A kid on the team has type 1 diabetes. Most of the time you don’t even notice. Sometimes a practice runs long, the kid hasn’t eaten, blood sugar drops, and the kid goes pale and starts acting strange. The protocol below is what you do.
Type 2 diabetes in kids is also rising and changes the picture in different ways. Most of what’s below applies to T1D specifically.
The plan you need on file. A kid with T1D should have a written Diabetes Medical Management Plan from their endocrinologist or pediatrician. The plan covers target blood sugar ranges, insulin dosing, what to do for low (hypoglycemia) and high (hyperglycemia) events, and emergency contacts. The plan should be on file with the team manager.
If your kid has diabetes and there is no written plan on file, that is the homework before the next practice.
Hypoglycemia (low blood sugar) is the immediate emergency. Exercise, missed meals, or a recent insulin dose can drop blood sugar below 70 mg/dL. The signs:
- Shakiness, sweating, clammy skin
- Headache
- Hunger
- Confusion, irritability, “out of it” behavior
- Slurred speech
- Loss of coordination
- Seizure or unconsciousness (severe)
A kid with T1D who is “off” mid-practice is hypoglycemic until proven otherwise. Speed matters because severe hypoglycemia can produce seizure and unconsciousness.
The 15-15 rule. ADA-published protocol for conscious mild-to-moderate hypoglycemia.
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Stop activity. Sit the kid down.
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Give 15 grams of fast-acting carbohydrate. Standard options: 4 ounces of juice, 6 ounces of regular (not diet) soda, 4 glucose tablets, a tube of glucose gel, 1 tablespoon of sugar or honey.
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Wait 15 minutes. Re-check blood sugar if a meter is on hand.
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If still low, repeat with another 15 grams. If above 70, give a longer-lasting snack (peanut butter and crackers, a granola bar) and continue rest.
The kid does not return to play immediately even if blood sugar normalizes. Wait at least 15 to 30 minutes after recovery, eat a longer-lasting snack, and clear with the parent.
Severe hypoglycemia (unconsciousness, seizure, can’t swallow). Different protocol. Do not put anything in the kid’s mouth — aspiration risk.
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Call 911 immediately.
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Administer glucagon if the kid’s plan includes it and you are trained or have written authorization. Glucagon comes as injection (Glucagen Hypokit) or nasal spray (Baqsimi). Most diabetic kids’ families carry one or both.
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Place the kid on their side (recovery position).
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Stay with the kid until EMS arrives.
The team should know in advance whether the kid has glucagon on site, where it is, and which adults are authorized to administer.
Hyperglycemia (high blood sugar) is the slower emergency. Skipped insulin, infection, or stress can drive blood sugar above 250 mg/dL. The signs:
- Excessive thirst
- Frequent urination
- Fatigue
- Fruity-smelling breath (sign of diabetic ketoacidosis, DKA)
- Nausea, vomiting
- Confusion (severe)
Sustained hyperglycemia with vomiting, fruity breath, or confusion is DKA territory and a medical emergency. Call 911 or get the kid to the ER. DKA is the more common diabetic-emergency hospital admission for kids.
Pre-game and pre-practice management. Most T1D kids manage this routinely. The standard pattern:
Check blood sugar before activity. If below 100, eat a snack. If above 250 with ketones, hold off on activity per the plan.
Have fast-acting carbs on the bench. Glucose tablets, juice, sports drink. Some kids prefer specific brands; the parent will tell you.
Recheck blood sugar mid-practice for long sessions, particularly two-a-days or tournament days.
Hydrate. Hyperglycemia is partly a hydration issue.
For coaches.
Know which kids have T1D. Know where their fast-acting carbs and glucagon live during practice. Know the parent’s phone number.
Treat low first. When a kid is acting strange and you are not sure, treat as if hypoglycemic. The cost of wrong is small (a juice box). The cost of missing it is large.
Read the Diabetes Medical Management Plan once at the start of the season. Five minutes.
The honest read. Diabetic emergencies in youth sports are rare in raw count and almost always recoverable when handled fast. The kids who play the longest and the safest with T1D have parents who built the plan, coaches who read it, and teammates who know to call an adult fast.
If this content is reaching someone whose kid is currently low and they cannot raise the blood sugar, call 911. The 15-15 rule is for mild events.