Kelli Kuehne was diagnosed with diabetes long before she took up golfing.
Now the former University of Texas All-American makes a living firing golf balls down the course. In her 11 years on the LPGA tour, she's recorded 26 top 10 finishes.
Fitness is crucial to her career. It's also critical to managing her disease.
But like the 25 million other Americans — more than 7 percent of our population — who have diabetes, she has to be careful about how and when she exercises, and how she fuels those workouts.
"There's no reason being diabetic can stop you from doing what you want to do," Kuehne says.
First, some background.
Most of the food we eat is broken down into glucose, a form of sugar used as energy. The body needs insulin to absorb that glucose, and lower the blood sugar level. People with diabetes have high blood sugar because their bodies either don't make enough insulin or their cells don't respond to the insulin their body makes.
Regular exercise is one of the best ways to control the disease, says Dr. Elena Arizmendez, president of the board of the Central Texas chapter of the American Diabetes Association.
"Exercise is wonderful because it can reduce your need for blood pressure medication or insulin or oral medications, but you have to be cautious," says Arizmendez, who treats patients at Health South Rehabilitation Hospital of Austin.
Kuehne, 33, was diagnosed with Type 1 diabetes — her body can't produce insulin — at age 10. She was always active, playing sports as a child and golfing for UT from 1995 to 1997. Today she splits her time between Austin and Salt Lake City, and travels the country competing in golf tournaments.
During college and into her pro career, Kuehne has worked closely with Tina Bonci, co-director of the athletic training department at UT. Bonci also has diabetes, and helped Kuehne learn how different foods affect the way she feels on the course. She also learned to feel when her blood sugar was high or low.
To stay in shape, Kuehne works out on an elliptical trainer, spins on a stationary bicycle and runs. She also does core-strengthening work. Depending on her playing schedule, the workouts last from 30 to 90 minutes.
Before exercising, she checks her blood sugar and eats an energy bar (she likes low-carb bars like PowerBar's Nut Natural, Pria Bar or Power Crunch Bar). Afterward, she checks her blood sugar again and eats a small meal.
In all, Kuehne tests her blood sugar three to eight times a day. She wears an insulin pump with a subcutaneous port at her waist that automatically gives her insulin when she needs it.
"When in doubt, check blood sugar," Kuehne says.
She's also conscious of what she eats. She tries to eat five small meals instead of three larger ones. Instead of drinking straight Gatorade, she mixes it with water. She avoids white flour, opting instead for whole grains, which are absorbed more slowly into the blood stream. "Get educated. The more you know, the more equipped you are to handle it," she says.
Arizmendez, the physician, recommends consulting a doctor before starting any exercise program.
For many diabetics, the main goal is to improve the ability to do daily tasks. Walking is a good place to start, she says. Ease into a new regimen slowly, with a goal of 20 to 30 minutes of exercise two or three times a week to get in shape.
For non-diabetics, a normal blood sugar level is between 70 and 100. That number is higher in diabetics.
As long as your blood sugar is below 200, it's usually OK to exercise, Arizmendez says. If it's above that, let it drop before exercising.
Arizmendez recommends checking blood sugar before, during and after exercise. If you don't feel well at any point, stop and check your blood sugar. If it's low, some diabetics eat a small piece of hard candy or sip juice to control the hypoglycemia. Even better, Arizmendez says, learn how exercise affects your blood sugar levels so you don't need to consume empty calories.
Lean meats and complex carbohydrates like whole wheat bread and brown rice make good fuel. Avoid soda and too much fruit juice, unless you are hypoglycemic. "Hydrate with water, water, water," Arizmendez says. After exercising, eat a little complex carbohydrate and protein. Oatmeal and a few nuts, or a small piece of baked chicken and wild rice are good choices.
"Make a plan," Arizmendez says. "Don't try to be perfect on day one. If you can't find time to exercise, skip the elevator and take the stairs. Little things add up."
The good news is that your fate is within your control, she says. "All you need is knowledge to take care of yourself. It's up to you."
That's a lesson that Kuehne learned long ago.
"I don't use diabetes as an excuse or reason I'm not successful at something," she says. "There definitely are challenges, but it's about getting educated, promoting awareness and understanding the disease."
Tips to be fit and healthy
Remember that a host of other problems often accompany diabetes. Be aware of them so you can modify your exercise program as needed. You should consult with your physician, but Dr. Elena Arizmendez gives these suggestions:
1. Coronary artery disease: Nearly everyone who has diabetes has some element of coronary disease. That doesn't mean you shouldn't exercise; it just means you need to take precautions. When starting a fitness program, don't lift weights. Focus on the lower extremities, especially the legs. Don't exercise in a reclined position, which can put added stress on your heart. Be sensible when it comes to heat and sun exposure. Try walking at an indoor shopping mall, or early in the morning or late in the afternoon.
2. Peripheral vascular disease: If you have this narrowing of the large arteries in the legs and arms, it might be painful to walk. Exercise is still good for you, but don't put a heating pad on sore muscles when you're done. It can cause ischemia, or restricted blood supply. Tylenol is usually safe; don't take ibuprofen (Advil) or Aleve, which can cause renal failure.
3. Diabetic retinopathy: The fragile blood vessels in the retina can bleed or detach if you have diabetic retinopathy. Avoid high-impact exercises that can put you at risk for vision loss.
4. Peripheral neuropathy: Patients whose nerves are affected by this disorder can't always feel if their feet are traumatized. Wear good shoes and cotton socks when you exercise. Afterward, look at your feet. If you see red areas or broken skin, get fitted with orthotics and shoes that don't rub. Otherwise you risk limb loss.
5. Autonomic dysregulation: People with this disorder, which affects the involuntary reflexive activities of the body, sometimes feel light-headed. The condition is worse after eating, when the body focuses on digestion. Don't exercise immediately after meals.
For more information about managing diabetes, go to diabetes.org or call the American Diabetes Association at 800-342-2383.