My son plays high school/travel ice hockey and has recently gone on the Omnipod pump. He is now experiencing shaky legs and muscle fatigue during hockey. ( This never happened before the pump except one time when he overbolused his before game meal and started at 82 while eating carbs pregame and on the bench. Even though his BG came up he never really got the muscle tone back during that game.) So we do think that it might be related to the circulating insulin or his BG levels.
His current regime is to change bolus -50% pregame while dressing out for 3.5 hours. The games are about an hour. He will have a pregame small meal two hours before game time so not to be on the peak of insulin and lower bolus so BG is around 140. We do not correct the highs after a game - we just wait for the drop. He usually will eat a large meal an hour or two after the game and bolus only food with no correction. This is similar to the regime in the Diabetes Athlete Book.
Ice Hockey is more like sprinting with very quick 2-3 minute shifts at full speed and then resting on the bench until it is your shift again in 4-6 minutes. During a game he will rise so he is not taking carbs unless feels too low. There also seems to be a rise from the adreneline and competition that he does not get with a practice.
Any help is appreciated. Especially if you do intense exercise and your BG rises or if you have lost muscle strength during exercise.
I use the Pod as well and do a lot of triathlon training. Does your son have a CGM by chance? That might help in your troubleshooting process. I do many of things you describe above, but make adjustments as needed in workouts to make sure I don’t go low. Also, if it helps - my daughter (6 yrs old and type 1) is on the Animas pump. She swims regularly and we generally will see her go high following the swim efforts and have a similar management as you do (don’t treat the high post exercise), but she hasn’t complained of muscle fatigue.
You might be onto something with the “circulating insulin” question. Biggest difference before and now is that he is always on fast acting on the pump versus a Levemir or whatever your basal shot was before. Net, I believe it absorbs easier/faster. You might need to dial back his basal rate on the pod even more. I’m def not an expert, but I think this is the case.
I’d recommend testing more during exercise to see if you can get trending or get a CGM from your endo for a little while to monitor and adjust with your endo support.
How long before activity starts is “while dressing out”? I would guess he needs to have his basal rate reduced at least an hour before he starts.
However, it seems like you’re saying that his blood sugar is high during games, not low. But you didn’t really say.
What are his blood sugar readings during his breaks on the bench?
I’m not a hockey player. My experience is mostly in completely different kinds of exercise, so I hope you get some other replies.
Best wishes.
We don’t have a CGM at this time. The more I hear about them the more I think we need one. I’ll have to check on the insurance requirements for that. It would certainly help to know how his BG are trending more often than we can test. At 16 he will not test on the bench in front of his teammates but his coaches are very aware of his situation. We are at every game with our glucogan pen and snacks,
During the game, he normally will rise 60 - 80 points so it has not been a hugh concern. We think it is due to the adrenaline and anaerobic activity. It is hard to tell how much of the BG number is due to the stress of play and how much is the true BG # fueling his muscles. Only during “light” practices where the focus is on shooting and strategy and not skating drills has he ever had lower BG.
So he has shaky legs and muscle fatigue during the game, and his blood sugar some time after the game when he could test without anyone seeing him is 60-80 mg/dl higher than it was some time before the game when he could test without anyone seeing him.
You really don’t know what is happening to give him the shaky legs feeling during a game.
A CGM would be good.
In the meantime it would also be good if he would buck up, be a diabetic, and test his blood sugar.
I’m guessing it would be far less embarrassing to test your blood sugar on the bench than to collapse on the ice jerking uncontrollably.
It’s good that his coaches are aware of his condition and are willing to help him if he needs it. Your son is old enough to show the maturity to do his part. The coaches have a lot of things occupying their minds during a game.
I have to agree w/ Jerry about testing in front of the other players. If he continues to hide it, it limits his ability to play–or at least to play to the best of his abilities. You can do anything you want to do as a person with diabetes, but you have to be willing to man up (or woman up 
and take care of the diabetes management aspect in order to do those desired items.
Without a CGM, frequent testing is going to be your only option right now. Without any of that vital info (of during the game), you’re just going to struggle with trying to make adjustments to basal rates, etc.
As far as his BG increasing, it’s likely due to the insulin resistance that some people get when doing high intensity activities (myself included on occasion). I don’t know all of the science behind it, but some of it has to do with an increase in cortisol (another hormone) from the stress of the situation (either mental stress/anxiety/excitement leading up to the game, or physical stress of exertion during the game). But without more BG information, you’re not going to know.
Also you might look at what type of insulin you’re using and how you are bolusing for that pre-game meal/snack that he has “two hours prior”. The bolus may have peaked of course, but the “tail” of the insulin (depending on which rapid-acting analog you’re using) may be as much as 5 hrs in some individuals, so you’ve got that to take into consideration with the amount of total insulin-on-board at the time of the game.
Because his high intensity efforts are only a few minutes at a time, the -50% basal drop might be too much (it kind of depends on total overall game play time within that hour…is it only 10 minutes worth of game time, or is he playing frequently enough to total about 40-45 minutes?). He may need less of a cut to have more insulin on board to cover the increased insulin resistance (so he wouldn’t rise as much). But then this may all factor onto what his starting BG is as well (if he starts at 82, you’d definitely want less insulin on board. If he started at 140, you’d likely be alright).
Ultimately I think your first step is to get more information, either from testing more or from utilizing a CGM. Good luck with getting some answers so your son can play at his best! 
