Tag: health

Fuel for Football: The Pre-Match Preparation

Posted on by thediabetesfootballcommunity in diabetes, diabetes research, Football

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition. Thank you to JDRF and Matt for the support in the creation of this content. For more information, support and resources from JDRF, click here

Author: Dr Matthew Campbell | PhD ACSM-CEP MIFST RNutr FHEA BSc hons.

Read time: 10 minutes

Introduction

Food is made up from a combination of macronutrients and micronutrients. Macronutrients are nutrients that the body needs in large amounts and include carbohydrates, fats, proteins, and fibre, whereas micronutrients include vitamins and minerals. Achieving the right balance of macronutrients and ensuring adequate intake of micronutrients is important for maintaining energy balance – i.e., meeting, but not exceeding the body’s energy demands – as well as maintaining normal physiological processes that are important for day-to-day and long-term health.

What fuels are important for football?

Our bodies preferentially and predominantly use carbohydrate and fat as fuel sources. The amount of energy used, as well as the proportion of energy derived from carbohydrate and fat is influenced by several factors including genetics, training status, as well as what fuels are available – all of these factors differ between individuals meaning that generic, one-size-fits-all recommendations are usually inappropriate1. One constant however is exercise intensity and duration2. At lower exercise intensities (about 60%-70% of maximum heart rate – calculate your maximum heart rate by subtracting your age in years from 220), the body predominantly uses fat. With increasing exercise intensity and duration however, your body will turn to carbohydrate, such that at very high intensities (90%-100% of maximum heart rate) your body will be utilising carbohydrate almost exclusively2.

Why is having enough carbohydrate on-board important?

Having enough carbohydrate available to the body is important during football because low levels of carbohydrate availability is a major cause of early fatigue, decreased performance, reduced concentrations, and hypoglycaemia, especially towards the later stages of a match, extra-time, or long or intense training sessions3. Because the body has only a limited capacity for carbohydrate storage4, it is important to eat enough carbohydrate in the time leading up to a match. Data from a number of research studies show that carbohydrate intake before (and during) a match can delay fatigue5, enhance the capacity for intermittent high-intensity activities6,7 (such as sprint speed and recovery), and prevent hypoglycaemia when insulin doses are adjusted too8. It’s not known how much of the body’s carbohydrate stores are depleted during football, although previous research has suggested that  about 50% of muscle fibres are empty or partially empty after a game9. Players who begin a game with lower muscle carbohydrate stores are known to cover less distance and much less at speed, especially in the second half and during extra-time periods, than those who have ensured adequate carbohydrate stores10.

How much carbohydrate should I eat?

On the days leading up to a match, training is usually light or avoided completely. During this time and on match day itself, carbohydrate intake can be increased to about 6-8 grams per kilogram of body weight per day11 (for a 70 kilogram person this equates to approximately 490 grams of carbohydrate across the whole day). This sounds a lot, but it can be easily achieved by incorporating carbohydrate-based foods (bread, pasta, and potatoes) into each meal. If you are playing in a tournament with congested match fixtures then carbohydrate intake should be maintained at about 6-8 grams per kilogram of body weight per day11 whilst you’re between games in order to replenish carbohydrate stores that may have been (partially) depleted. Although carbohydrate intake in the hours before a game is important, try and avoid eating immediately before (within an hour) and chose easily digestible foods (low in fibre) to avoid exercise-induced stomach upset12.

Is there a way to increase the amount of carbohydrate stored?

Interestingly, although there is an upper limit to the amount of carbohydrate that the body can store, this varies from person to person and can be improved using the right training and feeding strategies. For example, research has shown that training with low muscle glycogen levels can lead to ‘supercompensation’ – i.e., an increase in the amount of carbohydrate stored above and beyond an individual’s normal baseline level13. The challenge for people with type 1 diabetes adopting this strategy, however, is managing glucose levels during exercise to avoid hypoglycaemia. You can also try manipulating the type of carbohydrate consumed which has been shown to increased carbohydrate stores in some tissues14

Does it matter what time I eat carbohydrates?

The timing of carbohydrate consumption is important and can be manipulated to optimise carbohydrate storage. Carbohydrate-rich meals can be consumed on heavy training days, or specific times in the day when stored carbohydrate levels are low. For example, at breakfast the liver has partially depleted its carbohydrate stores because it has been releasing glucose during the night to maintain blood glucose levels15. When carbohydrate stores are low, the body is metabolically primed to preferentially restore these supplies, meaning that less of what you eat will be stored as fat, or ‘burnt-off’ as extra energy. Conversely, when carbohydrate stores are full, the body will is unable to store excess carbohydrate and so some of this will be stored as fat and some will be ‘burnt-off’ as extra energy.

 Aside from carbohydrates, what else should I focus on?

Hydration is also key. Players should aim to start the match fully hydrated – you can tell if you are fully hydrated by the colour of your urine; anything darker than a pale-yellow colour and you need to drink more fluids. General recommendations are to drink 5-7 millilitres per kilogram of body weight in the 2 to 4 hours before kick-off (for a 70 kilogram person this equates to about half a litre. This allows sufficient time for excess fluid to pass through the system and achieve urine that is pale yellow in colour16. Make sure that your drinks are largely sugar-free (to avoid big glucose spikes) and try adding a pinch of salt (1 gram of table salt for every litre of water) as this helps increases hydration rates17.

If you are interested in learning how to improve managing your type 1 diabetes around exercise book a consultation with the author, Dr Matthew Campbell: matt@t1dcoaching.co.uk

 

About Matthew

Matthew is an internationally recognised research scientist specialising in exercise, diet, and type 1 diabetes. He also provides consultancy and diabetes coaching to people living with type 1 diabetes and those that support them.

 

Matthew has a PhD in nutrition and exercise metabolism, is author to over 150 research publications, and holds honorary titles with the University of Cambridge and University of Leeds. He is a certified clinical exercise physiologist accredited by the American College of Sports Medicine, a registered nutritionist, and a member of the Institute of Food Science and Technology. He also provides consultancy to professional bodies and professional athletes including NHS England, the World Health Organisation, and TeamGB.

References

  1. Venables MC, Achten J, Jeukendrup AE. Determinants of fat oxidation during exercise in healthy men and women: a cross-sectional study. Journal of applied physiology. 2005;98(1):160-167.
  2. Melzer K. Carbohydrate and fat utilization during rest and physical activity. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2011;6(2):e45-e52.
  3. Costill DL, Hargreaves M. Carbohydrate nutrition and fatigue. Sports medicine. 1992;13(2):86-92.
  4. Acheson K, Schutz Y, Bessard T, Anantharaman K, Flatt J, Jequier E. Glycogen storage capacity and de novo lipogenesis during massive carbohydrate overfeeding in man. The American journal of clinical nutrition. 1988;48(2):240-247.
  5. Holway FE, Spriet LL. Sport-specific nutrition: practical strategies for team sports. Journal of sports sciences. 2011;29(sup1):S115-S125.
  6. Phillips SM, Sproule J, Turner AP. Carbohydrate ingestion during team games exercise. Sports Medicine. 2011;41(7):559-585.
  7. Russell M, Benton D, Kingsley M. Influence of carbohydrate supplementation on skill performance during a soccer match simulation. Journal of Science and Medicine in Sport. 2012;15(4):348-354.
  8. Campbell MD, Walker M, Bracken RM, et al. Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial. BMJ Open Diabetes Research and Care. 2015;3(1):e000085.
  9. Krustrup P, Mohr M, Steensberg A, Bencke J, Kjær M, Bangsbo J. Muscle and blood metabolites during a soccer game: implications for sprint performance. Medicine and science in sports and exercise. 2006;38(6):1165-1174.
  10. Jacobs I, Westlin N, Karlsson J, Rasmusson M, Houghton B. Muscle glycogen and diet in elite soccer players. European journal of applied physiology and occupational physiology. 1982;48(3):297-302.
  11. Collins J, Maughan RJ, Gleeson M, et al. UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research. British journal of sports medicine. 2021;55(8):416-416.
  12. De Oliveira EP, Burini RC. Carbohydrate-dependent, exercise-induced gastrointestinal distress. Nutrients. 2014;6(10):4191-4199.
  13. Burke L. Fueling strategies to optimize performance: training high or training low? Scandinavian journal of medicine & science in sports. 2010;20:48-58.
  14. Gonzalez JT, Fuchs CJ, Betts JA, Van Loon LJ. Glucose plus fructose ingestion for post-exercise recovery—greater than the sum of its parts? Nutrients. 2017;9(4):344.
  15. Nilsson LH, Fürst P, Hultman E. Carbohydrate metabolism of the liver in normal man under varying dietary conditions. Scandinavian journal of clinical and laboratory investigation. 1973;32(4):331-337.
  16. Armstrong LE, Pumerantz AC, Fiala KA, et al. Human hydration indices: acute and longitudinal reference values. International Journal of Sport Nutrition & Exercise Metabolism. 2010;20(2).
  17. Pratama RY, Muliarta IM, Sundari LPR, Sutjana IDP, Dewi NNA, Griadi IPA. Provision of Coconut Water as Good as Packed Coconut Water and Isotonic Beverages on Hydration Status in Football Athlete. Journal of Physical Education Health and Sport. 2022;9(1):18-26.

