Teeing Up for a Healthy Heart

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Golf and Diabetes

Lush green fairways roll through stands of tall pine trees at Indian Canyon golf course in Spokane, Washington. And on these fairways, men and women of all ages are knocking around little white balls. Recently, I was among those men and women, having developed a passion for knocking a golf ball around. I realize the activity must seem absurd to some nongolfers — the strange vocabulary, the odd clothes, and the hours of concentrating on a small, white ball. But I’ve discovered one benefit of golf that few would argue with: the workout.

I have Type 1 diabetes, and like all people with diabetes, I’ve heard from my doctor about the importance of exercising and staying in good physical shape. The good news: No matter what type of diabetes you have, golf can be the exercise the doctor ordered.

It works better, however, if you walk the course. As reported in Golf Magazine’s May 2010 issue, a tester with a pedometer on a 7,000-yard course logged 16,000 steps, or eight miles. Keep in mind, however, that course length varies. A course length of 7,000 yards, though about average for those played on the PGA Tour, is probably longer than your local course. The courses I played in Spokane, for example, were generally 6,500 yards or shorter.

But even if you ride a cart to play golf, you’ll be exercising, because you always have to walk some distance to your ball. The cart rules, which outline where you’re allowed to drive the cart, dictate this. Cart rules vary from course to course, but there are some standard ones, such as to never drive up onto the tee box or the green (the area of shorter grass surrounding a hole). A course’s cart rules can change daily based on grass conditions. For example, the fairways may be wet and vulnerable to damage, so the rule becomes “cart path only.” When this is the case, you can expect to walk more. When you rent a cart, the pro shop or the starter (the person who manages the queue of players at the first tee) will tell you the day’s cart rules.

Getting started

If you already played golf when you were diagnosed with diabetes, you had a head start when it came to figuring out the “exercise” part of diabetes management. If you don’t currently play golf but think you might like to, it’s never too late to start. And unless you’re unusually talented, you may find you could spend the rest of your life “perfecting” your game.

If you’re brand-new to the game, a good first step is to call a local course or driving range and ask their advice on how to get started: They will know what resources are available in your area. Chances are, they’ll suggest you sign up for a beginner lesson with the pro at the course. (Most courses have a pro on staff.) Learning from a pro is a good way to learn proper technique and avoid injury. It is also likely to be less frustrating than trying to learn from a friend or a video. During your lessons you’ll be introduced to the gear and how to use it, learn what to wear, and learn the basics of playing the game (for example, whose turn is it to hit?). With a pro’s help, you’ll learn how to hit balls up into the air (probably on a driving range at first), before heading out for a game of 9 or 18 holes.

In my experience, golf as a sport is far more difficult than it seems it should be. I’ve practiced endlessly on driving ranges and played lots of courses, but I continue to struggle to swing just right, to hit the ball with solid contact, and to send the ball sailing in the intended direction. All too often I hit it way off to the left or right and have to go chasing after it.

But why complain? With all that chasing, I’m burning calories and building muscle. The worse I play, the more exercise I get. This is really the most advanced level of positive thinking a golfer could ever hope to achieve. I’m not really like this on the course, all the time. I’m competitive. I do want to improve my game. I want to play like the pros! On a par 3 hole, I want to hit it on the green in one shot. I rarely do that today. So I keep telling myself: While I’m working at getting to that pro level, I’m getting great exercise.

Diabetes on the course

I wear an insulin pump, and when I play golf, I also like to wear my continuous glucose monitor to help me stay on top of my glucose levels during the round: The monitor display shows arrows to indicate a rising or falling glucose level. I also set the continuous glucose monitor to alarm if my blood glucose drops to 90 mg/dl. This way, I can treat a low early, before it becomes an emergency.

When I was playing in Spokane, for example, I was on the fifth hole hitting from the trees when I heard the alarm. I ate three glucose tablets and continued to play. At the next hole, the others in my group teed off first while I took a fingerstick reading using my blood glucose meter. I found the reading to be normal, but according to the continuous monitor, the trend was a steady decline, so I ate a granola bar and then teed off (a very good drive!). By having my diabetes supplies with me — and using them promptly — I was able to continue playing without experiencing a low that would have affected my ability to play.

Had I needed to recover from low blood glucose before continuing to play, my foursome would not have hesitated to take 15 minutes or so out of the game at a tee box and allow the group behind us to play through.

When I’m exercising, I like to carry lightweight foods that have lower glycemic index values, so they’re digested more slowly. Energy bars that contain nuts and grains, are high in fiber, and contain about 20 grams of carbohydrate per bar are one of my favorites. (The widely available book The New Glucose Revolution Shopper’s Guide to GI Values can help you identify lower-glycemic-index snacks.) I steer away from energy bars with sweet coatings or with chocolate chips inside because they tend to melt on hot days and make a mess.

