How To Achieve Normal Blood Sugar in Teen Athletes with Type 1 Diabetes


Hi, I’m David.

I was diagnosed with type 1 diabetes almost 7 years ago, at the age of 9. My diagnosis story is probably similar to many other kids – I was thirsty, didn’t feel well, then I lost a lot of weight. After a blood test, my pediatrician called and told us to immediately head to the emergency room because I was in DKA. When I was diagnosed in the hospital, my endocrinologist was honest with me right from the beginning. He gave it to me straight and told me about the problems that come along with running high blood sugars. He explained to me that carbs make your blood sugar go up and insulin makes it go down. I shot back right there from my hospital bed that I just wouldn’t eat any carbs. After a few weeks of struggling with the rollercoaster blood sugars from the recommended high carb diet, my mother found Dr. Bernstein’s book and I’ve been following a very low carb diet ever since. My results were so good that after a while, my family contacted Dr. Bernstein and we have been friends for years now. More recently, I’ve been working as Dr. B’s intern producing his Diabetes University videos on YouTube.  

I’m an athlete, and I’d like to share my approach to participating in sports as a teen athlete with type 1 diabetes, while eating a very low carb diet. As background, I am in my sophomore year in high school and play QB for the varsity football team as well as basketball for the JV team. In addition, I am on club teams for those sports, so my activity level is both high and frequent as I participate in these sports year-round.  And I have closely followed Dr. Bernstein’s best practices throughout my years of sports activities.

Here is how I approach my practice and game days:

BEFORE ACTIVITY: My main goal before daily practice or weightlifting is to make sure I am at a normal and steady blood sugar and without bolus insulin onboard (I aim for around 85 to 90 mg/dL and I wear a Dexcom, BTW).  Practice is usually after school, around 4:30 PM. So, what this means is that I have a big lunch (mostly protein) with a bolus of Regular insulin to cover that protein. A few hours after lunch and a few hours before practice, I’ll double check my Dexcom with a fingerstick and at this point it’s possible that I might need a very small correction (e.g., a glucose tab or a quarter or half unit of insulin). I will, however, avoid snacking. Again, the goal is to ensure my blood sugars are in my optimal range and stable.  The real key here is to make sure I don’t have any active bolus insulin since without any insulin onboard, I won’t have to play ‘defense’ and run my blood sugar high in order to avoid hypoglycemia. Preventing hypoglycemia during sports is my main goal. And with that goal, even if my blood sugar is 110 mg/dL or even 120 mg/dL as I go into practice (which is higher than I usually like), I will still avoid giving a correction because it usually won’t go much higher, and I prefer to avoid a low in practice. I want to focus on practice and not be concerned about a low blood sugar.

DURING ACTIVITY. Because I do most of my diabetes management routine before each practice, I don’t need to do a lot during the game or practice.  I keep an eye on my blood sugar to make sure I don’t need to take glucose and I keep liquid glucose in my bag, as it works fastest. Basically, I keep my routine very consistent which means there aren’t any real potential surprises. How do I check my blood sugars? I use a CGM. Surprisingly, I don’t have many issues with my CGM tearing off – I wear it on my arm and use a Johnson and Johnson toughpad which holds it in place. But without a CGM, I’d be fine using a blood sugar meter during a water break.

3 Keys to Normal Blood Sugar in Teen Athletes - Football

AFTER ACTIVITY: After practice, my blood sugar might be a bit elevated – 110 mg/dL or 120 mg/dL but by the time I get home my blood sugar usually drops about 30 mg/dL on its own. That tells me that for the times I get in the car after practice and my blood sugar is 80 mg/dL, I will likely need to eat a few tabs, so I monitor my CGM as I head home. When I get home, I eat one or two meals with protein as the main focus. My goal is to eat a lot of protein and to replenish calories without carbs so as to keep blood sugars normal – so I focus on high protein and high fat. My typical post-game meal is a big steak, fathead rolls, and a salad or vegetable. And my mom makes a lot of amazing low carb desserts (she first found out about them on this site, so thanks ASweetLife!). In addition to my dinner, I do a very high fat/calorie and high protein shake that I make from sugar free whey and heavy cream. One of the things I am trying to avoid with my post exercise routine is nighttime hypoglycemia, which can occur after a high intensity activity. This high calorie low carb shake is my secret weapon, and allows me to stabilize my blood glucose levels and remove the need for waking all night to take glucose corrections.  By the way, using Dr. Bernstein’s approach, I know the amount of Humulin-R (Regular) to take for each high protein/low carb meal I eat. However, after sports, I have a different (smaller) amount of bolus insulin for a given meal than I would if I hadn’t practiced that day. So for example that steak dinner might be 8 units of R for a non-activity day, but only 5 units after a football practice.

3 Keys to Normal Blood Sugar in Teen Athletes - Resting

My goal with this diabetes management plan is to totally remove the impact/work of rollercoaster blood sugars and to just focus on being a teenager who plays sports. My meal plan to eat a lot of protein, doesn’t seem to be that different from what other modern athletes are doing. I’m just using fat energy for fuel to a larger degree than most because of the issues involved with using insulin to cover carbohydrate energy and keeping my blood sugar normal. Switching to low carb has been a relatively easy transition honestly, and I’m glad we figured all of this out. The benefits for me are huge: I get rid of the fear of hypos without having to run my blood sugars high.  In all this, I learned that eating pre-game carbohydrate, so called carb loading, isn’t required for athletic performance. In fact, the blood sugar rollercoaster created by high carb/high insulin is not optimal at all for my performance, as I would feel sluggish and nauseated.  My message to other teens with diabetes and their families is that it is not only possible, but relatively simple, to have the same blood sugars or very close to the same blood sugars as any other student athlete, while maintaining peak athletic performance.

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Lester Hightower
Lester Hightower
3 years ago

Great article! Well done, Dave.

3 years ago

Thanks David! My teen son was diagnosed last week and despite the nutritionist telling him to “eat whatever he wants” we both thought low carb was the way to go. Still early but no spikes and still lowering insulin requirements everyday. Appreciate your advocacy and attitude! Exactly what we needed today.

Paul Starkey
Paul Starkey
3 years ago

Thanks for sharing! Im also a father with a young (and very active) daughter who was very recently diagnosed.

Tim Hanley
Tim Hanley
3 years ago

Thanks David! Very informative! A great read for me as a father with a recently diagnosed son with T1D who loves to play sports.

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