My 15 year old daughter does springboard diving. Even when she eats an extra snack before diving, her blood sugars drop too low while exercising. She must be at least 150 mg/dl [8.3 mmol/L] to dive (according to her endocrinologist) and her blood sugar can drop up to 200 mg/dl [11.1 mmol/L] points in one diving session (over approximately three hours). The only way she has found to keep her blood sugar up is to drink about 120 ounces of Gatorade plus 8 ounces of Coke plus a granola bar. This then causes her numbers to spike up real high before they level off. This is also causing her to gain weight I think. She is 5′ feet 4 inches tall and weighs 145 pounds. Any other ideas? I have suggested eating a more substantial snack (including protein to maintain the carbs), but she insists this is the only thing that works.

There are a couple of options which your daughter might try, including speaking to her diabetes team about lowering her insulin dosage on the days she is diving. You don’t specify her insulin regimen, but if her sports participation occurs after school, she might speak to her team about lowering her lunchtime insulin dosage (if applicable), or lowering the morning intermediate (NPH or Lente) dosage. She also has the option of increasing her lunchtime carb and protein intake.

Sipping on the Gatorade or similar carb throughout her exercise session, rather than drinking it all at once prior to the exercise, might also work better to avoid the spikes yet provide a steady supply of glucose to meet the energy demands of the intense exercise. In addition, some people have found the “extended carbohydrate” products, such as Z-bars or Extend bars, helpful. She may wish to experiment with some of these techniques.

Your daughter may be more motivated when she realizes that if she can avoid those dramatic swings in blood sugar, she will feel more energetic throughout her exercise. Certainly, we can all understand how frustrating it can be to feel like you must shovel in huge quantities of food in order to maintain blood sugar during exercise. Finding the right management techniques for her will assist her in performing to the best of her ability. We wish her best of luck with her sport!

DMW