When my son Makar was four years old and diagnosed with Type 1 Diabetes, I remember thinking: Will he ever be able to play sports?
Fast forward five years, and he’s skating three times a week with his travel hockey team, competing in tournaments across multiple states, and honestly? He’s thriving. Not despite his T1D—but managing it well while doing something he loves.
After 21 years of parenting two kids with Type 1 Diabetes, I’ve learned that T1D and sports aren’t mutually exclusive. They’re not even particularly difficult together once you understand the mechanics of how exercise affects blood sugar and plan accordingly. My daughter played soccer and ran track. Makar lives and breathes hockey. Both have had completely normal, athletic childhoods.
The secret? It’s not about preventing your child from playing sports. It’s about learning to manage their diabetes while they play—and that’s absolutely doable.
Why Sports Are Good for Kids with Type 1 Diabetes
Let me start here, because this is important: Your T1D child should play sports. Full stop.
Physical activity is one of the most powerful tools we have for managing diabetes over the long term. Here’s why:
Better insulin sensitivity. Exercise makes your child’s body more responsive to insulin, which can mean more stable blood sugars overall and potentially lower insulin doses over time.
Improved cardiovascular health. Kids with T1D have a higher risk of cardiovascular disease, but regular exercise significantly reduces that risk.
Mental health benefits. The confidence, social connection, and sense of accomplishment that come from being part of a team or pursuing a sport can’t be overstated—especially for a kid managing a chronic illness.
Better long-term glucose management. Kids and teens who are active typically have better A1Cs and fewer complications down the road.
Normalcy. And honestly? The biggest benefit might be this: sports let your kid be a kid. Not a diabetic kid. Just a kid who plays hockey and checks her blood sugar, not a kid whose whole identity is wrapped up in her diabetes.
I’m not going to pretend there aren’t logistical challenges. There absolutely are. But they’re manageable challenges, and every single one of them has solutions that we’ve tested and refined over years of experience.
Understanding Blood Sugar During Exercise
Before we talk about strategies, you need to understand what exercise does to your child’s body.
Aerobic exercise (running, soccer, basketball, hockey, cycling) causes blood sugar to drop—sometimes dramatically. During steady aerobic activity, your child’s muscles burn glucose rapidly, and their body uses insulin more efficiently. If your child is on a pump, they might need 30-50% less insulin during aerobic exercise.
Anaerobic exercise (sprinting, weight lifting, intense intervals) can actually cause blood sugar to rise in the short term because the body releases counter-regulatory hormones (adrenaline, cortisol) that increase glucose production. But it’s usually followed by a longer period of increased insulin sensitivity afterward.
Mixed sports (like hockey) are tricky because they combine both. Hockey is largely aerobic with sprints and intensity bursts mixed in, which means Makar’s blood sugar can do somewhat unpredictable things during a game.
Post-exercise delayed hypos are the real wildcard. This is when your child’s blood sugar drops 4-12 hours after exercise ends, sometimes dramatically. This happens because the muscles are still pulling glucose to refill their glycogen stores, and the body’s insulin sensitivity remains elevated. This is why we often see lows overnight after a hockey game or tournament day.
Understanding these patterns in your child specifically is key. Every kid’s body is slightly different, and what works for Makar might need adjustment for another child. But these are the general principles you’re working with.
Pre-Game Preparation Checklist
Game days require planning. Here’s what we do before Makar hits the ice:
2-3 hours before game time:
- Check blood sugar. We want him between 150-200 mg/dL when he starts playing.
- If he’s trending low, give a small snack (15g carbs) and recheck in 15 minutes.
- If he’s trending high, we might reduce his pre-activity insulin slightly, or do nothing and let the exercise bring it down.
- Ensure Omnipod is securely placed. (More on placement below.)
- Check Dexcom is working and we have our phone/receiver.
