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: 5 minutes
Introduction
The objective of adjusting insulin doses before exercise is to prevent hypoglycaemia during a match whilst minimising hyperglycaemia during the run up to kick off. Important factors to consider are the insulin dose, where insulin is administered, the blood glucose level before exercise, the type, amount, and timing of the last meal or snack eaten, the intensity and duration of the match (difficult opposition? Will you play a full 90 minutes?), as well as recent hypos1.
What is the best blood glucose level to have during football?
Blood glucose levels are individual; some people feel (and perform) worse with higher glucose levels before exercise, whereas others don’t. The consensus amongst the medical research community is that a reasonable starting range for most footballers would be between 5-10 mmol/L depending on whether blood glucose levels usually decrease, stay stable, or increase as well as the expected difficulty of the match and the likely duration of play (are you a super-sub?). This range generally balances performance considerations against the risk of hypoglycaemia, although achieving and maintaining glucose levels in this range can be very challenging. If starting exercise below 5 mmol/L it is recommended that you eat 10-20 grams of glucose beforehand and delay (if possible) the start of exercise until glucose levels are more than 5 mmol/L. If glucose levels are between 5-10 mmol/L then most people will be ok to start playing football, although some people may see a rise in glucose levels during the match. If glucose levels are above target (10-15 mmol/L) most people will expect a further rise in glucose during a game. Importantly, if glucose levels are above 15 mmol/L it is recommended to check blood ketone levels; if ketones are elevated up to 1.4 mmol/L then a small correction dose might be needed; if ketones are elevated over 1.4 mmol/L then exercise should be suspended and glucose management should be initiated rapidly.
What should I do if I struggle to avoid a hypo during a game?
People who tend to develop hypoglycaemia during exercise will usually turn to eating carbohydrates as a technique to avoid it. There is an issue with this, however. Firstly, if you find yourself eating lots of carbohydrate to prevent glucose lows the extra calories eaten might contribute to unwanted weight gain in the long-term. Secondly, eating carbohydrates does not necessarily tackle the underlying cause of a hypo.
The reason for the fall in glucose during exercise is at least partly due to high insulin levels. Whereas insulin levels fall in people without type 1 diabetes (in order to preserve blood glucose), in people with type 1 diabetes insulin levels are the result of the previously administered insulin dose or the rate of insulin being infused by an insulin pump. Irrespective of the method of insulin delivery, once insulin is in the body, it is unregulated and does not decrease in response to exercise; this results in excessive glucose removal from the blood. Even if individuals with insulin pumps half their basal insulin rates up to an hour before exercise, circulating insulin in the body does not decrease sufficiently before the start of exercise. Moreover, insulin levels tend to increase during exercise even when insulin pump rates are reduced because of changes in blood flow2. Although aggressively lowering insulin levels through reducing insulin administration or skipping an insulin dose can prevent hypoglycaemia during exercise3,4, this often causes hyperglycaemia and raises ketone levels before and during exercise5. For people using insulin pumps, a basal rate reduction, rather than a suspension can be attempted 60-90 minutes before the start of a game. An 80% basal reduction at the onset of exercise helps to mitigate hyperglycaemia after exercise more effectively than basal insulin suspension and appears to reduce the risk of hypoglycaemia both during and after the activity. For individuals treated with insulin pens, mealtime insulin dose can be reduced by about 50% when taken with a carbohydrate-based meal around 1 hour before the start of a game3. However, it must be stressed that people respond very differently to any strategy and there is no one-size fits all approach.
What should I do if struggle to avoid hyperglycaemia during a game?
High blood glucose levels can raise ketone levels, increases the perception of effort, and reduces performance. As discussed elsewhere, carbohydrate intake before a game is important for both performance and managing the risk of hypoglycaemia. If hyperglycaemia is an issue prior to a match, try eating earlier in the day and maintaining a normal mealtime insulin dose; most mealtime insulins peak in strength by 2-3 hours meaning that a normal insulin dose can be administered with an earlier meal and taking a small snack before exercise omitting insulin – this may reduce the risk of starting exercise with high glucose levels whilst ensuring adequate carbohydrate availability and lowered insulin levels for the game. If hyperglycaemia is a continual issue, starting glucose management preparations earlier in the day gives a longer window to achieve glucose targets. Unless glucose levels are above 10 mmol/L it is not recommended to take a correction dose of insulin because of the increased risk in developing hypoglycaemia.
