soccer – The Diabetes Football Community

Fuel for football: half-time strategies for maintaining performance with type 1 diabetes

Posted on January 15, 2023 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

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

Read time: 5-10 minutes

Introduction

The two main nutritional considerations for football are eating enough carbohydrate and drinking enough fluid. Whereas this is important in the time leading up to a match, it is also important to take on additional energy and fluids during the match.

What should I eat during exercise?

Research studies consistently show performance benefits during simulated football matches when carbohydrate is consumed during exercise at a rate of approximately 30-60 grams per hour (41-44), or up to 60 grams before each half (45). The 30-60 grams of carbohydrate can be taken after warm-up and again at half-time to meet these guidelines. Consuming 30-60 grams of carbohydrate in the form of food such as energy bars can sometimes be difficult and result in stomach upset. However, carbohydrate-based drinks and gels can often minimise potential stomach issues – it will also help with hydration as discussed below. A major consideration about carbohydrate intake immediately before and during exercise will be managing the impact of this on blood glucose levels. You will need to make a judgement about how best to manage your insulin dose to minimise blood glucose spikes, and, to ensure that you do not have excessive insulin ‘on-board’ during the game which could cause hypoglycaemia – read this article about insulin dosing strategies for exercise.

What should I do if I struggle to manage blood glucose levels when consuming carbohydrate during a match?

If controlling blood glucose levels is difficult for you during football and you’re worried that eating carbohydrate might make this worse there is another, rather strange, but very special technique to try – carbohydrate mouth rinsing. The body is equipped with specialised receptors within the mouth that can detect carbohydrate. This detection of carbohydrates sends signals to the brain that reduce the perception of effort¹. Carbohydrate mouth rinsing, which involves rinsing, but not swallowing, the mouth with a carbohydrate-based solution – like you would with mouthwash – has been shown to increase self-paced jogging speed with likely benefits in sprint performance during intermittent types of exercise^2,3. There is limited research investigating this technique within applied football settings, although it is logical to think that this strategy could be effective. Using the carbohydrate mouth rinsing technique during breaks in match play (like half-time periods, extra-time, injury stoppages, and medical breaks) could potentially improve performance in situations where eating carbohydrate is either impractical or likely to cause stomach upset or unwanted blood glucose spikes. If your glucose levels tend to be stable during the match and managing hyperglycaemia isn’t too much of an issue for you, then you can combine mouth-rinsing and swallowing. Swallowing a carbohydrate-based drink following a short (approximately 5 second) mouth rinse allows for both the activation of brain signals to reduce perceived effort and will provide extra fuel to the body. This type of strategy might be particularly effective towards the end of games where fatigue may start to impact decisions making processes.

How much fluid should I drink during a match?

Although you can buy isotonic sports drinks, you can also make your own by simply adding a little salt to some squash. It is well established that dehydration impairs both physical and mental performance^4,5, although some people are more sensitive to the effects of dehydration than others. The amount of fluid your body requires during a match is determined largely by the amount that you sweat, which, differs from one person to the next, and is dependent on the intensity of exercise, external factors like humidity and temperature, and how well you are acclimatised to the conditions⁶. Sweat rates in male footballers have previously been reported to range from 0.5-2.5 litres per hour^7-9, whereas lower values are generally reported in female players largely because women tend to be smaller than men and expend less energy during exercise^10-12. As well as water, sweat also contains electrolytes – primarily sodium (salt) – the amounts of which, again vary from person to person⁹. As a general guide, footballers should aim to drink sufficient fluids to avoid a reduction of 2-3% of pre-match body weight during a match¹³ and avoiding gains in body weight to prevent over hydration. As a starting point, measure your weight before and after a match (or even better during training), if you have lost more than 2-3% of your starting body weight then you need to drink more during matches when you can!

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.

