0 out of 18 steps completed0%
13 Lessons

Diabetes mellitus is a chronic endocrine disorder characterised by hyperglycaemia resulting from either defects in insulin secretion, insulin action, or both. 1 Regular physical activity and participation in team sports from a young age have been associated with reduced macrovascular complications in type-1 diabetes and a delay in the onset of type-2 diabetes. 2

Athletes suffering from diabetes mellitus range from recreational athletes to competitive athletes participating in sport at the highest level. While the health benefits of physical activity are numerous, it is well established that exercise has specific short- and long-term effects on glucose control, which need to be closely monitored in order to avoid complications in diabetic athletes. All diabetic athletes engaging in physical activity must be periodically screened for complications, comorbidities and risk factors. Based on this assessment and the athlete’s exercise goals, an individualised training schedule and diabetes care plan should be created for the diabetic athlete.

This module will provide a general overview of diabetes mellitus, the effects of exercise on glucose metabolism, and details on how to identify and manage potential complications in the diabetic football player.

It is important to note that according to the World Anti-Doping Agency (WADA) guidelines, insulin is a prohibited substance in sport. Football players who have undergone a full medical assessment, meet the diagnostic criteria of diabetes mellitus, and have been prescribed with any form of insulin for the management of their condition must apply for Therapeutic Use Exemption (TUE). Updated details on the process and criteria for TUE application are available from the WADA website.

Prof Martin Schwellnus

Sport and Exercise Medicine Physician

Presented by

Learning outcomes

By the end of this topic you should know:

  • the different types of diabetes
  • how exercise affects glucose control
  • what to focus on when screening the diabetic football player
  • how to identify and manage hypo- and hyperglycaemia in diabetic football players


  • Read the relevant section in the FIFA Medical Manual
  • Review the suggested reading
  • View, or listen to, any relevant multimedia content
  • Complete the relevant assessment module


  1. Schwellnus MP, Patel DN, Nossel C, Dreyer M, Whitesman S, Derman EW. South African Family Practice 2009;51(1):19-25
  2. Shugart C, Jackson J, Fields KB. Diabetes in Sports. Sports Health 2010;2(1):29-38. [10.1177/1941738109347974].
  3. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice 2014;103(2):137-149. [].
  4. American Diabetes Association. Standards of medical care in diabetes – 2015. Diabetes Care 2015;8(1):S1-S94. [10.2337/dc15-S003].
  5. Harris GD, White RD. Diabetes in the Competetive Athlete. Current Sports Medicine Reports 2012;11(6):309-315. [10.1249/JSR.0b013e3182751007].
  6. Jiménez CC, Corcoran MH, Crawley JT, Hornsby WG, Peer KS, Philbin RD, et al. National Athletic Trainers’ Association Position Statement: Management of the Athlete With Type-1 Diabetes Mellitus. J Athl Training 2007;42(4):536-545.
  7. Anderson JM, Trojian TH, Kraemer WJ. Endocrinology. In: Shwellnus MP, editor. The Olympic Textbook of Medicine in Sport Oxford, UK: Wiley-Blackwell; 2008.
  8. Harris EH. Elevated Liver Function Tests in Type 2 Diabetes. Clinical Diabetes 2005;23(3):115-119. [Elevated Liver Function Tests in Type-2 Diabetes].
  9. Avery L, Flynn D, Van Wersh A, Sniehotta FF, Trenell MI. Changing Physical Activity Behavior in Type-2 Diabetes. A systematic review and meta-analysis of behavioral interventions. Diabetes Care 2012;35:2681-2689. [10.2337/dc11-2452].
  10. Ackerman KE, Babwah T, Bahr R, Bangsbo J, Bartsch P, Bizzini M, et al. Diabetes. In: Dvorak J, Junge A, Grimm K, editors. F-MARC Football Medicine Manual. 2nd ed. Zurich, Switzerland: Fédération Internationale de Football Association; 2008. p. 222-228.
  11. Diabetes UK. Travel & Diabetes. 2015; Available at: Accessed September, 26, 2015.
  12. American Diabetes Association. Air Travel and Diabetes. Available at: Accessed October, 10, 2015.
  13. Centre for Disease Control and Prevention. Have Diabetes? Safe tips for travel. 2015; Available at: Accessed October, 6, 2015.
  14. Blakytny R, Jude E. The molecular biology of chronic wounds and delayed healing in diabetes. Diabetic Medicine 2006;23(6):594-608. [10.1111/j.1464-5491.2006.01773.x].
  15. Thomson SE, McLennan SV, Hennessy A, Boughton P, Bonner J, Zoellner H, et al. A novel primate model of delayed wound healing in diabetes: dysregulation of connective tissue growth factor. Diabetologia 2010;53:572-583. [10.1007/s00125-009-1610-6].
  16. Retzepu M, Donos N. The effect of diabetes mellitus on osseous healing. Clinical Oral Implants Research 2010;21(7):673-681. [10.1111/j.1600-0501.2010.01923.x].
  17. Ilić J, Kovacev B. Diabetic osteopathy. [Article in Serbian]. Med Pregl 2005;58(3-4):147-152.