Why Education on Diabetes and Sports Safety Matters

Every athlete deserves a safe, supportive environment to train and compete. Yet when coaches and teammates lack an understanding of diabetes, the risks multiply dramatically. According to the American Diabetes Association, approximately 1.6 million Americans live with type 1 diabetes, and many actively participate in school, club, and recreational sports. Without proper education, a simple low blood sugar episode can escalate into a seizure or loss of consciousness, while misinformation leads to stigma, exclusion, and even dangerous medical decisions. Educating the entire team is not just about preventing emergencies—it is about building a culture where athletes with diabetes can push their limits and achieve peak performance without fear.

Consider a young soccer player whose teammates heard that "diabetics cannot have sugar" and hesitated to give her juice when she showed symptoms. That ten-minute delay turned a treatable low into a 911 call. When knowledge flows freely, the opposite happens: a teammate spots the signs, grabs a snack, and the athlete is back on the field within minutes. The gap between crisis and routine support is education, and closing that gap requires intentional effort from everyone involved in the athletic environment.

The stakes extend beyond the individual athlete. Teams that embrace diabetes education build stronger bonds and foster a culture of awareness that benefits all players. When every member of the squad understands how to respond to a medical need, the entire team becomes safer and more cohesive. Coaches who prioritize this education demonstrate leadership that transcends wins and losses—they show they care about the whole person, not just the performer.

Understanding Diabetes in the Athletic Context

Diabetes mellitus disrupts the body's ability to regulate blood glucose. For athletes, the two main types present distinct challenges that require tailored management strategies during training and competition.

  • Type 1 diabetes: an autoimmune condition in which the pancreas produces little or no insulin. Requires lifelong insulin therapy, usually via injections or an insulin pump. This form is most commonly diagnosed in children and young adults, making it the most prevalent type in school and youth sports.
  • Type 2 diabetes: insulin resistance with relative insulin deficiency. Often managed with lifestyle changes, oral medications, and sometimes insulin. Increasingly seen in younger populations due to rising obesity rates and sedentary lifestyles.

Physical activity naturally lowers blood glucose by increasing insulin sensitivity and glucose uptake in muscles. This is a huge benefit for managing the condition long-term—but it also creates a tightrope that athletes must walk every day. Exercise can trigger hypoglycemia during or hours after activity, a phenomenon known as the "lag" effect that catches many athletes and coaches off guard. Meanwhile, illness, stress, or forgetting insulin can cause hyperglycemia that impairs performance and threatens health. Coaches do not need to become endocrinologists, but they must absorb a few critical concepts to keep their athletes safe.

  • Hypoglycemia (below 70 mg/dL) impairs coordination, cognition, and consciousness. Early signs include shakiness, sweating, irritability, and hunger. If untreated, it progresses to confusion, seizure, and unconsciousness. Brain function begins to degrade within minutes of blood glucose dropping too low.
  • Hyperglycemia (above 250 mg/dL) causes thirst, frequent urination, fatigue, and blurred vision. Prolonged high blood sugar with ketones can lead to diabetic ketoacidosis (DKA), a life-threatening emergency that requires immediate medical intervention.
  • Insulin timing and food intake directly affect glucose before, during, and after exercise. Knowing when an athlete typically checks or eats helps everyone anticipate needs and avoid conflicts with practice schedules.

Different sports impose different demands on glucose metabolism. Endurance sports like cross-country or swimming present a steady, prolonged glucose draw that requires careful carbohydrate timing. Sprint or power sports may cause sharp drops after intense bursts of activity because of how the liver and muscles respond to anaerobic effort. Coaches should understand these nuances so they can adjust expectations and support accordingly. The JDRF (Juvenile Diabetes Research Foundation) offers sport-specific tips for athletes and their teams that provide detailed guidance for everything from wrestling to cheerleading.

