Considerations for Swimmers with Type 1 Diabetes: A Narrative Review

Achieving success at the highest level in swimming requires exceptional physical abilities and technical skills. Type 1 diabetes (T1D) poses an additional challenge to maintaining optimal glycemic control. Most information on the nutritional aspects of competitive swimming is available in the literature, but specific considerations for swimmers with T1D are scarce. To excel, swimmers' nutrition and fueling strategies must align with the varied training and competition requirements, which can elicit different glycemic responses. Continuous glucose monitoring can help develop optimal fueling strategies. Dryland and altitude training will require different approaches than regular pool sessions. Competition-related stress can make glycemia unpredictable, and practiced scenarios must be established. The importance of early recognition of hypoglycemia with planned and practiced treatment scenarios should be established. There is limited evidence on the safety of using ergogenic aids other than caffeine in swimmers with T1D. Given the higher incidence of disordered eating behaviors and eating disorders among swimmers and other individuals with T1D, coaches and everyone involved in the swimmers' environment should be educated on how to communicate potential body composition issues and, if necessary, manage body composition safely. Swimmers and their team members should be aware of the specific considerations for T1D in swimming for safe sports participation, as presented in this review.