The new year is always a chance to take a fresh look at things and alter the path or journey we’re on…. At the start of every year I try to look at the context I’m surrounded by and set myself new goals or challenges which drive my motivation for what’s ahead.
But what I thought I’d do, to help some of you out there who might be thinking about starting a journey with Football/Futsal & Type 1 Diabetes or taking it up a level, is give you some insight around how I manage my condition. 2019 was a pretty good year for me with my sport so it’s probably a good time to share with you some of the ways I go about trying to get the best from my glucose levels to allow me to play to the best of my ability.
So I thought I’d outline some of the ideas, most of which I shared at the #SporT1Day conference, to hopefully provide some insight and support to anyone out there who might need it.
Here’s my general thoughts on what I try to do or think about for my management before any sport or exercise:
A plan of how to approach the sport/exercise/game – What type of exercise is it (interval, aerobic, anaerobic etc)? Intensity? Duration? Time of day? Timing of meals? Last Bolus?
Consistency of Routine – If it’s working, I keep using it.
Good night’s sleep.
Plenty of time between pre match meal insulin dose and starting the game (3 hours + ideally)
Lots of Testing – As much as you can or utilising a CGM such as the Dexcom G6 which has been the best I’ve used so far. This way you can learn about the effects of types of exercises, intensities, durations etc on your glucose levels.
Small adjustments of insulin & carbs to try and find the right glucose level for your best performance or for you to just enjoy it.
I aim for 7-8 mmols throughout the duration of any game to try and achieve my best performances.
Having my quick acting hypo treatments and insulin available and accessible for any adjustment I might need.
Consider the weather… Is it cold or hot? They usually play a part in how our glucose levels respond.
Am I in good general health? Have I been ill recently? Can play a part in less predictable glucose levels.
Keeping on top of my hydration… I find my levels drop more quickly if I’m dehydrated.
Stress Levels – Do I feel nervous? Am I calm? Sometimes bigger games cause a bigger adrenaline spike in glucose levels. Do I need to account for this?
Have I fuelled up well before the exercise? Have I eaten enough calories/carbs in general for the energy I’m going to expend.
Always consider how much activity you’ve been doing around the particular sport or exercise you’re about to take part in, because the more active you are, the more sensitive to insulin you are!
Below are some of the generic details about my day to day management…
• My daily carb intake is around 180g. ( + or – depending on activity levels). I’m on MDI and CGM, No pump.
• Carb Ratios are roughly 1:15 g breakfast, 1:10g lunch, 1:7.5 g for dinner.
Much of what I’ve said above is linked to a generic way I tackle my Football or Futsal but there are some subtle differences I employ between the two because the intensity of the two sports is very different. This has a drastic impact on the reaction of my glucose levels and the way I manage them during and afterwards especially. So I’ll show you some of the key differences below:
Football (Example is preparation towards a Saturday 3pm Kick Off)
Aiming to be 7-8mmols to start the game and throughout.
Ensuring my pre-game meal & bolus is 3 hours before kick off.
Reducing pre-game meal bolus by roughly 10%.
Half time testing and adjusting based on level. If I’m below 9mmols I’ll take on 10g of carbs to cater for the second half dip and even more if my levels are below 5mmols. These choices very much depend on length of time you’re going to play and how hard the game is. If it’s a tough game with a lot of chasing then I sometimes have an extra 5-10g of carbs. If I’m over 13mmols I’ll take on a unit of insulin.
Post game meal I reduce my bolus by 25-50% depending on how much I’ve played and the intensity of the game.
I try to make my post-game meal both full of protein and carbohydrate to help with the recovery of glycogen stores and muscle growth/repair.
I will have a bed-time snack of 10-15g without a bolus to try and alleviate the nocturnal hypo risk. (If I’ve played a whole 90 minutes, I’ll scale all of this back if I’ve played less than that)
I don’t adjust my basal insulin because I use Tresiba, which is an ultra-long acting insulin and this will have no effect on my risk of a nocturnal hypo.
I like to start the game at 5mmols if I can, because despite being lower, I’m still likely to need a small bolus before the game or at half time to manage my levels rising as a result of the higher intensity and expected spike.