Match play demands: how does football impact blood glucose levels?

Posted on by thediabetesfootballcommunity in diabetes, diabetes research, Football, sport

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition. Thank you to JDRF and Matt for the support in the creation of this content. For more information, support and resources from JDRF, click here

A REMINDER – this blog post is written by a healthcare professional but no changes should be made to the treatment of your condition without consultation with your own Diabetes team. 

Author: Dr Matthew Campbell | PhD ACSM-CEP MIFST RNutr FHEA BSc hons.

Read time: 10 minutes

 

Introduction

During a football match, you will find yourself walking, jogging, running, sprinting, jumping, dribbling, striking the ball, changing direction, as well as coming into contact with the opposition (and possibly arguing with the referee). This places a significant demand on our body’s physiological energy systems as it tries to cope with repeated changes in exercise intensity1.

 

How does the body use blood glucose during exercise?

The body requires energy to exercise, and this is generated by breaking-down various fuels. The main fuels used for exercise are carbohydrate and fat. Everyone (including professional footballers) has enough fat stored away to the meet the body’s fat-derived energy requirements for a football match. However, for higher intensity exercise the body relies more on carbohydrate but has only a limited storage capacity. Carbohydrate is stored in the form of glycogen – bundles of individual glucose molecules packaged together. During exercise, muscles convert stored glycogen into glucose which is then converted into energy. Muscles are also able to extract glucose directly from the blood to help meet their energy demands, and as exercise intensity and duration is increased more and more glucose from the blood is pulled into muscle – this can cause low blood glucose levels, even in people without type 1 diabetes.

 

Why do people with type 1 diabetes have an increased risk of hypoglycaemia during exercise?

In people without type 1 diabetes, insulin levels are regulated and are reduced in response to exercise. This enables two things; firstly, it limits muscle tissue from extracting excessive amounts of glucose from the blood; secondly, lower insulin levels allow the liver to release more glucose into the blood2. Think of this as trying to fill a bucket with a hole in the bottom… if the liver can release enough glucose into the blood to meet the rate at which glucose is being removed by muscle (and other tissues) then blood glucose levels will remain stable. If the rate at which glucose is removed from the blood exceeds the rate at which blood glucose is being replaced, then fatigue, reduced performance, and potentially hypoglycaemia will ensue. Importantly, in type 1 diabetes, insulin levels are the result of the previously administered dose and/or background insulin. This means that once in the body, insulin is unregulated and does not decrease in response to exercise. This results in two things; firstly, higher insulin levels promote excessive glucose removal from the blood; secondly, higher insulin levels prevent the liver from releasing sufficient glucose into the blood to meet demand. This will result in hypoglycaemia.

 

Does playing football mean I will have a hypo?

Although most people associate exercise in type 1 diabetes with hypoglycaemia3 – i.e., the ability of exercise to lower blood glucose to potentially dangerous levels – not all forms of exercise lower blood glucose acutely4-8. Whereas continuous or prolonged aerobic-based exercise (like running a 10K or half-marathon at a steady pace) carries with it a heightened risk of hypoglycaemia8, high-intensity types of exercise (like lifting weights or sprinting) often cause a short-term rise in blood glucose levels4,6,9. Intermittent types of activity which involve repeated bouts of high-intensity activity interspersed with lower and moderate intensity activities, like football, tend to produce more stabilised glucose levels during the activity5,10-13. For example, Figure 1 below illustrates the average change in blood glucose levels during 45-minutes of a simulated match in people with type 1 diabetes. Compared with running (red trace), a simulated first half of football (blue trace) tends to, on average, induce a lower drop in blood glucose levels even when the total amount of energy used (termed energy expenditure) is similar5. Note however, the long bars that stretch above and beyond each data point – this illustrates the amount of variability around the mean response; in other words, it demonstrates how much people can vary in their response to the average…. It’s quite a bit!

Figure 1. The impact of different types of exercise on blood glucose levels during and immediately after a simulated first half of football running (blue trace) and continuous running (red trace) in people with type 1 diabetes. Hashed area indicates exercise period. Figure reproduced from Campbell at al14.

 

Ok, but how are glucose levels maintained or even increased during football?

Although insulin is a very important hormone for blood glucose regulation, other hormones also play important roles. Intense activity produces a marked increase in the release of stress-hormones9, like adrenaline, noradrenaline and cortisol which can help preserve (or even increase) glucose levels during, and for a short-time after, exercise. This is illustrated in Figure 2 where cortisol levels were shown to be elevated in response to 45-minutes of a simulated match (blue trace) compared to continuous running (red trace) in people with type 1 diabetes. Cortisol – which is produced and released by the adrenal glands on top of the kidney – as well as adrenaline, is also partly responsible for those glucose rises that you might see with pre-match nerves or a poor night’s sleep15.

Figure 2. The impact of different types of exercise on blood cortisol levels during and immediately after a simulated first half of football running (blue trace) and continuous running (red trace) in people with type 1 diabetes. Hashed area indicates exercise period. Figure reproduced from Campbell at al14.

 

How do stress hormones increase glucose?

These stress-hormones stimulate the body to break down stored glycogen into glucose2. In the muscle, glycogen broken down into glucose is simply converted into energy because this tissue lacks a special enzyme that prevents glucose being released into the blood. The culprit for increased blood glucose levels is the liver. Unlike muscle, the liver has a special enzyme that enables the conversion of glycogen to glucose for release into the blood. With high levels of stress hormones circulating, the liver is stimulated to increase its release of stored glucose2. In contrast to football, continuous moderate-intensity activity achieves only achieves a modest increase in stress-hormones5 meaning that they have only a minor impact on glucose levels.

 

How long will the effects of stress hormones last?

Although these hormones can have dramatic effects on blood glucose levels, they are usually very short lasting – for example, adrenaline is usually cleared from the blood within 5-10 minutes16. Importantly however, the hormonal and metabolic responses during repeated intense bouts are additive when recovery intervals are short17. This means that in a typical football match (especially those that are physically demanding, and for certain positions like wingers or attacking wingbacks) that there is likely insufficient time for full clearance of these hormones from the circulation before the next high-intensity bout. This means that you could see a gradual rise in glucose levels over each playing half.

 

How long will it take my glucose levels to normalise after football?

Hormones act for a relatively short time meaning that once levels drop, their influence on glucose levels will also be short-lasting. Although football might confer a lower risk of hypoglycaemia during and immediately afterwards, there is still an increased risk of developing hypoglycaemia later after exercise, so much so that the risk of developing late-onset hypoglycaemia seems to be comparable to other forms of exercise like running or lifting weights5. Read our other article to learn more about post-exercise hypoglycaemia and how to avoid it.

 

Are there other factors that can affect blood glucose levels during exercise?

Yes. Lots. Of course, with all aspects of type 1 diabetes, blood glucose responses to any form of exercise will to some extent vary from person to person, and from match to match. Your own physical fitness, technical ability, playing position, tactical role, style of playing, as well as ball possession of the team, quality of the opponent, importance of the game, seasonal period, playing surface, and environmental factors like humidity and temperature18 (to name but a few) will all influence both performance and diabetes management. As such, careful planning of training, nutrition, and insulin dosing strategies are required in preparation for training and match days in optimise performance and manage diabetes effectively and safely.

About Matthew

Matthew is an internationally recognised research scientist specialising in exercise, diet, and type 1 diabetes. He also provides consultancy and diabetes coaching to people living with type 1 diabetes and those that support them.

Matthew has a PhD in nutrition and exercise metabolism, is author to over 150 research publications and holds honorary titles with the University of Cambridge and University of Leeds. He is a certified clinical exercise physiologist accredited by the American College of Sports Medicine, a registered nutritionist, and a member of the Institute of Food Science and Technology. He also provides consultancy to professional bodies and professional athletes including NHS England, the World Health Organisation, and TeamGB.

If you are interested in learning how to improve your type 1 diabetes management around exercise, contact Matthew at: matt@t1dcoaching.co.uk

