April 10, 2006

Care of the collegiate athlete takes many forms. Besides possessing the skills in injury management, prevention and rehabilitation, there are the common pre-existing medical conditions that the certified athletic trainer must have the knowledge to manage and the ability to administer care should a situation arise.

During my years as the softball athletic trainer I had the opportunity to work with and care for a diabetic athlete. While there are no `particulars' that make this case exclusive from treating any athlete with diabetes, not having the proper understanding to administer the appropriate care or the knowledge of treating a diabetic athlete can delay care and potentially lead to a life-threatening condition. Thus the sole purpose of this article is to educate the athletic trainer, coach and/or student athlete on the basics of caring for a diabetic athlete.

The keys to successful and safe participation are education and regulation of the diabetic illness. The first year of participation in college athletics can be overwhelming and physically demanding and challenging. Many student-athletes during their first year do not anticipate the time commitment or recognize the overall change in lifestyle that a commitment to college athletics requires. For the diabetic athlete it is imperative he/she fully understand the demands and the illness because of the potential damage that could result if taken lightly.

Education
Education is the key to preventing emergency situations with diabetic athletes. The diabetic has to know his/her body so that he/she recognizes when a problem is arising. Thus education begins first at diagnosis, understanding the illness and determining the necessary treatment available.

No matter what particular type of diabetes an athlete has, educating everyone involved is a must. Thus education should not be limited to the student-athlete and the immediate sports medicine staff. Everyone and anyone that has direct contact, supervision or care of the student-athlete should be trained. This group can be identified as the primary response team. These individuals include but may not be limited to the certified athletic trainer, team physician, parents, if necessary, coaches and teammates.

As the team is identified, it's best to explain diabetes and how it relates to the particular student-athlete. In most instances, the student-athlete's diagnosis would have occurred prior to his/her arrival to campus; therefore he/she has experience in management of the illness. The goal is getting everyone else on board. (Note: for the purposes of this article, we will discuss Type I diabetes)

In short, Type I diabetes, previously know as juvenile diabetes, is caused by a shortage of insulin, the hormone produced by the pancreas. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. Insulin is necessary for the body to be able to use sugar. Without this hormone, glucose/sugar is denied entrance into the body's cells and therefore cannot be converted to heat and energy. As a result the athlete can experience either high blood sugar levels or low blood sugar levels (pending effects of the illness) when in competitive activity which can likely result in an inability to perform or function. Thus he/she should check blood sugar levels regularly (approximately every 30 minutes).

If the athlete experiences a high blood sugar level, insulin should be administered whether through an insulin pump or injections. If the athlete experiences a low blood sugar level, he/she will need to ingest some form of food or drink with a high concentration of carbohydrates or glucose tablets to increase blood sugar levels. Type I diabetes can be treated with daily insulin injections that allow glucose to enter the cells.

Diabetic illnesses can occur when least expected, therefore everyone including the student-athlete must be recognize and be ready to respond. Response begins with identifying signs and symptoms.

Signs and symptoms of a `diabetic high' include:
• Sleepiness
• Dry mouth
• Fruity breath
• Frequent urination
• Fatigue
• Extreme thirst

Signs and symptoms of a `diabetic low' include:
• Decreased physical performance
• Variable mood swings
• Paleness
• Tremors
• Headaches
• Profuse sweating
• Poor vision
• Fatigue
• Hunger
• Dizziness

Once blood sugar levels are adjusted re-checks of blood sugar levels should occur after 15 minutes to ensure they have returned to normal levels. (Normal levels: 70-180mg)

Education about diabetic illness is ongoing. Periodic follow-up appointments with the endocrinologist are a must to check blood sugar levels and to adjust medication if needed.

Regulation
Regulation of the diabetic student-athlete involves keeping the student-athlete as well as the primary team involved, as necessary. Regulation implies that prior to arrival on campus through successful completion of the college career that all areas of care are managed. Thus regulation requires that everyone applies the knowledge.

Though most student-athletes that are diagnosed with Type I diabetes have had ample experience with treatment and management prior to his/her arrival to campus, it's imperative that all medical records are received and reviewed prior to clearance in collegiate athletics. Medical history and records will provide the team physician and sports medicine staff with pertinent diagnostic and treatment details about the particular illness. Additionally, this will afford the student-athlete's endocrinologist time to communicate with the university's medical staff, determine specific needs and coordinate efforts to ensure safe participation. Upon review of records, the supervising team physician and athletic trainer may request a final consultation to ensure compliance and a complete understanding of the student-athlete's condition and further answer any outstanding questions. Likewise, it may be wise to have the student-athlete meet with a team nutritionist to discuss balanced diet `do's' and `don'ts'.

Once cleared to participate, as mentioned about, it's time to get the primary support team involved. The coaching staff, which includes the head coach, assistant coaches, and the strength and conditioning coach, must have a good understanding of diabetes and the common occurrences if the student-athlete does not manage him/herself.

Some common `need-to-knows' include:
• Signs and symptoms that occur with a low or high blood sugar level
• Management of any diabetic situation, especially during individual coaching or practice sessions where athletic trainers are not in attendance
• Cessation of practice by student-athlete to check blood sugar levels, especially if it's at the athlete's discretion. (Remember: he/she should know his/her body and how it responds)
• Ensure that the diabetic student-athlete ALWAYS has a roommate during travel in case an emergency occurs during the night

Additionally and most important, teammates and roommates should be educated and prepared to respond. Both teammates and roommates will spend the most time engaging with the student-athlete. They will best know the individual and his/her mood, and will be able to recognize a difference in low or high glucose readings. Because of the inordinate amounts of time both groups spend together, most will be able to determine first if the individual is experiencing either a low or high.

Preparation, education and regulation are keys to successful administration and management of these special needs student-athletes. While athletic trainers and the sports medicine staff are the primary means of ensuring a safe and competitive environment for all participants, coordinating efforts and teaching coaches and teammates the specifics of diabetic illnesses are beneficial and can help not only the athletic trainer identify problems, but also may save the life of a teammate, friend and student.