I have a question about sports participation. My 9 year old son has always been very active (bike riding, roller blading, etc.) but nothing like the 2 hours of intense physical training that he does five days a week for football practice. This is his first "real" organized sports experience and he is loving every second of it. In just a few weeks his attitude and self esteem have gone way up and he is very much looking forward to the first game next weekend.
Everything is going very well aside from the fact that I am about to have a nervous breakdown! For starters, practice is at 5:30 PM to 7:30 PM every night: right smack in the middle of dinner time. His evening shot used to be at 6 PM, but I am now having him do his combined regular and NPH insulin when he gets home (8PM) at which time he is starving, eats a huge dinner and falls asleep within the hour. I have to be very carefull not to give him too much insulin as he is usually too tired and too full to have a snack before bed. A few times I have tested him at 10PM (the reg. peak) and found him to be too low.
Another problem, he refuses to eat during practice or games and is also too excited to eat a lot right before a game either. I have found that a mixture of Gatorade and water in a squeeze bottle works best during practice or games to keep his blood sugar from dropping too low, but as you can imagine, it is easy to underestimate how much he will need to drink and sometimes this has caused him to get too high. I have switched him to plain water but a few times he said that he was low when in fact he was about 150.
Another problem is days when he does not practice. I don't like changing his insulin doses on a daily basis and so on days when he does not practice he tends to run a little high. NOW we are about to be faced with a mid-day game every weekend! This seems frightening to me as instead of at night, before a shot, when insulin reactions are unlikely, he will be running around and doing push ups right after his morning injection!!!
Needless to say, I go to every single game and watch him like a hawk, but I am very stressed about this whole thing. I don't let him see my worries, but they are there. So far we have done well and have had fairly good blood sugars and have "survived", but I would appreciate any and all advice you can give me about how best to handle high-activity sports. Are there any sports figures that you are aware of who have diabetes and can encourage young sports players who may feel "different"?
Thanks in advance.
This question was referred to several members of the Diabetes Team, who have each given an answer:
Answer from Dr. Robertson:This is a really excellent question and one which I come across fairly regularly. I am delighted to hear that your son is enjoying his sport so much and hope that this continues for many years. Probably the only part of this answer that I can be totally confident about is that he should continue to participate in all the sport he wants to and you have to find a way round the diabetes problems.
In an older child/adolescent, I would probably recommend a change to a basal-bolus insulin regimen with regular before meals three times a day and NPH before bed. I guess, however that you wouldn't find it convenient for your son to have to take regular at school before lunch. Some paediatric centres in the UK do recommend this regimen even for quite young children who need a lot of flexibility. Although you are having a "nervous breakdown," the fact that he does training every evening should allow you to find a routine that suits. It's okay to give the evening shot later provided that this is built into your regimen. As you have already discovered, this may mean that he needs a lower dose if you are to avoid late hypos. You are correct to have a fast-acting carbohydrate such as Gatorade handy when he's playing football but if you could persuade him to have eg. a chocolate biscuit and a sandwich before playing then the need for "treatment" during a game or training would be less. One of the effects of exercise is to sensitise the body to insulin - this may mean that sugars run low for up to 24h after particularly vigorous activity. The weekend games can be handled by making a small reduction in insulin dose before a game and a similar approach to preventive therapy. The main weapon in your fight for good control through the ups and downs of vigorous sport is a well kept blood sugar diary. Every child responds differently depending upon the intensity of exercise, carbohydrate eaten beforehand etc. Only by doing lots of sugars and recording all the appropriate details can you and your diabetes team build up the information necessary to make sensible choices. Discuss your worries with them.
Finally, I hope that you will soon be in a position where you don't feel obliged to attend every game and watch him like a hawk. Is there a coach or teacher who you could explain hypo symptoms to and who could keep a discreet eye on him? He certainly won't want mum at all his games for the next 20 years - especially when he starts travelling with the team! You should contact the American Diabetes Association about famous footballers with diabetes. I know there are some because I met one recently in Pittsburgh when he was being honoured for his work for the ADA - His name is Jonathan Hayes, Tight End for the Pittsburgh Steelers.
Hope this helps.
Answer from Dr. Lebinger:I'd like to add a few more suggestions. First of all, if you find that Gatorade is hard to estimate, you might want to try separating his "carbohydrate" requirements from his "fluid" needs. If you give him a completely sugar-free drink such as water, he can drink according to how thirsty he is without keeping track of the amount. You can than try to concentrate on figuring out how much extra carbohydrate he needs for exercise. Although I agree, you definitely want to find a way for him to participate in all activities and learn to manage the diabetes, he has to understand that he must eat when necessary even when he is too excited or not hungry to avoid dangerous lows. I explain to the kids that they will not perform their best if their blood sugar is very high (and they are uncomfortable with a full bladder and can't run fast enough) or they are low (they also may not run as fast or may be more clumsy and miss the ball even if it is a mild low blood sugar). I think if you link optimal sport performance to blood sugar control, kids are more apt to cooperate. You will not be able to leave your child unattended until you are sure he will eat when necessary or someone else will take the responsibility to remind him.
Although you don't like to change his insulin every day, you might find you have to make small adjustments (decreases) on days when he is very active if you are not able to adjust enough with extra food to compensate for the extra exercise.
Catfish Hunter and Bill Gullickson are famous US baseball players with diabetes. Forecast Magazine (published by the American Diabetes Association) has had many article about famous athletes.
Original posting 9 Sep 96
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