinary people going through life having been dealt a bad hand. You work and take care of yourself and your responsibilities. That’s motivating. I won’t allow diabetes to undermine what I value.”
Diabetes, especially Type 1, is a difficult disease that demands near constant attention. However, with control and preparation, there’s no reason why diabetes should interfere with your fun or compromise your shooting performance. Type 1 diabetic Gary Hall Jr. won ten Olympic swimming medals. Type 1 diabetic Jay Cutler quarterbacks the Chicago Bears. Hundreds of Type 1 diabetics successfully compete in Iron Man Triathlons. Don’t let diabetes prevent you from getting your gold medal.