Cycling, racing and coaching for young diabetic riders
15 May 2014
Willie Watt, a diabetic himself, tells us about how youth riders with Type 1 diabetes can take a full part in cycle racing. He looks at the coaching environment for young diabetic cyclists, how technology can help, and the way that individuals, parents, clubs and coaches can all work together to manage the condition.
Also check out our article about 11-year-old CC Hackney rider Kai Watts and how he handles his Type 1 diabetes.
Supporting young diabetic cyclists
I am a newly qualified cycle coach and, if I say it myself, an imperfect diabetic. I say imperfect because diabetes tends to be a very difficult condition to master on an ongoing basis, but I have been an imperfect diabetic for some 25 years so hope that I have a degree of experience to offer. This article is not medical advice – instead, it is written from the perspective of the sufferer (and indeed their parents) and how they can all be supported to create a safe and inclusive coaching environment.
Most people will have a vague notion of what diabetes is which more than likely these days will focus on lifestyle issues, its long term complications and probably a fear of needles. That, though, is a little knowledge and will tend to have been fed by current (and at times unsympathetic) press interest in issues such as obesity, and how that is fueling an increase in diabetes.
Type 1 and Type 2 diabetes
That, though, is often a very simplistic overview which probably obscures a more detailed understanding of the condition. The first and most obvious issue is that there are actually two types of diabetes. Both mean that the sufferer cannot metabolise sugar in their blood stream. The successful correction of that problem is critical to the sufferer’s ongoing health, safety and wellbeing. It is also important to remember that sugar is a generic term. Sugars include all carbohydrates.
Type 2 diabetes is often maturity onset where sufferers have an impaired ability to control their sugar levels. Type 2 tends to be controlled by diet and tablets which “encourage” the body’s ability to metabolise sugar.
The other is Type 1 diabetes which is treated by insulin because the sufferer’s pancreas has stopped producing it. Type 1 diabetes can afflict a new-born baby, the young, and sometimes the not-so-young. Precisely how and why that happens is still unknown but, once diagnosed, the sufferer must take insulin by some form of injection. Insulin cannot be taken orally because it would be digested, broken down, and would not reach the blood stream to carry out its important work.
It is this latter condition (i.e. Type 1) which I suffer from myself, and which is the focus of this article.
More information on diabetes and its treatment is provided by Diabetes UK.
The balance of insulin and sugar
Insulin is analogous to a key: it unlocks the energy in blood sugar to power the body. If there are too few keys (i.e. not enough insulin) the amount of sugar in a diabetic’s bloodstream will gradually rise. They will become fatigued and, if left unchecked, dangerously ill. Unfortunately the long-term build up of excess sugar residue in the blood system (rather like blocked pipes) also leads to the condition’s infamous complications.
Therefore the diabetic takes insulin to unlock the sugar.
That said, if too much insulin is taken there will then be too many keys to unlock the available blood sugar, resulting in low blood sugar or “hypo” (glycemia). With that, the body’s power supply is rapidly burned up leading to confusion at first, lack of coordination and, if left unchecked, a fit and a slide into coma. Hypos unfortunately can happen all too easily. They are dangerous and if they continue into a fit are distressing for the diabetic, their loved ones, and those around them.
Diabetics and their clinicians therefore often talk about achieving balanced control. That said, it is often easier to aspire to a balanced outcome than it is to deliver it. That balance will be affected by food and insulin intake, their relative timing, types of food, exercise (crucially from the point of cycling), and emotions (hormones) say, in a race, but also other external factors like temperature. Such “cross winds” tend to prevent the use of prescribed and predetermined doses given by a clinician. Instead, diabetics and their parents are taught to count carbohydrates in food and understand how such external factors will influence their insulin dosing. Such decisions regarding dosing are therefore devolved, initially to the parent and, as the child grows older, to the child themselves.
Type 1 and participation in children’s sport
As we have already discussed Type 1 diabetes tends to fall on the young. As we have seen it is not without its perils, and parents may be naturally tempted to wrap their diabetic child in cotton wool because the condition frightens them. Hence it may be difficult for many diabetic kids to get started in a sport. This is perhaps best underlined by the relative absence of diabetics competing in the London Olympics and Paralympics, yet many primary schools will have four diabetics on their roll.
Parents, I would suggest, therefore need as much encouragement and support as young diabetic cyclists themselves.
Part of that will be achieved by showing an understanding of the condition and its dangers, but also perhaps an empathy with the child that reinforces their positive management of their diabetes.
Coaching children with Type 1 diabetes
A first step may be as simple as welcoming the parent to stay and watch the coaching session and to be on hand if assistance is required. Indeed, parents may wish to shadow their child in case urgent intervention is required. Encouraging them to become a club helper or indeed a coach may make this less obvious or awkward for the child and more interesting for the parent. Over the longer term building a rapport with the parents may allow you to use their knowledge of the condition to reinforce your own. After all, they will know their child and how exercise & conditions must be managed better than anyone else.
Diabetic riders and their parents should be encouraged to speak about their desire to cycle and their participation in coaching sessions to their clinicians and their diabetic specialist nurses. They will be able to knowledgeably engage with the rider and their parents to offer detailed advice and assist their management of their diabetes alongside cycling. They may also direct them to internet based assistance such as the charity JDRF which principally offers guidance for younger diabetics or Runsweet which is a specialist resource for diabetics engaged in sports. It has subsections focused upon getting started, cycling, children and doping. I would suggest that coaches who are interfacing with diabetics will also find the information contained within Runsweet very useful.
