HOCKEY AND DIABETES

[hockeydad]

Hi I just found this site today.
My son is 12 yrs old and has had type 1 diabetes since he was 6 yrs. He is now on a pump and has been for the last 2-1/2 yrs. He plays a lot of sports but his true love is hockey. He plays on a Rep team that is on the ice 4-6 times a week. I would love to hear from someone who has type 1 themselves or has a child with type 1 that plays a lot of hockey as it seems like a constant   struggle to keep his blood sugars and engery levels at a consistant rate.  Any info on the timing and make up of pre game/practice meals and or nutritional info would be much appreciated. He frequently mentions that he can tell what type of game he is going to play by the way his legs feel when he first steps on to the ice.  Quite often his legs will feel "heavy" and his skating speed is much reduced. This can take place when his blood sugar is "normal" or more often when it is high or he is dropping from a higher blood sugar.  "Dagis" since you mention that you played a lot of sports, specifically hockey at a high level and are on the pump if you can past along advice or personal experiences it would be much appreciated.
Thanks in Advance - HockeyDad

[JDRF-Team-sgg]

I am the person who is assigned to answer questions that come in on Wednesdays, but I do hope that "Dagis" will respond to you. I have been a type 1 since age 12 also and now am 47. I am an active person, and I rode horses competitively in my teen years and played USTA tennis as a young adult into my 30's. I spent two summers being a white water rafting guide just a few years ago, so I am well-acquainted with sports and insulin regiments.

I particularly noticed that the swings in glucose affected my tennis game when either high or low. So going hight to avoid a low is not a particularly good answer for a highly competitive diabetic. Many diabetics who wear pumps simply turn off the pump while playing strenuous sports, making sure that the glucose levels are normal BEFORE the activity. This way, the body burns off glucose but can't drop low. But this would mean eating any kind of pre-game meal at least 3 hours before the game so all insulin required to cover the meal will have time to do its thing and the meal digest so no spikes will happen. Others find that simply slowing down the basal rate does the job, and there is no real answer to which solution will work best for your son except trial and error, for each person is different and needs different amounts of basal insulin. One he establishes a proper basal dose (even if it means NO dose while playing hockey), he can use this as a routine for game time. If he should drop low, keep Gatorade handy, for this absorbs into the system quicker than orange juice or any other juice and also replaces electrolytes lost in strenuous activity.

By eating the pre-game meal 3 hours before the game, any severe drops that happen while digestion is trying to match bolus will have already happened and he should be at his peak, and he should also be well-nourished for maximum energy, for eating a meal just before playing does not allow time for digestion to occur and that meal to help his body.

I found when playing extremely long tennis games, I would need both a water bottle and a Gatorade bottle, and it helped to do frequent finger pricks during breaks so I could keep the glucose levels even-keeled. The muscles and brain work best for optimum coordination and strength when he can keep glucose levels in the normal range without any kind of ups or downs during play. He is absolutely correct that he feels bad when his glucose is doing a sudden drop even before the numbers move out of the normal range, so avoiding any kind of bolus insulin work during games would be very helpful to him. A small sip of Gatorade during the game may not cause glucose levels to rise much if any, and then he can replenish the nutrients he has used by eating a hefty meal AFTER the game. His pre-game meal (eaten 3 hours before activity) should include both slowly-digested carbs such as whole grains and proteins for maximum energy.

Any other sports fans out there? If so, please feel free to jump in and comment. I would not give up my sports for anything, and all are safe and can be done well with VERY careful glucose monitoring.

[JDRF-Team-LRS]

It is so ironic that you posted this question today.  While waiting to see my endo today, I picked up a copy of Diabetes Health magazine.  I had never seen that publication before & they had some useful articles.  Their cover story & feature article was about a young man (tho' "old" in your son's eyes!) who has been a pro hockey player for many years.  He's also a pumper.  I visited their website, in hopes of finding that article online, but I didn't see it.  The website is www.diabeteshealth.com and they do have several articles from the past few years about rigorous exercise and pumping/ diabetes.  Here's an article about an NBA player that will likely have some good parallels for you to consider:
http://www.diabeteshealth.com/read,1038,1515.html

What I recall from the article I skimmed today, was that this fellow takes great pains to keep careful records of foods that "work" during the days/hours before a practice or a game.  He has settled on some standard foods now that he knows how he responds to them.  He mentioned that his preferred BG range for starting a game is 130-140.  He's a new pumper (a coupla months) and hasn't yet begun to do separate basal programs for hockey days, so he simply takes off his pump.