45 minutes to 1 hour before:
- Have him eat a balanced pre-activity snack. For Makar, this is usually something like:
- Half a bagel with peanut butter, or
- A granola bar + cheese stick, or
- Apple with almond butter
- We aim for 20-30g carbs + some protein/fat, which won’t spike his blood sugar but will sustain him through the activity.
- Reduce basal insulin if he’s using an insulin pump. On Omnipod 5, we use the “Exercise” activity setting if available, which automatically reduces basal rates during the selected time window.
15 minutes before:
- Final blood sugar check with Dexcom (or finger stick if needed).
- Have fast carbs accessible on the sidelines (juice box, glucose tablets, regular soda).
- Make sure the coach or team staff knows he has diabetes and has easy access to his emergency supplies.
Right before the game:
- One last Dexcom check. We want visibility into what his blood sugar is doing.
What to Pack in the Sports Bag
I learned the hard way what we actually need. Here’s the non-negotiable list:
- Dexcom receiver or phone (with high-volume alarms enabled—you need to hear them over crowd noise)
- Omnipod supplies (extra pod, batteries if applicable, adhesive patches, tape)
- Fast-acting carbs: Juice boxes, glucose tablets, fruit pouches, regular soda, honey packets
- Sustained carbs: Granola bars, pretzels, fruit, crackers
- Protein sources: Cheese sticks, nuts, peanut butter packets
- Blood sugar meter and strips (backup in case Dexcom fails)
- Finger-stick lancets
- Wet wipes (clean hands before checking blood sugar)
- Glucagon kit (hopefully never needed, but required)
- Insulin pen or backup pump supplies (if using a pump backup system)
- Carb counting reference (I have a laminated card in Makar’s hockey bag)
- Medical ID bracelet (always, everywhere)
We also keep a “game day box” at home that travels to every tournament. It has everything we might need for a full day of hockey, including backup supplies for if something fails.
Pump Management During Sports: Why Tubeless Wins
One of the biggest advantages we’ve found with Omnipod is that it’s completely tubeless. For hockey specifically, this is huge.
With a traditional tubed insulin pump, Makar would need to either:
- Disconnect before getting on the ice (meaning his basal insulin would stop), or
- Keep the pump connected and worry about the tubing getting caught on his hockey stick or other equipment, or
- Worry about the pump site getting hit during a check or collision.
With Omnipod, there’s no tubing to worry about. The pod is just stuck to his body. But—and this is critical—placement matters, especially for a contact sport like hockey.
The arm was our first instinct. But during hockey? His pod slipped off his arm multiple times during his first season. It doesn’t take much—a hard check, the aggression of getting dressed in bulky gear, the friction inside his uniform—and suddenly the pod is partially detached and not working properly.
Now, we place his pod on the back of his thigh, slightly above his buttocks. This spot is protected. It’s not going to get hit during play, it’s not subject to the friction of gear rubbing against it, and Makar is completely comfortable there. We haven’t had a pod failure from dislocation since we switched to this spot.
On game days, we use extra athletic tape to secure the pod. We tape around the edges and sometimes over the top of the adhesive patch, giving it extra insurance against movement. Some parents use adhesive overlays designed for pumps (like Skin Tac or SecureWear patches), which are also excellent.
Omnipod’s tubing-free design also means adjustments are easier. If Makar’s blood sugar is dropping too fast during a game, I can quickly reduce his basal rate using the app on my phone from the sidelines. With a traditional pump, that would require him to pull the pump out of whatever pocket he’s stashed it in and make adjustments.
For swimming, gymnastics, or other sports, you might need different placements—but the principle is the same: put the pod somewhere it won’t get hit, won’t rub excessively, and will stay secure.
Monitoring Your Child During Games
This is where Dexcom becomes your best friend.
The Dexcom G6 gives you real-time insight into your child’s blood sugar trend.