Key Education Topics for Coaches and Teammates

Recognizing Symptoms – Beyond the Basics

Classic low blood sugar signs are well-known, but coaches must recognize subtle changes that often appear first. An athlete who becomes unusually quiet, clumsy, argumentative, or tearful may be experiencing neuroglycopenia—a shortage of glucose in the brain that alters behavior and cognition before physical symptoms become obvious. Watch for these warning signs during every practice and game:

  • Pale skin, sweating, or chills in neutral weather conditions
  • Dizziness, headache, blurred vision that does not resolve with rest
  • Slurred speech or inability to follow simple commands that the athlete normally executes without issue
  • Rapid heart rate or visible tremors in the hands or legs
  • Personality changes – confusion, frustration, apathy, or sudden withdrawal from teammates
  • Stumbling, loss of coordination, or difficulty gripping equipment

For hyperglycemia, watch for excessive thirst that goes beyond normal exercise-related thirst, frequent bathroom breaks that interrupt practice flow, unusual fatigue disproportionate to exertion level, and a fruity breath odor that signals ketone production. Teammates who notice these signs should alert the coach or athletic trainer immediately without waiting for the athlete to self-report. Role-playing these scenarios during preseason meetings builds recognition and reduces hesitation when real symptoms appear. The more familiar the signs become, the faster the response.

Emergency Response – Speed and Clarity Are Everything

During a severe hypoglycemic event, every second counts. Coaches must know exactly where the athlete's emergency kit is stored and how to use every item inside it. Standard protocol for managing a diabetic emergency follows a clear sequence that anyone can learn with practice:

  1. Check blood glucose if the athlete is conscious and able to cooperate. Below 70 mg/dL: give fast-acting carbohydrates immediately—glucose tablets, juice, or regular soda work best because they enter the bloodstream quickly.
  2. Recheck after 15 minutes. If still low, repeat the treatment. The "15-15 rule" is standard: consume 15 grams of carbohydrate, wait 15 minutes, and reassess. If the athlete is unconscious or unable to swallow, do not give anything by mouth—administer glucagon (nasal or injectable) and call 911 without delay.
  3. Stay with the athlete until help arrives. Never leave them alone, even for a moment. Position them on their side if unconscious to protect the airway in case of vomiting.

Teammates should know they cannot "over-treat" low blood sugar with oral carbohydrates in the moment—the immediate danger is brain starvation, not a temporary spike. Practice with training glucagon kits removes the hesitation that costs precious time during real emergencies. Every coach and captain should know how to administer glucagon without having to read instructions in a crisis. The Association of Diabetes Care and Education Specialists provides training materials specifically designed for non-medical personnel in school and sports settings.

Monitoring Blood Sugar Around Activity

Continuous glucose monitors (CGMs) and flash sensors like Dexcom and Libre are common among young athletes and provide real-time data that can prevent emergencies before they begin. Coaches should understand the basics of interpreting this data: trend arrows show direction and speed of glucose change. A downward arrow means glucose is falling quickly, even if the current number appears to be in range—the athlete may need a snack before starting exercise or may require a break during activity. Teammates must respect that checking a receiver or performing a finger-stick is essential self-care, not laziness or distraction. Pausing a drill for thirty seconds to allow a glucose check is far better than dealing with a collapse that sidelines the athlete for the rest of the season.

Coaches should also understand the limitations of these devices. Sensors can sometimes lag behind actual blood glucose levels by ten to fifteen minutes, especially during rapid changes. Finger-sticks remain the gold standard for accuracy in critical moments. Athletes may need to calibrate their devices or change sensors periodically, which requires access to supplies and a clean surface. Create a space in the locker room or on the sideline where athletes can perform these tasks privately and efficiently without feeling rushed or watched.

Medication Management and Exercise Timing

Insulin magnifies exercise's glucose-lowering effect, sometimes dramatically. Many athletes reduce their insulin dose or eat extra carbohydrates before practice to compensate for the increased glucose demand. Coaches can support this process by asking simple, non-intrusive questions like, "Did you check your glucose? Did you eat enough?" without prying for specific numbers or medical details they do not need. They should never pressure an athlete to share medical data unless the athlete volunteers it willingly. Understanding that an insulin pump can be disconnected for short periods of activity (with guidance from the athlete's healthcare team) reduces fear around equipment and prevents athletes from skipping necessary insulin doses out of embarrassment or inconvenience.

Timing matters enormously. An athlete who takes rapid-acting insulin too close to practice may experience a dangerous drop in glucose midway through the session. Conversely, an athlete who skipped a meal before exercise may start practice with low glycogen stores and insufficient fuel. Coaches who build flexibility into their practice schedules—allowing athletes to eat a snack fifteen minutes before warm-ups, for example—remove unnecessary barriers to safe participation.

