Hockey is one of the most physically demanding sports. It is a sport that requires players to be in top shape as they fly down the ice and move the puck at even higher speeds, while simultaneously trying to outhit the opposition. It is hard enough to be in shape at baseline. When players have a chronic disease, how do they cope? Each player has their own struggles but for me, it has been type one diabetes. I wanted to provide some insight on what I have learned and how I have adjusted with the hopes of helping others in similar situations. *NOTE this is not intended to be medical advice and you should always check with your licensed physician when it comes to treatment of type one diabetes or any other disease.
Type One Diabetes for a Hockey Player
Diabetes is a chronic disease where a person’s pancreas does not produce a hormone called insulin, or produces an insufficient amount. At a high level, insulin is used to breakdown carbohydrates in the body to provide energy to the body. When your pancreas does not regulate the blood sugar level in the body, you have to do it manually. This will lead to both high blood sugars and low blood sugars, which are not optimal for physical activity. This disease also makes a person more susceptible to sickness and increases the time it takes for their body to heal from injury.
Players with Diabetes
As this disease touches over 37 million people in United States and their families, professional hockey players are not immune. Former Philadelphia Flyer Bobby Clarke played with type one diabetes in the 70s and 80s. Diagnosed as a teenager, he decided early on he would take care of himself. And it paid off as Clarke had a magnificent career. That is really impressive given his lack of the advancements in modern medicine we have now.
Currently, Max Domi, son of former NHLer Tie Domi, is playing with type one diabetes. In addition, he has celiac disease which makes him intolerant to gluten. Domi wrote an excellent book about his experience with diabetes and what he has done to overcome the challenges it poses. The book really explained the frustrations he had getting the disease and how he has adjusted to make it to the NHL. It is called “No Days Off” and is a perfect title as there truly are no days off with diabetes. I highly suggest giving it a read. Clarke and Domi show that while this disease is a hurdle, it can be overcome with intentionality.
My Experience
I was diagnosed with diabetes at age ten. At first, it felt like an earth-shattering moment. And it was but not in the ways a ten-year-old felt. At the time my thoughts were “I can’t eat sugar” and “I have to take shots.” (This was pre pump days). But while those were either not true or something that turned out to not be a big deal at all, what diabetes did do is force a lifestyle change with no time off.
Now I am not a doctor. But I do have pride in my management of diabetes and consistently have an A1C level of six or below. A1C is basically a measure of your average blood sugar over a period of time.
Every moment, diabetes is affecting my life. When I sleep, when I work, when I am on a plane, it doesn’t matter. Every time I eat there is a mathematic equation going on in my head. Not just how many carbohydrates are in this food but also what type of carbohydrates (complex, simple, etc.), how much fat or protein because it affects the timing of how insulin works and what else is going on at that time.
For the third consideration, I mean did I just exercise, am I getting ready to exercise, am I stressed, am I going to an event where it will be a little trickier to correct a low blood sugar. Many times, it is not being unable to eat what I want, but having to eat when I don’t want to that is frustrating. These are all considerations that are at play all of the time.
Diabetes and Exercise
When it comes to exercise, it depends on the activity and what else is going on. It is important to keep in mind that the way each person’s body reacts to exercise can be different. For me, if I am doing something that is longer lasting but more moderate like bike riding my blood sugar tends to drop during activity. Sometimes, my blood sugar will then raise after I finish. Low blood sugar makes you feel light headed, without any energy, and overall just weak and empty. When my blood sugar drops, I have to stop what I am doing and eat or drink something to correct.
If I am playing a high intensity sport like hockey, my blood sugar has actually done various things. In organized games when my ice time is more controlled, I have experienced my blood sugar rising while playing. High blood sugar also depletes your energy but it is different to me than low. You almost feel too full and a lot of times your muscles will feel very fatigued or even cramped. At that point you have to take insulin. But it is very tricky because if you drop too far then you are out again. Meanwhile, if I play more of a pickup game where I am on the ice more consistently my blood sugar tends to drop.
So What Do You Do?
When it comes to playing hockey with diabetes, there are a few things that every player should do. There are also a few tricks and tips I have picked up that may require more personal consideration.
