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Last month my 8-year-old son Casey competed in a jiu-jitsu tournament against older and more experienced boys. Unlike his competitors, he would also be grappling with another challenge: controlling his blood glucose (BG) level sufficiently to stay safe and perform well.
More factors influence BG than we realized before Casey’s diagnosis of type 1 (T1) diabetes, including sleep, schedule changes, illness, travel, timing of meals and exercise. Sports make BG control especially complex by drawing so heavily and quickly on the body’s energy (glucose) reserves. The healthy pancreas secrets insulin into the bloodstream as needed to achieve glucose homeostasis, then turns it off. People with T1 must inject insulin under the skin, but it’s often hard to know how much is required. An oversupply cannot be withdrawn or deactivated, causing hypoglycemia. On the other hand, injecting too little causes hyperglycemia, but injecting additional insulin won’t reverse BG quickly because insulin is absorbed more slowly when injected.
Before Casey participates in sports, we must consider how the event might affect his BG (including the activity’s intensity and duration, time of day, ambient temperature), in combination with personal factors too (amount of insulin remaining in his body, current BG level, hydration, emotional stress and excitement). Short-burst, extremely intense activities with frequent breaks (anaerobic sports like weightlifting) tend to raise BG, as do stress and excitement. This risks hyperglycemia. Prolonged vigorous activities (aerobic sports like cycling) lower BG, which risks hypoglycemia. Like jiu-jitsu, some are a mix. Our challenge, of course, is predicting how and when these factors will actually affect Casey, what to do about them, how quickly and what supplies we might need. I was eager to watch my three sons compete in the tournament, but nervous managing Casey’s BG during a competition.
Casey ate breakfast several hours before his first match. I wrapped the continuous glucose monitor (CGM) on his arm with self-adhering “vet” tape so it wouldn’t be knocked off. We set his pump to exercise mode so it would deliver less insulin and reduce the risk of hypoglycemia, but removed it for safekeeping an hour before his first match. This precaution meant he would not automatically be receiving preset micro doses of insulin over several hours, which risks hyperglycemia.
Casey’s BG hovered near 100 before his first match (for most, a safe pre-exercise BG is 100-250). Exercise can make BG plunge, causing hypoglycemia. Hypoglycemia degrades performance by making you sweaty, shaky, nauseated, dizzy, lightheaded, tired, anxious and unable to concentrate. To avoid hypoglycemia, I therefore didn’t replace the hour of basal background insulin he had missed, despite standard recommendations to do so every hour. When Casey’s BG is apt to fall during exercise, I will give him a carbohydrate snack without insulin coverage to avoid hypoglycemia, but I suspected it wouldn’t fall.
I knew that competition can induce the opposite extreme, hyperglycemia, because stress and excitement cause the liver to release stored glucose. Hyperglycemia also degrades performance by blurring vision and making you feel weak and tired. Furthermore, BGs over 250 are cause for caution. If there is insufficient insulin to deliver the accumulating glucose to the exercising muscles, the body starts burning fat reserves to fuel them, turning the blood acidic with ketones, which risks ketoacidosis. A lot rode on my treatment decisions.
The tournament began with no-gi (no-uniform) matches. Casey faced another “gray belt,” but 6 years older. He lost that match. His BG still hovered around 100, but I gave him the 2 glucose tablets he requested to cover his energy expenditure. He knew he wouldn’t place in the tournament if he lost again. He won his next match against a yellow-belt (higher-ranked) 10-year-old. Now eligible for 3rd place, Casey faced an extremely athletic 10-year-old yellow belt. And he knew exactly how good this boy—his brother Jaiden—would be. His BG shot up to 230 and was rising fast toward hyperglycemia. I could only watch nervously as the match began.
The coach introduced it by saying that third place would be decided by a brother-against-brother match. The crowd erupted in cheers; all eyes turned to watch. Neither brother held anything back. Casey gained points, then Jaiden, then Casey, then Jaiden, back to Casey.
Casey’s vet tape started to slip off, exposing his CGM. We shouted for Jaiden to be careful not to knock it off, but the match remained intense. We held our breath. Jaiden got points. Then Casey did. Then Jaiden again. Casey won, 8-7! But he had simultaneously prevailed against another formidable opponent—T1.
I was relieved to see that Casey’s BG descended to 180 following the match, likely from the exertion and subsiding stress and excitement. Before the gi matches, Casey ate a snack and injected sufficient insulin to cover it plus the 2 hours of background insulin he had missed not wearing his pump. I re-secured his CGM, and replaced a now-peeling pump patch to protect his insulin infusion site. My phone temporarily lost input from his CGM, so I tested his BG with a hand-held glucometer. It was 156, so I let Casey compete without further treatment.
He faced a 10-year-old yellow belt in his first gi match. He flipped his opponent with a monkey flip, to his own surprise. As he beamed with pride, he got plowed down, but came back victorious. He went on to win his next match against the 10-year-old yellow belt from no-gi. Next, he faced his brother again, just as vigorously, his BG rising. This time Jaiden won. Finally, Casey faced the 14-year-old gray belt he had lost to in no-gi, performing two astonishing back bridges to maneuver out of risky positions. When it seemed he’d lose, he gained points and won. He took another 3rd place.
I rejoiced as we drove to a celebratory meal. All my boys had placed in the tournament, and I had managed Casey’s BG successfully. Like professional athletes with T1, Casey had shown that it needn’t hold you back if you learn to work with it.
Lisa Seitles
Hammonton
Lisa Seitles and her husband Sam are the owners of READ Preschool and Camp Tuscaloosa. They have four children and are active members of the community.
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