During Makar’s games, I’m not watching the score as much as I’m watching his glucose curve. My phone is in my hand, and I have high and low alarms set to wake the dead (seriously—I have them at maximum volume). When I see the arrow pointing up, I relax a little. When I see the arrow pointing down, I’m mentally preparing to get some carbs in him at first intermission.
Here’s what I watch for:
- Downward trending arrows during play? Typically, I wait until a whistle or stoppage and get him a small carb. A sip of regular soda, a few glucose tablets. I don’t panic over a single arrow—hockey is supposed to lower his blood sugar. But if I see multiple down arrows, I’m intervening.
- Flat or upward trending during play? I usually don’t need to do anything. The exercise will keep bringing him down.
- Sharp drop below 100? I’m pulling him aside and getting fast carbs in immediately. Blood sugar is dropping too fast, and we need to interrupt that momentum.
- Above 200 during play? I might give him water to drink, but I typically don’t inject insulin during a game. The exercise will bring that down.
The key is frequent monitoring and small, preventive adjustments rather than waiting for a low to happen and doing a dramatic rescue. Prevention is always easier than crisis management.
Communication with the coaching staff is non-negotiable. Before every season, we have a conversation with the coach about T1D, what we’re doing to manage it, and when he or she should pause play to let Makar check his blood sugar or have a snack. Most coaches are incredibly supportive once they understand what’s happening.
Dealing with Hypos During Sports
We used to have frequent low blood sugars during hockey. Makar would come off the ice shaky, frustrated, and depleted. It was stressful for all of us.
Now? We’ve learned to manage them so they rarely happen.
Here’s what changed:
Better carb loading before the game. The pre-game snack is specifically designed to sustain him through 60-90 minutes of hockey without dropping too low.
Proactive pump adjustments. Once we figured out Makar’s pattern (his blood sugar drops about 30-50 mg/dL every 20 minutes of hockey), we adjusted his pre-game insulin strategy. If he’s going into a game at 180, that’s actually fine—he’ll end up around 130 by the end of the first period.
Intermission snacks. Between periods, Makar has a quick carb snack. Not something complicated—just 10-15g carbs. A few pretzels, a piece of fruit, a small juice box. This bridges him through the next period.
Ongoing monitoring with Dexcom. We catch concerning trends before they become emergencies.
Understanding his specific pattern. Every kid is different. Some kids’ blood sugar drops linearly during exercise. Others stay stable for 30 minutes and then drop off a cliff. Knowing Makar’s specific pattern lets us predict and prevent.
Here’s how to figure out your child’s pattern:
- During a low-stakes practice or friendly game, pay close attention to their blood sugar trend throughout the activity.
- Note the starting blood sugar, the trend, and the ending blood sugar.
- Do this several times to see if there’s a consistent pattern.
- Once you see the pattern, adjust your pre-activity strategy accordingly.
For Makar, it took about 3-4 games before we had enough data to really understand what his body was doing. Now, it’s second nature.
Post-Game Lows: The Delayed Hypo Problem
Here’s the thing about sports that surprised me, even after 21 years of managing diabetes: the biggest blood sugar challenges often happen 4-12 hours after the activity ends.
This is called “delayed post-exercise hypoglycemia,” and it happens because muscles are still refilling their glycogen stores and the body’s insulin sensitivity remains elevated long after your kid gets off the ice.
For Makar, this typically means:
- He plays hockey at 5:30 PM and comes off the ice at 7 PM with a blood sugar of 140 (totally fine).
- We have dinner, we relax, his blood sugar is stable all evening.
- At 11 PM, he’s at 85 and dropping.
- At 1 AM, he’s at 52.
- We’re waking up to alarm him, giving him juice, and managing a low in the middle of the night.
How to manage this:
Reduce basal insulin for 8-12 hours after intense activity. On Omnipod 5, we reduce his basal rate by 20-30% starting about 4 hours after the game ends and continuing until bedtime. Some parents reduce it further overnight if their child tends to have severe overnight lows.