References

  1. Dolci F, Hart NH, Kilding AE, Chivers P, Piggott B, Spiteri T. Physical and energetic demand of soccer: a brief review. Strength & Conditioning Journal. 2020;42(3):70-77.
  2. Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation: implications for diabetes. Diabetes. 2002;51(suppl_1):S271-S283.
  3. Cockcroft E, Narendran P, Andrews R. Exercise‐induced hypoglycaemia in type 1 diabetes. Experimental physiology. 2020;105(4):590-599.
  4. Turner D, Luzio S, Gray B, et al. Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scandinavian journal of medicine & science in sports. 2015;25(1):e99-e109.
  5. Campbell MD, West DJ, Bain SC, et al. Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic responses in T1DM patients. Scandinavian journal of medicine & science in sports. 2015;25(2):216-222.
  6. Yardley JE, Kenny GP, Perkins BA, et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes care. 2012;35(4):669-675.
  7. Hasan S, Shaw SM, Gelling LH, Kerr CJ, Meads CA. Exercise modes and their association with hypoglycemia episodes in adults with type 1 diabetes mellitus: a systematic review. BMJ Open Diabetes Research and Care. 2018;6(1):e000578.
  8. Campbell MD, Walker M, Trenell MI, et al. Large pre-and postexercise rapid-acting insulin reductions preserve glycemia and prevent early-but not late-onset hypoglycemia in patients with type 1 diabetes. Diabetes care. 2013;36(8):2217-2224.
  9. Fahey A, Paramalingam N, Davey R, Davis E, Jones T, Fournier P. The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus. The Journal of Clinical Endocrinology & Metabolism. 2012;97(11):4193-4200.
  10. Guelfi K, Ratnam N, Smythe G, Jones T, Fournier P. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. American Journal of Physiology-Endocrinology And Metabolism. 2007;292(3):E865-E870.
  11. Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes care. 2005;28(6):1289-1294.
  12. Bussau V, Ferreira L, Jones T, Fournier P. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia. 2007;50(9):1815-1818.
  13. Bussau VA, Ferreira LD, Jones TW, Fournier PA. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes care. 2006;29(3):601-606.
  14. Campbell MD, West DJ, Bain SC, et al. Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic responses in T1DM patients. 2015;25(2):216-222.
  15. Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetology & metabolic syndrome. 2015;7(1):1-16.
  16. Goldstein DS, Eisenhofer G, Kopin IJ. Sources and significance of plasma levels of catechols and their metabolites in humans. Journal of Pharmacology and Experimental Therapeutics. 2003;305(3):800-811.
  17. Bogardus C, LaGrange BM, Horton ES, Sims E. Comparison of carbohydrate-containing and carbohydrate-restricted hypocaloric diets in the treatment of obesity. Endurance and metabolic fuel homeostasis during strenuous exercise. The Journal of clinical investigation. 1981;68(2):399-404.
  18. Al‐Qaissi A, Papageorgiou M, Javed Z, et al. Environmental effects of ambient temperature and relative humidity on insulin pharmacodynamics in adults with type 1 diabetes mellitus. Diabetes, Obesity and Metabolism. 2019;21(3):569-574.

Award Winning TDFC London: The Power of Peer Support

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

TDFC London – Quality In Care Diabetes Award Winners 2022. I can’t quite believe it. It’s been a huge team effort and after a few weeks to let it settle in, I thought I’d share mine and the team’s journey.

I was diagnosed with type 1 diabetes over ten years ago, and needless to say it was quite a shock! There was so much to get my head around, but one of my biggest concerns was being able to get back playing football. I went years before meeting a fellow type 1 and it took a long time to work out how to manage the condition while playing sport.

And then there was a breakthrough moment. I came across a fledgling initiative called The Diabetes Football Community (TDFC). I signed up to one of their first ever meet-ups, and what a journey it’s been since.

Suddenly I was playing competitive matches against other people with type 1 diabetes. In between games, team members exchanged insights about new glucose tracking technologies, different methods of delivering insulin and practical tips on managing diabetes whilst playing football. After just one match I picked up so much useful advice and diabetes life-hacks that I wouldn’t have known otherwise.

At DiaEuro 2018 we realised that there was the enough players to potentially set a team based in London and if we did so we’d be the first ever all-type 1 diabetes team to compete in a mainstream league. Hence TDFC London was formed, with the aim of providing open and inclusive football-based meet-ups for people with type 1 diabetes, and to help show that the diagnosis doesn’t need to be a barrier to participation. This diverse group celebrates each individual as their own entity. We’ve helped each other gain access to diabetes technology and referred individuals to health services they were unaware of prior to joining.

COVID-19 put a long pause on the group meeting up, but the peer support element of the project really kicked in, with teammates all sharing support and guidance in dealing with the dreaded ‘COVID-type 1 combo’ via WhatsApp. Post-pandemic, we came back even stronger, going on a winning streak to eventually fulfil our goal of becoming champions of the North London Futsal League 🏆

https://twitter.com/TDFCLondon/status/1482765960637468674?s=20&t=MfnsfwlVLra3I1_4tKtDwQ

 

I work at the Royal College for Paediatrics and Child Health alongside a great team as part of the National Diabetes Quality Programme. We see first-hand the issues around drop-out rates when transitioning from paediatric to adult services. I’m convinced that projects like TDFC can directly support diabetes services in enabling self-management and help to signpost people back into diabetes services to ensure things like technology access.

My teammate Muhammed Ismail has been an amazing ambassador for the project and secretly submitted our team’s concept and achievement for this year’s Quality in Care Diabetes Awards. To our amazement, we won the Unsung Heroes award! The judges commented:

“TDFC London was an inspirational, heart-warming and feel-good entry that has offered support to a group of young Type 1s. This could be replicated nationwide. It is a great example of peer support, ingenious and particularly focusses on young men – a notoriously difficult group to connect with and an often-overlooked group.”

 

 Much like my glucose levels, there’s been lots of ups and downs over the years since being diagnosed. However, I’m very grateful to have stumbled across TDFC and my experience with this group has been a standout highlight.

Peer support is a powerful tool for empowering those with long-term conditions. Sport is a powerful vehicle for bringing people together. Combining the two has so much potential!

 Bryn White

TDFC London Manager

Diagnosed at 34 and trying to adapt to Football again…

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

It’s been a little while since we shared a blog on the website, so we thought it was a great opportunity to share the story of one of our newest members to the community… Thank you Tom for sharing what you went through upon diagnosis and we hope that your story will provide comfort and support to those who may face this in the future… No more words from us, over to you Tom to talk us through what happened.

“Football was the first sign

The last game of the 2021/2022 season was a mid-week evening fixture on the 20th April, away in a small village outside of Lincoln. A very scratchy 11 players were put together with a couple of late stragglers turning up to fill the subs bench after work and family commitments… Sunday league football in England at it’s finest. Playing at centre half, the dream of being a marauding midfielder has long been forgotten since turning 30! After around 70 minutes something happened which I had never experienced in my whole-time playing football, as I had excruciating pain in both of my calves as they cramped up. At the time, through lack of awareness and a large chunk of denial about my own health, I convinced myself that age had finally caught up with me and I wasn’t as fit as I once was! I struggled on for 10 more minutes before giving up and giving the gaffer the dreaded arm roll signal above the head to indicate I needed to come off. To add to the dismay of being subbed off, we managed to throw away a two-goal lead and concede two late goals to draw the game and consign ourselves to rock bottom of the 1st division after a long tough season! Unfortunately, our collective lack of footballing ability wasn’t the only thing to become apparent after this game.

Diagnosis

My ‘diaversary’, as I have often affectionately seen it referred to on social media, is 18th May 2022. The usual sore muscles and cramping up in the night after a football game occurred, which I attributed to dehydration from the game that evening. I also attributed my constant thirst and then spending most of the night getting up to go to the toilet to this! I felt could explain all these things with a plausible causality to feelings after a tough game so thought nothing more of it. I carried on my usual daily routine after this, a little bit tired and run down, still thirsty and still weeing a lot! I was a teacher, and we were coming to the end of a school year, and I told myself I must be ready for a break and ploughed on through, although the symptoms never went away. I always tell people never to google your symptoms, but you never follow your own advice and one word kept coming up whenever I put them into the NHS website……. DIABETES. I was 34, fit, healthy, a good weight, no family history anywhere of Diabetes, I was sure it wouldn’t be that. I couldn’t deny that I wasn’t well for much longer and finally succumbed to pressure from my partner to book a doctor’s appointment. Casually dropping off a urine sample and having some bloods taken at the doctors before setting off on my way to work. I received a phone call about an hour later containing lots of words such as: ‘DKA’, ‘Diabetes’ and ‘A&E’. Within an hour I was sat in A&E on a drip with more bloods being taken, more meetings with doctors and no more idea what was going on! A very long and scary night at home alone followed this and a phone call from the doctor in the morning confirming Diabetes and directing me straight to Clinic 1 at the hospital. I was greeted by Diabetes Specialist Nurse and walked out an hour later with a blood glucose monitor, 2 pens of insulin and a lot of leaflets. I had never felt more overwhelmed in my life!

Getting back to football

I am never ashamed to admit I cried for most of that evening. The gravity of what a lifetime of diabetes means really is something which is quite incomprehensible at times. I was convinced footballing life was over and I was going to be confined to a life of golf! I had no idea how playing sport whilst managing diabetes worked and it was one of my first questions in my follow-up with my diabetes nurse the next week. As always seems to be the way with diabetes, it could not have been anymore inconvenient, with a house move and job move all scheduled for June! It did however afford me a summer break to get my head around living with diabetes and my body’s responses to exercise. My first experience of getting back into sport was an attempted cricket game in early June. As could be expected this went terribly and after having a very sweaty, dizzy and shaky moment whilst batting, I spent most of our turn to field eating a banana and various sweets from my pocket – there was a lot to learn! I was luckily given a libre 2 sensor around 3 weeks after diagnosis and this made the start of preseason in late June a lot more successful. I’m sure I did over 30 scans in my first session! I turned up armed with chocolate bars for some sugar beforehand, enough Haribo for a kid’s party and more water than any one person would ever need. At any opportunity I would nip off to tap my arm with my phone and check my levels. After a 90-minute session with some highs and lows it was overall a positive result. Maybe this wasn’t the end of the road for me after all! I managed to negotiate most of pre-season training and matches without too many wobbles, although the heat nearly did me a couple of times if it wasn’t the diabetes. However, after every session, there was always advice and support to fall back on from the TDFC community if things had gone wrong with people always happy to answer any questions or offer advice.