Children can be shy and don’t tend to enjoy being “unusual”. Part of their management of diabetes alongside cycling will be to understand how the two interact, and how that will affect their insulin and food requirements. Such an understanding can only be achieved via blood tests. The child will therefore need encouragement, time, understanding and perhaps privacy to facilitate that as and when appropriate. In the immediate term that will enhance their safety and, in the longer term, it should assist them to fine tune their management of cycling alongside their diabetes. It will also offer their clinicians valuable feedback on which to base their ongoing advice.
Diabetic riders should have a source of rapid acting sugar with them easily to hand during coaching sessions. The sugar will need to be taken if they suffer a low blood sugar – hypo. Again, engagement with their parents may help to identify obvious warning signs of an impending low blood sugar – hypo, whilst empathy towards the child may mean that a discrete “Are you ok?” can successfully encourage them to check their blood level and, if necessary, take sugar.
The fact that the child is diabetic will have to be appropriately logged in club and session records. Similarly, First Aiders and coaches should be aware of the appropriate procedure if the child appears to suffer a debilitating low blood sugar – hypo. It is a dangerous condition which requires urgent intervention. Fundamentally it is best avoided from the point of their safety and wellbeing, but it is also the type of event which could undermine their ongoing confidence, parental support and participation.
Although diabetics of all ages lead very varied lives, a degree of routine does simplify the management of the condition. A child and their parents will gradually improve their management of the condition alongside cycling by modifying insulin doses and food intake relative to an expected amount of exercise. Therefore a coach springing a 20 mile mock road race on them when they had been expecting a relatively light training session will therefore upset that applecart. It is best to be aware of that and, again, engage with the rider and their parents to flag in advance upcoming changes to what they might consider the routine so that they can adjust their management approach accordingly.
Technology and devices
Enhanced medical technology may also be opened up to the child as time goes on. Few diabetics use “classic” syringes for their injections these days. Many will instead use insulin pens which are convenient and more discrete, whilst an increasing number may be offered insulin pumps which drip feed insulin constantly into the diabetic. I can only speak for myself, but I have been using an insulin pump for almost three years and have found that it has enhanced my control of my diabetes. It has also greatly improved my confidence and, for me at least, has allowed me to cycle with ever-greater freedom. It has offered me more subtlety and the ability to reprogramme dosing to reflect exercise.
In a similar manner blood tests are increasingly convenient and pain-free, providing a blood glucose result discreetly in a few seconds. That technology can now also be linked to insulin pumps, which can now also be enhanced by continuous glucose monitoring systems whereby an “injectable” sensor relays live blood glucose results to the diabetic’s insulin pump. I have had the pleasure of occasionally using such a device whilst cycling and can vouch for the sophisticated feedback it provides, allowing better control and again improving confidence, not least because it can be set to predict hypos. Further details for that type of technology are available here.
Although the provision of such technology within the NHS is widening it is as yet by no means universal. It is important to remember that such devices are not a “magic wand” but, if it is felt that they will help, parents may need to champion availability to their child. Many factors will no doubt be used to determine their use but one would hope that many of the issues surrounding the responsible management of their diabetes and their involvement in a sport would help their case.
My view is that the gradual uptake of such technology will offer a new generation of young diabetics fresh sporting horizons, and that the involvement of diabetics in cycling and other sports will increase.
Hopefully if a young diabetic loves cycling and if a safe and inclusive coaching environment is created for them, their parents will support them and their cycling will flourish.
No doubt that will present fresh challenges, not least because the finer control of their diabetes will improve their performance and perhaps encourage them to compete. A fatigued, confused or poorly coordinated cyclist with poorer control of their diabetes will be at a competitive disadvantage. Again such an observation if delivered with appropriate empathy may positively reinforce the rider’s management of their diabetes in a holistic sense, encouraging them to be safer, healthier and perhaps faster.
As the young rider becomes more successful detailed information available on Runsweet will become increasingly important as will their ongoing engagement with their clinicians and diabetic specialist nurses. Whilst the coach can positively reinforce behaviour, lifestyle and dietary choices they must remember that they are indeed a coach and not the child’s clinician.
Role models and the future
Role models are also important and, over time, may become more prevalent. Although there were few diabetics competing in the Olympics diabetic role models do exist in the world of cycling. There is in fact a pro road cycling team over in the United States whose members are all diabetics – Team NovoNordisk.
Sir Steve Redgrave is perhaps the world’s most famous diabetic – he is actually a Type 2 diabetic who takes insulin. As we have already discussed that condition is typically treated with tablets. That said, the extreme nature of his training meant that he could only effectively be treated on insulin. Sir Steve Redgrave became a diabetic during his Olympic career. He is undoubtedly a role model for all diabetics – even those who were born after he finished competing. But it is interesting to ponder whether he would have flourished as he did if he had become a diabetic as a child, or would there have been too many perceived obstacles in his way?
As coaches we must therefore create a safe and inclusive coaching environment to allow everyone to flourish as best they can.