How to Support Your T1D Teen in Running
Editor’s Note: Bella runs with Type One Run, a program of Beyond Type 1.
When my daughter Bella was diagnosed with Type 1 diabetes two years ago, one of her first questions was “Will I still be able to run?” Running was a huge part of her life. Since then, I have been her committed “pit crew” in helping her continue to run and improve as an athlete, so she does not feel that diabetes took one more thing away from her.
During this time we have gone through many trials, experiments and tribulations to make it work for her to the best of our ability. We have had coaches that gave up on her. We have had coaches that broke her heart when they criticized her for pulling off an interval to handle a low blood sugar, insisted that she was eating “too much candy” and insisted that fruit was a better alternative for low blood sugar than Smarties. On the opposite end of the spectrum, we have had coaches who believed in her and pulled her off an interval for low blood sugar when she herself didn’t want to. Through these experiences, my advice to anyone dealing with a runner with Type 1 diabetes comes down to this: know what you’re working with and know who you’re working with.
The “know what you’re working with” is the educational component of T1D in general. Exercise is so important for anyone with T1D, but it also imposes variables into the blood sugar equation that further complicate that delicate balance. Everyone associated with the athlete should be trained on spotting signs of highs (hyperglycemia) and lows (hypoglycemia) and what to do about them. Coaches must be trained on glucagon (nasal and injectable) and must carry it with them whenever they are with the athlete. This is a non-negotiable and must be a part of every 504 plan as it truly can be the difference between life and death.
Another non-negotiable is that the runner (and coach as back-up) must carry sugar (Smarties are the most portable) and their phone on every single off-campus practice. For efficiency, it should really be carried in a hip belt of some sort. Coaches should check-in and make sure that the athlete has what they need and the hip belt before each off-campus run. Some kids (including mine) like to carry it in their hands, but the bottom line is you can’t carry as much as you might need, and even attempting to do so messes up your form.
The general “rule” is that exercise decreases your blood sugar and because of that you must always have low blood sugar supplies with you, start your exercise at a higher blood sugar than normal (have a little snack beforehand) or decrease your basal insulin at least an hour before the activity and continue that an hour after the activity. The best way we know to approach this management is by using a Dexcom and Omnipod along with her phone and an Apple watch to monitor her blood sugar throughout activity. This combination allows for the greatest management/freedom combination. Additionally, stay hydrated. We swear by Nuun tablets. That and a hydro-flask can save your day.
The other part of the equation is the “Know Who You’re Working With” part. That’s because just as everyone is different, everyone’s T1D is different and diabetes is often like trying to manage a drunk toddler. When Bella went back to racing after diagnosis, we quickly discovered that her blood sugar would go sky high during a race. She ended her first race in the high 300s mg/dl (16.5 mmol/L) and her second one in the 400s mg/dl (22.2 mmol/L). We discovered that she gets an adrenaline dump during competition that makes her blood sugar go sky high.
She has to account for this with temp basal increases and monitor very closely before races to make sure her blood sugar is at a good starting point, between 100-180 mg/dl (5.5-10 mmol/L). Running higher causes long-term damage and can adversely affect performance but running lower can be immediately dangerous. We’re still working on ways to avoid starting high and still adequately fuel before a race. Often she doesn’t eat a few hours before a race so that she doesn’t start on a spike. Conversely, she also tries to avoid having active insulin in her body before practice so it doesn’t make her go lower. We are looking into experimenting with Afrezza before practices and races to help fix this. I recommend doing a few 5ks and training runs in the off-season to get a sense of how your body responds to competition.
If I could mandate one thing, it would be Dexcom. We both say that she would be dead without it as her level of activity has brought on sudden and dangerous lows we were fortunate to receive alarms for. Additionally, the arrows allow us to predict blood sugar trends and deal with them accordingly. In an ideal safety situation, the coach would be willing to follow your child on Dexcom Share and receive alerts for potentially dangerous lows during training sessions. They’d just have to remember to turn off alerts after practice.
Every kid wants to feel normal and in an effort to do so, especially in new environments, they might not want to break out their diabetes gear or even be reminded of it. When parents notice something concerning on the glucose monitor and communicate that to their child, they aren’t overreacting. At this age kids are craving independence and as parents we get that and want to give it to them, but we also want them to be safe. Support communication and trust that the parent is proactively trying to head off potentially dangerous situations so they don’t happen at all and also do not fall on somebody else’s shoulders. Gossip between parents, students and staff that dismisses concerns and potentially discourages the communication that promotes safety is dangerous.
Every mom just wants to feel that their child is safe and this is especially true with a mom of a child with T1D. To this end, good communication is essential. While the 504 plan should provide mandatory training, it’s good to help the coach get to know your individual child as all kids are different. Some check their sugar regularly and some seem to act that if they don’t check, maybe this whole diabetes thing will disappear. These kids will need extra monitoring from a coach to keep them safe. Some kids are very committed athletes, some are just starting out and need encouragement to realize that the personal victories and progress in running are one of the things that make it addicting. That part isn’t exclusive to T1D kids. Successful coaching needs to be highly individualized to anyone to make it work right.
Lastly, be flexible as things change. Just when you think you have the blood sugar thing down, that little drunk changes it’s mind … You will constantly have to evolve and change and find new things that work for your child. The most important thing is doing this as part of a well-communicating partnership to ensure both safety, success and mostly happiness for all.