The National Athletic Trainers Association has issued a seven-element plan for helping athletes with type 1 diabetes maintain proper blood sugar levels while competing, training or traveling.

The plan offers guidelines for dealing with matters ranging from blood glucose monitoring and hypoglycemia to insulin therapy and emergency contact information.

"Exercise training and competition can cause major disturbances when it comes to blood-glucose management," says certified athletic trainer Carolyn C. Jimenez, PhD, ATC, lead author of NATA's position statement. "Special considerations for blood-glucose control, medication, travel and recovery from injury are required for all athletes with type 1 diabetes."

The guidelines include:

1. Blood glucose monitoring guidelines: These should address the frequency of monitoring as well as pre-exercise blood glucose levels where beginning exercise could be unsafe.
2. Insulin therapy guidelines: These should include the type of insulin used, dosages and adjustment strategies for planned activities types, as well as insulin correction dosages for high blood glucose levels.
3. List of other medications: Make sure to include medicines used to assist with blood glucose control and/or to treat other diabetes-related conditions.
4. Guidelines for low blood glucose (hypoglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms and treatment of hypoglycemia, including instructions on the use of the hormone glucagon to metabolize carbohydrates.
5. Guidelines for high blood glucose (hyperglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms and treatment of hyperglycemia and diabetic ketoacidosis, a condition where insufficient levels of insulin lead to hyperglycemia and the buildup of ketones (byproducts of fat metabolism which can reach toxic levels) in the blood. Diabetic ketoacidosis can be life threatening.
6. Emergency contact information: Include parents' and/or other family members' telephone numbers, doctor's telephone number and consent for medical treatment (for minors).
7. Medic alert: Athletes with diabetes should have a medic alert tag with them at all times.

Since travel is also often a part of life for those on sports teams, NATA advises athletes with diabetes to carry pre-packaged meals and snacks in case food availability is interrupted. If travel occurs over several time zones, insulin therapy may need to be adjusted to coordinate with changes in eating and activity patterns. 

To view the NATA guidelines, go to: www.nata.org/jat/readers/archives/42.4/i1062-6050-42-4-536.pdf.