Reflection

The soccer season is coming to an end. We play the final game this Sunday. If we win, we end third and collect a cash prize to make our ending-party even better :-) Approaching the end of the out door soccer year makes me reflect upon the seasons (spring and fall) as a whole.

I entered a new club in the spring and felt welcome there from the first minute. A couple of team mates from my former club are in this new club too, and that made the transfer a bit easier – at least I only had to learn about 20 new names in stead of 22 ;-) I am proud of the fact that I fairly quickly entered the team for the games, having only missed 4 games or so (of 20) over the two seasons in total, and three of these were due to me having other appointments on game days. Given that we are more than 20 players, occasionally our coach have had to drop players, so being picked for the team on those occasion feels extra good.

This year was also my first of combining CSII management of my diabetes with soccer. Before that I had about 15 years of experience in handling insulin dosing with injections around practise and games. I was comfortable with that, and although it did not always work out quite as would have liked it too, it usually did not cause too many problems. Exchanging Insulatard for Lantus as my basal insulin three years ago didn’t cause any changes around soccer, other than making it a bit easier to manage in some situations. Starting pumping back in April this year, however, is another story! I felt quite helpless not really knowing how to handle things around soccer. This of course was due to lack of experience, but also because I knew the theory behind pumping, the pharmacokinetics of NovoLog that I was now totally dependent upon and needed to learn my response to, and not least the fact that I did not feel like wearing the pump while playing soccer. Practise quickly turned out not to pose any problems, as my theory about giving a small bolus along with a snack about an hour before starting practise worked very nicely, without causing too many lows during practise or highs post practise. Games turned out to be a tough challenge, though. It was, and actually still is, not at all an easy task to make things work without too large fluctuations in BG levels, and I have expressed my frustration about this several times on this blog. In the summer break my diabetes nurse and I agreed that I should try to wear the pump while playing. That prompted finding a way to wear the pump in order to protect it against the hits of close encounters with the field, ball and other players that occurs in the heat of competition, without affecting my free movability. After a few unsuccessful attempts, the sports pack entered the scene and solved the problem in an acceptable way. I must admit, though, that I would still prefer to play without wearing this. Anyway, the next challenge was to find out how to regulate basals around games. This challenge has yet to be solved completely. For the first game of the fall season I was able to wear the Guardian RT sensor, which provided me with very useful information about BG trends during games, and gave me some ideas on how to fit the basals to counteract large fluctuations. Still, theory and actual occurrences are not always the same. I have only had a few successful game days BG-wise in the current season, and it bothers me because even though I may not see the high BG until after the game, being too high or too low surely affects my performance. The issue have mostly been high BG’s, especially towards the end of the game and immediately after. I am annoyed by the fact that I still haven’t been able to figure out how to avoid the spikes towards the end and immediately after games, without having to battle low blood sugars during warm-up and the first part of the games. It is not that I had perfect sugars for games when I was doing MDIs, but the post-game highs never really went above 13.0 (234), whereas with the pump 15-18.0 (270-324) are the typical results. An example of this is from one of the games this fall. I played most of the game, being replaced about 15 minutes before the end of the game. At that time I tested and got a perfect 6.3 (113). Knowing that it was likely to rise, but also wanting to risk going low, I entered a small bolus, 0.8 U (1U will usually drop me 2.7-3.0 mmol/l [49-54 points]). The game ended, we did a short evaluation of it and then headed for the showers and victory beers. Out of the shower, I did a quick test just to be sure I wasn’t too low. About 45 minutes after the perfect 6.3 (113) and 0.8 U bolus, I was at….. 15.7 (283)! Where did that come from? I had not had anything to eat or drink other than lots of water, and the result had me turn down the beer offer outside the locker room, as I did not want to make it even harder to get back into range again.

The series of examples of severe BG changes in relation to soccer while being on the pump is already long. Why is it that I can start out with a 4.7 (85), just a little lower than I would like, thus eating a couple of glucose tabs and a small banana, and then two hours later, after a full warm-up and only 15 minutes break during the 90 minutes game, landing at 16.8 (302)? I just don’t get it!

Anyway, now the indoor soccer season is coming up, and I look forward to that. Not only because I like the technical aspect of indoor soccer, but I also anticipate that it will be somewhat easier to manage BG-levels for this, as the games usually are no more than 7-15 minutes each. Thus, disconnecting for games should not be an issue, and as for practise I may wear the pump or disconnect by the same procedure as I used for outdoor practise back in spring. Time will tell which it will be :-)