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MUSC Health Blog

Date: Jan 23, 2017

Guest Post by:
Brittney Lang
Athletic Trainer
MUSC Health Sports Medicine

Athletic trainers and other health care professionals care for a wide variety of athletes. With so many advancements in medicine and technology we are able to manage the health care needs of athletes with different chronic conditions including type 1 diabetes.

When managing an athlete who has type 1 diabetes, the main goal is to maintain normal to near normal blood glucose levels and not have the athlete become hypoglycemic. This is very stressful and demanding, both on the athlete and the athletic trainer. Doing research and asking questions is paramount for the health care professional to be able to assist or treat the athlete in times of need. This can also help to ease some of the athletes’ concerns, knowing that they will be in good hands if something happens.

The National Athletic Trainers’ Association offers a few guidelines for managing the care of type 1 diabetic athletes. The guidelines are grouped into categories, including: diabetes care plan, supplies for the kit, recognition/treatment and prevention of hypoglycemia and hyperglycemia, insulin administration, and athletic injury and glycemic control. These guidelines can help with current and future care of the athlete.

In the beginning, the athlete, possibly family members, and athletic trainer should meet to discuss a diabetes care plan for practices and games. This should include insulin therapy guidelines such as type of insulin, dosage, adjustment dosages for activities and if levels increase, and whether the athlete has an insulin pump or does injections. There should be blood glucose monitoring guidelines as well as guidelines for what should be done if the athlete is hypoglycemic or hyperglycemic. This needs to include a list of any other medications the athlete may be taking, and of course physicians’ numbers and other emergency contact information. It is beneficial to have this information updated and kept secure with the athletic trainer and possibly coaches, if necessary, on a regular basis.

Athletic trainers should always have supplies in their kit to help them monitor the athlete. These supplies are usually provided by the athlete or parents. They include blood glucose testing strips, blood and/or urine ketone testing supplies, spare batteries for insulin pumps, possibly insulin infusion sets and a container for used needles. Another big item to have on hand is supplies to treat hypoglycemia such as sugary food or drinks like orange juice or glucose tablets or sugar packets. There should also be a glucagon emergency kit and insulin for injections. The athlete will likely keep a kit on hand, but it is a good idea for the trainer to have one too.

Protocols for recognition, treatment and prevention of hypoglycemia and hyperglycemia should be discussed with the athlete and coaches so that proper care can be given at a moment’s notice. The athlete may be able to control this alone but procedures should be in place in case of emergency. This should include letting the coaches know to keep an eye on the athlete and to maybe not push the athlete during certain situations. They should be supportive and allow the athlete to take breaks as needed. The athletes walk a fine line trying to keep their levels at a normal range during competition. It may also be helpful for the athletic trainer and coaches to discuss having the athletes share their knowledge of the condition with teammates so they can understand and notice any signs or symptoms in the future. The more understanding and support the athlete has the better it is for the person’s overall health.

Another important area involves insulin administration. This is a very important procedure and should be done properly. If done by injection, the athlete is likely to handle this, but it’s good to learn proper procedures. Insulin pumps administer the insulin regularly, but the infusion sets should be changed every couple of days to limit site irritation and make sure no infections are occurring. Depending on type of insulin used (i.e. fast-acting or rapid acting insulin), make sure to avoid heat or cold for periods of time afterward, to avoid interfering with absorption rates.

Just like any other athlete, there is the possibility for injury, but for a diabetic athlete this can be more serious. For all athletes, an injury can cause high stress hormones, which raise blood glucose levels. For non-diabetic athletes, this process produces high levels for the healing process, but for diabetic athletes this can be very serious. It is important to have the diabetic athlete maintain normal levels of insulin. If this means restricting playing or practice time till levels are sufficient, then it something to consider. It has also been shown that poor blood glucose control can lead to increased risk of infection as well as poor wound and fracture repair. Make sure the athlete is taking proper care of all injuries, no matter how small. This is especially true when it comes to the feet, where blood flow can already be decreased, thereby slowing the healing process. If not treated correctly and as soon as possible there is risk for it to become a serious injury. Having a good relationship with your athletes will help with treating any possible injuries, increasing the odds that they will come to you for help.

In the end, just doing your research and being proactive will have a big impact on the athlete and situation at hand. Making sure the athlete is able to maintain a normal blood glucose level and being an advocate if need be is a start in the right direction. Follow up yearly during the pre-participation exams to make sure nothing has changed and update the care plan as needed. Continue to learn and always be ready to do your part as a health care professional.

As Hurricane Matthew swept into the Lowcountry in the early morning light on October 8, engineer Leigh Colyer took a tumble down a darkened flight of stairs. He was unable to walk without assistance and was not even able to get to the Emergency Department at MUSC Health until late afternoon due to the flooding in downtown Charleston.Photo of Leigh Colyer, sons and wife

  Leigh Colyer pictured with his sons and wife at Clemson graduation.

He was first seen in the ED by Dr. Edward Jauch, then by two orthopedic residents. The diagnosis was a complete tear of the quadriceps tendon. Leigh was referred to Dr. Harris Slone, an orthopaedic surgeon specializing in injuries to the ACL, ankle, knee and shoulder at the MUSC Musculoskeletal Institute. On Thursday, October 13, outpatient surgery was performed at Rutledge Tower. It involved reattaching the tendon that connects the muscle of the thigh to the knee cap with two anchors in the kneecap and sewing down the torn tendon. The surgery went well and Colyer was discharged the same day and returned home.

Colyer has had several follow up visits with Dr. Slone and has been making good progress in the recovery phase, with physical therapy sessions two or three times per week with therapist Michelle Mills.

“Dr. Slone is an engaging doctor with a wonderful bedside manner. He fully explained what this injury entailed and what outcomes I could expect after surgery,” says Colyer. “Dr. Slone fully understood that my prognosis was essential in planning how I could best deal with my family and business commitments. I can sum this up by saying the entire experience, from the ED to surgery to outpatient visits and now through PT, has been extremely good. I can’t think of anything that could have been done to improve my experience with the entire MUSC staff.”

The injury has been a particularly difficult one due to the nature of Colyer’s business, which involves a lot of travel both by car and air. For the first four weeks, he was unable to even sit at a desk comfortably and it wasn’t until week six that he could start travelling on a limited basis. He is now close to his original travel schedule, even though he still wears a full leg brace and has limited flexibility.

Colyer is also looking forward to returning to his recreational activities, which include hunting, fishing, walking – and especially golf. “I can't wait to see Leigh back on the golf course in a few short months,” quips Slone. “Since we will let him back on the putting green before playing a full round, maybe we will even take a few strokes off his game!”

 

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