My 17-year-old son has had diabetes for 10 years. He plays competitive basketball and soccer. He must remove his pump during games for both sports. He boluses for corrections just before removing his pump and takes an extra injection of Regular insulin to cover the dose of the rapid acting insulin he will be missing while his pump is off. Sometimes, this works quite well and other times, often, when he is playing a tough team, it doesn’t work at all and his blood sugar will rise rapidly to over 20 mmol/L [360 mg/dl]. At this point, the extra insulin he takes to counteract this high blood sugar doesn’t do anything at all. He can’t play sports at this level as he feels very ill and must sit out. The problem is that is somewhat unpredictable so we hesitate to give him a higher dose of insulin just in case he doesn’t have this spike. What do you suggest? This is very frustrating.

Highly intense sports, such as basketball and soccer, can cause blood sugar to rise due to the increased secretion of stress hormones (i.e., adrenaline, cortisol, growth hormone). This can be due to physical stress as well as mental stress from the competition. If the decision is to keep the pump off during competition, it is important to check during a timeout or at half time to make sure blood sugars are in a good range. Keeping the pump off more than an hour frequently can cause a spike in blood sugar. Using insulin to bring down a high blood sugar during competition can be dangerous, but oftentimes it will not take affect until afterwards. Drinking water will also help decrease blood sugar and wash away ketones if they are present.

My recommendation would be to wear the pump during competition if you cannot come up with a plan to keep blood sugars in a good range without wearing the pump. There are ways to protect the pump with padding so it will not become damaged or injure anyone. You can get padding at your local sports store (i.e., Sports Authority) in the football section where pads are sold ($13.99) for football pants. Use one pad to cut a hole the size of the pump. Place the pump in the hole and use another pad without cutting a hole over top the original pad. This can be secured with an ace bandage or possibly compression shorts underneath athletic shorts. If the pump gets hit, the pad will disperse the force so it will not become damaged or hurt anyone. Before using this technique, check with your health care team to make sure any changes in your diabetes management will be safe.

RP