If you are interested in learning how to tailor strategies like the ones presented to your own individual requirements, contact Matthew at: matt@t1dcoaching.co.uk
References
Bally L, Laimer M, Stettler C. Exercise-associated glucose metabolism in individuals with type 1 diabetes mellitus. Current opinion in clinical nutrition & metabolic care. 2015;18(4):428-433.
McAuley SA, Horsburgh JC, Ward GM, et al. Insulin pump basal adjustment for exercise in type 1 diabetes: a randomised crossover study. Diabetologia. 2016;59(8):1636-1644.
West DJ, Morton RD, Bain SC, Stephens JW, Bracken RM. Blood glucose responses to reductions in pre-exercise rapid-acting insulin for 24 h after running in individuals with type 1 diabetes. Journal of sports sciences. 2010;28(7):781-788.
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. 2013;36(8):2217-2224.
Berger M, Berchtold P, Cüppers H, et al. Metabolic and hormonal effects of muscular exercise in juvenile type diabetics. Diabetologia. 1977;13(4):355-365.
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
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.
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.
Cockcroft E, Narendran P, Andrews R. Exercise‐induced hypoglycaemia in type 1 diabetes. Experimental physiology. 2020;105(4):590-599.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 🏆
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!
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:
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.
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.
I attended my first TDFC session in July following an introduction to the project by Mo who found my Facebook profile on a Type-1 diabetes page & saw from my profile photo that I was a football fan.
I have been a Type-1 diabetic for over 30 years and could probably count the number of fellow Type-1’s who I have met during this time on one hand. However, during the challenges of the past 18 months and after experiencing some side effects caused by diabetes, the want & need to meet with people going through similar life experiences was heightened. The TDFC project provided this; the fact that everyone also had a passion for the sport I have loved for the past 35 years was a bonus!
In a strange coincidence, one of the other guys who was also planning on attending the session in July lives literally around the corner from me, a mere 7-min drive away! Buncy and me agreed to travel the 2.5hrs to Worcester (from Berkshire) together and got to know each other through an exchange that covered blood glucose levels, diabetes management, hypo symptoms and of course, football. Turns out Buncy is a Watford fan, so there was much fun to be had….
Once we arrived into Worcester, I found the meet & greet/get to know each other session really powerful. I have not before realised the benefits of such a session. They empower people to work to solve their own problems. Everyone in attendance are equals and I felt that this made people feel much more comfortable opening up about their diabetes journey and related experiences. After a very tough last 18 months with Covid & the various lockdowns, I believe that sessions like this can reduce any anxieties, whilst improving self-esteem, and providing a sense of well-being overall.
The actual training session was itself a surreal experience. Playing futsal/football with other guys who were flicking their phone across the Libre on their arms to monitor their BG levels every so often whilst having conversations about various diabetes management strategies adopted for a rigorous football/futsal session was something I hadn’t seen before. Somehow, it almost seemed ‘normal’ to take mini-breaks to take BG readings and to read them out to the group with no judgments made. I personally awoke with a BG of 12mmol so spent the whole car journey up trying to get it to a suitable level, but I did too much of a good job of this and ended up starting the session with a 3.3mmol highlighted in red flashing up on my own phone via my Libre. Thankfully, there was an assortment of glucose options supplied to support the treatment of a low BG.
I have been playing a decent standard of football for over 30 years, but futsal is a very different game; more tactical, more structured and more intense with less time to recover from a period of attacking or defending. Having put in a couple of additional pounds during the lockdowns, I’d admit that I need to better prepare myself to suitably compete for the next session! The standards were pretty high and were refined by the guidance and coaching of Brighty, culminating in a very good team goal during the actual practice match. Thankfully, the goal was scored by the team that I was on…
After a competitive and enjoyable session, I managed to join a couple of the guys for a quick ad-hoc lunch before we all departed for our return journeys home. We all shared some more stories on our diabetes journey. A couple of the guys were newly diagnosed, so it was empowering for me to share my own 30 year story of diabetes & to highlight what I had achieved, both personally & professionally to send a message that diabetes shouldn’t hold you back.
