How dangerous is a high blood sugar (400 to 500 mg/dl [22.2 to 27.8 mmol/L]), without ketones, at wrestling practice, if it comes back down to normal after practice is over? What should be done besides taking insulin, drinking water and keeping in contact with the doctor?

Most athletes with high blood sugars (300 to 400 mg/dl [16.7 to 22.2 mmol/L]) will not perform as well as when they are in a lower range (e.g., 150 to 200 mg/dl [8.3 to 11.1 mmol/L]). Even though no ketones are present, there is more literature coming out discouraging extreme excursions. A low A1c may be an indicator of good control, but not necessarily so when an individual has extreme highs and many lows. It is believed that extreme excursions may cause cellular damage similar to a constant high blood sugar.

As long as your healthcare is okay, it may be helpful to experiment with small amounts of insulin prior to wrestling to see if the 400 to 500 mg/dl [22.2 to 27.8 mmol/L] comes down to the 200 to 300 mg/dl [11.1 to 16.7 mmol/L]. Drinking water is very important to help with performance and to wash out any ketones present. It may also be prudent to have a lower starting blood sugar prior to wrestling. For example, if 175 mg/dl [9.7 mmol/L] has been a pre exercise goal, maybe 125 mg/dl [6.9 mmol/L] would help with the extreme highs.

RP