My 11 year old daughter just started on an insulin pump, plays soccer in the youth recreation league, and our pump educator says she should wear her pump while playing. Does the league have the right to keep her from wearing it while playing? I haven’t checked into this yet, but last year while she played middle school soccer, she was not allowed to wear her identification bracelet, and since I was at every game and practice, I did not question or argue with them.

This question, in one form or another, is asked by virtually all parents of child with a diabetes at one time. You’d think that the school systems out there would listen to parents or doctors! Okay, having gotten that off my chest, here are some things to consider:

First of all, the league (probably) has the best interest of your child pretty close to the top of the list. I have never understood the “jewelry” ban other than the rare theoretical concern that another child could be injured by a flying necklace or bracelet. I suggest to my families that as far as medical identification is concerned, you can buy (and possible even make) a medical identification “sweat band”. I’ve had patients simply wear a sweat band over the bracelet, but this does somewhat defeat the purpose of medical identification. At least one medical identification company does make “sports-band” medical ID’s. There are temporary tattoos you can rub on. I know of folks who have had permanent tattoos applied. (There is debate about the safety of this. Discuss it with your child’s diabetes team. I personally am not usually opposed to tattoo application in young, otherwise healthy older children and teens with diabetes.)
As for the insulin pump, a preemptive discussion from you with a letter from her diabetes doctor should help. Pumps need to be secured on the body, and I find that my patients actually tell me whether or not they wish to wear the pump during athletics, based on their comfort levels. That is the beauty of a pump: a lot of flexibility. Have her wear it with lower infusion levels, or suspended mode, or even disconnect. Be certain to have glucose testing equipment/supplies as well as fast-acting glucose (gel, tablets, cake frosting) and glucagon around. Remember, soccer is not a dainty sport: falls and collisions occur. Do you want to risk a $5000 piece of medical equipment on a slippery, muddy field? I’d suggest disconnecting during the game and letting her burn off the sugar with the exercise she is doing. However, I do have competitive athletes, male and female, on insulin pumps who do wear their pumps during soccer, basketball, baseball/softball, and other sports.
The use of long-acting insulin [such as Ultralente or Lantus (insulin glargine)] might fit the bill during soccer, although they last too long for your daughter’s needs.

There almost always options.

DS
Additional comments from Dr. Jim Lane:

Having gone through this with the NCAA, the ability to use an insulin pump during competition is interpreted variably. Some allow at official’s discretion, if the pump is adequately padded. Some do not allow it. When not allowed, it is an issue of ignorance. I would check with your local coaches and league administration to see if they have a policy.

Some kids can use it without problems. Others prefer to disconnect and replace it after competition. If disconnected, some invariably need insulin; others do not with the exercise.

Your diabetes care team would be the best resource for the appropriate use of the pump during intense exercise.

JTL
Additional comments from Dr. Stuart Brink:

The real question is why you would want to wear the pump while playing soccer. Most of our patients using pumps take off their pumps for such sports but there needs to be a strategy to make sure sufficient insulin is available while the pump is off. Sometimes this means a small bolus just before taking the pump off. You should discus this in some detail with your diabetes team since they know your child best. They will also likely know the rules and regulations for local sports leagues etc — and then be available to assist you should any problems arise. Also not much reason to wear medic-alert since it could get caught or cause some injuries to others during sports. Your child should know to place the medic-alert back on after the sports events are finished, of course.

SB
Additional comments from David S. Holtzman, Esq.:

Since the league has not indicated their position on this issue, then I would suggest that we keep this in the realm of the hypothetical. The league probably justified the removal of the bracelet due to the risk of injury to other players from jewelry worn on the players. The pump though is quite different since it is worn underneath clothing, and it is required for treatment of a medical condition.

I would have a letter from your daughter’s physician handy documenting the need to have the pump on at all times as well as a statement that it does not pose a risk to other players coming into contact with the child.

DSH