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November 20, 2006

Exercise and Sports

Question from Elkhorn, Nebraska, USA:

My 11 year old son was diagnosed with type 1 16 months ago. He also has celiac disease. He has played competitive sports since age five. Currently, he is on a select basketball team and playing developmental soccer. Before diabetes, or about two years ago, he was Mister Hustle. He even won awards for Mr. Hustle at camps. Now, when playing, he stands around a lot or jogs down the court. We are not sure what has caused the change in his play, but his coach has been riding him about dogging it. I think it is medically related and my husband thinks it is that he has lost his desire or drive. My son says that sometimes he is tired but, overall, he still loves to play and is unsure why he isn't running as hard as he used to. Can his medical conditions be causing a problem for him after that much time and/or is our sports protocol for his blood sugars causing a problem? Currently, he disconnects during play and has his sugar over 150 mg/dl [8.3 mmol/L] before the game. He is usually much higher than that during the game. He used to play most of the game but, now, he isn't getting as much play time. Please, any advice you might have would be great. I am worried all the negative criticism about his effort will affect his self esteem. Also, I was wondering if all the restrictions and structure in his daily life combined with competitive sports is too much for him to handle. Everything in his life is, "You have to do this..., you have to do that...."


It is certainly tempting and easy to attribute his “fatigue” simply to being “overly scheduled.” But, I’d guess that if he had the get up and go to participate 100% for things he likes, as he has in the past, then he would. So, I’d take his diminished performance as “real.” Is it from sub-optimally controlled diabetes? Maybe…. Many sources suggest that athletes with diabetes feel they perform most optimally when glucose is in the 150 mg/dl [8.3 mmol/L] to 180 mg/dL [10.0 mmol/L] range.

Has he gained weight? Given his diagnosis of type 1 diabetes, he is at some increased risk of other conditions that might affect his energy levels including, but not limited to, thyroid issues, celiac disease, adrenal gland function, Vitamin B12 deficiency and others.

Might there be some genuine psychosocial issues? Perhaps he was inherently more talented than the other boys when younger, but they’ve caught up. Could this be causing him frustration?

Your child’s diabetes team should be able to assess him for overall glucose control and other possible co-morbidities.