Building a Supportive Team Culture

Normalize Diabetes Conversations

When diabetes is treated as a normal part of team life, athletes feel safe enough to check their glucose, treat lows, and speak up when something feels wrong. Start by letting the athlete, if comfortable, lead a brief talk at the beginning of the season about what teammates should know: what a low feels like for them personally, where their supplies are kept, and how teammates can help. This simple act breaks the ice and empowers everyone with the knowledge they need to act effectively. Follow up with a team meeting that includes the athletic trainer or a diabetes educator to reinforce the information and answer questions teammates may be hesitant to ask in front of the athlete.

Make diabetes awareness part of the team's identity, not an afterthought. Include reminders in pre-game huddles, post-practice debriefs, and team communications. When the culture normalizes these conversations, athletes with diabetes no longer feel like they are asking for special treatment—they feel like valued members of a team that supports each other unconditionally.

Use Inclusive Language

Avoid phrases like "You again?" or "Is it really that bad?" when an athlete needs to stop for a glucose check or treatment. These comments, even when intended as jokes, create shame and encourage athletes to hide their symptoms to avoid judgment. Instead, adopt language that reinforces support and teamwork: "Good job checking. Let us get you treated and back in the game." Teammates can offer to walk with the athlete to get water or snacks, demonstrating solidarity rather than frustration. This small gesture reduces the psychological load of managing a chronic condition in a competitive environment where the pressure to perform is already intense.

Coaches should model inclusive language consistently and correct teammates who use dismissive or judgmental phrasing. When the coach sets the standard for respect, the rest of the team follows. Over time, supportive language becomes automatic, and the athlete no longer has to advocate alone for their basic medical needs.

Address Stigma Head-On

Fear of being perceived as "weak," "different," or "a burden" leads athletes to hide symptoms, skip glucose checks, or delay treatment. This behavior is dangerous and can turn a manageable situation into a medical emergency. Coaches must publicly affirm that taking care of diabetes is part of being a strong, responsible athlete—not a sign of weakness. When the team culture values health over pride, compliance improves and emergencies drop dramatically.

Share stories of successful athletes who manage diabetes at elite levels. From professional soccer players to Olympic swimmers, many high-performing athletes thrive with diabetes and credit their management routines for their success. These examples show young athletes that diabetes does not limit their potential and that taking care of their health is the foundation of athletic achievement, not a barrier to it.

Developing a Comprehensive Diabetes Action Plan

A written plan tailored to each athlete is non-negotiable for safe participation in sports. This plan should be developed collaboratively with the athlete, their family, and their healthcare team before the season starts, and it should be reviewed and updated regularly. Key components of an effective action plan include:

Pre-Activity Preparations

  • Target blood glucose range before exercise, typically 100–200 mg/dL for most athletes, though individual targets may vary based on healthcare provider recommendations
  • Insulin dose adjustments for that day's specific activity, accounting for exercise type, intensity, and duration
  • Timing of meals and snacks relative to practice start times
  • Hydration plan, since dehydration raises blood glucose and increases the risk of hyperglycemia
  • Weather considerations—heat and cold can both affect glucose metabolism and insulin absorption

During-Activity Monitoring

  • Frequency of glucose checks, such as every thirty minutes during practice or at natural breaks in competition
  • Signs that indicate the athlete should stop and check their glucose immediately
  • Clear designation of who is responsible for reminding the athlete to check (coach, athletic trainer, or the athlete themselves)
  • Protocol for notifying parents or guardians if glucose values fall outside the target range
  • Plan for handling competition-day stress, which can elevate glucose independently of food and insulin

Post-Activity Considerations

  • Risk of delayed hypoglycemia up to twelve hours after intense exercise, often occurring during sleep
  • Requirement to check glucose before driving home or riding the team bus—low glucose after exercise is a significant safety risk behind the wheel
  • Communication plan, such as texting post-workout reading to parents or guardians
  • Evening snack recommendations to prevent overnight lows
  • Strategy for adjusting insulin doses after particularly strenuous workouts or tournaments

The plan should be reviewed at least once per season or whenever treatment changes occur. Templates for creating these plans are available from the Association of Diabetes Care and Education Specialists and can be customized for individual athletes and specific sports.