TDFC

I stumbled across Chris whilst searching out other people with Diabetes on twitter, looking for insight, inspiration, advice and general empathy from people going through something similar to me. I found the TDFC twitter page and dropped it a message before carrying on my mindless scrolling and forgetting all about it. The next day I got a reply from Chris and before long he had introduced me to the TDFC community and added me to the WhatsApp group. To find a place where people had experienced the same thing or going through similar situations was a comfort and motivator. Being able to ask questions and get answers from people all over the country and beyond was brilliant. Not just on football topics but every life experience with diabetes you can think of! I am yet to make a TDFC training session and join in a kick about but look forward to hopefully making one and sharing synchronised glucose checking and hypo snacks!

From speaking to others about diabetes I realise that it is a marathon not a sprint and no one ever truly masters it. You are thrown in at the deep end on day one and must quickly adapt to the basics but with the pace at which things are moving with diabetes and technology there is so much more to learn. I recently listened to a discussion on Twitter speaking about exercise and my mind was blown listening to people talk about open and closed loop systems, basal rates, adjustments and insulin sensitivity. I’m sure it will all make sense to me one day and I am not the only newly diagnosed diabetic trying to make sense of it all.

Today

Game one of the season has just gone without a hitch (a boring 0-0 draw) and 90 minutes at centre half was successfully negotiated. This is thanks to some of the advice and routines I have put in place with advice from the TDFC group chat and the post which Chris had done on the TDFC website which helped a lot. I’ve managed to keep my sensor on which I thought would never happen and have had great support from my teammates! I’m hoping I have a few years left in me yet……”

 

Thank you for sharing your story so openly Tom and If you’ve enjoyed reading this blog and want to share your own story with us please do get in contact with us…

Chris Bright Reviews 2021 at TDFC

Posted on by thediabetesfootballcommunity in diabetes, sport

Well, here we are… On the cusp of 2022 after a year which followed probably one of the toughest years of many people’s lives. I think at this stage of the pandemic so many of us have lost someone we know or know of and I just want to add to the condolences if you’re one of those people who have lost a loved one during the last year to COVID or anything else. My thoughts are with you.

There’s no doubt that at TDFC we’ve faced some big challenges in the last year. From company finances, to ongoing restrictions which curtailed many of the project ideas we had, through to the challenges of supporting our community during a period of uncertainty, pressure and ultimately fear. It’s been tough to move forward but move forward we have. Because for me, that’s the mindset I’ve always had, when you want to make something happen and there’s a barrier in the way, you don’t run away from it, you find a way to leap over it and that’s how we’ve approached 2021. We’ve tried our best to adapt and overcome the challenges we’ve been faced with. It’s not been easy, but nothing worth doing in life is made easy for us.

So, we’ve given it a good go.

With the start of 2021 in the UK being a period of lockdown, much of the support we could offer was via our online tools. So, we maxed this out as much as we could. We had great engagement in the Men’s whatsapp group which continues to be an incredible resource for support, awareness and troubleshooting around type 1 Diabetes. This year we’ve had discussions on the impact of vaccines on our Diabetes, the effect of COVID on our condition and how long it may have impacted on people, all the way through to the performances of Mikel Arteta’s Arsenal (too often a conversation in my opinion!). It’s incredible to see and as the founder who envisaged this idea in 2017, to see how we’re able to help so many people in this way is mind blowing sometimes. We’ve changed lives and we continue to influence the way the healthcare system views peer support, and for this I’m always grateful. Our community, our vision and our direction.

In amongst that vision has always been to shed a spotlight on the incredible people involved in football living with Diabetes. Storytelling is one of the greatest gifts that we all have available to us and the power a story can have, if told in the right way, can be profound. We’ve told stories on our social media, through our blog and in the media before but we felt with the growth of podcasts, it was time to start telling stories using this popular medium. So, during the early part of 2021, myself and peachy launched The Diabetes Dugout to do just that. We’ve interviewed people from the community, told stories from people involved in professional football and most importantly shed a light on our condition which educates others. I’ve thoroughly enjoyed it and I hope those who have tuned in to the episodes have done too (I even got to speak with the legend that is Gary Mabbutt MBE!) … It’s a resource now that we will always be able utilise and if you haven’t checked it out, search for The Diabetes Dugout on spotify or apple podcasts or head to www.thediabetesfootballcommunity.com/the-diabetes-dugout

As the early part of 2021 turned into spring and summer, the impact of the vaccine was felt widely across the UK with life returning to something which looked a little bit more like our previous normal. This allowed myself and the teams to get back to playing. We opted to bring the UK Men’s team back together but outdoors throughout the summer to maximise the safety of the players. It proved to be really well received and the guys welcomed the sessions back with open arms. We had a number of new attendees who had found our work during the pandemic who came to experience the environment we create for the first time. The below podcast link outlines how that session played out, so make sure you go and check that out because I think it really demonstrates what it’s all about:

UK MEN’S TRAINING SESSION PODCAST EPISODE

Whilst myself, I got to make my comeback to playing competitive Futsal after the pandemic and after my post-concussion syndrome. I was back playing for Birmingham Futsal club in the National Futsal series, where for the first time in the sport’s history in England, games were being shown on TV through FreeSports and then live on BT Sports later in the year. The sport finally had the coverage it deserved, and it was great to be back doing what I do. I even got to get on the court alongside an Aston Villa legend in Stiliyan Petrov who I’d grown up watching as a teenager at Villa Park.

 

Another group which also got back playing this year was our TDFC London team. They were back on the Futsal court and just like the wider men’s team, their numbers had grown during the pandemic. Honestly, this group has given me so much pride this year with the way they’ve come together as their own community as well as how they’ve performed on the court. They’re enjoying themselves, supporting each other and they’ve even managed to feature on Channel News Asia TV too (video below)! They’re an incredible example of the TDFC ethos spreading and expanding. This hub idea is something I hope to see more growth around in 2022 and beyond as we reach more corners of the UK and beyond.

 

 

But alongside this growth in the men’s groups, we’ve seen the development of the Women’s project for the first time in TDFC history. We now have a great group of Female leaders shaping the strategy & direction of the TDFC Womens project as we head into 2022. The team now have their first date in the diary for a meet up in Worcester on March 12th (Yes right next to International Women’s Day!) to really push this and keep an eye out for the girls appearing on social media in 2022 as they look to grow the awareness of the project. We have to also thank the incredible team at HerGameToo who we partnered with to support this project and they’ve since provided us with really generous donations to help the girls get going! So, a huge thank you to everyone at HerGameToo and to Caz and Amy specifically who I’ve spoken to.  You’re doing an incredible job!

 

 

Alongside the success of creating the women’s project, I also had the chance to celebrate The People’s Award at the QIC Diabetes awards. The award was given to me as an individual but for me it’s all about the way the community came together during the pandemic to provide the guidance, moral support and positivity we all needed to get us through a challenging time whilst living with Diabetes. I’m just the fortunate one who created this idea but the voices within our project and community win awards like this, not me. Nevertheless, as a project it was wonderful to be recognised in an awards ceremony designed to celebrate the excellent care provided by healthcare professionals in the Diabetes sector, so for us it was brilliant to raise awareness of our project to more and more of the professionals up and down the country who work tirelessly to make our lives easier. Check out the result of the award below and one of the pictures… It was also pretty cool to meet the voice of Strictly Come Dancing Mr Alan Dedicoat.

 

 

https://www.qualityincare.org/diabetes/awards/results/qic_diabetes_2021_results/the_peoples_award

Awards help us with awareness, and I can’t deny that, however they’re not something I dwell on too much. I’ve always had this saying coached into me since I was as a kid “you’re only as good as your last game.” Obviously, this relates to my Football background but it’s true of life too, we’re only as good as we are right now in the moment, what we’ve achieved or done has already been written and what’s to come is now our focus. This always helps me to get me focussed on what’s next. In 2021, I’ve had a couple of great opportunities on behalf of TDFC to help position ourselves to influence “What’s next” for the overall Diabetes Community. Firstly, I was invited to become part of a steering group to help expand peer support across England with NHS England at the heart of leading it, with the vision of those of us with the condition very much helping to steer the ship. TDFC is recognised and commended widely by those in healthcare teams up and down the country, so it was really exciting for us to be invited to be involved in pathing the way for wider adoption of peer support in the healthcare structure and treatment pathways of the future for people with Diabetes. This project is just gathering momentum so keep an eye out on developments in this area in the next few months. Whilst this project has been gaining traction, I’ve also been working away with Professor Gyozo Molnar from the University of Worcester on the first academic publication related to my research on The Diabetes Football Community ( If you haven’t come across the research before check out the blog post by clicking here). We’ve now submitted our first draft to the editors and will await amendments in preparation for final submissions & publication later in 2022/ early 2023. Another important step having our community’s example being utilised within academia to inform the next generation of researchers and policy makers within the healthcare industry regarding the impact of peer support.

But as always…. We’re a long way from being finished.

To begin 2022, we have the exciting launch of The Diabetes Awareness education program for schools, aimed at kids aged between 5-11. Our hope is that this will raise awareness of the condition, whilst encouraging healthy lifestyle choices and understanding the differences between the 2 main types of diabetes. An awareness program to help make Diabetes a bigger, more understood conversation for the next generation, as we attempt to tackle the longstanding stigma and stereotypes many of us have faced over many years with the condition. It’s an exciting development and if you want to find out more or point your schools in the direction of it head to www.ajbactiveminds.co.uk

Below are some pictures from our recent trip to Everton in the community to promote the work and to talk about future links for the programme.

