The Coach’s Guide To Type 1 Diabetes

As a coach, you want to encourage and challenge each member of your team, including children and teens with type 1 diabetes (T1D). While it’s often seen as a roadblock, it’s really just a condition to manage—one that you can help your players with as a coach.

In this guide, we cover what you should know to support your T1D athletes in having the most normal and positive experience playing on your team. This guide is designed to help you feel more confident and prepared as a coach for a child or teen with T1D.

What is type 1 diabetes?

First thing’s first—what is T1D? T1D is an autoimmune disease that affects the pancreas. Researchers believe a combination of genetic, viral and environmental factors may cause T1D. In a person without diabetes, the pancreas normally makes insulin—a hormone your body needs to turn food into energy. 

For reasons doctors and scientists don’t fully understand yet, when you have T1D, your pancreas stops making insulin. As a result, people with T1D need to inject insulin with a syringe or smart pen or deliver it through an insulin pump. 

So don’t be alarmed or angry if you hear beeps and boops from a player during a training session or group practice—it’s probably just their insulin pump or continuous glucose monitor (CGM). Players with T1D may even need to use their phones during practice to stay in touch with their support system or to check their CGM or insulin pump apps to manage their diabetes.

People with T1D also have to carefully balance their insulin with what they eat and how active they are, all while checking their blood sugar regularly. Your player may need to stop mid-practice to treat highs or lows, so have grace with them when that happens—we dive into how to identify blood sugar swings and offer support later in this guide.

Managing T1D is a nonstop, 24/7 balancing act. There’s no way to prevent it, and there’s no cure (yet)!

How is type 1 diabetes managed?

People with T1D rely on a few key tools: insulin, needles, blood sugar monitors and glucose. A blood glucose meter (BGM) measures blood sugar using a small device that pricks the finger to collect a blood sample. That sample goes on a test strip, which the meter reads and displays as a number.

A continuous glucose monitor (CGM) is worn on the body, usually on the arm, to track blood sugar levels all day. They are usually monitored through a CGM receiver (that usually looks like a tiny pager or mobile device) or through an app on a phone. These are an alternative to BGMs or BGMs are typically used as a backup or way to double-check a CGM.

Insulin can be given through multiple daily injections (MDI) or an insulin pump. Injections are delivered using insulin pens and needles. If your player follows an MDI strategy to manage their diabetes, there are two types of insulin involved:

• Fast-acting (bolus) insulin: works quickly and is taken with meals or to correct high blood sugar, often several times a day. 
• Long-acting (basal) insulin: is a slow-release insulin usually given once a day to provide steady coverage over 24 hours.

An insulin pump is a small device connected to the body, either through a tube or wirelessly, that delivers insulin continuously. At mealtimes, a person with T1D can use the pump to deliver the exact amount of insulin needed, since the device is already attached and ready to go.

Type 1 diabetes and exercise

Managing T1D during exercise requires constant attention and attunement to your body. It can be tricky if your athlete is tackling a new sport with T1D, so stick with them as they figure it out! They’ll get there, but it will likely require some trial and error.

When it comes to managing T1D with exercise, the type of activity matters because different forms of exercise affect blood sugar in different ways. Low-intensity cardio, such as running, jogging, walking, biking or swimming, tends to lower blood sugar. 

High-intensity interval training can raise blood sugar because of adrenaline and the energy the body uses. Every athlete’s body responds differently, so the best way to understand these patterns is to test blood sugar before, during and after physical activity to track trends over time. T1D is a personal disease, which means it requires personal attention. While general guidelines are available, no two people manage it quite the same.

Usually, parents or caregivers support their children or teens with this, but if they’ve left you in charge, this is critical to be aware of. Always set expectations with parents and caregivers before the season starts so everyone feels safe and comfortable. If you coach teens with T1D, you may also speak to them directly about it. They sometimes manage everything by themselves. Parents or caregivers can confirm if this is the case.

What’s it like to manage type 1 diabetes day-to-day?

