Written by: Carrie Cheadle, CC-AASP

Anyone working with collegiate athletes knows how much work it takes to be both a dedicated student and a competitive athlete. It’s challenging to balance practice and games with classes and exams, not to mention trying to have a social life and maybe sleep somewhere in between. Then add trying to balance your blood sugar for optimal performance and it can seem like an astronomical task.

The science behind our understanding of diabetes and the treatment of diabetes has come a very long way. From faster acting insulin to insulin pump therapy, advances in technology have helped tremendously with diabetes management. However, this still doesn’t remove all of the challenges that come with diabetes. Dr. Matt Corcoran knows all about these challenges. Dr. Corcoran is an endocrinologist and founder of Diabetes Training Camp, a multisport and exercise camp that specializes in comprehensive educational camps and programs to help people living with diabetes achieve their health and fitness goals. Dr. Corcoran says:

"There are several great challenges facing the competitive athlete with type 1 diabetes, few of them greater than the requirement of regulating their own fuel metabolism through manipulation of their insulin and fuel supplies. In normal physiology, the body regulates insulin and glucose production in the moment to accommodate for the needs of the working muscle, accounting for the level of stress that body finds itself in. In type 1 diabetes, by definition the body does not produce insulin, and as a result has lost the capacity to self-regulate fuel metabolism at rest or in sport."

Basically, your pancreas is in charge of secreting insulin to help keep your blood sugar within a normal range. Blood sugar (also called blood glucose) is the sugar that moves through your bloodstream supplying energy to the cells in your body. Insulin is a hormone produced by your pancreas and acts as a key allowing the blood sugar to get used by your body for energy. When you live with type 1 diabetes (T1D) – you have to give yourself insulin through multiple daily injections or through a pump that acts as an external pancreas.

Without insulin, the sugar doesn’t get to where it needs to go to be burned for energy and blood sugar level increases. You’ve probably heard your diabetic athletes talk about blood sugar being “high” or being “low”. When blood sugar is high, your body needs insulin – when blood sugar is low, your body needs carbs. Dr. Corcoran explains:

"Related to insulin dosing strategies, the athlete often finds herself walking a tight rope, balancing between a state of over-insulinization and under-insulinization, resulting in a tendency for hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), respectively. Adjustments to insulin may be made to basal (long-acting) insulin supplies, or the rapid acting insulin that is utilized for dosing meals/snacks, and for correcting hyperglycemia."

One of the many inaccurate assumptions about diabetes is that it all comes down to food. There are many different factors that affect blood glucose level – stress, hormones, illness, exercise – it’s much more complex than what foods to eat and avoid. Hannah Vester, a swimmer at the College of William and Mary and recipient of Team Type 1 Scholarship says, “I would never wish to have diabetes, but I certainly don’t mind having it. I just wish people understood all of the complexities of the condition.”

As a collegiate athlete with diabetes, there are countless decisions and calculations that are made, every day, to try and replicate what your pancreas does automatically. Imagine just for a moment that you had to consciously make decisions for your body to perform some of its automatic functions. Shelby Payne, another scholarship recipient, recent graduate and soccer player for Stanford University, explains:

"My greatest challenges were trying to maintain good blood glucose values during training to be able to compete at the best of my ability and while having a very demanding schedule. As a college athlete, you are constantly on the move: traveling, playing games, attending class and meeting with groups. It is challenging to manage diabetes with not only a busy schedule but with a very inconsistent schedule compared to high school."

For persons living with diabetes, they have to receive external feedback, both from how they feel and from testing their blood sugar, and then make calculations and attempt to regulate something that happens instantaneously with an optimally functioning pancreas. It can be extremely frustrating for an athlete when he or she is mentally ready to compete, but have to physically deal with a diabetes-related issue.

Dr. Corcoran believes that one of the most important things for coaches and athletic trainers of T1D athletes to know is:

"It is of paramount importance for coaches and athletic trainers to understand that athletes with uncomplicated type 1 diabetes are equally capable as athletes without diabetes. Certain accommodations for diabetes management need to be made so that the well-educated athlete and his or her support team can manage the diabetes in an effective manner permitting performance at a high level."