Practical Safety Measures for the Sports Environment

Maintain an Accessible Emergency Kit

Every team should have a clearly labeled "Diabetes Emergency Kit" that travels to every practice, game, and tournament, no exceptions. The kit must be accessible at all times—never locked in a coach's office, storage closet, or vehicle trunk. Contents should include:

  • Glucose tablets, gel, or hard candy providing at least 15 grams of fast-acting sugar per serving
  • Juice box or can of regular soda for athletes who prefer liquid treatment
  • Glucagon nasal powder like Baqsimi or injectable glucagon kit with clear instructions attached
  • Blood glucose meter with extra test strips, lancets, and batteries
  • Ketone test strips to check for DKA risk when glucose runs high
  • Longer-acting snacks such as granola bars, peanut butter crackers, or trail mix for stabilizing glucose after the low is corrected
  • Cell phone with emergency contacts programmed and readily accessible
  • List of medications the athlete is currently taking, including dosages and timing

Assign one coach as the designated "kit keeper" responsible for checking supplies weekly and restocking items that have been used or expired. The kit should be inspected at the start of each season and before every away game or tournament trip. A laminated inventory checklist inside the kit makes restocking quick and reliable.

Coaches must be flexible and responsive to real-time glucose data. If an athlete's CGM shows a downward trend, allow a five-minute break to treat and wait for glucose to rise before resuming intense activity. If glucose is above 250 mg/dL with ketones present, strenuous activity can worsen hyperglycemia and increase the risk of DKA—the athlete may need to sit out until glucose comes down under medical guidance. A great coach says, "Let us check your sensor and see how you are doing," rather than insisting on completing every drill regardless of medical risk.

Build this flexibility into your practice plans from the start. Design drills that allow athletes to step out temporarily without disrupting the entire session. Create a system where the athlete can signal a need for a break without drawing attention or feeling embarrassed. When the structure supports medical needs, athletes with diabetes can participate fully without compromising their safety.

Incorporate Technology for Real-Time Safety

Many athletes now use smartphones or smartwatches to display CGM data from devices like Dexcom and Libre. Some apps allow selective sharing of glucose readings with coaches through features like Dexcom Follow. With the athlete's written permission, a coach can view glucose trends during practice and competition—never for judgment or performance evaluation, only for safety monitoring. This capability is a game-changer for early detection of dangerous trends before symptoms appear.

Technology also enables better communication between athletes and medical support staff. Some teams use encrypted messaging apps to share glucose data with athletic trainers during practice. Others use shared digital dashboards that display multiple athletes' data simultaneously. Whatever system your team adopts, ensure it respects privacy, obtains proper consent, and never shares medical data publicly. The goal is safety, not surveillance.

Coaches should understand basic privacy laws including HIPAA and FERPA and obtain written consent before receiving any medical information about an athlete. The diabetes action plan and emergency cheat sheet should be kept in a secure but accessible location—available to those who need it, but not posted on a public bulletin board or shared widely without permission. Never post sensitive information where others can see it accidentally.

Respect the athlete's right to keep their condition private if they choose, but encourage them to share enough information to stay safe. Some athletes prefer that only the coach and athletic trainer know their medical details, while others are comfortable with the whole team knowing. Follow the athlete's lead and adjust your communication approach accordingly. Document all consent forms and action plans in the athlete's file for liability protection and continuity of care.

Strategies for Effective Education

Healthcare-Led Workshops

The most impactful education comes from qualified professionals who can answer questions accurately and demonstrate techniques with authority. Invite a certified diabetes care and education specialist (CDCES) or local endocrinologist to lead a thirty-minute preseason session for coaches, athletic trainers, and team captains. Cover symptom recognition, glucagon administration, and common misconceptions about diabetes and exercise. Allow time for questions and role-playing scenarios. The CDC's diabetes and sports guidelines provide a ready-to-use framework for structuring these sessions with evidence-based content.