Good article on other diabetic hockey players:
http://www.usahockeymagazine.com/article/2009-03/balancing-act-hock…
Doesn’t even mention Nick Boynton who just won the Stanley Cup with the Blackhawks, though.
good quote by Jeff Costello part way down the page on the right-hand side about his pre-game meal and insulin, and about his proximity to his glucometer during the game…
I also love the closing quote by Peterson! Couldn’t agree more
Thanks, Jerry & Bradford,
I had first seen this article last October when Greg was diagnosed but after re-reading it today and knowing more now, we may need to change some things up. Especially, the timing of that pre-meal two hours before. We are not hitting that peak but I’m sure there is still insulin on board.
Ironically, Toby Peterson from the Dallas Stars had just met with his high school team during the August preseason training camp regarding nutrition when Greg was diagnosed at the end of September.
Maybe your coach has a contact point where he could get your son at least an email or phone call w/ Toby. They wouldn’t have to talk diabetes (although I think it would be helpful :-), but I think having that contact w/ someone who’s doing what he loves and successfully managing this disease could have a big impact on your son (and it might help w/ the transition of “changing some things up” as you mentioned). I think it would at least be worth looking into…
Actually we were trying to make that happen in the Spring. Toby Peterson came to speak to one of the Pre-Med or Sports Med Classes at the high school but Greg was out at a Clinical Trial Appointment. Several of the Trainers and Coaches know him and he is very active here in Dallas in fundraising for Juvenile Diabetes so I’m sure we will be able to set that up as soon as school starts in August.
It will probably be better for them to meet and talk now. Greg will be able to talk about the pump options better now that he has been on the pump. I’m not sure that he would have understood what Toby was doing before even if he explained it in detail.
wow, your poor son, I’ve never experience that type of reaction but I can only imagine from my past experiences that the muscle fatigue and shaky legs may be his blood sugar going down or his need for replacement minerals aka: low cal. gatoraide during his game. Keep us posted, is he hydrating when he plays? It might just be plain old dehydration if he is not drinking enough fluids so try and find some low sugar or low cal gatoraide, might help him and won’t hurt him either.
Good luck
Just a thought. If you convince your son to test during games, you might want to tell his coaches it doesn’t mean that anything is wrong. He’s just doing something he should have been doing before.
Hydration during the game is normally just water - they all share those squirt bottles. I think that it is a little gross. He was diagnosed last year during flu season and got everything that was going around so I insisted that he stop sharing. He tried gatorade in his own water bottle but thought it just made him go higher. I had not thought of the low cal ones - that might be better.
Interesting enough, I have found one triathele runner that could not do the pump because the around the clock fast acting insulin seemed to deplete her body of minerals faster than the slower release ones. She had similar muscle problems. She only used the pump for bolus insulin.
Greg has always had trouble maintaining potassium, iron, magnesium anyway because the autoimmune problems started with his thyroid in second grade. Maybe he is going in low - his teenage diet is not the best.
That’s a good idea telling his coaches that nothing is wrong. The main coach is cool - he was really interested in Greg’s pump. He played for Boston in college and is in Texas going to med school. The boys love him because they have normally had older “dad type” coaches before high school.
Nobody wants to be different at 16 but I think we need the game data to make changes. We have tested during practices but it is totally different in a game situation.
My son is 16 and plays high school, beach, and competitive club volleyball. He tests all the time during games and practices. The other players on the team are so supportive and interested in his diabetes. It helps that my son is very open and often jokes about itl When he tests, the other players often try to guess his numbers, Some even want to poke his finger for him. He even had a few players ask if they could prick their own fingers to see how it feels. He is on the omnipod and his friends call it the omnitron, his life patch, his defibrilator and many other names. I would encourage your son to be open about his diabetes. It makes all the difference in the world. Good luck!
Thanks, Hilary for your reply. When was your son diagnosed ? We are at 10 months and getting more used to it but some days are still hard. The summer season is almost over and the coaches, us and he will probably need to make a few new rules for Fall especially with him driving himself after practices now.
His last games were much better with eating a longer time period before the game (less insulin in body from bolus). He seemd to feel a lot more stable.
Christian was diagnosed at 14, so almost 3 years ago. He was on shots for the first 1 1/2 years and has been on the omnipod for a year. The omnipod has made things so much easier. The first couple months on the pod were hard. We had a lot of occlusions, probelms with the pod staying on, skin problems, and many others! After a lot of trial and error, things have improved greatly.
When he is playing sports, he just has to test more frequently. He has gone low many times in practices and games but luckily he has felt it and treated it. He always has gatorade in his bag (I get the small ones - about 27 carbs or so) and will drink it if he feels low. Unfortunately he won’t wait till he comes up (at least in games) and will go right back in. Either my husband or I go to all his games to make sure he is testing and is doing ok… At practices, he is usually fine. He puts a temp bolus on at least an hour before activity and for 2 hours after. This seems to help too.
We went on the Omnipod in June and are going through the same thing. He is currently on antibiotics with a skin infection which means we cannot use those sites. We have not had any pods come off during hockey which is surprising. Greg really likes the pump and his basals from the fasting tests are great so I guess all of those high numbers are from his food and hockey. So, we will start to work on that more with the pump options.
It is good to hear that you have been able to work out the pod issues and it is smooth now. This last month has been a full time job getting everything setup and dealing with the pod issues so I was beginning to have my doubts.
Does Christian able to use his legs at all ? We were told not to use them - too much muscle ?
I don’t play hockey, but I cycle and run a lot. My legs are pretty muscular on both my thighs and my calves. I’ve tried both as potential spots for pods too. Those sites worked marginally, but I either had issues w/ absorption or I had discomfort issues (the slightly medial aspect of my thigh), so I steer clear of them now. I would say give them a try (it’s always good to have additional sites to choose from and vary your rotation schedule), but I would keep an extra pod and insulin around in case you have any high glucose issues…
and take care of the diabetes management aspect in order to do those desired items.