The National Athletic Trainers’ Association (NATA) offers guidelines to help athletes and their parents, coaches, and health care professionals manage diabetes. NATA’s position statement, which is published in the Journal of Athletic Training—the association’s scientific publication—provides relevant information on type 1 diabetes mellitus, including specific recommendations for athletic trainers who work with diabetic athletes.

The goal of diabetes management is to maintain blood-glucose levels consistently in a normal or near-normal range. Strategies to recognize, treat, and prevent hypoglycemia (low blood glucose) typically include blood-glucose monitoring, carbohydrate supplementation, and insulin adjustments.

“Although the literature supports the benefits of physical activity for people with diabetes, exercise training and competition can cause major disturbances when it comes to blood-glucose management,” says Carolyn C. Jimenez, PhD, ATC, lead author of NATA’s position statement and certified athletic trainer. "Special considerations for blood-glucose control, medication, travel, and recovery from injury are required for all athletes with type 1 diabetes. Also critical to diabetes management is weight control and attention to nutrition.”

According to the statement, athletes with type 1 diabetes can benefit from a well-organized plan that allows them to compete on equal ground with their teammates and competitors. This plan should include the following elements:

• Blood glucose monitoring guidelines: These should address the frequency of monitoring as well as pre-exercise blood glucose levels where beginning exercise could be unsafe.

• Insulin therapy guidelines: These should include the type of insulin used, dosages, and adjustment strategies for planned activities types, as well as insulin-correction dosages for high blood glucose levels.

• List of other medications: Make sure to include medicines that help control blood glucose and/or to treat other diabetes-related conditions.

• Guidelines for low blood glucose (hypoglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms, and treatment of hypoglycemia, including instructions on the use of the hormone glucagon to metabolize carbohydrates. 

• Guidelines for high blood glucose (hyperglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms, and treatment of hyperglycemia and diabetic ketoacidosis, a condition where insufficient levels of insulin lead to hyperglycemia and the buildup of ketones (by-products of fat metabolism that can reach toxic levels) in the blood.

• Emergency contact information: Include parents’ and/or other family members' telephone numbers, physician’s telephone number, and consent for medical treatment (for minors).

• Medic alert: Athletes with diabetes should have a medic alert tag with them at all times.

Since travel is often a part of life for those on sports teams, athletes with diabetes are advised to carry prepackaged meals and snacks in case food availability is interrupted. If travel occurs over several time zones, insulin therapy may need to be adjusted to coordinate with changes in eating and activity patterns.