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

References

Carter JM, Jeukendrup AE, Jones DA. The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Medicine and science in sports and exercise. 2004;36(12):2107-2111.
Rollo I, Homewood G, Williams C, Carter J, Goosey-Tolfrey VL. The influence of carbohydrate mouth rinse on self-selected intermittent running performance. Internatonal journal of sports and exercise metabolism. 2015;25(6):550-558.
Rollo I, Williams C, Gant N, Nute M. The influence of carbohydrate mouth rinse on self-selected speeds during a 30-min treadmill run. International journal of sport nutrition and exercise metabolism. 2008;18(6):585-600.
Mohr M, Krustrup P. Heat stress impairs repeated jump ability after competitive elite soccer games. The journal of strength & conditioning research. 2013;27(3):683-689.
McGregor S, Nicholas C, Lakomy H, Williams C. The influence of intermittent high-intensity shuttle running and fluid ingestion on the performance of a soccer skill. Journal of sports sciences.1999;17(11):895-903.
Smith JW, Bello ML, Price FG. A case-series observation of sweat rate variability in endurance-trained athletes. Nutrients. 2021;13(6):1807.
Shirreffs SM, Aragon-Vargas LF, Chamorro M, Maughan RJ, Serratosa L, Zachwieja JJ. The sweating response of elite professional soccer players to training in the heat. International journal of sports medicine. 2005;26(02):90-95.
Baker LB, Barnes KA, Anderson ML, Passe DH, Stofan JR. Normative data for regional sweat sodium concentration and whole-body sweating rate in athletes. Journal of sports sciences. 2016;34(4):358-368.
Maughan R, Shirreffs S, Merson S, Horswill C. Fluid and electrolyte balance in elite male football (soccer) players training in a cool environment. Journal of sports sciences. 2005;23(1):73-79.
Da Silva RP, Mündel T, Natali AJ, et al. Pre-game hydration status, sweat loss, and fluid intake in elite Brazilian young male soccer players during competition. Journal of sports sciences. 2012;30(1):37-42.
Horowitz M. Heat acclimation, epigenetics, and cytoprotection memory. Comprehensive Physiology. 2011;4(1):199-230.
Kilding A, Tunstall H, Wraith E, Good M, Gammon C, Smith C. Sweat rate and sweat electrolyte composition in international female soccer players during game specific training. International journal of sports medicine. 2009;30(06):443-447.
McDermott BP, Anderson SA, Armstrong LE, et al. National athletic trainers’ association position statement: fluid replacement for the physically active. Journal of athletic training. 2017;52(9):877-895.

Fuel for Football: The Pre-Match Preparation

Posted on December 21, 2022 by thediabetesfootballcommunity in diabetes, diabetes research, Football

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 activities^6,7 (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

References

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.
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.
Costill DL, Hargreaves M. Carbohydrate nutrition and fatigue. Sports medicine. 1992;13(2):86-92.
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.
Holway FE, Spriet LL. Sport-specific nutrition: practical strategies for team sports. Journal of sports sciences. 2011;29(sup1):S115-S125.
Phillips SM, Sproule J, Turner AP. Carbohydrate ingestion during team games exercise. Sports Medicine. 2011;41(7):559-585.
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.
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.
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.
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.
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.
De Oliveira EP, Burini RC. Carbohydrate-dependent, exercise-induced gastrointestinal distress. Nutrients. 2014;6(10):4191-4199.
Burke L. Fueling strategies to optimize performance: training high or training low? Scandinavian journal of medicine & science in sports. 2010;20:48-58.
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.
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.
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).
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.

Insulin dosing strategies before Football

Posted on December 20, 2022 by thediabetesfootballcommunity in diabetes, 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: 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 exercise^3,4, 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.

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

Posted on December 12, 2022December 13, 2022 by thediabetesfootballcommunity in diabetes, diabetes research, Football, sport

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 acutely^4-8. 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 levels^4,6,9. 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 activity^5,10-13. 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 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.

Award Winning TDFC London: The Power of Peer Support

Posted on November 9, 2022 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

Back in the saddle by Tim Ward

Posted on August 20, 2021 by thediabetesfootballcommunity in diabetes, Football, sport

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.

We are back… Diabetes Futsal Returns!

Posted on June 21, 2021 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 27^th of June with another session planned in for the 25^th 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

Louise’s Story & the launch of TDFC Womens

Posted on May 13, 2021May 13, 2021 by thediabetesfootballcommunity in diabetes, Football, sport

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…

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

Posted on February 17, 2021 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.

Zak Brown reviews 2020… Happy New Year Everyone!

Posted on December 31, 2020 by thediabetesfootballcommunity in diabetes, diabetes research, Football, sport

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.

Zak Brown”