Even though I walk the course and try to keep my bag light, I always carry a full water bottle to avoid dehydration. I drink a lot of water during the game. I refill the bottle whenever possible, and I don’t worry about the weight that it adds to my bag.

Because I’m committed to exercising when I play golf, I walk quickly, and I sweat. In addition, my body twists when I swing. With all this movement, my pump infusion set or CGM sensor could fall out. So far, it has only happened once, when I felt my CGM sensor coming loose. I pulled off the sensor and transmitter and put them in my pocket for the remainder of the round. Because I had my meter, however, I could still keep tabs on my blood glucose level.

What goes into your bag will depend on how you control your diabetes, but at the very least, you should have a blood glucose meter and test strips, treatment for hypoglycemia (such as glucose tablets or raisins), a more substantial snack for when you get hungry or need more than your hypoglycemia treatment to raise your blood glucose, and a bottle of water. Having some cash with you on the course is also essential, in case you need to wave down the beer cart to buy more water or something more to treat hypoglycemia, such as a soft drink.

Sun protection

The sun is another hazard to navigate on the golf course. I’m particularly attuned to this because I am a skin cancer survivor, but everyone would do well to wear sunscreen, a hat, and often, sunglasses while playing golf. When I head out for a round, I smear on 30 SPF sunscreen, pull on UPF-rated clothing, and keep a hat on my head that protects my face, ears, and neck. I carry a small bottle of sunscreen in a pocket of my golf bag, and I reapply sunscreen when it makes sense (such as when I’m sweating a lot). It’s not uncommon for me to reapply twice during a round. I typically do this when I’m waiting at the tee.

I keep a few small sunscreen bottles at home in the closet, and before heading out I check to make sure the one in my bag isn’t empty. If I’m low on sunscreen, I know it’s usually sold at the pro shop.

Avoiding injury

Tiger Woods’s knee and neck, Spanish golfer Sergio Garcia’s sprained wrist, LPGA star Michelle Wie’s twisted ankle, Masters champ Fred Couples’s back pain —; the list of injuries among pro players is a long one. The list of injuries among recreational players is no doubt equally long, but many injuries can be prevented.

When you have diabetes, especially if you haven’t been active recently, a good place to start is with a visit to your doctor for both a physical exam and a conversation about what types of exercise are safe for you. You’ll want to have your cardiovascular health assessed, as well as your eyes and feet, before you start a new program of physical activity. If you have uncontrolled high blood pressure, for example, or certain types of retinopathy, your doctor may advise you to seek treatment before increasing your activity. Any loss of sensation in your feet may mean that extensive walking is not a good idea for you (and a golf cart is!). For most people, however, the most important thing is to start slowly and build up gradually.

Before heading out to the first tee, warm up your muscles with a few minutes of brisk walking or jogging, then do some stretches, being sure to stretch your arms and shoulders. For example, roll your shoulders forward and backward, swing your arms in big circles, gently twist your torso to the left and right, and do some leg and back stretches. Follow your stretches with practice swings: first with your shorter irons, and gradually building to full swings. (For more details on stretching see “Injury Prevention Resources.”) Now you’re ready to head out to the course.

Even after you’ve graduated from beginner lessons and are playing golf independently, have a pro check your grip and your swing from time to time to correct any bad habits that could lead to injury. (For additional resources and suggestions, also see “Golfing With Disabilities.”)

Maintaining the right attitude

At the “19th hole,” I’ve watched others enjoy a cheeseburger, fries, and beer, and sometimes I’m tempted to order the same meal. After all, at the end of a round, you’re tired, you’re famished, and maybe you’re feeling discouraged as well, asking yourself whether your game will ever improve. (Or maybe you’re feeling like rewarding yourself for a particularly great round!) At moments like these, it’s easy to forget all the benefits you’ve reaped simply by playing, no matter what your final score. But poor food choices at the finish can undermine those healthy gains made on the course.

When I need a little boost of inspiration, I look to pro players such as Scott Verplank, a PGA Tour player who also has Type 1 diabetes. He’s in great shape: At 5’9″, he weighs in at 165 pounds. His driving distance averages 278 yards. He wears an insulin pump on the course. In team tournaments like the Presidents Cup and the Ryder Cup, he has represented the United States seven times, beginning with the Walker Cup in 1985 at Pine Valley, when the United States won 13–11 over Great Britain and Ireland. He came very close to winning the Travelers Championship in 2010.

Some other pro golfers with diabetes include LPGA Tour players Kelli Kuehne, Michelle McGann, and Sherri Turner. Like Verplank, Kelli Kuehne also has Type 1 diabetes and uses an insulin pump.

These men and women are athletes, who use this sport to stay in good health. They compete not only against other players but against themselves and against diabetes — and they are winning. You can, too.

Originally Published August 16, 2011

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