Personally, for me, the whole experience was humbling, empowering & enlightening whilst providing a much-needed boost to my mental mindset. I also got to find out that I ‘wasn’t the only type-1 in the village’….
Guess what, it’s been a weird 18 months hasn’t it, but as the restrictions end and some form of normality returns it was great to get the message from TDFC HQ that the futsal sessions are back on and a couple of summer meet ups are in the diary. Get in!!
As many us will know (especially if you’re a parent or carer) you must wear different heads daily, nurse, best friend, coach, Darth Vader. All of which had to been worn in increasingly difficult lockdown circumstances. Having worn all of these (including the new Key stage 2 teacher head) I was driving down to Worcester for the session thinking I haven’t worn the futsal keeper/skipper one for over two years.
A light bulb moment that almost felt like imposter syndrome, as if I was stepping into someone else’s shoes. I’d felt a little like this going to the first ever meet up back in 2018 when I felt like the old guy who had come for the dads v lads’ game. Believe me that feeling disappeared almost instantly in 2018 and the same in 2021.
The reason why, it’s easy, it is the people. The strength and support of community is powerful. Something you don’t (or I didn’t at least) realise until you’re involved, meeting and listening to others, simply having a chat, a laugh or empathising with the issues they are encountering. The WhatsApp group that all who join TDFC are invited to has been fantastic in keeping in touch with everyone but meeting up with some old and new faces, getting the boots on and simply having a game, that is a life saver.
I have family down in Worcester, so we decided to make a day of the first session and catch up, so the Ward clan turned up on mass at Worcester FA HQ.
The meet up followed the usual routine the hello’s, how are you doing, nice to meet you, take the mickey out of each other and have a laugh (mostly at my lockdown barnet), yes Tob’s I know the barbers are open now but I’m going full Zlatan! 😊
There were loads of new faces and although I didn’t get to chat with everyone it was great to meet you all, apart from Bryn who megged me 3 times, you mate, can stay in Aberystwyth next session!
The presentation and discussion with Chris and Jon that opened the session was a real eye opener with the differing level of access to diabetic support across the country, be that physiological support, CGMs, pumps, and dietary & lifestyle advice offered was frighteningly varied, far from consistent and really not great to see. The tireless work Partha Kar and others are doing to remedy this is vital for people with type 1 across the country.
A special shout out to Mo Ismail, who has been an absolute legend throughout the pandemic and well ever since I’ve met him. His advice and guidance (he’s a qualified Pharmacist and T1D brother working in the NHS) on all the questions posted in the group has been a real source of inspiration and support and the recognition he received during the session is well deserved! Well done and thank you pal from us all.
After the presentation and discussion, it was down to the pitch for the futsal, but first media duties for me and Mo discussing the project with Active Herefordshire and Worcestershire, who have provided us with some great support to get back on our feet. It was great to chat about TDFC and the return to playing and training.
The training was great as usual (apart from the megs) and it’s always nice to learn as well as get chatting to Tom about Goalkeeping and his master’s Studies in the USA too!
I coach academy and grassroots football, so I am on a pitch most days of the week but being out there playing and being coached is such a release, you don’t know how much you miss it.
A nice end to the day was having my picture taken by Chris from Reaction Photography of me with Brighty and my boys all of us in TDFC kit, I think they are expecting to be on the flight to Bosnia now for the next DiaEuro.
It was great to be back to see some old and dear friends and make some new ones. I can’t wait to catch up with the rest of the lads and keep meeting new people within TDFC.
In a thousand different ways the day was a real family affair.
Hey! My name is Louise McCay and I am a 27-year-old type one diabetic with a passion for football & futsal.
At the age of 11 I was diagnosed with type one diabetes after my parents picked up on a dramatic change in my water intake. I had gone from having been forced to have to have a drink before school to literally downing pints after pints and never quite quenching my thirst. After a couple of days of monitoring this change in behavior my parents purchased a blood glucose meter and tested my bloods to find that they were 32 mmol. At this point we had very little knowledge of what this meant, how the body works and just simply the severity of high blood sugars. It didn’t help that I had ravaged through a bag of skittles after school too, so we decided to hold fire and test them again in the morning after fasting. Sure, enough when we tested them again in the morning, they were still super high, and it was an inevitable trip to the A&E…
“Can I still play football…?” – The first and only question I asked when the nurse broke the news of my Type 1 diagnosis to me. It may sound stupid to most of you considering the health implications of Type 1 Diabetes but at the age of 11 football was all I could think about and the thought of that being taken away from me tore me apart. This is why when I stumbled across The Diabetes Football Community (TDFC) I just HAD to get involved.