There is an obvious physiological impact to being an athlete with diabetes, but there is a psychological impact as well. Hannah shares, “Every time I have a tough day at practice or in a meet where my blood sugar just wasn’t cooperating, I wish I had another teammate that understood what it was like. It’s hard to be the only one dealing with the problem when things are challenging.”

Although there have been recommendations for athletic trainers on how to work with athletes from a physiological standpoint (Jimenez, et al., 2007), information for coaches and athletic trainers on how to mentally and emotionally support athletes living with diabetes is lacking. Here are some key things for you to know when it comes to supporting your athletes:

Get to know diabetes:

Have a rudimentary understanding of type 1 and type 2 diabetes to steer clear of saying something that is inadvertently hurtful to your athlete. Something as simple as not knowing when your athlete would need insulin versus carbs or making assumptions about what they can and can’t eat may feel upsetting to an athlete. Hannah says, “My coaches were fantastic when I first explained everything to them. They were extremely receptive and made sure they knew what all of my equipment (pump, shots, test kits, glucose tabs, glucagon) was for and how it worked, as well as what to do if I went too low or high.”

Watch your reactions:

The reactions of others while performing diabetes-related self-care can feel stressful and can impact metabolic control, (Hains, et al., 2007; Hains et al., 2009). Some athletes will feel guilty at having to disrupt the flow of practice or frustrated at having to come out of play in order to treat a low blood sugar. These athletes also may be concerned with what their coaches and teammates are thinking and may delay making corrections to their insulin or fueling.

Pay attention to your reactions when your athlete is doing what he or she needs to do to manage diabetes. Marshall Zahn is another scholarship recipient and plays football and baseball for Ripon College and he says, “My coaches and trainers have been fully supportive. They are open and willing to do whatever I need when it comes to my diabetes.”

Talk to your athletes:

Some people tend to hold back from asking questions out of their own discomfort or not wanting to offend the person with diabetes. Don’t make assumptions and don’t be afraid to ask. Showing an interest and understanding of diabetes is important for your athlete’s well-being, both physically and mentally. As long as you are thoughtful and sincere with your inquiries, don’t be afraid to ask your athletes about their diabetes. You can even check in with your athlete and see if he or she would like to have the opportunity to talk to the team about his or her diabetes. Shelby shares:

"I organized a Diabetes Awareness Night at one of our games to bring together children and adults with T1D in the community as well as other T1D athletes at Stanford. My coaches and teammates were extremely supportive of this event and it was great to see their interest in learning more about type 1 diabetes as I managed it on and off the field."

All collegiate athletes, whether living with type 1 diabetes or not, need to feel emotionally supported by their coaches, trainers and teammates. Marshall sums it up best, noting it’s important “just to be open to being supportive and helpful for athletes with diabetes. An athlete with diabetes can perform just as well as anyone else.”

For more information about Diabetes Training Camp visit: http://www.diabetestrainingcamp.com

For more information about scholarships available through Team Type 1 Foundation visit: http://teamtype1.org/scholarships/

And for more general information about diabetes, visit the American Diabetes Association.

References:

Hains, A.A., Berlin, K.S., Davies, W.H., Smothers, M.K., Sato, A.F., & Alemzadeh, R. (2007). Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: The moderating role of friend support. Journal of Pediatric Psychology, 32, 561 – 570.

Hains, A.A., Berlin, K.S., Davies, W.H., Sato, A.F., Smothers, M.K., Clifford, L.C., & Alemzadeh, R. (2009). Attributions of teacher reactions to diabetes self-care behaviors. Journal of Pediatric Psychology, 34, 97 – 107.

Jimenez, C.C, Corcoran, M. H., Crawley, J.T., Hornsby, W.G., Peer, K.S., Philbin, R.D., Riddell, M.C. (2007). National athletic trainers’ association position statement: Management of the athlete with type 1 diabetes mellitus. Journal of Athletic Training. 42, 536-545.

About Carrie Cheadle:

Carrie Cheadle is a Certified Consultant through the Association for Applied Sport Psychology (CC-AASP) and author of the book On Top of Your Game: Mental Skills to Maximize Your Athletic Performance. Carrie consults with athletes on mental skills training at every level, from collegiate athletes to elite and professional athletes competing at national and international levels. She is one of the foremost experts specializing in Mental Skills Training for athletes and exercisers with type 1 diabetes and directs the Mental Training Program for Diabetes Training Camp.