Use Your Tools
First, I currently use a Dexcom G6 continuous glucose monitor system and the Omnipod 5 insulin pump. (I am not being paid to promote these. I have used various versions of the Omnipod for years as well as the Freestyle Libre CGM). The Dexcom and Ominipod 5 talk to each other so that they can regulate my blood sugars automatically. If it goes high, the reading goes to the Ominipod and it can give me insulin or if it goes low it can suspend my insulin. Note there is nothing that actually raises my blood sugar here. That is still manual. I also can set it up in an “Activity” setting which keeps my target blood sugar a little higher than normal for a temporary amount of time.
This system works very well for me, especially considering that I started with insulin shots and manual finger pricks. The Dexcom not only constantly tells you your blood sugar by simply looking at the Omnipod 5 device or phone, it tells you which way you are trending so you have an idea how to act. The target blood sugar levels are set with assistance from my physician.
There are other automatic insulin pumps made by various companies but the thing I like about these is they are wireless. I wear a pod and a CGM sensor that speak with my phone and device wirelessly. This is nice for playing hockey as I do not have to wear the pump but can keep the device on the bench with me. Wearing the pod and sensor have never given me any issues even in the physicality of hockey.
The downside is that there are times where the connection can get lost or bad and so you have to act manually, but that is not the norm. Whenever I play hockey, I set my Omnipod 5 to the activity setting at least an hour before playing and keep it through the duration of activity. I do this unless I am having trouble lowering my blood sugar and it is high. The activity feature works so that it keeps it at a higher level but not too high either. So it will kick in insulin if needed.
This is step one for me – utilize the best devices I can so that I can have all the information necessary to make adequate decisions and even in this case take some of the decision out of my hands. It keeps the blood sugar regulation happening instantly.
Don’t be Afraid to Over Communicate
Next, you always want to let people know about your condition when playing hockey with diabetes. The obvious people are the coaches and if you have a team trainer. Depending on the level of hockey you are playing, the trainer or other team associated medical personnel may actually be able to assist you in management while playing. Just keep in mind that you are in control, if you are feeling off you need to listen to your body. Even in adult league hockey I make sure to let my teammates know in case something were to happen. I feel pretty self sufficient but being too careful is not wrong in this situation.
Aso be very candid with your healthcare provider. Your doctor is there to help you. Even though he or she may not be a hockey expert, they can assist you with advice for managing diabetes and maybe even connect you with an expert. There are also organizations you can get involved with including the Juvenile Diabetes Research Foundation. Connect with the people around you.
Diet for Playing Hockey with Diabetes
Diet for a diabetic is key and takes a lot of discipline. For hockey players, you sort of have two sides to consider when it comes to dieting: the best for the player as a diabetic combined with the best for the player as an active player.
Hockey Diet
If you look at diet advice for any hockey player, some of the keys are eating a lot of protein, making sure to take in enough carbs and the right carbs at the right time, and keeping your hydration and electrolytes up. This oversimplifies it but that is the gist. Then depending on the time of year and your goal, that can affect caloric intake and other pieces of your diet.
Diabetic Diet
For a normal diabetic, the key to diet in my opinion is balance. You see all of these different diets that people do like keto, paleo etc. I suppose you could utilize one of them as a diabetic but I never have. In that case I would talk with a doctor. But for me balance and portion are key. In a normal meal I try to hold to the 80% fruits, vegetables and grains to 20% meat plan. This is not strict for me, but the idea is that the plate is balanced. I want lean protein and then some vitamins and fiber from veggies.
Hockey with Diabetes Diet
Playing hockey with diabetes, you still follow these principles in my experience. I always try to take in protein after playing or working out. Sometimes in supplements and sometimes in the form of actual food like chicken or turkey. I am constantly drinking water and try to also take in electrolytes either via a banana or a drink prior to, during and after play. I also drink coffee throughout the day because frankly I love it. That seems to work for me as long as I also hydrate enough. Again, I am not a nutritionist or trainer so this is all based on my personal experience.