I have very recently become part of TDFC team to help focus on the women’s side of the game. The Diabetes Football Community is well established within the men’s game – driven and founded by Welsh Futsal International Chris Bright and I want to help make the women’s side just as established. I have joined Chris alongside Katie McLean, Lucy Wieland & Becky Upsher to help kick start and maintain TDFC Women’s.
I have played football since the age of nine with the majority of my childhood being spent at Watford Centre of Excellence before I set off to Bournemouth University where I continued to play. I now play locally for AFC Dunstable who currently sit in Tier 5 of women’s football as well as dabbling in futsal in recent months. When I was younger there was very limited attention and focus on women’s football as it was, let alone on type one diabetes in women’s football and until joining the team here at TDFC I have not knowingly come across another female player with type one. Without really realizing it at the time this made my whole experience in football different to the other girls around me, for many years I just wanted to play football and underestimated the impact my diabetes could have on my performance.
With so much more awareness and resources surrounding type one over recent years, I am learning so much more about control during exercise and more specifically during football. I believe that if there were resources and communities like TDFC around when I was younger it would have made a huge difference on both my control and performance. I would love to be able to make a difference and help other type one footballers excel at what they love most. I was so inspired by the stories, podcasts, resources and accomplishments of TDFC – which is why I got in contact with Chris.
The aim – Through TDFC Women’s we hope to raise awareness of Type 1 diabetes whilst also building a supportive and safe community for diabetics within football where you can meet other likeminded people. Our long-term aim of creating an all-female, all diabetic futsal team with the hope to enter competitions, inspire others and show the world that having diabetes doesn’t hold you back within sport.
Currently we are in the recruitment and awareness stage of the project which, as many others, has been on the back foot due to covid.
So, to kick start things, over the last few weeks we have:
– Set up our Twitter page @TDFCWomens which has already started to gain momentum and spread the word (go on… give us a follow!!)
– Created a core team to work with Chris and really bring the project to life
– In progress of planning our launch event!! Hoping to incorporate networking, learning and of course playing some ball – watch this space for more information and a pretty amazing venue.
Would you like to get involved!? We are actively looking for anyone who wants to get involved in any way, shape or form! Whether it be playing, coaching, helping out in the background or just being part of the online community.
If you want regular updates on what we have going on, have any questions or want to be part of the team, follow @TDFCWomens on Twitter or contact us by email – thediabetesfootballcommunity@gmail.com
We look forward to hearing from you and are excited to watch the TDFC Women’s journey unfold…
Another leading member of The Diabetes Football Community and a veteran of the UK Diabetes Futsal squad wanted to share his views on 2020. Zak has been living a long way from home, with the pandemic unfolding in a completely different way in the country of his birth, to the country he’s been living in…. A really interesting insight from Zak and we want to wish you all a Happy New Year wherever you are in the world and thank you for all of your support. Over to you Zak:
“It’s obvious that many people will be glad to see the back of 2020. However, reflection is an important part of every cycle or transition to a new period.
And with any reflection, it is important to acknowledge the positives of the year just passed.
Despite challenging circumstances, I have seen so many friends on social media starting up a side-business this year, whether it be selling hand-made gifts, homemade cakes, or launching a company they had been thinking about for years, and had finally been given the time to turn a vision into action.
Secondly, I have seen some seriously impressive 5km, 10km and further run times from people who had barely ran those distances before. The ability to get out in the fresh air and to explore the local environment will always be free, and for that we should be grateful. It also shows how quickly we can improve at something if we just put the time and effort in.
My situation is different to most right now, as I moved to New Zealand at the end of 2019 from Sydney, where I had been working on an overseas visa for the previous three years. The events that were about to unfold meant that it turned out to be a fortunate decision in many ways, with New Zealand containing the virus for much of 2020. However, despite the relative freedom, it still affects me in a similar way to others as I don’t know when I can next fly home to see my family and friends (I was due to see them this Christmas).