A typical day for someone with T1D involves frequent blood sugar testing and insulin management. Insulin doesn’t cure T1D. It’s used to help manage blood sugar. High or low blood sugar levels can happen often, even daily, and what counts as high or low varies by athlete. Generally, blood sugar above 180 mg/dL (10 mmol/L) is considered high, and below 70 mg/dL (4 mmol/L) is considered low. A pre-activity of roughly 100-250 mg/dL is generally safe to play. Guidelines suggest a blood sugar of about 126-180 mg/dL (7-10 mmol/L) before activity, but the family’s exact plan comes first.

High blood sugar (hyperglycemia) can cause:

• Nausea
• Deep breathing
• Confusion
• Flushed skin
• Drowsiness
• Intense thirst
• Blurred vision

Treatment depends on your athlete’s age and medical plan. Some athletes will have training on a specific protocol to follow. Insulin, and sometimes physical activity, can help lower blood sugar. Review the athlete’s medical plan and know who’s responsible for administering insulin if needed. Make sure your athlete stays hydrated throughout practice.

Mild highs are common and often come down on their own or with athlete’s usual insulin. If blood sugar is very high (around 350 mg/dL/19mmol/L or more) and the athlete feels sick, intense activity should be postponed until the family or care team says it is safe. 

Low blood sugar (hypoglycemia) can cause: 

• Shakiness
• Pale or sweaty skin
• Headache
• Hunger
• Weakness
• Trembling
• Confusion
• A fast heartbeat
• Nausea
• Trouble concentrating
• Excessive hunger
• Slurred speech

Low blood sugar (below 70 mg/dL (4 mmol/L)  should be treated right away with fast-acting sugar, like: 

• Glucose tablets, gummies, powders or gels
• Hard candy
• Gatorade
• Juice

Treat a low right away using the “15-15” rule: 

1. Give 15 grams of fast acting sugar like  a ½ cup of juice, regular (non-diet) soda or sports drink. 
2. Wait 15 minutes, then recheck blood sugar. 
3. If they’re still below 70 mg/dL/3.9 mmol/L, they’ll need to eat another 15g of fast-acting sugar.

Do not send an athlete back to play until their blood sugar is back in safe range. 

How to help a student athlete with T1D in an emergency

Severe hypoglycemia is dangerous and requires immediate action. If your athlete becomes unconscious, call emergency services right away. You may need to administer emergency glucagon, either as a nasal spray like BAQSIMI or as an injection, like Gvoke Hypopen. If your athlete is conscious, give fast-acting carbs immediately using the options listed in the section above.

What every coach should know about athletes with T1D

The unpredictability of T1D can affect your athlete’s performance on and off the field. It doesn’t just matter what happens at practice—it’s everything that happens before, during and after. T1D is constant with no breaks. The habits your athlete forms at home matter.

Without singling your athlete out in front of the team, have a conversation about how they manage their blood sugar and how they typically feel before activity. Especially if you feel like something is “off.” Allow water breaks and quick opportunities to test blood sugar when needed, and make sure you understand the symptoms of high and low blood sugar, so you know when to step in.

If they feel comfortable, your player with T1D should also let their teammates know. This can foster camaraderie and good sportsmanship in unexpected ways. It shows your athletes that they’re playing a team sport and that they’re not out here doing anything alone!

Don’t be afraid to push athletes with T1D: they want to feel normal

As a coach, you want to push every athlete on your team to reach their highest potential. Don’t see T1D as a roadblock. See it as a challenge your athlete takes on every day at practice—one you can help them manage with the right knowledge, context, understanding and supportive language!

If you’re looking for even more helpful advice, a great resource for coaches is The Diabetic Athlete’s Handbook: Your Guide to Peak Performance by Sheri R. Colberg, Ph.D. It covers a wide range of sports, pump adjustments and carbohydrate needs for different activities, and offers a solid foundation for understanding diabetes management across various types of activity.

Remember: you got this, and so does your athlete with T1D! Just like you’re playing a team sport, T1D is a team effort.

Want to level up your T1D knowledge as a coach? Move on to the big leagues! Dig into the ins and outs of T1D here.