This isn’t our only foray into education & resources for 2022 as we’re hoping to develop further resources and CPD opportunities for those involved in football, so watch this space! Ideas will be progressing in the early part of 2022 and as always if you want to help or support us please do get in touch.

Whilst on the participation front, we’ll be delivering futsal sessions for our men’s and women’s teams in 2022 and I hope for the first time we will be doing something for a kids participation day (I’ve said this a lot but the pandemic did put pay to this idea for a while!)…. Who knows, we may even manage to participate in DiaEuro 2022 if the pandemic allows us a safe time to do so….But as always we have lots of ideas to focus on.

As usual though, we’re going for it. We don’t sit back and wait for things to happen at TDFC, we strive for positive change and that’s what will be doing in 2022. But, we can’t do this alone and these efforts aren’t always the easiest to fund or find a way to deliver, so if you could help us financially to continue to do what we do, please head to our donate page: www.thediabetesfootballcommunity.com/donate or head over to our patreon page to subscribe to exclusive content www.patreon.com/thediabetesfootballcommunity

However before I finish, I just wanted to say a huge thank you to the incredible TDFC team behind the scenes…. You all know who you are but a special mention to the man who helps keep us on the straight and narrow, my fellow podcast host, director and really good friend Jon Peach who’s made a huge difference to me in the last year since stepping onto the board. Thank you mate!

But most importantly to me, I wanted to end this blog with the views of our community… So I reached out to them on WhatsApp and I simply said to them finish this sentence:

Being part of TDFC in 2021 has been…..

“Informative, really helpful and great knowing I’m not alone. Great Football banter too.”

“An arm of support I didn’t really know I needed until times got hard. Support, guidance and laughs.”

“The most supportive and helpful tool I have used to help manage my T1D since first being diagnosed, whilst also feeling part of a special with a great bunch of lads.”

“A useful source of information and humour, at a time where both have been hard to find elsewhere.”

“A great source of comfort and knowledge in a subject that’s lacking in information in the public domain.”

“Really great and useful. Helped me through some struggles and getting to know people in the same situation.”

“A big eye opener into how good of a community we have. The support has been amazing and being a part of TDFC is something I highly recommend people get involved with.”

“Inspiring and encouraging! It’s amazing to be connected to so many people who understand what I go through every day, and all through football.”

“Like being part of a family, I’ve enjoyed bringing diabetes and football together to raise awareness and inspire others.”

“A great experience allowing me to connect with other girls within football living with type 1 whilst working on inspiring others. Can’t wait for what the next year will bring.”

“So far brief! But for the short time I’ve been part of TDFC, it has been great knowing there’s a whole group of people who share your passion and understand the difficulties of diabetes. Having that support system is incredible and I’m really looking forward to seeing what we can achieve in 2022.”

“The continuation of a fantastic support network for all things diabetes and football (could even change that to sport!)”

And their responses continue to show me why we do what we do. Happy New year everyone here’s to another year of changing the perception of Diabetes.

Chris

Louise McCay – The First Type 1 Woman to play Futsal Live on British TV

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

“In some respects what I am about to talk about is not a day I want to remember, however TDFC founder Chris Bright made me think about the experience in a different way.  

I am currently playing my first season of futsal for Bedford Futsal Club who are in the Women’s Super Series South. Our season got off to a great start with a strong win & I even bagged myself a hat-trick, however our second game of the season stepped up a level…  

The day itself brought a lot of new challenges that we all as a team had to try and combat. For instance, playing a very strong opposition, having crowds back and being streamed live on TV with BT Sports.. yes BT Sports!  

On Saturday 9th October I was lucky enough to be the first female type 1 diabetic to play competitive futsal live on BT Sports (as far as I am aware… definitely reach out if you know differently!!!).  

The Lead Up to the Game  

The day before was sensor change day, something I’ve never had problems with.  

I applied my sensor as normal, however, once set up was complete I received an error notification reading ‘replace sensor, sensor not working’ – luckily, I did have another sensor with me as I get two a month. So I thought no stress I will just replace the faulty one and as I’ve never had this issue before it must be a one off. After applying the second sensor and after checking my levels once or twice I got the same error message – what are the chances both sensors didn’t work??  

The panic started to kick in – I am not going to be able to control my bloods as I would want to for the big game tomorrow without my sensor. Fortunately, I was able to go and purchase an additional sensor from a local pharmacy which thankfully worked. I was however very conscious of the accuracy given my experience that day, therefore I was sense checking my sugars with a finger prick for the rest of the evening to gain confidence.  

On The Day..  

I hadn’t had a great night with the blood sugars, I often go to sleep with bloods in range to find them spike in the night, which is what happened the night before the game. I woke up around 2/3am by chance and had a correction dose as my blood glucose levels were rising above 15mmol’s. As you can see from the below graph this started to kick in but as my bloods dropped back into range it spiked again. I then woke up just before 6am and saw my bloods were too high yet again so I decided to do another correction dose, hoping to wake in a couple of hours with much better glucose level.

 

When my alarm went off around 7:30am my bloods were dipping into the low territory, which I treated with my usual carton of orange juice. I then had a decision to make as it was essential I got my levels under control for the day.  

We had a 2:30pm kick off which in itself adds complications and decisions to be made around when I would need to fuel up for the game with potentially 2 meal times to squeeze in whilst also ensuring my bloods were under control from the get-go. As I had just treated my low sugars, I was conscious of them spiking if I had breakfast straight away – so I decided to hold out and just pack breakfast for the journey.  

To help relax before the game and give the legs a good stretch beforehand we decided to travel up early and catch some of the earlier games. We wanted to familiarise ourselves with the settings, try to squash the external pressures and settle the nerves.  

I had read a very interesting blog only days before from a type 1 who ran the London Marathon (who I now know to be Scott Burrell (what a legend and don’t miss his podcast about it by clicking here) who had experienced the negative side of adrenaline and added pressures of big events on blood sugars, leading him to not be able to bring his levels down to perform at his best.  

This was playing a lot on my mind in the lead up to and on game day.  

As I had held out on having breakfast my bloods started to drop during the journey up to Birmingham, so I decided to treat this again with the trusty orange juice carton and one Weetabix.  

My bloods started to rise again ahead of the warm-up, so I did another couple of units as I know my bloods tend to rise once I start playing. This seemed to eventually start to work, however, the adrenaline mixed with the usual during exercise spike still managed to creep in across the second half of the game.  

I didn’t feel the impact of this movement as I was very focused on the game but on reflection I probably could have benefited from another unit or so whilst I was off the court.  

Overall, considering the occasion, I was fairly happy with my blood sugars, however, I wish the lead up to game day and previous night’s levels were a bit more in control as I know the middle of the night highs, and the corresponding lows, have an impact on my body throughout the following day.  

After a tough game and unfortunate result, the day ended with a huge spike in sugars from the evening meal that I consumed post game to drown the sorrows.  

There are definitely some learning points I can take from the day to help me move forward if we are lucky enough to be on live tv again in the new year.  

When I take a step back, I am extremely proud to have had the opportunity to play live on BT Sports and will continue to work hard to have that opportunity again.  

Having type 1 diabetes does add a number of extra daily considerations and decision points, but I will never let it hold me back from doing the things I work hard for. “
Louise is part of the TDFC Womens team leading the push to provide more education, support and opportunities for girls and women to get more from their Football and Futsal, whilst living with Diabetes. Get in touch if you’re interested in finding out more!

We are back… Diabetes Futsal Returns!

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

It’s been a long time since we’ve been able to write this, but…….. WE ARE BACK! This weekend coming, we will be resuming our Men’s Diabetes Futsal sessions at the Worcestershire FA headquarters after a gap of 15 months due to the impact of the Coronavirus pandemic.

It’s been a tough break for us all. We know so many of the group took a lot from the sessions in the past and we’re hoping to bring back all of that positivity, engagement and support to our upcoming sessions. We know there’s a lot of excitement amongst the ranks from existing and new players to the project so we can’t wait to get back out there!

We will be starting back on the 27th of June with another session planned in for the 25th of July as well so if you want to get involved please do get in touch!

For us these sessions will be about re-engaging with our community, getting our squad back together to play as well as welcoming new faces to the pitch. We should have a good laugh and a lot of fun which is what it’s all about.

We must also say a big thank you to The Tackling Inequalities fund created by Sport England and put into practice by Active Herefordshire and Worcestershire. They’ve supported us with funding and support to help get us back off the ground after what has been a really challenging period during the pandemic.

It’s going to be a really exciting month for us as the sessions get back underway whilst we also continue to grow the women’s arm of the Diabetes Futsal squads…. However, ahead of this first session we thought we’d invite one of the newest members of the community, who will be attending his first session this weekend, to describe how he’s feeling ahead of Sunday…. Over to you Bryn:

“I’m really excited to be finally meeting up with the lads from TDFC. Ever since I watched Chris’ story I just knew it was something I would love to be Involved in. So to be invited to training with them is really special.

