November is American Diabetes Month—a time to come together and raise awareness of this ever-growing epidemic that is facing our nation. According to the American Diabetes Association, nearly 26 million children and adults in the United States have diabetes. "Diabetes doesn't stop," states the American Diabetes Association. "It is 24/7, 365 days a year.
Athletic Trainers (ATs) play a critical role in the prevention, recognition and immediate care of athlete with diabetes. ATs work to provide perspectives on proper exercise and nutrition, counsel athletes on proper hydration and help them keep track of the intensity of exercise sessions, so they can adjust glucose and insulin levels accordingly.
Based on current research and literature, the National Athletic Trainers’ Association (NATA) suggests guidelines in their position statement for management of athletes with type 1 diabetes. These recommendations are organized into categories: diabetes care plan; supplies for athletic training kits; preparticipation physical examination (PPE); recognition treatment, and prevention of hypoglycemia; insulin administration; travel recommendations; and athletic injury and glycemic control.
According to the statement, athletes with type 1 diabetes can benefit from a well-organized plan that allows them to compete on equal ground with their teammates and competitors. This plan should include the following seven elements:
* Blood glucose monitoring guidelines: These should address the frequency of monitoring as well as pre-exercise blood glucose levels where beginning exercise could be unsafe.
* Insulin therapy guidelines: These should include the type of insulin used, dosages and adjustment strategies for planned activities types, as well as insulin correction dosages for high blood glucose levels.
* List of other medications: Make sure to include medicines used to assist with blood glucose control and/or to treat other diabetes-related conditions.
* Guidelines for low blood glucose (hypoglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms and treatment of hypoglycemia, including instructions on the use of the hormone glucagon to metabolize carbohydrates.
* Guidelines for high blood glucose (hyperglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms and treatment of hyperglycemia and diabetic ketoacidosis, a condition where insufficient levels of insulin lead to hyperglycemia and the buildup of ketones (by-products of fat metabolism which can reach toxic levels) in the blood. Diabetic ketoacidosis can be life threatening.
* Emergency contact information: Include parents’ and/or other family member’s telephone numbers, physician’s telephone number and consent for medical treatment (for minors).
* Medic alert: Athletes with diabetes should have a medic alert tag with them at all times.
Since travel is also often a part of life for those on sports teams, athletes with diabetes are also advised to carry pre-packaged meals and snacks in case food availability is interrupted. If travel occurs over several time zones, insulin therapy may need to be adjusted to coordinate with changes in eating and activity patterns.
The primary goal of diabetes management is to maintain blood-glucose levels consistently in a normal or near-normal range. Strategies to recognize, treat and prevent hypoglycemia (low blood glucose) typically include blood-glucose monitoring, carbohydrate supplementation and insulin adjustments.
Here is an interesting PowerPoint called the Diabetic Athlete that was presented at the March 2013 Great Lakes Athletic Trainers' Association.
Athletes are likely to see their AT more often than any other healthcare professional. This frequent contact means ATs have an opportunity and a responsibility to develop a plan for their patients with diabetes – a plan that empowers ATs to prevent and recognize problems, as well as treat problems when they occur. As an AT, how do you plan your care for diabetic athletes?