can athletes compete with type 1 diabetes?

Charlotte Drury, an alternate for the 2021 U.S. Olympic trampoline gymnastics team, was diagnosed with type 1 diabetes in March – just months before the Tokyo Olympics. We sat down with Dayton Children’s endocrinologist, Yelena Nicholson, DO, to talk about how athletes can compete at the highest levels while managing type 1 diabetes.

Charlotte said she'd felt really off for the last few months, and the last sign that something was off was under-performing against her teammates despite intensive training. Is that in line with what you'd expect? What kind of symptoms should you look for?
Fatigue, decline in sports performance and weight loss can be the first signs of type 1. But, the definite signs of diabetes are drinking and peeing a lot. Signs of an emergency situation in new onset diabetes are peeing a lot, drinking a lot and vomiting. These symptoms require emergency intervention.

Is it common for people to be diagnosed at this age? Charlotte is 25.
It is not very common, but it can happen. Type 1 diabetes is still most often diagnosed in children, however, it can occur at any age. In adults, we refer to type 1 diabetes as LADA: Late onset Autoimmune Diabetes in Adults.

Charlotte has a Dexcom - How can technology help athletes manage their care?
Dexcom is a continuous glucose monitoring system that monitors blood sugar every 5 minutes and displays readings on compatible phones or other devices. It also shows trends of blood sugar changing, allowing the patient to treat highs and lows before they become a problem. It virtually eliminates the need to check blood sugars on the finger, which would be very inconvenient for an athlete.

What resources or support might a competitive athlete need with type 1?
Competitive athletes always need extensive education on type 1 and have treatment ready. Athletes with type 1 should also discuss their training regimens with their endocrine team so they can help manage blood sugars during training.

I also recommend Beyond Type 1 – an organization set on helping people with type 1 diabetes with support, education and information. There you can find out about other athletes with type 1, connect with other people with type 1 and get involved in advocacy for type 1 diabetes. 

What do athletes with type 1 need to consider before a big game, match or performance?
Athletes should monitor and optimize blood sugar, so it is not too low or high. They also need to have access to treatment if their blood sugar is too low or high. 

Does type 1 have any impact on athletic ability?
Type 1 does not impact athletic ability if blood sugar is well controlled. However, during episodes where blood sugar is too low, performance can be affected. It’s also not safe for athletes to compete if their blood sugar is too low; they can lose consciousness or have a seizure. If it is too high, it can alter reaction time and affect competitive performance.

How does exercise impact blood sugar? What about supplements like sports drinks or protein powders?
Exercise usually lowers blood sugar. Carefully monitor blood sugar, treat if too low, and possibly adjust insulin doses to accommodate exercise.

Talk to your diabetes doctor about sports drinks and supplements before you take them. Sports drinks can have too much sugar, so we recommend lower equivalents like Gatorade Zero. Adding protein powder to drinks is ok, but monitor sugar content and ask your doctor first.

How do you support team members who have diabetes?
To support team members with diabetes, it is important to be educated about diabetes. Most endocrine programs offer virtual or in-person education about type 1 diabetes and how to provide first aid, such as how to help during a low blood sugar episode.

Any advice for kids managing diabetes and participating in competitive sports?
Diabetes can absolutely be managed during sports. I encourage kids with diabetes to participate in sports all the time. It teaches kids discipline, social skills and sportsmanship skills. I recommend talking to your endocrinology team about adjustments to your insulin plan and monitoring blood sugar closely, especially with the help of technology and a glucose sensor.