Have a post-activity meal plan. A light snack with protein and complex carbs 1-2 hours after activity (like a sandwich with peanut butter, or pasta with cheese) helps sustain blood sugar without spiking it.
Check at bedtime, even if you normally don’t. After a game day, Makar’s Dexcom alarm goes off before bed. This is our chance to catch a declining trend early.
Sleep with Dexcom alerts on high volume. I still do this on game nights, even though Makar is 9 and pretty stable now. The peace of mind is worth a potentially interrupted night’s sleep.
Consider a temporary basal rate reduction overnight. If your pump allows it, set an overnight basal rate that’s 25-40% lower than normal. This gives his blood sugar room to drop without you having to panic.
This is one area where having a CGM (continuous glucose monitor) makes an enormous difference. You can see the trend happening and intervene before it becomes a dangerous low. Without a CGM, you’re basically gambling with overnight lows after sports.
Specific Sports Considerations
Every sport interacts with diabetes differently. Here’s what we’ve learned:
Hockey (Makar’s sport):
- Intense, mixed aerobic and anaerobic activity.
- High injury risk means you want the pump securely placed (we use the thigh).
- Games are shorter but higher-intensity than something like soccer (which is 90 minutes of constant aerobic activity).
- Delayed lows are real and require overnight monitoring.
- Pack extra carbs because games can run over with OT.
Soccer:
- Sustained aerobic activity means relatively predictable blood sugar dropping.
- Subs give you opportunities to check blood sugar and have snacks.
- Field is big, so communication with the coach about blood sugar checks is important.
- Usually lower injury risk than hockey, so pump placement is more flexible.
Swimming:
- Water resistance means you might need to remove your pump or use a waterproof case.
- Many families disconnect the pump for swimming and do a manual injection before and after.
- Fast-acting carbs need to be completely waterproof (glucose tablets in a waterproof container, not juice boxes).
- Chlorine exposure doesn’t affect sensors, but adhesive patches can loosen.
Gymnastics and cheer:
- High-intensity bursts (like vault or tumbling) followed by rest.
- You might see small blood sugar spikes from the adrenaline, but overall, activity duration is shorter than team sports.
- Tight uniforms mean pump placement might need to be on the abdomen or back of the arm (with extra tape).
Cross country and track:
- Sustained aerobic activity, very predictable blood sugar dropping.
- Races are usually short (under 30 minutes), but training runs are longer.
- You might need to provide sports drinks or gels on really long runs to prevent lows.
- Post-activity delayed lows are very common.
Baseball and softball:
- Shorter total activity time with bursts of intensity.
- Lots of standing around between plays, so carbs might not be needed during the game.
- More flexibility in when blood sugar checks happen (before at-bats, between innings).
The principle for any sport: Understand the intensity and duration, predict the blood sugar impact, and adjust accordingly.
Managing Your Own Stress and Emotions
I want to be real here for a minute. Watching your T1D child play sports is emotionally complicated.
You’re watching them do something they love. You’re proud. You’re also hypervigilant, watching their CGM, ready to spring into action if their blood sugar drops, worried about what happens on the field if you’re not there to monitor.
Some of this is unavoidable. But some of it can be managed:
Trust your child’s understanding of their own body. Makar knows what a low feels like. He knows to tell me if he’s feeling shaky or dizzy. He’s old enough to recognize his own symptoms.
Train backup monitors. A coach, assistant coach, or a team parent who understands the basics of T1D can be your backup eyes during games. You don’t have to be the only person paying attention.
Use technology to your advantage. Dexcom’s share feature means I can watch Makar’s blood sugar from my phone even if I’m not at the game. A parent at the hockey rink can give me real-time updates.
Accept that occasional lows will happen. They’re not a failure. They’re a data point. Figure out what went wrong, adjust, and move on.
Give yourself grace on the emotional side. It’s okay to feel anxious about your child playing sports with T1D. It’s also okay to recognize that the anxiety doesn’t need to stop them from playing.
