Type 1 Diabetes & Football / Futsal – Management Ideas for MDI & Hybrid Closed Loop

It’s been a little while since I sat down to write a blog post for the website… It’s mostly because the balance of my job, our community work, general life stuff and continuing to play Futsal, as well as coach, is just quite a bit to work through (to say the least!)…. So, apologies if you’ve enjoyed my posts in the past and have been missing them! Do comment and let us know if you’d like more of this kind of thing from either myself or others in the community, your feedback is always incredibly valuable to us!

But the reason for getting down to write this, is because I know how often the conversation comes up about the “How To” tackle sport/exercise, so I thought I’d write an update to my previous post from 2020 to hopefully provide some insight from my own perspective. As we all know technology and methods move on so quickly in this world, so to help some of you out there who might be thinking about beginning or continuing a journey with Football/Futsal alongside Type 1 Diabetes, or just want some ideas, hopefully this gives you some thoughts around how I’ve managed my condition on injections in the past, whilst also showcasing how I’m now approaching it on a Hybrid Closed Loop system currently.

These are 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 system I’ve used since 2018. 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.
• The length of the training session, or the amount of minutes involved… Sometimes you can get a heads up from the coach about how long you’re going to be playing, or the type of training you’re doing, and this can really help to understand your output on the day making the planning for during and after the game, or training session, a little easier forecast.
• The opposition – is this going to be a tough game where you’re expecting to be without the ball a lot and chasing to retrieve it? Or conversely an easier day at the office, where you might be a defender and you’re expecting to win the game comfortably? These factors are likely to impact your output on the day and as a result the response of your glucose levels.
• The position you’re playing – There are positions on the pitch which require different types of movement and physicality… If you change position frequently it’s worth bearing in mind some of those positions, which require more running, may impact more greatly on a glucose level drop during and after the game than others where you might be a little less involved in the gameplay.
• The time of day I’m exercising: I’ve noticed how this impacts me far more on my Hybrid closed loop system than it did on injections. In mornings I’m far more insulin resistant so hypos are less likely, however exercising in the late afternoon/evening has seen me encounter more instances of low blood glucose.
• NEW – The Hybrid Closed Loop (HCL) algorithm: The systems often offer an activity mode, but they all work differently to respond to your glucose levels. I’d highly recommend learning more about how this mode works alongside your healthcare professional team and the manufacturers. It may influence your methods of dosing before and after exercise as well as the timing you need to apply it and the likelihood of needing to use fast acting carbs whilst playing.
• Type of Insulin you’re using: There are many NEW insulins appearing in the community now and the speed at which they respond, and last in our systems, is definitely something to be aware of when managing your exercise.
• Stress Levels– Do I feel nervous? Am I calm? Sometimes bigger games or occasions 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!

Something to think about… Ranking particular criteria  –  You may want to consider ranking things like stress / excitement/ nervous levels, opposition difficulty faced, effort levels/ duration played, time in range with your glucose levels, nutrition and hydration preparation, as well as overall execution of your T1D Football plan or routine out of 10, per game. This is just to see how it impacts on your enjoyment and performance week by week. This may help spot patterns in how you’re approaching T1D management for Football/Futsal and help to address areas that might be having a detrimental impact.

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

• My daily carb intake is around 200g. ( + or – depending on activity levels).
• I’m on a hybrid closed loop system called Omnipod 5, using Novo Rapid Insulin.
• Carb Ratios are roughly 1:15 g breakfast, 1:10g lunch, 1:9 g for dinner.

Much of what I’ve said above is linked to a generic way I tackle my Football or Futsal, and the considerations I make, but there are some subtle differences I employ between the two because the intensity of the two sports is very different. This has an 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 taking into account using Multiple Daily Injections (MDI) as well as Hybrid Closed Loop (HCL):

Football (Example is preparation towards a Saturday 3pm Kick Off)

• Aiming to be 7-8mmols to start the game and throughout.
• (HCL) I’ll be wearing my Omnipod on my lower back for any competitive match I’m involved in.
• Ensuring my pre-game meal & bolus is 3 hours before kick-off.
• Reducing pre-game meal bolus by roughly 10%.
• (HCL) Applying my Activity Mode on my HCL when I arrive at the ground around 1 hour before warming up & 1 hour 30 minutes before the game starts and applying it for 3-4 hours to cover the entirety of the game.
• Half time testing and adjusting based on level. If I’m below 9 mmols I’ll take on 10g of carbs to cater for the second half dip and even more if my levels are below 5 mmols or closer to that level. These choices very much depend on the 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 13 mmols I’ll take on a unit of insulin. With the HCL system, I’ll leave it to autocorrect my levels.
• (Injections/MDI) Post game meal I reduce my bolus by 25-50% depending on how much I’ve played and the intensity of the game.
• (HCL) Following the completion of the game I’ll end the activity mode on my HCL as soon as possible and dose pretty normally with at most a 10-20% reduction on my meal bolus, depending on the intensity and duration of the minutes I’ve played.
• 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.
• (Injections/MDI) I would have had 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, if I haven’t I’ll scale this back if I’ve played less minutes than that)
• (Injections/MDI) I didn’t adjust my basal insulin because I used Tresiba, which is an ultra-long acting insulin and this will have no effect on my risk of a nocturnal hypo.
• (HCL) I’ll allow the system to manage my overnight, whilst ensuring I give it the best chance of success by not eating dinner too late before bed, and having a meal bolus on board when trying to go to sleep. This means I’m able to make any small adjustments prior to going to bed in the knowledge those levels aren’t impacted by a previous meal dose.

Futsal

• I like to start the game at 5-7 mmols if I can.
• (HCL) I’ll be wearing my Omnipod on my lower back for any competitive match I’m involved in.
• Ensuring my pre-game meal & bolus is 3 hours before kick-off.
• Reducing pre-game meal bolus by roughly 10%.
• (HCL) I’ll be applying my Activity Mode on my HCL when I arrive at the ground around 1 hour before warm up & 1 hour 30 before the game starts, and applying it for 3-4 hours to cover the entirety of the game.
• (Injections/MDI) Despite aiming to be slightly lower, I’m quite likely to need a small bolus / insulin before the game or at half time to manage my levels rising as a result of the higher intensity and expected spike. This isn’t relevant for my HCL as it’s doing this work automatically.
• 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.
• (Injections/MDI) 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.
• (HCL) I tend to be more ready to react with fast acting glucose during games due to the nature of the system automatically correcting and aiming for my levels to be at 8.4 mmols with the insulin it provides.
• 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 acting insulin during my sport and the intensity. This normally doesn’t require any insulin doses on either HCL or injections for me. I’ll allow HCL to make any small auto-corrections should it need to.
• I don’t make any bolus adjustments post – game to my meals. Again, I’ll eat a meal heavy in protein and carbohydrate.
• (Injections/MDI) No basal adjustments as a result of using tresiba.
• (Injections/MDI) If I want a bed-time snack I’ll bolus for it with a small reduction of 25%.

If you’ve enjoyed reading about my approach, I’ve also done some analysis of other types of exercise such as the gym, running and more on Futsal whilst being on Hybrid Closed Loop, which you can find on my Instagram highlights. My profile is @chrisbrighty1 on Insta if you want to take a look.

But to finish, I really hope that this has been a useful post for people out there trying to tackle football or futsal for the first time, or who are just looking for some more ideas about type 1 management for the sport. 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 helpful.

Thanks for reading and thanks as always for the support for our work and please also be aware of the below disclaimer.

All the best,

Chris

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.