I was so inspired by the work of TDFC I even held an active fundraiser for the charity through my sports coaching business ‘BMO Coaching’ – we managed to raise £377.50 for TDFC and £900 in total, which we shared with other local charities.

Living in the Welsh coastal town of Aberystwyth, I have only met a total of two T1D players that are still playing senior football so It’s going to be a fantastic experience playing / meeting with other T1 diabetics in a football environment.

I’m passionate about raising awareness and passing on knowledge about diabetes, especially throughout my area of Wales. I’ve been playing football with T1D for 20 years and I’m keen to show people that it doesn’t stop me from playing sport and doing the things I love.

The lads have been really welcoming on the group chat so I’m looking forward to a session with them to break the ice. “

Thanks for sharing your thoughts Bryn and isn’t it great to be back!

TDFC

This wasn’t easy… My story with Post – Concussion Syndrome

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

To be honest, until I heard Stevie Ward talk about his struggles with Post-Concussion Syndrome on the Mantality podcast I hadn’t even considered talking about this….. Nor was I really ready to share what it’s been like, because to be brutally honest it’s been far from ok.

However, having heard him talk so well about the challenges and how it mimicked so much of my own experience, I felt empowered to get it off my chest as this subject hasn’t been spoken about anywhere near enough, especially within sport. As someone who’s used to dealing with an invisible condition on a daily basis, I thought I’d be relatively well equipped to cope but there was a key difference to this diagnosis from the off. This time I opened up from the off and told people what I was living with, a different approach to my type 1 diagnosis, but ultimately very quickly I was reminded why I adopted that approach before….

When people can’t see, feel or experience what you’re going through they find it hard to believe what you’re telling them. Throughout society there’s a distinct lack of empathy (in my opinion!), that ability to see the world through someone else’s eyes for just a minute. I think it’s a root cause of many many issues across the globe but this is slightly away from my point. It’s also had a huge impact on my life again coping with post-concussion syndrome ( a brain injury!).

I’ve had people almost patronise me, almost can’t believe I’m still talking about, think it’s not that serious, think I’m overdoing it and overall think I’m making a mountain out of a mole hill. Another invisible condition, something else people can’t see through my eyes for a moment and here we go again, another condition with stigma attached.

For me it again just demonstrates why people with hidden conditions like type 1 diabetes, don’t talk about it much in mainstream society. You’re made to feel as though you’re constantly the problem. I hear the lip service paid to the words diversity and inclusion all over the place in 2021 but until individuals become accountable for those words to themselves, how can those things really be achieved?

I wanted to make that point clear, that empathy can make all the difference and if you catch yourself making a pre-judgement of someone, see if you can just take a minute to look at the world through their eyes….. It might change everything.

But I want to talk about what the condition has been like as well, because it’s been awful at times and it needs more people talking about it.

So, since September 2020 I’ve been dealing with symptoms of post-concussion syndrome which started with not much more than being off balance for a header which then came off the wrong part of my head and followed with a number of other knocks in the same game, contributing to an initial concussion. But the concussion wasn’t immediate….

My symptoms didn’t start until 4/5 hours later….. I was just sat in the pub with my friends that evening and I suddenly felt incredibly tired and my brain was a bit foggy, whilst struggling to engage in the conversation around me. Luckily, we all headed off pretty early that night and I got home and went straight to bed not thinking too much about it, other than the fact I was a lot more tired than usual…. Then I woke up the next morning.

The first thing I noticed was that I’d slept for 9 hours without stirring, which is unusual for me. Following that I could tell I still felt extremely tired despite sleeping that long! I felt I could’ve slept another 3 hours easily. Both of these things really struck me… Then the really obvious issues began.

I didn’t quite feel steady on my feet, I mean I wasn’t falling over or tripping but I just felt a bit off, then I had this foggy way of thinking which affected my recall and ability to properly participate in conversation. Ultimately, I was struggling to process information and provide speech as easily as I had found it 24 hours before. I was also noticing that concentration and especially on screens, such as my phone or laptop would really flare up a headache and intensify the throbbing, pressurised feeling I had in my head. Alongside this was a feeling of nausea when I concentrated too much. This was the day after the first concussion.

I then woke up on Monday morning and felt much the same, with things ever so slightly improving but I needed to speak to my GP to understand what was happening. So I managed to get through and speak to them about what I was experiencing and through a telephone triage appointment I was diagnosed with mild concussion, no tests, no examination, all via the phone. As this was my first experience of concussion in my life, the lack of urgency or need to examine me, filled me with a view that it wasn’t too serious, and I’ll be ok in a few days. The advice was to rest and not do contact sport for 2 weeks. If things got worse, I was told to go to A&E to have a scan but as things improved I didn’t feel that it was necessary to do that. The key word was REST in the GP’s advice, but rest looks different to each person and without any sort of definition of what that looked like I chilled out for a few days, took time off work, didn’t really exercise and then gradually incorporated some of that back in, towards the end of the week. The very blasé view given at the start of my diagnosis filled me with an ill-informed opinion of the gravity of the situation and no real insight as to how to approach the next 2 weeks bearing in mind my personal situation. It could’ve been read out of a textbook. I now know that this was a huge mistake but I can’t turn back the clock…. I wish I could.

Needless to say, that 2 weeks after that first concussion I went back and started an FA Vase game. Looking back, I think I knew I wasn’t quite right but with it being a biggish game for the club and me being a senior player, I wanted to get out there and play. When you’re a competitor you always want to be out there. I played the full 90 minutes, we played really well, won the game 4-1 and after initially feeling a tiny bit rough, by the end I was good as gold, or so I thought. I had played the game with no head collisions or challenges and made 6 or 7 routine headers, so I thought I’d probably be ok as a result. But after the adrenaline subsided, the symptoms came on quicker. On the car in the way home (I wasn’t driving!), I could feel that the nausea was there with the fogginess and they were getting worse. This time I obviously knew what it was, so I accepted I was going to feel awful for a few days again and hoped that maybe after a month of not playing this time it’ll go back to normal….

I was obviously wrong… I went back to square -1!

The symptoms were worse than previously and because I was having to work to bring in money, and I wanted to try and keep my mental health in a good place by exercising too, I was struggling with making any progress as I wasn’t getting enough rest. I got better to a point after 2 weeks and then after that I had lingering reoccurring symptoms which affected me on a daily basis. It was worrying, frustrating, frightening and all the other emotions mixed in between.

After continuing like this for a month to 6 weeks, my anxiety about it reached the point where I needed some advice. I rang my GP again, I reached out on Social Media and I looked for anyone who could help. Coupling that with the November Lockdown and it was a really tough place!

I got some good advice and support which has helped to move me forwards and my symptoms have gradually lessened but I’m still not able to work at a full intensity with my exercise and I struggle with continuous screen work as it brings on a throbbing pain in my head and I can feel a little skippy or unbalanced but compared to October/November it’s a world apart. I need to look after myself for a moment and forget about playing sport, this is bigger than that.

But still to this day I’ve not been scanned, examined or seen in person at all regarding my concussion and my memory/ recall is just not as sharp as it was. I hope that one day it’ll come back to something closer to where I was but my recovery is still in progress and even recently took a bit of a hit after too much time spent at a screen working. I thought I was in a place where I was ready for it but in turns out I wasn’t! I heard Stevie say it and I resonate it with so much, the recovery just isn’t linear at all, one day I’ll feel like it’s disappeared and then another I’m really reminded it hasn’t!

I look back now and I know I should have stopped myself playing. I reflect on that every single day. I wished I’d taken things far more seriously and I wish that there was less stigma surrounding talking about brain injuries or mental health conditions within sport. It might have been the difference in me taking the time out to properly rest.

We can’t change that overnight but even if me just sharing this blog post and my experience can help one other person who may be going through this, has gone through this or may unfortunately have to face this in the future, at least through the dark times I’ve been through someone else might take some comfort.

A huge thank you to Stevie for sharing his experience so publicly, which has given me the courage to put mine out there, as writing some of this hasn’t been easy, especially when I’m still going through this. I hope to one day look back at this post and say I recovered. If you have never checked out Mantality before, you should! The work that Stevie and Natalie are doing is shedding a light on concussion specifically and mental health more broadly. It’s a fantastic project and it’s certainly supported and inspired me.

With the premier league recently introducing concussion substitutions and demonstrating a step forward around these types of injuries, more stories and experiences need to be shown as to how it effects everyday lives. It needs more awareness to end the stigma and allow people to feel comfortable talking about something so dangerous.

I have no idea if my Diabetes continues to play a part in my recovery or whether it had an impact in the concussion in the first place, but like with everything I’ve faced in my life, this challenge is one I’ve accepted and will continue to embrace.

I now advocate for Type 1 Diabetes and for greater awareness around the impact of concussion.

I would love to hear anyone’s thoughts on this subject and thank you for reading.

Chris

A summary of some of my symptoms below:

 

  • Immediate symptom: tired much earlier in the evening than I’d ever been before.
  • On and off symptom: Felt a little bit off balance.
  • Continued symptom: Working with screens would really upset my head. Whilst looking at them in the mornings before I’d got going would cause a headache which lasted for hours.
  • An immediate symptom and when I’ve done too much: Felt skippy, turning too quickly would set me off.
  • An early symptom and when I’ve done too much: Pressure in my head and a headache for quite a number of days.
  • An early symptom: Nausea, feeling a bit like being car sick or motion sick.
  • An early symptom and when I’ve done far too much: Foggy, I struggled to connect my brain to the conversation around me.
  • I even got my eyes tested to check that I wasn’t irritating my head with my eyesight.
  • When I exercised or ran too quickly, I’d irritate my symptoms and go backwards.
  • Immediate and continuous symptom: Forgetful – Forgetting names of people I always remembered previously and getting frustrated and worried/upset about noticing this. Just forgetting what I was doing a few days ago or situations I always remember.

