My 11 year old son has had type 1 diabetes for less than a year, and I am at a loss in understanding the reason behind the following two incidents. When he played competitive soccer team, we gave an activity snack (approximately 20-30 grams of carb) before the game, and his blood glucose rose by 10 mmol/L [180 mg/dl] during the game. Within an hour after the game, his blood glucose was back to normal. This rapid rise does not occur when he participates in other sports he plays, and no additional insulin was given.

The same rapid rise and fall in blood glucose, within an hour long duration, was a result of the excitement he felt the day he bought his first pet. My guess is that adrenaline is creating the rise in blood glucose, but what I don’t understand is what is causing the blood glucose to fall. Could adrenaline or something else be causing a false high reading? In this type of adrenaline event, can the body make use of and lower blood glucose without insulin?

Great question! Adrenaline and other “stress-related” hormones cause a rapid rise in blood sugar as a result of release of liver glycogen. This process is the body’s attempt to assure the availability of enough glucose for energy production. In those of us with diabetes, the absence of circulating insulin may cause this liver glycogen “dump” to be excessive and may also prevent or reduce the entrance of glucose into the cells. This hormone induced rise might be observed in situations such as illness, emotional stress or excitement, and the nerves of competition. A similar rise in blood sugar does typically occur during high intensity, anaerobic-type exercise such as soccer, sprinting, weight training, etc.

In your son’s situation, it may have been a combination of both the snack provided prior to intense (stop-start/power-type exercise) and the hormonal influences that caused the rapid rise in blood sugar. The return to normal levels probably came as a result of both his circulating insulin levels (NPH), and the prolonged effects of the exercise on his metabolism, allowing for an increased consumption of glucose for energy after exercise. During exercise there actually are alternate pathways (besides insulin) called PPAR receptors which allow glucose to enter cells. Insulin however, although not directly involved, must be present for this to occur. Perhaps the excitement regarding his new pet had a similar effect. Adrenaline should not be causing a false high reading on the glucose monitor. It is important to recognize that some of these rapid rises with subsequent returns to target range will occur in diabetes management, and despite the knowledge and our current technologies, as of yet we can’t control for all.

DMW