Hands-On Training with Emergency Supplies

People remember what they practice far more reliably than what they read or hear. Distribute training glucagon kits that contain saline instead of active medication and have everyone simulate an emergency response: "Your teammate slumps over on the sideline. What do you do?" Walk through the steps in real time, from checking responsiveness to administering glucagon and calling 911. Step-by-step practice builds muscle memory that overrides panic when real emergencies occur. Also practice using a blood glucose meter on a training arm so that everyone on the coaching staff knows how to get a reading quickly and accurately.

Create a Diabetes Cheat Sheet for the Dugout

Laminate a one-page reference card that lives in the coach's clipboard, team bag, and athletic trainer's kit. This cheat sheet should include:

  • The athlete's typical low and high symptoms, described in the athlete's own words if possible
  • Emergency kit location and contents
  • Step-by-step instructions for using glucagon with simple diagrams
  • Emergency contacts including parents, physician, and nearest hospital
  • Athlete's preferred treatment foods and glucose targets
  • Clear "do not" notes—such as never give insulin to treat a low, and never give oral carbohydrates to an unconscious person

Distribute the cheat sheet to every assistant coach, team manager, and volunteer who may be responsible for the athlete's safety. Obtain athlete and family approval on all content before distributing it, and update the sheet whenever treatment protocols change.

Leverage Video and Online Resources

Short video modules are highly effective for delivering consistent baseline education to large groups. The American Diabetes Association's "Safe at School" series includes sports-specific modules that cover everything from glucose monitoring during competition to managing diabetes on overnight tournament trips. Assign a short video as preseason homework for all coaching staff, then discuss key takeaways at a team meeting. Video-based learning ensures that every coach receives the same foundational knowledge regardless of their prior experience with diabetes. Supplement videos with written resources that coaches can reference throughout the season.

Managing Diabetes During Competition and Travel

Game-Day Protocols

Competition days introduce variables that can disrupt even the most consistent diabetes management routines. Adrenaline and stress hormones can raise blood glucose significantly, while the unpredictability of game schedules can delay meals and snacks. Coaches should work with athletes to establish game-day protocols that account for these factors. Pre-game meals should be timed to allow for proper digestion and glucose stabilization. Halftime and break periods should include opportunities for glucose checks and quick snacks if needed.

Tournament days are especially challenging because multiple games stretch across many hours with limited access to food, rest, and medical supplies. Create a tournament checklist that includes all diabetes supplies, backup batteries for devices, and emergency snacks. Assign a point person—usually a coach or parent—who tracks glucose trends across the day and communicates with the athlete about when to eat, check, and rest. The goal is to remove the mental burden of diabetes management during competition so the athlete can focus on performance.

Travel Considerations

Travel for away games and tournaments adds complexity to diabetes management. Changes in time zones affect insulin timing and meal schedules. Different food options at restaurants or concession stands may not match the athlete's usual eating plan. Coaches should plan travel itineraries with diabetes management in mind, building in time for meals, glucose checks, and rest stops. Communicate with host teams or tournament organizers about access to refrigeration for insulin and clean spaces for glucose testing.

Air travel presents additional challenges. Insulin and diabetes supplies should always be carried in a personal bag, never checked in luggage. Athletes traveling with insulin pumps or CGM devices need to navigate airport security procedures, which may require advance notification and documentation. Coaches traveling with athletes who have diabetes should carry copies of the athlete's action plan, medication list, and emergency contacts in case the athlete becomes separated from their supplies or needs medical attention away from home.

Conclusion: Ongoing Education Saves Lives

Diabetes education is not a one-time event that can be checked off a preseason to-do list. Each season brings new coaches, new teammates, new schedules, and new challenges. The athlete's treatment plan may change as they grow, switch medications, or adjust their training regimen. Commit to an annual preseason refresher for all coaching staff and returning teammates, and provide comprehensive onboarding for new team members who join mid-season. Keep emergency plans current with updated contact information and treatment protocols. Maintain open lines of communication with the athlete, their family, and their healthcare providers throughout the season.

The payoff for this ongoing investment is immense. Athletes with diabetes can compete safely, confidently, and at their full potential, knowing that everyone around them is prepared to support them. Teams that prioritize diabetes education build a culture of awareness, respect, and mutual care that benefits every member. For more resources and continuing education, explore the American Diabetes Association's sports and activity hub and the National Athletic Trainers' Association diabetes guidelines for evidence-based practices that keep athletes safe and performing at their best.