Exercise

Rugby and Type 1 Diabetes

 

Managing blood sugar (BG) levels while playing rugby is a completely different ball game in comparison to your typical exercise such as running or weight training. In comparison, “normal” exercise seems easy.

The Backstory

My rugby playing days without T1 lasted approximately 4 months before I was diagnosed at the end of January in 2017. From then on, I had to figure out the best strategy to try and keep my levels in range before training or a game.

I was not given very good advise coming out of hospital and in the months after with regards managing this unfamiliar and contrary illness with rugby. I was told that I could go straight back into contact and exercise immediately after being discharged. Leaving hospital I weighed 45kgs with no muscle mass whatsoever. I had literally wasted away in the weeks leading up to my diagnosis and even more so in hospital. Frankly even considering returning to rugby at that weight was dangerous given my malnourished state.

Originally, I was told to reduce the insulin with my meal prior to rugby sessions. I tried that before a rugby match and it was possibly the worst piece of advice I was given. Rugby matches cause an increase in adrenaline which increases BG levels. So if your bloods are already high because you took less insulin and they’re getting higher because of the adrenaline in your system, it’s a recipe for disaster. I remember looking at my reading just as the game was starting and it was 20 mmol/L (normal range = 4 – 8/10 mmol/L). I didn’t know enough about the effects of exercise at the time to have the wherewith-all to give myself an injection to bring my levels back down, so I played on with dangerously high levels. With BG levels this high, all you want is a nap.

Training

Testing Blood Glucose levels

As a general rule of thumb, I test my blood sugars at every interval I have in a training session. I can test my levels very easily with my Freestyle Libre using the app on my phone so I will get a reading immediately. This will tell me if my bloods are rising or falling or if they are steady, meaning I can take sugar (if bloods are going low) or insulin (if bloods are high) if necessary.

Aerobic vs anaerobic

During aerobic training, my glucose requirement goes up and additional supplementation is sometimes needed on top of the sports drinks to avoid hypoglycemia. Glucose is the main form of energy during aerobic training (jogging/running) so the body will use the glucose in the blood to power the muscles, decreasing your BG levels. I always have a bottle of lucozade with me no matter what the training entails but I consume this more if there is a high volume of running involved in the session. The amount I drink depends on the length and intensity of the session but as a general rule of thumb it’s 20-30ml.

During anaerobic training I rarely need a top of sugar. This type of training may include weight training or sprints. Adrenaline is typically released during anaerobic exercise so this will increase your levels naturally. 1-2 hours after the session, adrenaline will wear off and levels may drop.

Food and Reducing Insulin

I eat 3-4 hours prior to training to ensure that the short acting insulin is out of my system – this is a carb heavy meal for me I never reduce insulin with the meals prior for the reasons mentioned above but I will always reduce insulin with the meals following no matter what form of exercise I have done.

I also reduce my night time dose of insulin after a session. This is a trial and error process because if you reduce it by too much, BG levels might climb overnight and if you don’t reduce it enough, levels will drop and you may suffer from a night-time hypo. The sweet spot will take a few weeks to find and it’s useful to monitor training intensities, amount of insulin you have taken & reduced by and also noting your levels before bed and in the morning.

Sometimes I use the RPE scale (below) to monitor training intensities – the higher the number on the scale the more I reduce my insulin levels.

RPE Scale

Game Day

Testing

I test my blood sugar before the warm-up, just before kick-off, at half-time and after the game. If there are long breaks in the game I will usually test again during the time frame. Again, this will allow me to adjust accordingly. I keep my insulin, lucozade and phone/BG tester in the medical bag which is usually on the sideline so it is easily accessed should I need it urgently.

Managing Insulin

Game days are going to be very similar to a training session in regards to insulin doses and food consumption prior to the match. Again, I eat 3-4 hours prior and don’t reduce insulin levels prior to a game but I will always reduce after.

Managing Game day spikes in BG levels

Nerves and adrenaline may cause your blood sugars to rise before and during a game which will lead to a general feeling fatigue. This obviously wants to be avoided where possible. Not reducing my insulin with my meal prior helps keep my blood sugars normal heading into a game and if I spike at all you will usually see me giving myself a shot of insulin before a game and more often than not during a game to counteract this rise in levels (know your ratio of how much one unit of insulin will drop your blood sugars by before giving yourself corrections shots. My ratio is 1:3. 1 unit of insulin drops my levels by 3. 

Incorporating a cool-down post-game

This is something I need to do more of!

A cool-down is roughly 10 – 15 minutes of gentle aerobic exercise/stretching post training or a game. This is really beneficial to help bring your levels back down to normal should they be a little high after the game.

It’s hard to find the right balance with rugby and T1 but little things like knowing the effects of adrenaline and knowing they type of exercise you’re doing will go a long way to aiding your management. Tracking the trends in your levels alongside rugby will help you understand your body’s reaction which will allow you to plan accordingly going forward.

Here’s a really nice video with Exeter Chiefs and England Rugby player Henry Slade explaining his journey with Type 1 Diabetes and how he copes with being a professional rugby player.

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