The main challenge for me this year has actually been diabetes-related. The health care system here isn’t quite as advanced as in the UK, meaning diabetes care options are much more limited. For example, only one type of long-acting insulin is government funded (Lantus) and CGM is mainly self-funded here too. Due to my current visa status, I am not eligible for any discount on prescriptions. The full price of insulin, the thing that keeps me alive on a day-to-day basis is eye-watering at times, and certainly makes me feel some empathy for our friends across the Atlantic in USA, who deal with similar battles over the cost of their diabetes.
Despite these hurdles, I have taken a positive outlook and tried to address how I can combat this challenge. To save some money, I decided to cut back on a couple of other “luxury” expenses. However, I made sure I did not cut back on my diabetes care, as health is so important, therefore I tested as much as I usually would, despite the extra costs. This yielded a positive result, with my HbA1c resulting in 42 at my last check-up; the lowest it has been since diagnosis 14 years ago. I remain hopeful that my new visa will come through soon and that I can then access my insulin, test strips etc. at a more reasonable cost.
Looking ahead to 2021, our CEO at Sport Wellington summed it up quite well by wishing for a “dull and boring” 2021! With uncertainty set to continue for a while, “prepare for the worst, hope for the best” may be a good mantra to live by. For me personally, the current situation just re-iterates how happiness and health are essential to our livelihoods. So, I would encourage everybody to think about what makes them most happy? And think of how you can achieve this in whatever circumstances are thrown at you. And when we think about health, as people with Diabetes we have that extra aspect to think about; but remember that health is holistic and not just physical – mental, emotional, social and spiritual health are all contributors to our overall wellbeing.
Take care everyone and wishing you all a Happy New Year.
Firstly, I never thought I’d have to write a statement like this to address a world pandemic but on March 17th2020 that is reluctantly what I’m having to do.
Unity, community and togetherness are the words which TDFC embodies on a daily basis and more than ever we need this right now in the face of the global challenge we have ahead of us….
As the Corona Virus pandemic continues to grow and the world changes its approach every day, I write to you from an ever-changing United Kingdom landscape which has seen drastic measures beginning their introduction into our everyday lives from today.
As an at risk group of people I was fully aware of our responsibility as a community organisation to support and make the right decisions for everyone involved which is why I’m reluctantly pulling together this post.
It is therefore, with sadness we are announcing that no physical TDFC projects will take place for a minimum of 3 months to cover the 12-week social distancing advisory from the UK Government. We will not be delivering any training or education in person during this time for children and adults with diabetes. We had a children’s session in planning for Bristol, our UK men’s team training for DiaEuro, a women’s team on the cusp of creating their first session as well as the launch of our TDFC N/W hub and the growth of TDFC London towards competitive Football/Futsal again this year. This 3-month period may be extended depending upon government advice as things change so rapidly at the moment, but we felt we needed to address the situation.
However, in the greatest adversity I want to call for unity, togetherness and for our COMMUNITY to be just that, a community! We all need each other right now and the beauty of TDFC is that it was brought about through the online space, so guess what, we’re still here and we will still be doing our best to provide positivity and content which provides support, guidance and inspiration. We’re going to need each other to help us have fun throughout this period so let’s do our best to do this too! The team and I will be looking at ways we can provide that so please get in touch if you have any ideas!
During these most challenging times, stick together, be kind and please remember we are here for you all.
Stay Safe.
Chris (Founder of The Diabetes Football Community)
“Darkness cannot drive out darkness… only the light can!”
I have just fulfilled the dream of every schoolboy and girl who loves sport. I have represented my country at an international tournament. Belting out the national anthem before each game as loud and proud as I could, wearing the union Jack on my kit – this is something I have always dreamed of, but never really thought could happen. But it has. And it has happened with an amazing bunch of team mates, all with the same thing in common. Diabetes.
Since I was diagnosed with diabetes age 5, I have had a love hate relationship with it. When I’m on top of it, and I’m winning, I love it. However, far too often it gets the better of me and I hate it. However, if it wasn’t for diabetes, I wouldn’t have met such an amazing community of people.
