Today we had a tough situation. One and a half hour before a game, my teen son got a strong hormone peak.
The timing could not be worse, because his insulin needs about 40 minutes to be in full force. This means that he would spend most of his game during the period of highest activation for his insulin, with an increased risk of running low.
In the end, the decision we made was to underdose for his peak by about half, so as not to have too much risk of running low. The problem is that these peaks are quite unpredictable, and may keep on rising while he plays, bringing him to an unsafely high level for sports (ketones).
He is out there right now. I can’t say I am thrilled. This is one of the few cases where we are ready, reluctantly, to use substandard solutions for his diabetes treatment. But the alternative would be to forsake an activity that a glucose-normal kid would do. There is no good choice
Michel, I feel your pain, literally. Last week a similar thing happened to Cody and he played a baseball game at catcher between 250-300 until the 5th inning when the insulin brought him lower. Cody didn’t feel great, and unfortunately when it rains it pours, and the other catcher got injured early in the game, so he caught all 7 innings.
On a team, the ability to call out “sick” is limited at best. However, unless Cody took himself out, I would be hesitant to stop him.
I don’t think there is a great answer to all of this.
Part of it is just learning to play high or play low or play on an empty stomach. Not all games will be perfect, so you learn to deal with less than perfect circumstances.
When I was coaching, I would tell my team that we practice in the rain so we will know how to play in the rain. Each of these circumstances for him is a great lesson.
On the practical side of things - which sport is it? If he is playing soccer or volleyball, take the insulin beforehand, and have a squeeze bottle of Prime available somewhere near the court or field. That stuff will correct a drop really quickly. And over time he will develop a feel for when he needs it and how much. And take advantage of halftime or set breaks to test and adjust. It is a process of constant adjustment (or whenever you possibly can) just like the non-diabetic pancreas.
There is no damage to the body when you fix a low or high quickly. When the game is over, just get it fixed and do not worry. When you hear about people who have problems with diabetes from hypo’s or hyper’s, it is because those were over a very long time. A quick one is not a problem. Do not worry.
My belief - more damage is done by missing an opportunity for life than anything the disease does to you. The only way the disease wins is if it stops you from trying.
Old Army quote I used to hear 300 times per day, “If it ain’t raining, we ain’t training.” I agree with Eric and Chris, though. NOT doing something because of BG levels isn’t being Unlimited. Make the best of this bad situation and if you can, learn from it! If not, just correct and move on. He’s living life!
If possible, having him on the side of the field where his bench is would allow him to run past the bench and get a bit of gatorade when he needs it. I played soccer my whole life. My mom sewed a small pocket inside my soccer shorts and I carried sugar packets with me. I went by feel. That is a big thing to develop. Using technology is great, but being a slave to it is not. It is important to develop the BG meter that is in your brain.
the peak was as high as expected, and no higher – that was lucky. We used 2U instead of 4.5U to underdose as explained in OP
BG started coming down with exercise and insulin right at the same time as pre-game practice was starting. Note that insulin was not enough to make it drop (should have started dropping around 12:45)
He did not need any glucose during the game – although I find his decision not to take glucose at 1/2 time questionable.
BG gracefully went down and landed perfectly right after the game with a 10 carb glycogen replenishment right at the end of the game.
One lesson out of today is that a hormone peak can actually replenish glucose during sports. Normally, my son needs to take glucose multiple times during a game.
Normally he is a goalie, but he jammed his finger Friday in a volleyball tournament, so he will play the field this game.