When to Sit Out
There are times when your T1D child should not play.
Severe blood sugar instability in the days leading up to the activity. If your child has had 4+ unexplained lows in the past 24 hours, something is wrong. Playing sports is not the time to figure out what.
Ketones present. If your child has tested positive for ketones (a sign of diabetic ketoacidosis beginning), they should sit out until cleared by their doctor.
Uncontrolled high blood sugar. If your child’s blood sugar is consistently above 250 and climbing, exercise might make it worse before it gets better. Wait until it’s coming down.
Illness. Sick days are off days. Flu, strep throat, stomach bugs—these are times to rest, hydrate, and focus on recovery, not competition.
Extreme emotional distress. If your child is having a really hard diabetes day emotionally and just wants to rest, it’s okay to let them. Sports are supposed to be fun, not another source of stress.
Most of the time? Your T1D child should be playing. But these exceptions exist, and it’s important to recognize them.
FAQ
Q: Will my child’s blood sugar be unpredictable during sports?
A: Not unpredictable forever. There’s definitely a learning curve—maybe the first 5-10 times your child plays a new sport, you’ll be gathering data. But once you understand their body’s response to that specific activity, it becomes quite manageable. Makar’s blood sugar during hockey is now more predictable than his baseline—I can predict almost exactly where he’ll be at the end of the second period.
Q: Do I need a continuous glucose monitor to manage sports?
A: No, but it makes a huge difference. You could manage with finger-stick testing, but you’d need to check much more frequently, and you’d miss the trend information that tells you whether blood sugar is dropping quickly or holding steady. Dexcom (or another CGM) is worth the investment if your child is active in sports.
Q: What if my child’s school sports team doesn’t support diabetes management?
A: Have a conversation with the coach and athletic director about accommodations. If they’re unwilling to work with you, escalate to the school administration. Your child has a legal right to manage their medical condition during school activities (Section 504 Plan—more on that in another article). Don’t let a coach’s lack of understanding prevent your child from participating.
Q: Can my child use an insulin pump while swimming?
A: Yes, but you have options. Some families use waterproof pump cases (like a flip belt). Others disconnect the pump for the duration of the swim and use a manual insulin injection before getting in the water. Talk to your endocrinologist about what’s best for your child’s insulin regimen.
Q: How much extra insulin should my child take before sports to prevent lows?
A: There’s no universal answer. Some kids need to reduce their insulin before activity. Others need a small dose of insulin before intense activity to prevent blood sugar spikes from adrenaline. Work with your endocrinologist to develop a strategy specific to your child and the sport they’re playing.
Q: What if my child has a severe low during a game?
A: This is why you carry fast carbs and have a glucagon kit. Treat the low with 15g of fast carbs (juice, glucose tablets, regular soda). Recheck blood sugar in 15 minutes. If your child is unconscious or unable to swallow, use the glucagon kit and call 911. Severe lows during sports are rare when you’re monitoring with a CGM and being proactive, but they can happen, and that’s why you’re prepared.
Q: Should my T1D child avoid competitive sports?
A: Absolutely not. If your child loves a sport, they should play it. T1D is not a barrier to competition. Some of the most accomplished athletes in the world have Type 1 Diabetes. Your child can too.
Important Disclaimer
This article is based on the author’s personal experience managing Type 1 Diabetes in two children. It should not be considered medical advice. Every child’s diabetes is unique, and management strategies should be developed in close collaboration with your child’s endocrinologist and diabetes care team. Always follow your healthcare provider’s recommendations, and adjust these strategies based on your child’s individual needs, blood sugar patterns, and medical history.
Katerina has 21 years of experience parenting kids with Type 1 Diabetes. Her daughter was diagnosed at age 2; her son Makar at age 4. She uses Omnipod 5 insulin pumps and Dexcom G6 continuous glucose monitors for both children and is passionate about helping other parents see T1D as manageable—not limiting.