Because of the roll on, roll off substitutions within Futsal, there’s a lot more opportunity for adjustment. So I always come off from the court and immediately check my CGM and look for the trend arrows and glucose level.
I always tend to carry a bit of short acting insulin in my system because for me within Futsal, knowing I have frequent breaks and the likely impact of the intensity (levels rising), I’d rather be lower and taking on some glucose, as it reacts quicker than my insulin, than being too high and waiting for my insulin to kick in. The important factor for me is having a glucose level which allows for performance, not the number of adjustments I have to make.
I will always have a protein bar/snack post game of around 20g of carbs because I tend to have a sharp drop in my levels post game. Probably as a result of carrying short – acting insulin during my sport and the intensity.
I don’t make any bolus adjustments post – game to my meals. Again I’ll eat a meal heavy in protein and carbohydrate.
No basal adjustments as a result of using tresiba.
If I want a bed-time snack I’ll bolus for it with a small reduction of 25%.
I really hope that this is a useful post for people out there trying to tackle football or futsal for the first time, or who might be finding it challenging currently. If something from this article helps someone out there get more from their performance or just allows them to enjoy it more I’ll be happy!! Please give it a share if you can because I’m sure you’ll know someone who may also find this useful.
I’ve also added my slides from the #SporT1Day Conference to the bottom of this post if you wanted to see what I shared on the day, which also has much of this detail in.
Thanks for reading and I wish you all a happy and healthy new year! Please also be aware of the below disclaimer.
Disclaimer – Always remember that this a personal perspective and is not endorsed by a medical professional. So any advice or ideas you take from this post is at your own risk and should always be cleared by your diabetes team.
I suppose it’s taken me a little while to get this written down with the vast amount of things on my plate in the last month but we got there eventually!
A culmination of months of behind the scenes work, emails, phone calls, marketing and raising awareness of what we were putting on came to fruition on November 17th. There was no better timing than to host it 3 days after World Diabetes Day as a statement of support for one of the most important days in the calendar.
Before I talk about the event itself, I need to thank the University of Worcester for allowing us to host the last 2 SporT1Day conferences within their facilities. I have a brilliant relationship with so many people at the university and their continued support for me, the conference and The Diabetes Football Community is incredible. I will always have a strong affinity to my university for how they’ve encouraged & facilitated the projects we’ve come up with and I just hope I represent their values & ethos in the work I now do. A huge thank you must also go to Dexcom & Roche for sponsoring the conference and supporting with refreshments & the programme.
I also must say a huge thank you to Paul, who shares this joint vision to drive education in sport for people with type 1 diabetes. A mate of mine whom I’ve been able to co-create something special alongside. Thank you buddy… We’re on some journey with this and I can’t wait to see what we can do next.
But lastly before talking about the day a final thank you to the incredible speakers, paul’s family and my own family for helping us deliver the day. Without you it wouldn’t have been possible.
An early start for myself, the family and one of our speakers Alex Richards, as we made our way down to the university. I was definitely less nervous than the first time round after having the experience of last year’s conference already under the belt. After setting it up the best we could based upon the volunteers and resources we have available for this kind of event we were all really excited to start seeing people arrive.
As soon as you see people arriving with their tickets it’s an incredible feeling to know that all of the planning you’ve put in place is about to happen but it’s also the moment when you realise there’s a show to put on.
We kicked off the day with the incredible Professor Partha Kar, who really needs no introduction. An amazing man, who through his determination, passion and ability has helped drive a transformation in the way type 1 diabetes is both viewed and supported within the NHS. Partha gave us a talk about the focus and direction the NHS England Diabetes programme is heading in whilst demonstrating the incredible developments and uptake of technology across the country. Having someone of Partha’s credentials attend the conference was a huge compliment and I really do owe him (He’s got me down for a couple of beers the next time I see him!). @parthaskar on Twitter
We’d planned the day to give our audience a chance to take on the recommendations and thoughts of the healthcare professionals at the beginning and end of the day. We felt this would be a good way of allowing people to pick up some tips before listening to some of the experiences of our athletes and people living with type 1 diabetes throughout the rest of the day.