Diabetes Month 2020 – Thoughts from Muhammad Ismail

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

It’s been a tough year for many of us. 

 

The world, what we value, how we see the future, jobs, the economy, sport, social activities, health etc have all been affected this year by Covid-19.

 

This piece was written to focus on the positive, and is focussed on gratitude 😊

 

Moving on to where we are now; Diabetes month! 

 

Throughout the years I’ve seen people post images of how many injections they’ve had to endure over their lifetime, images of libre scans, hypo treatments, Hba1cs, the DKA and diagnosis in hospital, how people have overcome their diabetes challenges and all those additional things we have to endure…..just to function everyday. 

 

This year I’ve had a think about what’s important to me, what has helped me keep ticking, year on year, and ultimately has led me to meet up with, and work with some of the most inspiring people I’ve ever met.

 

The story begins a few years back, sometime in 2017. I had a decent job, life was great on the outside, my diabetes control was awesome, but I was, at the time, not feeling good inside. There were two parts to why I wasn’t feeling great, one was diabetes related.

 

I was struggling with diabetes burnout. It was something I never knew existed as I’ve had t1 since the age of 2.5, and so not known what life was like otherwise. I guess when “not being okay” becomes a routine, it ends up being normal.

 

I’d figured out through my understanding of medicine and pharmacy, how rapid acting insulin worked. The bottom line was that I could get away with measuring my sugars less than a handful of times a day, guesstimate doses extremely well, have limited hypos and have an a1c of below 6.5. I could manage exercise well and only really struggled when I went out for a three course meal and desert at a posh curry place. 

 

I couldn’t really see the point of bothering really, even my hospital appointments were pointless. I’d turn up, be asked for my diary (which didn’t exist), someone would have a proper go at me for a bit, then open up my record. 

 

After this point they’d take some time to double check my hospital notes, scroll through my history and say well done. I often felt it was more out of shock than praise. That was it. No “sorry” for making me feel like the smallest thing on planet earth, no “is there anything I can do for you?”, no “how do you manage to dose”, no “how are things?”. Then I’d get an appointment a year later and rush back to work. 

 

One time at work (I work as a hospital Pharmacist) I had a brief discussion with a dsn about care. She asked where my care was and I mentioned the hospital. She asked whether I thought about moving my care to my workplace. I didn’t know this was possible. I thought about it for a bit, and concluded that it would be hugely beneficial as I wouldn’t have to travel back to work by train, saving about 1 hour of my time, once a year. 

 

So I worked really hard to move my care over. Contacted the GP, my DSN and after a while, I got the appointment notification in the post. 

 

A few weeks before my appointment, I was working in a GP surgery, running a clinic that aimed at preventing blood clots. A routine patient came in, mentioned that they were really worried at the time as their sibling was unwell. They lived nearby and asked if I could do a quick blood test for their sibling, who was also part of our service. I stated that I’d do their consultation, and if I had time, would look into it as I had other patients waiting. 

 

Later on, I read through the sibling’s discharge summary and was shattered. There was a lot on there about poor compliance, complications of diabetes…….it was a mess. I took the kit I needed and headed to the home. The person was in an awful state. I took the blood test needed and they used the blood to test their sugars. I could tell this wasn’t going to be good. 

 

They were throwing up, dehydrated and their sugars were 17. It was a bad mix. They asked for advice and I couldn’t give any, as my clinic wasn’t a diabetes one. It really broke my heart, but you have to be professional. I advised they seek medical attention, and left. As I got back to the clinic, I realised I forgot one of my monitoring devices. I headed back to the home and an ambulance was there. I got the device, wished them well, headed back to the clinic, tidied up and went home. 

 

There are times in my job I experience these things and often ask myself many questions. Most of them are “Why not me?”, “Why does diabetes lead to so many bad outcomes?”, “Why do I find people in situations I’ll probably never find myself in?” and it usually ends up with “Why bother?”. 

 

Afterall, it’s a lot easier hiding from a condition, not having to think about it, than grinding your way through your daily routine only to be seeing others suffering, with you not having the ability to influence or change their outcomes in a positive way. That stuff is soul destroying, but I guess at the time I couldn’t see any way to process that in a positive way. I thought, “who would understand, and who could, if they would understand, be able to do anything about it?” 

 

I guess weeks went past, and I cared a little less, it gets better from here onwards, promise!

 

So I turn up to my appointment, expecting the same response. Hopefully this year, a little quicker as I won’t have to travel back to work. 

 

So I get called up, knock on the door, open it. “Hi can I come in?”. “I haven’t had a chance to read your notes yet….do come in.”

 

From then onward it was quite an interesting consultation:

 

“Where’s your diary?”, “I don’t have one” (expecting a massive lecture/some condescending remarks at this point….).

 

“So how do you monitor?”, “I dose according to how I feel” (probably the first time in years someone has actually taken the time to ask the question, rather than judge straight away). 

 

Usually I get a sarcastic smile or a brief laugh. Instead I got a look of someone who was genuinely interested, trying to take a moment to understand.

 

I felt bad at this point and decided to pull out my phone to show a pic of a day I had with a libre, showing a full 24 hours without a sugar over 9mmol/L.

 

“Not a single sugar over 9?!”, “Yeah…” (I couldn’t really be bothered about a conversation at this point).

 

At the time I just wanted the consultation to end and go back to work. The checks (though understandably important), were just a tick box exercise of me. Nothing ever changes, so I decided to answer all the questions with short answers. It was the quickest way back to work, and the quickest way to forget I had a chronic condition to manage. 

 

Towards the end of conversation, doc was like “Have you ever thought of seeing a health psychologist?” 

 

Again, I just wanted to be out as quick as possible so decided to ask for their recommendation and then say “can’t be bothered, can I go now?”

 

To this day I will never forget what happened next. I asked “What would you recommend?”

 

“I’m not going to recommend anything, here is some information.”

 

I was stunned into silence I guess, and didn’t know what to do next. The freedom of choice is one thing, but it’s extremely powerful for a clinician to be extremely non-judgement. To understand the dark places a chronic condition like diabetes can take you is something you can’t really learn from a book, nor pick up from experience; you have to have a personal connection with diabetes to do that. 

 

“Do you have diabetes?” I asked, trying with all my years of having t1, to figure out how someone could pick up so much from so little information given.

 

“No I have a relative and growing up…….”

 

For the first time in years, I had a meaningful conversation about t1 with someone. I was still demotivated, and managed to negotiate a yearly appointment instead of a 6 month one. Doc was still okay with that, which was really nice. 😊

 

I thanked them for their time and went on my way, doc even managed to convince me to see the DSN and dietician at a later date. 

 

After that point I thought to myself, there must be some “good” out there. Over the next few months I searched for diabetes groups online, attended some in person meetups and actively searched for some diabetes stuff.

 

I even went to the health psychology appointment and it did help put things into perspective. 

 

A few months later I went to a diabetes tech event where Chris presented how the dexcom had helped him manage his sugars with sport. I caught up with him after and said “I think you should start a diabetes football team.” He was like, “There is one!.” 2 years in, it’s had a massive impact on people across the country (all the way from the Isle of Wight to Scotland!). 

 

 

It’s truly changed some people’s physical and psychological health – for the better! There’s even a local London team and every day it’s growing. It’s also got so much more to offer too! This is a must watch video if you want to find out more! 

 

https://www.youtube.com/watch?v=19T9M5944E4&t=6s

 

I even turned up to the annual diabetes picnic in London. This is where I met Tim Street and learnt about looping. What an amazing concept I thought. This eventually led me to building a loop system, making managing diabetes slightly less of a burden. I’ve seen the #WeAreNotWaiting movement take huge strides to making t1 safer, more manageable and less psychologically draining.

 

I also joined loads of T1 facebook forums and have seen so much positive support, and positive change coming from them. A big shoutout to Louise Troubridge, who helps to effectively manage the “Type 1 diabetes uk” facebook page. It’s got over 8,000 members! 😮

 

My favourite facebook group (sorry to disappoint Louise!) is “Libre line art”. Do have a look as you don’t need to be a facebook member to appreciate it!

 

 

There’s also the amazing “GBDoc” (Great Britain diabetes online community) on twitter, who are never far away to provide help and support if you tag “#gbdoc”. They even hold insightful and entertaining “TweetChats” on Wednesdays at 9pm. Follow ”@GbdocTChost”

 

 

Furthermore, this year I’ve fasted a whole month for the first time in my life (see my 30 day graph below). A huge thank you to Dr Sarah Ali (@AliRacaniere) and Dr Sufyan Hussain (@sugarydoc) for making this an achievable reality, despite Covid and it being my first ever attempt! 

 

 

I feel really good to get that off my chest. 

 

Just remember you are not alone! Sometimes it takes a human to just listen and “try” to understand. I know this year has been extremely tough psychologically, financially and socially. 