He tests before the game, during breaks, after the game, etc.  His teammates, trainers & coaches all know he's diabetic and they have been helpful to alert him if/when he seems "off."  He always has juice, Gatorade-type drinks, and protein bars nearby.  I hope you hear from hockey playing pumpers, directly, too.  As you know, we're not physicians here but we do have a lot of collective experience.

Good luck & enjoy those hockey games!

[hockeydad]

Thanks SGG and LRS (?) for your info.  We follow all the points that you mention with the exception of a meal 3 hours before a game/practice.  As my son is an active growing healthy 12 yr. and as such it is hard to keep him away from food for that long (we try to plan meals 1-1/2 -2 hours before he is on the ice) but we are going to try planning meals 3 hours before and see how he responses.  With hockey being an anaerobic exercise he can start the game with an optimal BGL but it will gradually rise during the game.  As a result he tests during the game and in most cases "pumps" in some insulin while on the bench. The trainer keeps the pump on the bench and my son uses it as needed. I am unsure if insulin during the activity helps with his performance but I don't know of any other options to keep his BGL from rising?????
Thanks Again and I will let you know how things work out.
Any other comments/experiences would be much appreciated.
HockeyDad

[moonlanding2]

My 12 year old son has been playing competitive basketball year-round since he was 8.  I fully agree with SGG's answer to your question.  We also strive to have my son eat a meal 2½-3 hours before a practice or game, in order to clear out the last meal bolus.  If the pump is connected until game time, however, there is still some basal insulin being delivered, which will allow the blood sugar to drop some with exercise.  Even that small amount of insulin remaining is enough for my son's blood sugar to drop about 60 points without any snack before the game.  Therefore, he almost always consumes a small snack, usually between 5 and 15 carbs, before a game or practice, depending on his blood sugar number about 15 minutes before play.  He used to consume juice, but now eats a portion of a granola bar for more sustained time-release, unless he is LOW before playing, in which case he drinks some juice AND eats some granola bar, usually as much as 25 carbs total, without more insulin.  My son always removes his pump before the game or practice.  He then checks his blood sugar at halftime, or during the practice break, and will consume more carbs (usually a small amount of juice) if his blood sugar is getting lower than target (90).  A check of blood sugar right after the game or practice is important to see how you did.

Basketball is usually very strenuous, as most aerobic sports tend to be.  I have read that some peoples' blood sugar actually goes UP, upon reaching their highest level of exercise, due to the release of glycogen in the muscles, and other hormones, such as adrenaline being released.  That level of exercise could certainly be cause for programming a custom basal rate into your pump (if blood sugar numbers are high), but you doctor should probably be consulted about that.  I would be very cautious about giving insulin to my son during a basketball game, or practice, because it is too risky.  His blood sugar would have to be over 240 for me to even consider it, and then I would only give about half of the dose recommended by the pump, and figure the game would be over before the blood sugar had time to drop below target.

I think each person and sport has a "method" to avoid the disaster of low blood sugar.  Once a real low occurs, you are forced to come out of the game, or practice, for about 10 minutes, while the body catches up, even longer for a severe low.  That's why I like to play it safe with a sustained time-release type of snack before the exercise.

[bdjoce]

Hey
I just found this site. My 10 year old son Dylan was just diagnosed in Sept. He has been playing hockey for 3 years. He is now a peewee A goalie. Hockey plays a hugh part in his life. I am finding that his hockey schedule really helps keep his levels under control. When it comes to playing the diabetes really has not had any effect on his game.
Dylan has dreams ,of course, of playing pro one day. I have been online trying to find any pro players that have diabetes. So far I have found 2. Bobby Clark and Nick Boynton. Dylan has been in touch with Bobby he has been a great supporter.We just recently sent a message to Nick Boynton. Ihope he hears from him being from Boston.
  I am now trying to start a group to introduce kids with diabetes to hockey. I seem to be getting good feedback.

  I hope all is going well with your son.