After the excitement of Partha’s opening we then had the pleasure of having 2 of the leading healthcare professionals in exercise and type 1 diabetes within the country, whom lead on the EXTOD programme (www.extod.org), talk to us about the science of managing blood glucose levels through particular types of physical activities and sport. Dr Alistair Lumb and Dr Parth Narendran have been imperative in driving attempts to improve the knowledge of other healthcare professionals across the country through EXTOD and having them share the knowledge and framework at SporT1day was a privilege. You can always tell when a topic and talk has captivated an audience by the response at the end…… Let’s just say we could’ve been there a lot longer with the questions. A huge thank you for coming along guys and I look forward to working with you in the future on some exciting ideas! @DrAliLumb & @parthnarendran on Twitter.
Following an opening of theory from the healthcare professionals we started to delve into some of the experiences of those living with the condition, who are putting this knowledge into practice day in and day out. So first up was Brian Hoadley or Type1Bri ( www.type1bri.com). A really top bloke, who encouraged me to share my journey and who had a huge impact on me personally as I became aware of the diabetes online community. He’s been a great friend of mine who’s always supported the work of TDFC from the very beginning. It was an honour to have Bri share his own inspirational journey of running the London marathon less than a year after being someone who didn’t do any exercise. To do that in under a year is epic for anyone, but made even more special and inspiring when you’re able to do it with type 1 diabetes. Bri shared the journey he went on, how he did it and the effect it had on him and his diabetes. A brilliant talk and achievement from Bri. So pleased we all got to hear it. @Type1Bri on Twitter
Next to the centre of our SporT1Day stage was Alex Richards. A very good friend of mine who’s work in sports psychology has taken a special interest in the experiences of people with type 1 diabetes in sport and exercise. Alex gave us a talk about perfectionism and it’s challenges to both athletes and those of us living with type 1. It was very poignantly linked to the goals we set ourselves and how most of us look towards outcome goals rather than process goals. Interestingly, those outcome goals are often out of our control to some extent, as winning trophies, representing teams or qualifying into tournaments relies on coaches, other players and beating the opposition which you can’t actually impact upon. His talk fascinated me having spent much of my life with this idea of perfectionism rooted inside of me and my focus on outcome goals, that I couldn’t always impact upon. Top work Al and I think there was a large proportion of the audience desperate for a chat about the presentation and keen to grab hold of the slides afterwards! It says it all about how interesting the talk was. @alex_acr on Twitter
Then we moved onto the incredible Melanie Gray. Now Mel will always have a special place in the history of TDFC as she was someone I spoke to when I was thinking about putting myself out there to share my individual experiences as well as creating TDFC in the early part of 2017. So to have her along to speak at our joint conference with 1BloodyDrop was an honour. Mel has been an inspiration to so many within the diabetes community as an international sprinter with the condition who has gone onto share her story widely through her renowned blog, advocacy work and now her role as a dietician. As an experienced speaker with a vast knowledge of her sport and how to manage type 1 diabetes within it, it was a brilliant watch and listen. I think anyone in the audience on the day would’ve enjoyed the insight surrounding Mel’s management which complimented talking about her work, which has had her featured in a nike campaign during the London 2012 olympics, seen her become a London 2012 olympics torch bearer whilst also developing her own peer support group Blue Circle Diabetes. If you want to take a closer look at what she’s up to head to www.lifesportdiabetes.co.uk to check out her blog and thank you Mel for supporting our conference.
We then had a chance to take a breath! It was lunch…. Now for everyone else it means take a breath and grab some food but for me, paul and a couple of the speakers who’d already spoken it was an opportunity to speak to members of the audience. So lunch went in the blink of an eye but we had so much more to come….
