Managing Type 1 Diabetes for Football & Futsal in 2020…

The new year is always a chance to take a fresh look at things and alter the path or journey we’re on…. At the start of every year I try to look at the context I’m surrounded by and set myself new goals or challenges which drive my motivation for what’s ahead.

But what I thought I’d do, to help some of you out there who might be thinking about starting a journey with Football/Futsal & Type 1 Diabetes or taking it up a level, is give you some insight around how I manage my condition. 2019 was a pretty good year for me with my sport so it’s probably a good time to share with you some of the ways I go about trying to get the best from my glucose levels to allow me to play to the best of my ability.

So I thought I’d outline some of the ideas, most of which I shared at the #SporT1Day conference, to hopefully provide some insight and support to anyone out there who might need it.

Here’s my general thoughts on what I try to do or think about for my management before any sport or exercise:

• A plan of how to approach the sport/exercise/game – What type of exercise is it (interval, aerobic, anaerobic etc)? Intensity? Duration? Time of day? Timing of meals? Last Bolus?
• Consistency of Routine – If it’s working, I keep using it.
• Good night’s sleep.
• Plenty of time between pre match meal insulin dose and starting the game (3 hours + ideally)
• Lots of Testing – As much as you can or utilising a CGM such as the Dexcom G6 which has been the best I’ve used so far. This way you can learn about the effects of types of exercises, intensities, durations etc on your glucose levels.
• Small adjustments of insulin & carbs to try and find the right glucose level for your best performance or for you to just enjoy it.
• I aim for 7-8 mmols throughout the duration of any game to try and achieve my best performances.
• Having my quick acting hypo treatments and insulin available and accessible for any adjustment I might need.
• Consider the weather… Is it cold or hot? They usually play a part in how our glucose levels respond.
• Am I in good general health? Have I been ill recently? Can play a part in less predictable glucose levels.
• Keeping on top of my hydration… I find my levels drop more quickly if I’m dehydrated.
•  Stress Levels – Do I feel nervous? Am I calm? Sometimes bigger games cause a bigger adrenaline spike in glucose levels. Do I need to account for this?
• Have I fuelled up well before the exercise? Have I eaten enough calories/carbs in general for the energy I’m going to expend.
• Always consider how much activity you’ve been doing around the particular sport or exercise you’re about to take part in, because the more active you are, the more sensitive to insulin you are!

Below are some of the generic details about my day to day management…

• Aiming to be 7-8mmols to start the game and throughout.
• Ensuring my pre-game meal & bolus is 3 hours before kick off.
• Reducing pre-game meal bolus by roughly 10%.
• Half time testing and adjusting based on level. If I’m below 9mmols I’ll take on 10g of carbs to cater for the second half dip and even more if my levels are below 5mmols. These choices very much depend on length of time you’re going to play and how hard the game is. If it’s a tough game with a lot of chasing then I sometimes have an extra 5-10g of carbs. If I’m over 13mmols I’ll take on a unit of insulin.
• Post game meal I reduce my bolus by 25-50% depending on how much I’ve played and the intensity of the game.
• I try to make my post-game meal both full of protein and carbohydrate to help with the recovery of glycogen stores and muscle growth/repair.
• I will have a bed-time snack of 10-15g without a bolus to try and alleviate the nocturnal hypo risk. (If I’ve played a whole 90 minutes, I’ll scale all of this back if I’ve played less than that)
• I don’t adjust my basal insulin because I use Tresiba, which is an ultra-long acting insulin and this will have no effect on my risk of a nocturnal hypo.

Futsal

• I like to start the game at 5mmols if I can, because despite being lower,  I’m still likely to need a small bolus before the game or at half time to manage my levels rising as a result of the higher intensity and expected spike.
• Because of the roll on, roll off substitutions within Futsal, there’s a lot more opportunity for adjustment. So I always come off from the court and immediately check my CGM and look for the trend arrows and glucose level.
• I always tend to carry a bit of short acting insulin in my system because for me within Futsal, knowing I have frequent breaks and the likely impact of the intensity (levels rising), I’d rather be lower and taking on some glucose, as it reacts quicker than my insulin, than being too high and waiting for my insulin to kick in. The important factor for me is having a glucose level which allows for performance, not the number of adjustments I have to make.
• I will always have a protein bar/snack post game of around 20g of carbs because I tend to have a sharp drop in my levels post game. Probably as a result of carrying short – acting insulin during my sport and the intensity.
• I don’t make any bolus adjustments post – game to my meals. Again I’ll eat a meal heavy in protein and carbohydrate.
• No basal adjustments as a result of using tresiba.
• If I want a bed-time snack I’ll bolus for it with a small reduction of 25%.

Chris Bright Presentation 2019 ( #SporT1Day Conference )