A year aģo, I watched on as Chris took the first ever UK team to the 2018 DiaEuros. I hadn’t kicked a ball in 3 years and had retired due to persistent injuries. 10 operations had taken their toll on my body and I’d had enough. However, this was an amazing project that he had set up, and one I wanted to be involved in. But my knowledge of futsal was incredibly limited. However, I didn’t want to be going along all the time if I wasn’t playing. So I decided to rejoin my old 11 a side team in Bristol as well as coming along to all the training sessions with TDFC. I had no intention of putting myself forward for the DiaEuro squad, but wanted to be part of the project. I was enjoying going along to the sessions, and when Chris asked for the final time who wanted to be part of the squad, I had a decision to make; did I want to put myself forward?! I’d heard so many positive things from the previous year that I thought I would. I had no expectation that I’d come close to going, but the thought of it was too good to not try out for. Fast forward a few months and I had been chosen to go to the Ukraine!
My only experience of going away with other diabetics was a kids camp I went on with my family when I was young. While I don’t remember much about it, I didn’t really enjoy it!! This was different though. Every one of us was type 1 diabetic, but we also loved sport, especially football, and in this case futsal. We were able to share stories and help each other out where necessary. Advice was always there if needed, and there was such a range in terms of years of having diabetes. We talked about levels before sporting performance, treatments, different types of insulin….In fact diabetes was quite often one of the main subjects we talked about (as well as football!)
Meals were a challenge, as it was a buffet every meal, we weren’t entirely sure of the carbohydrate content. Some managed it better than others, which was great to see. There was often talk of how much insulin people had given themselves, as well as at what point people gave their insulin.
Going in to the tournament, I thought my bloodsugar control was fairly good. However, being around other diabetics 24-7, I learnt that there is always room for improvement. People who felt 9 was too high to have our blood glucose for a game inspired me to think differently. Whereas before, I might have ignored that, I soon realised that this wasn’t okay, and starting a game with a blood glucose level of 10 might impact upon my performance. I also learnt better treatment of hypos. Too often I over eat and then end up shooting sky high. However, watching other diabetics being patient having had a couple of tablets or some of the amazing lift liquid products we’d been given helped me massively.
We were also incredibly fortunate to have the use of the dexcom G6 for the tournament, which helped my blood glucose levels no end. I started off setting the high alarm at 16, but by the end of the tournament, I had moved it to 10.5. This wasn’t necessarily to treat, but to be aware. It also helped by having arrows, single and double, showing which way my levels were going and at what rate. We have been able to keep this going since returning from Ukraine, and I’m now aware via an alarm when my levels are getting to 4.2, meaning I can treat it before I actually go low.
So after a week where I’ve been so proud to represent my country at futsal, I have also got tips and seen first hand how others also manage their diabetes. Inspired by others, not just from our team and country.
On the playing side of the tournament, sadly the results didn’t reflect the performances we put in. We were well beaten 5-1 by a very good Portugal team in our first game, but the second day was a tough one to take. We outplayed Slovakia but went down 1-0, then again outplayed Ireland, but only managed a 1-1 draw. We had chances, but just couldn’t seem to score the goals. We moved the ball around and the rotations that we’d worked on were going well, but not the results. The next day we were soundly beaten 11-3 by eventual champions Bosnia. By this point we were struggling physically having played the last game on day 2 (our 2nd game that day) and then the first game on day 3. But that’s sport, and we all love it!
The organisation and management was great. We’d get a text the night before telling us our plans, meeting times and what we had to wear or have with us the next day. We then also got one from the amazing physio, Milly, asking if anyone needed treatments, fixing or taping up the next day. As I was sharing a room with fellow old man and captain Tim, Milly spent her fair share of time in our room sorting us out so we could even get out of bed, let alone play!! We had enough kit to be able to have some taken to the laundrette whilst still having enough to wear around and about, train in and travel to and from matches.
There was also a bit of time for sightseeing. We looked around Kiev, and some of the squad were lucky enough to visit Chernobyl on the last day, which was an amazing cultural experience. Without doubt, this is my sporting highlight of my career. Representing my country at a major tournament. But with an amazing group of people who just seem to bond so well. And we all happen to have shown that diabetes can’t hold you back!