Our afternoon had a heavy tinge of football within it as 2 of the UK Diabetes Futsal squad shared their stories about getting involved in TDFC and their feelings towards the team. Having Tim and JT, share their thoughts so publicly about how TDFC has helped them through their involvement in our team was pretty special. I didn’t tell them what to say either!!! So for them to show their overwhelming support for what we do and showcase it so brilliantly to the audience was amazing. The power of peer support for people with chronic health conditions should never be overlooked and I firmly believe that its power can drive holistic improvements for people with conditions like type 1 diabetes. Listening to Tim and JT certainly made me feel that this is the case. After they’d both shared their stories it was a chance for me to briefly talk about how I manage my condition around my sport, some of the techniques and ideas I’ve adopted, as well as showcasing what TDFC has been up to and what’s planned for the future. To be honest, it was quite nice to just have a small part in the talking side of things such was the level of organisation required! Hopefully my small snapshot in the day was a worthwhile 10-15 minutes amongst the stars of the show. As we grabbed our coffees, we readied ourselves for Craig Stanley to take to the stage. If you wanted to hear more on JT or Tim’s journeys you can follow them on twitter under @Tim_Ward07 & @JonoTyrrell
I’m biased as a Football/Futsal player but Craig (Staners) talks so honestly and openly about his journey in professional football with type 1 diabetes that it just fascinates me every time I’ve heard him share it. Professional sport and the “elite” are supposedly supported by infinite resources, in the way of money, people and specialists, but Staners shares a story that despite his day job being to play in front of thousands of people playing Football, the support he had throughout his career was limited. I’d always felt this with my experiences in the part time game but you just assume that the added professionalism would improve the experience that players with type 1 diabetes had. Instead talks like Craig’s continue to demonstrate that mainstream sport still hasn’t got it right from the grassroots through to the elite for people living with chronic health conditions. This is where I hope campaigns like the #WeAreUndefeatable campaign created by Sport England goes some way to addressing the issues we face. Despite what Staners has faced he’s had an amazing pro career of over 500 appearances, a Wembley playoff victory and having the opportunity to captain the England C team. All of this despite living with type 1 diabetes. He’s a very down to earth guy but what an example he sets for us all. A massive thank you buddy for coming to share your story with us again. If anyone wants to follow Staners on social media you can find him on twitter under @staners6 and on instagram under @staners10.
Our last lived experience of the day came from my partner in crime Mr. Paul Coker. His experience of living with the condition for over 40 years which combines feats of endurance along the way always provides an insightful and inspiring listen. This time we had the pleasure of listening to the story of climbing Mount Kilimanjaro for JDRF with a number of other type 1s. I’ve heard Paul talk a few times but not on this topic with so much depth. It was really interesting to see the impact altitude had on himself and others managing the condition and certainly provided some important insight into how to go about tackling that sort of challenge. Paul’s experiences of Kilimanjaro provided yet another valuable varied talk for our audience whom I’m sure gleaned so much.
Another member of our healthcare profession came to round up the day with a specific view of what it’s like as a diabetes specialist nurse (DSN). Emma Innes talked us through some of the specifics of how we should work with our specialist team, some of the recommendations from healthcare professionals for sport & exercise and how technology is making it easier. Emma now uses her experience in the field to lecture at the University of Worcester for the nursing cohort of students. Her talk helped to remind us all of the importance of working with our healthcare professionals to achieve our joint goals together. A big thank you for sharing your insight for us Emma! You can follow Emma on Twitter under @emmainnes3
Finally we finished off with a Q&A session for the audience and as I stood at the front with my fellow speakers, providing answers in the best way we could, I knew we’d delivered something special. The engagement, the faces and the thank you’s we received told us that. Now we need to consider where we go from here…. The magic of what we’ve started needs to be built upon and myself & Paul need to go away to think about how we make this grow and work for the future. Nevertheless SporT1Day was an incredible success which I certainly will look back upon with a huge amount of pride!
If you’re interested in where we go next make sure you follow @SporT1Day on twitter for updates and news from the conference. Our plans are always ongoing and if you think you’d like to see us in a different part of the country or you have an idea you’d like to share with us, you can contact TDFC, 1BloodyDrop or the SporT1Day twitter account to get through to us.
Thank you for all of the support with our conference & the wider work of TDFC and I hope you all have an amazing Christmas!