Uncontrolled Type 1 Diabetes in a Young Athlete " Matthew is a 31-year-old professional football player "

Case study ( 3081 views as of September 21, 2017 )

Matthew is a 31-year-old professional football player with uncontrolled Type 1 Diabetes. He was diagnosed at 19 years old, and has followed the same insulin therapy plan for the last 10 years. He was diagnosed after passing out at home and was rushed to the emergency room by his brother. During his hospital stay he was given a prescription for the insulin. Since then he continues to use the same prescription he was given during his hospital stay and cannot recall if he had a follow-up visit with an endocrinologist.

Matthew recently injured his shoulder during a game and upon work-up for surgery was told that his blood sugars appeared significantly uncontrolled. The surgeon is concerned that without better blood glucose management the healing process could be negatively affected.

Matthew currently takes the insulin, Novolin 40/60, 2 times daily, and admits to taking a little extra at times for training. The amount he takes varies as he guesses on the dose based on what he eats. He does not test his blood sugars and isn’t sure he still owns a blood glucose meter.

Upon further investigation, Matthew describes extreme aggressive mood swings and more recently some intermittent difficulties “in the bedroom”. Matthew now also questions whether his performance on the field has been negatively affected over the recent months prior to his injury.

Matthew’s orthopedic surgeon has referred him to his local Diabetes Management Centre for further intervention pre/post operation. There he will work with an Endocrinologist, Dietitian and Nurse Educator to formulate a plan that will address his blood sugars and possible side effects. He may also wish to see an Optometrist to assess any damage to his eyes.

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Conversation based on: Uncontrolled Type 1 Diabetes in a Young Athlete " Matthew is a 31-year-old professional football player "

Uncontrolled Type 1 Diabetes in a Young Athlete " Matthew is a 31-year-old professional football player "

  • Would Matthew's diabetes affect his pre / post operative care ? Aside from daily disease management ?
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    • That's a great point @Michelle Kaarto. I never would have thought that a diabetic might need a little extra after care monitoring
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    • @K.Michael - I would assume that there would be special precautions to take with Matthew's post-operative care after his shoulder surgery. I understand there are risks for people with diabetes to become hyperglycaemic or hypoglycaemic after surgery, so monitoring glucose levels more closely would be important. Also, making sure Matthew and anyone helping him after surgery knows to watch for signs of dehydration, which can affect his urinary output and negatively affect his kidneys.
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  • Exercise not the only thing, obviously intervention with diet is appropriate, and we definitely recommend calorie restriction to lose a modest amount of weight, but we prefer you do it in a healthy way by following a balanced diet and this is where dietitians can play a crucial role.
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    • Managing blood glucose is especially important for athletes, as their increased activity level means they more quickly run out of stored glycogen. Diet needs to be taken into special consideration for athletes to begin with (especially prior to an event or training), and it is of particular importance if the athlete is diabetic. With a diabetic athlete, having a well developed care plan is essential as well - this would include blood glucose monitoring and insulin therapy among other considerations.
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    • Would the diet suggestions for an athlete be different than for someone that isn't as active ?
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  • It is fat that carries with it an increased insulin resistance, makes it harder to metabolize sugar, makes it more likely you're going to get diabetes, high blood pressure, high cholesterol, heart disease, and increased risk of cancer. So how much fat you have is very, very critical.
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    • BMI is used as a crude indicator of healthy versus unhealthy weight, but it cannot be used to determine body composition because its calculation only takes into account total body weight and height. Two people who have the exact same weight and height would have the same BMI, even though one may be very muscular and have little body fat while the other has little muscle and more stored fat. There are various anthropometric assessments that can be done to determine % body fat, for example caliper measurements or under-water weighing.
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    • Isn't that what BMI charts are used for ? Body Mass Index is one of the ways they determine how much unhealthy fat you are carrying
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    • How do you find out how much fat you have ? Is doing a blood test the only way ?
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  • Is blindness a risk of prolonged uncontrolled Type 1 Diabetes ? How does this occur ?
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    • Yes it is. I'm not sure why but do know that my father is experiencing vision loss as a result of his uncontrolled diabetes. He is working with his medical team to get himself stabilized but the damage to his vision is permanent.
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  • And as one becomes more and more obese you’re increasing your risk of cardiovascular disease, heart attacks, strokes, peripheral vascular disease, damage to the circulation to your lower limbs, an increased risk of cancer of reproductive organs, colon cancer, amongst others, an increased risk of mortality.
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  • As @sarah mentioned, it is a silent disease. In the beginning there are no overt signs that something is going on inside your body, but it is so important to keep all your levels in check and see your family physician or endocrinologist regularly.
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  • Type 1 Diabetes is not something that someone should not be taking seriously. We have a family member who was diagnosed 2 weeks shy of turning 2. This is something he has lived with for over 3 years and it has not been easy. The struggle is something that happens daily from learning to balance his blood sugars to what he can do to help bring them down. He has been on a pump since the summer and things are going better, however it is something he will live with for the rest of his life and something that is taken very seriously by his family. Being educationed about Type 1 Diabetes is the key.
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    • If you have any questions about obesity, the measurement or treatment of it, please do discuss it with your primary care practitioner.
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    • The additional challenge with children with Type 1 diabetes is that they may not understand their disease and why they are different in certain situations, such as when their peers are overindulging on treats. The positive part is that children are amazingly resilient and can take their conditions, such as diabetes, in stride and with confidence.
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  • It's good he is getting care for it now. Uncontrolled diabetes can have many effects. My friend had fertility issues related to diabetes. Matthew sounds like he is coming to an age where he is considering starting a family.
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  • People become overly complacent with diabetes and don't understand the long term effects that uncontrolled blood sugar could have. It is important for everybody to have regular follow ups with their doctors but particularly people with diabetes.
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    • It's easy to become complacent when there are no immediate signs that there is a problem. Both Type 1 and Type 2 diabetes can "silently" be causing problems leading to complications. A lack of overt symptoms gives false reassurance that ones diabetes is being managed well. It's so important to have regular follow ups with a certified diabetes educator or other diabetes specialist at least yearly but better yet quarterly.
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    • Being followed by a good Endocrinologist is key. Our family member is seen every 3 months at a Diabetes Clinic. He is monitored and a log is kept of his activity and food consumption. As he gets older this may change, however for now the amount of support and monitoring he receives is wonderful. It has kept him and his family on a path to maintain his glucose levels and helping him remain as healthy as possible.
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    • This is so true Michelle. Diabetes is such a serious disease and all serious diseases require supervision from a doctor. Weight changes and age can impact the amount of insulin a person needs. Also there are many different treatment options available - after several years on one medication you might find that another works best for you
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    • I agree @Dee, and also think that some diabetics will continue with the same treatment plan and dosages of insulin for a long time without having a follow-up check. The management of their diabetes could be negatively affected by not having routine care and follow-up appointments.
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