 

Reach out, know that you’re not alone, bounce off people, celebrate the small wins, take it one step at a time, love yourself, be grateful, there is a lot of good in this world and I’m thankful I’ve found it when I needed it most.

 

I dedicate this post to my awesome endocrinologist Dr Karen Anthony, and my now, unfortunately retired 😢 DSN and dietician; Susan Olive and Janice Mavroskoufis. 

 

Sometimes you just need to take a step back, listen, be non-judgemental and “try”.

 

Jon Rosser: My life with Type 1 Diabetes

Posted on by thediabetesfootballcommunity in diabetes, Football, sport

I’m Jon Rosser, 27 years old from Bristol and have been a type 1 diabetic for 17 years. Being involved with TDFC has enabled me to link up with other diabetics of varying ages and share our experiences, however this is often very focussed on the present – what we are currently doing, learning or going through. Reading these blogs, I found gaining an insight into these people’s pasts and hearing of their journey has been really enlightening and valuable, even for someone who has already learned to an extent how to live with the condition. So the obvious next step was to try and somehow put down my story outlining the changes it has made to my life and the lessons I’ve learned in the hope that others can take something from it like I have done. So here goes…

My journey starts with diagnosis at the age of 10 and the very familiar story of the tell tale signs. I was always thirsty! I didn’t really notice this symptom but my dad whose late mother was a Type 1 noticed I was increasingly up and down to the kitchen tap, filling up pint glasses of water and knocking them back like no tomorrow. As a result of this I was back and forth to the toilet and it didn’t take long for him to step in. Looking back at it now I suppose I was quite fortunate that my dad noticed this going on and intervened pretty early as I can’t actually remember feeling too bad! He made me do a urine sample and booked me into the doctors. A quick ketone test and finger prick confirmed what my dad had feared and arrangements were made for me to forget about going back to school, pack a bag and get to the hospital. Being a 10 year old I can remember feeling a bit oblivious to what was actually going on, but I knew that something had ultimately shifted by the way my dad had reacted, he seemed gutted and spoke to me about how we were going to go about telling my mum when we got home. I had never even heard of diabetes and was still completely naive about what was to come. 

A few hours later I was at Southmead Hospital being admitted into the children’s ward. A flurry of nurses were showing me my bed, where the toilets were, where the common room was, a full on tour of the facilities and this was the point where I kind of started to realise that I was here to stay for a while and this whole situation was going to be the start of something that was going to change my life forever. I was on this ward for 5 days and during this time I had to learn the skills that would ultimately keep me alive. One event that sticks in my mind from this period was when a 16 year old boy got rushed into the booth next to me. Other kids on the ward were all chatting to their neighbours so I welcomed a new face to hopefully ease the boredom. However on admission his curtains were shut and I remember feeling that the nurses were actively discouraging me from trying to say hello, and no sooner had he arrived he was gone again. I didn’t find out until years later that this guy was also a diabetic and had not woken up one morning due to having a serious hypo during the night. Looking back now I realise it was the right call not to let a newly diagnosed 10 year old get wind of this! The ward had a classroom where I spent a few hours a day which was nice as it got me out of my bed, but I remember being pulled out at regular intervals to be finger pricked and stuck with syringes and this was another point where I started to realise this was going to be the new normal from now on, and I didn’t like it one bit. How was this going to work at my own school? What about at football? I was bang into scouts at this age so how will I go on the camps? Can I even still do all these things? The answer of course was yes, but the anxiety and worry about all of this was something I will always remember. 

Fast forward a bit and I’d settled into my new routines, teachers and coaches had all been really engaged in making things as easy as possible for me. But it wasn’t all plain sailing by any means. I was initially put on the 2 injections a day regime and it wasn’t long before I felt frustrated at the restrictions of this, especially when transitioning to secondary school. Having to inject my insulin at the same time morning and evening, and knowing I HAD to also eat at these times each day meant things such as after school sports fixtures, clubs, and even just hanging out with friends would all have to be arranged around my insulin and meals. It took so much planning and at times I found it exhausting and stressful. 

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I want to shift the focus largely on how I’ve dealt with my diabetes within football and sport and I guess I’ve never let it stop me, but there have been times when I felt it has hindered me. At the age of 15 I joined Forest Green Rovers from just previously playing local junior football, and the training stepped up which was great! But it was a much more competitive environment and although to a certain extent I had always tried to keep my condition under wraps (which seems to be a common theme from guys writing these blogs), in this environment I found myself doing this even more. I didn’t want to show any weakness and felt an obligation to keep up with the standards being set, often not recognising that in order to do this I needed to take time out of sessions to take on sugar or test my levels. Occasionally this led me to playing on through hypos and my standards suffered as a result. Sometimes coaches and players would confuse my hypo reactions with being lazy or uninterested, and I found trying to explain what was actually going on sounded like excuses. The fact I was still on the 2 injections a day meant that I would get home from school, have to hastily eat a carby meal (to avoid going low during training) before heading straight off to train on a full stomach which personally my body did not deal well with – I’d feel heavy and slow. It was the same with the games – we played in a floodlit league so fixtures would be midweek evenings so my preparations would never be ideal. These pressures ultimately led me to change onto the basal bolus regime and immediately after I did that I saw the benefits, not just with my football but with my day to day life. The flexibility was something I’d been longing for and I continued to play for 2 more successful seasons at Forest Green, winning individual awards at presentations and I remember feeling really proud and realising at this point that I had gotten the upper hand on my diabetes and vowed to never let it beat me.

Another event that always sticks out to me as a time where I felt I overcame the urge to keep quiet and let my diabetes win was in a tennis tournament when I was about 17. Over the course of about 6 weeks I had played a match every week and got through to the final without any diabetes related issues. In this final however I struggled from the start. There were a fair few people watching and I was putting my performance down to nerves and threw away the first set in record time. On the switch around I asked the umpire for 10 minutes just to check my sugars which for me at the time took a lot of courage, I was 3.1. I remember sitting there in front of the crowd openly testing my sugars and taking on food which is something at that age I always felt really self conscious doing. My opponent was getting restless as were his supporters watching on but I stabilised my levels and got back out there… I smashed him in the next 2 sets to win the tournament. Like I said this was a real moment of realisation that I could achieve things in sport regardless of having this condition and getting dealt hypos, and it gave me confidence to keep aiming high. 

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The next major milestone for me was gaining a place at Plymouth University. Leaving the family home to move to a new city with new people, new surroundings and new routines was pretty daunting, and when you throw diabetes into the mix it was quite a challenge. I was having to shop and cook for myself and it took a while for me to get used to having full responsibility for what I put into my body in order to maintain good control of my condition. Students’ diets are notoriously not the best so resisting the urge to follow examples of quick, convenient, often high sugar and high carb meals set by my new found friends was important and something I’m glad I focussed on, as it set me up well to continue to control my diabetes successfully. I quickly got involved with the Uni football club and was playing regularly, although the routines and rituals of a university football club were much different to what I was used to. One thing I struggled with was the fact that if we’d win on a Wednesday afternoon (and often even when we lost!) after the game it was shirt and tie and straight to the bars. A lot of these guys wouldn’t take time out to eat post match, and especially after a good win, wouldn’t go home until the next morning. Being diabetic, I felt a bit of a kill joy having to temporarily leave a buzzing group of lads for a few hours to go and get some food of substance and make sure I recovered well in terms of glucose levels, especially when there was alcohol involved! This was a small price to pay though as I found if I put my diabetes first, I would have a much better time celebrating later on knowing I’d done what I needed to do in order for my sugars to behave (as well as they could) during a night out in Plymouth’s finest establishments. These were some of my best times playing football, the social side of the club was immense and winning a varsity and a cup in my 3 years at Plymouth are things I remember for the achievements and not how my diabetes hindered me!

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The most recent landmark in my footballing life has most definitely been getting involved with TDFC. I remember turning up to the first session and experiencing an environment where everyone there would openly discuss the condition, openly test their sugars and inject insulin, there was an underlying bond straight away. I had been so used to dealing with diabetes in a changing room and on a pitch on my own – it was solely my problem, and to feel that problem shared by everyone else there was so refreshing. No feeling guilty for taking time out to test sugars, no strange looks for sticking a needle in my arm, just a feeling of understanding and support. I have played in both DiaEuro tournaments that the UK team has entered in Bratislava and Kiev, and both times were amazing experiences. Playing against some top nations and top players gives you that drive to improve and I feel since being introduced to Futsal (which I had never played before TDFC) I have learned and improved my game as well as my control of my diabetes. I have also found myself transitioning skills I’ve learnt from Futsal into my 11-a-side game which is great! I’ve also found my Saturday team mates have taken a real interest in what I’ve been involved with regarding TDFC, seeing it on my social media and things like that. One of the lads has even adopted a pre match ritual of eating glucose tablets with me before kick off and now swears by it! 

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So that’s my story (so far!) of my life, football and sport with type 1 diabetes. My message to anyone maybe struggling to adapt to life and sport with diabetes is not to hide it, be open and honest about the problems you may encounter, it’s not a weakness! Although it presents challenges I feel diabetes has made me stronger in many ways, especially with discipline and will power… so keep at it!

Thanks all!

Jon

Instagram: @rossergram