Youth rider Kai Watts – training and racing with Type 1 diabetes
15 May 2014
Kai Watts is an Under 12 racing member of CC Hackney with Type 1 diabetes. His mum Karen tells us about how Kai, his parents, his club and its coaches all contribute as a team to managing the condition so that he can race as fully as anyone else.
Our eldest son Kai was diagnosed when he was eight years old. He is eleven now. He cycles for CC Hackney on the track at Welwyn, Herne Hill and now at the newly opened Lee Valley Velodrome (the London 2012 Olympic track). He races and also does some distance every Sunday – usually 30 to 40 miles, but occasionally longer 60 to 80 mile rides. His dad accompanies him on long rides. He wears an insulin pump (vital for temp basals both during rides and the night after) and has full-time funded sensors (CGMS). His pump is held in a case around his waist. He has no “hypo awareness” – and he eats lots of jelly babies. His preparations include an adult having a glucagon injection to hand during rides, and lots of blood glucose checks. He has milk shakes post-exercise.
About Kai’s insulin pump
Pumps deliver background insulin (basal) continuously throughout the day. You can set different rates for different times and can set a whole sports profile for days when you’re active (so you can deliver less insulin during activity) then also reduce it around 01:00 a.m. when blood glucose drops following intensive exercise.
The pump also has a bolus function. This is where you count the carbs you are going to eat, take your blood glucose with a finger pricker, and then input the information into the pump. It calculates the amount of insulin Kai needs for the meal, and it can measure down to 0.25 units which is very accurate.
About Kai’s CGMS
The CGMS has a small needle which is just under the skin and it continuously monitors blood glucose – it does not directly tell the pump what to do (that is the artificial pancreas – the next breakthrough on the horizon) but it will suspend the pump (basal insulin) if Kai goes below 3 mmol. It also gives clear graphs of blood glucose activity and uses arrows to show if it is dropping or rising fast.
It all sounds very technical but over time it becomes second-nature, and my partner Prosper and I are in the process of training and coaching Kai in use of the pump. Kai’s knowledge of carbs is brilliant.
We quickly realised that working with injections was really tricky – and Kai was on such small doses that preventing “hypos” was almost impossible. Kai was immediately put on the waiting list for a pump which he started in January 2012. His dad Prosper then started to accompany Kai to all cycling sessions and subsequently he came a volunteer for CC Hackney. He’s currently doing his British Cycling Level 2 coaching award.
I think if Kai hadn’t already been an active cyclist when he was diagnosed as a diabetic we honestly probably wouldn’t have encouraged him to ride. Seeing the banking of a velodrome still terrifies me, although Kai himself has no fear! And because cycling involves long rides in the middle of nowhere, he would probably have gone down the swimming or running routes instead of cycling. But sport and exercise have always been part of him. Swimming and athletics are also his joys though, and triathlon is probably his next step.
How we reacted to hypos
Hypos are our trickiest challenge. Kai has no hypo awareness – he can be running, cycling or swimming and the only way lows are recognised is sometimes by looking at him. He can get dangerously low in the mid-1’s before he says he is low. At first we did the standard glucose tabs but now jelly babies are his friend. For cycling he has one bottle containing diluted apple juice which he sips, and one with water, with jelly babies in his back pocket. Post-exercise he always has a milk shake drink.
Managing club sessions
Prosper is always with Kai at club sessions anyway, but all the coaches know Kai’s signs and on long rides the group has waited until he comes up. Touch wood Kai has never fitted – but the management this takes involves sensors plus up to 15 blood glucose tests per day. Prosper always has glucagon with him (the orange injection) because, although this is held in ambulances, they could be in the middle of nowhere. It’s never been used but it needs to be available at all times.
Becoming coaches is the best way. Kai is so active and we are so determined for him to be able to continue with the level of activity that he wants to do. We do anything to allow that to happen.
The main support that riders need if already diagnosed is simply awareness. A simple add-on to coaches’ First Aid courses covering hypos, hypers and safeguards would be great. Type 1 is such a hidden condition that it can be overlooked.
How things are going
Six months after starting on the pump, with the continual lows, we put in an application to the CCG for sensors. These are not cheap and are not provided as standard. Kai is lucky as he received full funding for sensors which is rare – and even rarer not only on hypo awareness grounds but also levels of physical activity. Technology is the way forward. I doubt there will be a cure in Kai’s lifetime but the pump, blood glucose monitors and sensors have all dramatically improved in the last five years and they are continually improving. Kai’s HBA1C over last year has ranged between 6.5 and 7.2.
Kai remains healthy but weight is a problem – i.e. keeping weight on. Balancing Type 1 and exercise is difficult, and we are continually working on getting more carbs into him. Without technology Kai would be at risk.
Fixed insulin and MDI injections are very difficult to manipulate – and, of course, at 11 years old Kai is growing rapidly so constant adjustments to insulin are needed. The pump and low suspend is our safety net.