"I was a sportswoman before I was a diabetic. You have to live your life and be the person you are."
A volleyball coach, keen padel tennis player, and dinghy racer, Sandra talks us through how she manages her blood glucose around sport and exercise, the gap in support for everyday athletes with T1D, and why listening to your own body matters more than following a one-size-fits-all rule.
This is Sandra's Hypo Diary…
A note: what works for Sandra works for her physiology specifically, developed over years of trial and error with her own diabetes team. It isn't a set of instructions to copy — and any changes to insulin doses or glucose targets should only be made with your own healthcare provider.
Could you tell us a bit about how you manage your blood glucose around exercise and coaching?
I coach volleyball, and when I'm coaching I'm pacing around for up to two hours – demonstrating, walking, talking. I don't sit down. You'd think because you're not doing a cardiovascular activity, you wouldn't need to think about it as much, but you're talking constantly, and there's a level of pressure being responsible for a hall full of people. Your body kicks into gear, and I have had hypos while coaching because of that.
My diabetes dietitian actually changed my approach here. I used to put a sugar-free electrolyte in my water because I've found I'm more prone to cramp as I've gotten older, especially in the heat. She told me instead to use the ones with carbs in them, because my body needs the energy when I'm moving for that long. That's been really useful advice.
How has this played out across the different sports you play?
It changes depending on what I'm doing. I try to eat before I play, and if I'm playing padel tennis or volleyball outside in the summer, I'll take less insulin with my meal beforehand.
I always have a fast-acting energy source in my bag, so I'm not caught out. For dinghy racing, I need something small enough to fit in my buoyancy aid zip. For coaching, I keep a back-up energy source on my desk now, after recently going low just before a session with nothing on me. I'm always careful to only take a small amount at a time, since it's easy to overdo it.
You've talked about everyone's body reacting differently to exercise. What's that like for you?
I've noticed my glucose tends to rise once my body kicks into gear during a session, before it comes back down again – so I've learned to expect that rather than panic about it. Everybody's different though: my best friend is the opposite, she'll drop immediately, whereas I'll rise first. It comes down to your own physiology, and what dictates what happens inside your body.
What have you learned about your body in the hours after you finish playing?
I always check my number afterwards, and often it's high. The real strategy is not to panic and immediately try to bring it down; I wait about 20 minutes to see what's actually happening, since correcting too early can send me overcorrecting and going through the floor, into a cycle of up and down. I'll also take less insulin with breakfast the next morning, because the effects of exercise on your insulin sensitivity can last around 24 hours.
Editor's note: adjusting insulin doses is a decision for you and your diabetes team, based on your own patterns – this is Sandra's individual approach, not general guidance.
You've spoken about a real gap in support for people managing T1D around sport. What's your experience of that?
I think if you're a high-level athlete, you probably have whole wraparound care – dietitians and a team around you to help with your medical condition. But for a lot of us who just play padel tennis, or do a park run, or coach a sport, I don't think there's much support or information out there. You have to make it up as you go along, and you have to really be on it. For people who maybe aren't in a position to do that, it must be a really difficult situation.
The wider medical attitude can be quite cautious, too – they'd rather you went for a thirty-minute walk every day than played a competitive sport, because they don't always know what to do with you when you do. I was a sportswoman before I was a diabetic, and you have to live your life and be the person you are. I don't think there's been enough research into everyday athletes and regular active people, and I think that's a real gap.
TAKEAWAY
Sandra's story is a reminder that for a lot of people managing T1D around sport, there isn't a rulebook to follow – just years of trial, error and self-advocacy, often without much tailored support. It's a gap she'd like to see closed, and one we're exploring too: we're currently gathering interest in future Klario research into exercise and hypo recovery. If that's something you'd find useful, you can register your interest here.
Thank you to Sandra for sharing her story and experience with us. Stay tuned for our next Hypo Diaries interview!