Managing type 1 diabetes before A football Game

Chris Bright, the founder of The Diabetes Football Community, shares the strategies that he uses to manage his type 1 diabetes before a football match with Paul Coker. Chris tells us that finding an approach that works for him most of the time and being consistent with his planning in the days and hours leading up to a match are important. Chris has detailed knowledge of type 1 diabetes and soccer and is driven by a passion to make the game more inclusive for those of us with type 1 diabetes.

I’m here with Chris Bright from the Diabetes Football Community. Chris is a semi professional football player. He has had type one diabetes for 18 years. He is also a Caps futsal player for a whiles. He has a wealth of experience and knowledge.

Chris, what I want to ask you today is, how do you prepare your diabetes, and how do you manage your diabetes in the lead up to a game either football or futsal.

I mean it is quite complex question. I guess you can’t say right or wrongly what you would do 100% of the time, but you have to approach it from, for me, an air of consistency. I would look to start preparing the day before a game, which for people that don’t have diabetes it’s unheard of, but I’m literally monitoring everything from the night before. Friday night I’m thinking about what I’m eating, what kind of meal it is. I tend to fuel it heavily with carbohydrates to stock those up in preparation for the game the following day, and try to get a good night sleep like everybody else does the day before. I guess, really start to notice on the morning prior to a game, so for example, a football game kicking off at three o’clock. I’d be up a set time in the morning, normally about half eight to make sure I had breakfast around nine knowing that I would want to squeeze my lunch in by 12 to ensure I had three hours prior to kickoff, before ever having to approach the exercise with extra insulin is not ideal. I would make … and all this time try to ensure that glucose was in range.

We get to lunch time following breakfast, and it’s the same meal … I’ve been having the same meal for, I don’t know, maybe 10 years and it’s literally because I know what it’s gonna do, and what kind of situation and level it will put me in when I get to the game. Consistent is what I would say on a Saturday. Try to keep things within range, and if you’re worried slightly … I run them slightly high to be fair, I put them at eight, nine minimal and not worry about it in the slightest because I know what’s about to come. Have the meal, lunchtime, and then arrive at the game half one. I’m normally there 90 minutes before kickoff. As soon as I get there, it’s all about checking glucose levels and starting to think about where are they gonna end up following what’s about to come. Check them, respond, it’s trial and error at this stage.

If there in range, probably gonna need a little bit of glucose, because I’m gonna end up out exercising and warming up in a minute. If they’re high out of range, then it might need a small insulin adjustment. It is understanding your body at this stage, and understanding how you react to certain elements of exercise. Then I go out and warmup. In the warmup I’m trying to focus on the game, but knowing that any slight change in the way I feel, I need to know what my glucose numbers are. I’ll go out with intention of fully doing the warmup as best I can, but knowing that glucose levels at this stage are mostly important, because if I don’t get them right, I’m not gonna be allowed to play.

Then following the warmup, I come back in, I check myself again. This is normally about 15 to 10 minutes before kickoff. It’s absolutely imperative that they are sat in range at this point. There’s been time where I found it a last minute reaction and it’s weak to try and get things right for three o’clock. There’s been time where I have absolutely no chance, and I’ve walked into a hypo, and I’ve had to either pull out of the game or put myself in the bench, or I’ve had to … or I’ve gone out and played, and not played to the ability I want to, and have to try and rectify a glucose level that I wasn’t happy with, and was slightly dangerous.

Healthcare professionals wouldn’t do it, but this practise and I’ve done it before, wouldn’t recommend it, but it’s part of preparation, you have to … you understand that this can happen and at that stage when three o’clock comes around, if I haven’t got things perfect, it may well be that this is a game that’s gonna be tough for me. If I’ve got it perfect, then I go out into the pitch at three o’clock, and I forget all about the diabetes. Once I cross the white line, you have to try and switch off from worrying about glucose levels because otherwise it will sit there and you’ll overthink how you’re feeling, when you just need to be thinking about how you’re performing and what your output is on the pitch.

Chris, I know that for me I’m using an insulin pump, and you’re using multiple daily injections. On the night before game, do you have to make any changes to your long acting insulin? I don’t know, do you split your doses of long acting insulin for morning and evening?

Yeah. Predominately I’ve been on Lantus for a very long time. I recently changed to Tresiba, and it’s one injection in the evening. I don’t tend to use it the day before. I like to try to think about having insulin on board to ensure that what I’m eating and what I’m putting in is put into the muscles prior to the game, so I like to ensure that there’s a … I’m not really reducing, I’m making sure everything’s covered. The reductions for me in insulin intake then come after a game.

Okay. Another point I noticed, and it’s something I think that we share. There’s many people out there with diabetes that follow a low carbohydrate diet in order to manage their blood glucose levels. For me when I was running the half marathons, and even now when I’m running, that just doesn’t work. I noticed that you were saying that when you … the night before you play football, your carbohydrate loading. Is that your normal method? Do you normally eat a relatively high carbohydrate diet?

I would say so. I think on any given normal day, it’s probably around 300 grammes, which for some people is quite a lot. For me, that’s probably, I’d say a medium day. When it comes to prior to a football match, on the day before, Friday night, it’s really stacking it in. I can have a meal that’s 220 on its own, 220 grammes, so it can be … I would never … I wouldn’t say I’m having a low carb diet, that’s all I think and fair for me and my performance is imperative. I have a fair bit on board.