My 13-year-old son is on the junior high wrestling team. He is 5 feet tall and weighs about 98 to 99 pounds with a fair amount of muscle. He practices very hard seven to eight times a week. His coach has asked him to “cut weight” so that he could wrestle in both the 95 and 100 pound classes to match up to a specific opponent. My son is using an insulin pump and has pretty good control, especially at school. I told my son to tell his coach that he will not cut weight because it is dangerous for a type 1 diabetic to skip meals and water while exercising excessively. His coach was not convinced and thinks my son is being difficult, therefore he has “sat out” the past two matches. I would like to talk to his coach “one on one” and explain the dangers of my son cutting weight. Can you elaborate on these dangers?

I agree with you! “Cutting weight,” as you describe for the wrestling team, typically does involve some significant, albeit usually temporary, changes such as cutting way down on food and fluids and has been known to be associated with kids making themselves throw up or taking laxative – and other maneuvers that ring of, or lead to chronic eating disorders. Sure, gradual safe weight loss can occur, for anyone, but typically involves cutting out some calories and exercising more.

I imagine that your son could exercise more, but I’d guess not by much, given your description. And, he could cut out some calories – and adjust his insulin accordingly. However, I think the risks to your son are too high! You did not really detail how “tight” his glycemic control is or his general HbA1c values, but you really risk there being significant hypoglycemia. Your coach does not want to be responsible for the boy having a hypoglycemic seizure, does he? Furthermore, if not done correctly, rapid weight loss can lead to ketosis, which, as you know for the patient with type 1 diabetes, can be associated with the always serious diabetic ketoacidosis (DKA). If your son were to allow his glucose values to rise and get in rapid poor control in order to lose weight (as he would literally be urinating glucose calories down the toilet), that is a surefire recipe for DKA.

It seems that your own Diabetes Education Team and Pediatric Endocrinology/Diabetes Center would be your best advocates here. The Children’s Hospital in your city has a world renown Pediatric Diabetes Center (and you probably get your son’s care there!). Talk to them for their input.

Let us know how things go with the coach. By the way, I would not go into your conversation with the coach with an antagonistic approach, at least not initially. I’d suggest you approach this as two mentors to a young man whom they want to achieve success, learn confidence in himself, and have a good time in the process and learn life lessons. Your son also must incorporate strategies to optimize his diabetes care at the same time. Of course, you know that: he’s wrestling.

DS