This holds true for an active hockey player with diabetes. In my experience the key is to think about your day and the timing of your food. If it is game day or a hard training day, I let myself eat higher carbohydrate and calorie meals and snacks. This needs to be combined with a lot of protein as well. But the key is still balance. If your blood sugar is hanging around 250 all day that doesn’t mean you should eat a bowl of pasta because you have a game that night. You can, but you ideally need to get your blood sugar to level off first.
How I Time My Food and Drink Intake
As far as timing of meals and snacks, there really is a balancing act requiring listening to your body and acknowledging how your day is going. The timing comes in stages related to hockey.
Pre-Game
Before playing hockey I try to eat a meal about two to three hours before playing if it is a full meal. A heavier snack may be more in the one to two hour range and light snacks can be shortly before playing. The key to me as a diabetic is that: 1) your body has enough time to process the protein, fat and complex carbs to give you the energy you need to play; and 2) that your insulin has time to do what it needs to so that while you are playing your blood sugar does not all of a sudden drop. I have had that happen and it is very frustrating.
After two and half to three hours if your blood sugar is still high or low, I would adjust at that point but keep in mind what typically happens when you play in considering that adjustment. The timing is very tricky and sometimes you have to just try and learn how your body acts. It depends on the amounts and types of protein, fat and carbs your meal includes as well as other factors like stress and adrenaline that affect the effects and timing of the food.
During Play
During play, I keep a bottle of water, a bottle of Gatorade and my Omnipod 5 device on the bench with me. If my blood sugar is where I want it to be staying level (or high) I drink water. A no sugar electrolyte drink or BCAA mix could be used as well. If I start going below my target blood sugar level, I use the Gatorade. Whatever you have you want it to be something that is a simple carbohydrate that will be fast acting. But every time I come to the bench, I look at my blood sugar and make an assessment. If you have a trainer, they can help with this too. The advancements to CGMs have really helped make monitoring blood sugar while playing a lot easier.
Post Game
Post game I try to take in electrolytes and protein. If my blood sugar is low then I will get my electrolytes via a drink like Gatorade. Otherwise, I use a non-sweetened drink. Many times, I finish a game with low blood sugar and then I have a spike. This I just have to monitor and keep in mind when planning a post-game meal or snack.
Realities and Concluding Thoughts for Hockey with Diabetes
The realty of playing hockey with diabetes is that the more intentional and responsible you are, the better. Utilize the people around you like doctors, nutritionists, medical trainers etc. but listen to your own body. Any serious hockey player is going to be monitoring their nutrition to some degree. As a diabetic, I have been monitoring my nutrition fairly strictly since being diagnosed at age ten. But you also have to live your life. Don’t avoid a piece of pizza or candy bar. But maybe you make sure you cover it with adequate insulin and consider what else you eat the rest of that day and maybe the next. So, you don’t cut yourself off, you just adjust. That is the key that I have found.
Even though diabetes can be frustrating and tough to manage, I also believe it can teach you a lot. Ultimately, I have come to the realization that most of us have something we have to overcome. Whether it is physical, external, mental, emotional, whatever the case may be, it is up to you to control what you can. Likewise, you minimize stress over what you cannot. I tried to use the diligence and responsibility I was forced to learn from having diabetes at a young age to carry over into my hockey training and wellness. I always sought to be the first on the ice and last off. Sought to never miss optional practices or off-ice trainings. And I was always intentional about what and when I ate.
Someone like Max Domi can have a personal nutritionist, trainer, and chef right there helping them along the way. But for most of us, it is truly up to us. How bad do you want to succeed? And maybe more importantly, how important is long term health to you? This is not to pat myself on the back. I will be the first to tell you my hockey career was not glamorous. But I have pride in what I accomplished when many odds were stacked against me. And I still enjoyed life. I had pizza, I had sweets. But maybe I tried to exercise more those days or maybe I look for alternate ingredients in those foods.
I sincerely hope that for any hockey player with diabetes, a parent with a child with diabetes, or maybe a player with some other disease, they can use this as an opportunity to learn and grow. Just remember, diabetes is a hurdle, not an iron gate. It’s up to you to jump it.
Post image attribution: By Jenn G, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons
