Four accomplished type 1 diabetic wrestlers (Conner Lefever, Travis Pascoe, Jake Pooton, & Kenneth Stank) share their blood glucose management techniques and the reciprocal effects of wrestling.

1. WRESTLING WITH TYPE 1
DIABETES:
A COMPETITIVE BLUEPRINT
Brian Broderick
MBA 592
Dr. Edmonds
April 7, 2016

2. Agenda
■ Overview of Type 1 Diabetes
■ Sport of Wrestling
■ Introduce 4 Diabetic Wrestlers
■ General Questions
■ Importance of Diet and Nutrition
■ Practice
■ Weigh-ins
■ Competition Days
■ Conclusion
2

3. History of Type 1 Diabetes
■ 1st symptoms discovered in 1552 B.C.
– Hesy-Ra - Egyptian Physician
– Proclaimed the disease led to frequent urination and emaciation
■ For thousands of years, no one knew how to survive with diabetes
– Children would typically die within a few days
– Elders lived with life-threatening complications
■ 1675 – “Water Testers”
– Individuals would “taste” urine to test for sweetness
3

4. ■ 1600-1700’s: exercise was prescribed and herbs were used for
treatment
■ 1800’s – Doctors realized the importance of diet and nutrition
– French Physician Apollionaire Bouchardat
■ During Franco-Prussian War
– Diabetic patients’ symptoms improved on food rationing diet
– Oat cure, potato therapy, milk diet, opium, or starvation diet
■ 1921 – Insulin was discovered
– Canadians Frederick Banting
and Charles H. Best
History of Type 1 Diabetes
4

5. ■ 1959 – Type 1 and Type 2 diabetes were now clearly defined
– Type 1 – insulin dependent
– Type 2 – non-insulin dependent
■ 1963 – First insulin pump was designed
■ 1970 – Introduction of instant glucose meters
– Prior to arrival of glucose meters, colored dipsticks were used
History of Type 1 Diabetes
5

6. ■ 1978 – Recombinant DNA testing began
– Scientists insert a human gene into the genetic material of a
common bacterium
– Prior to rDNA insulin, insulin was stockpiled from animal pancreatic
tissue
– Not approved for use by the FDA until 1996
■ 1983 – First biosynthetic insulin was introduced
– Allowed pharmaceutical companies to genetically manufacture
insulin
History of Type 1 Diabetes
6

7. Overview of Type 1
Diabetes
■ 29 million Americans diagnosed with some form of diabetes
– Approximately 10% or 3 million are type 1 diabetic
■ Type 1 Diabetes
– Diabetes Mellitus
– Juvenile Diabetes/Childhood-onset Diabetes
– Insulin-dependent Diabetes
– Petitioning for Beta Cell Apoptosis (BCA) Diabetes
■ Chronic illness which the individual has for the rest of their
life
– Pancreas transplant
– Beta cell/islet transplantation 7

8. What is Type 1 Diabetes?
■ Auto-immune disease when the pancreas no longer produces
insulin
■ Insulin is a hormone produced by beta cells that allow glucose to
be transported to the body’s cells
– Glucose stored in the cells can later be used as an energy source
■ Normal blood glucose range is 80 – 120 milligrams/deciliter
– Blood glucose > 140 mg/dl is considered hyperglycemia
– Blood glucose < 80 mg/dl is considered hypoglycemia
8

9. The Role of Insulin in the
Body
9

10. Hypoglycemia; < 80 mg/dl
■ Causes of Hypoglycemia
– Taking too much insulin, not enough carbohydrates, postponing or
skipping a meal or snack, increased activity or physical activity, and
drinking alcohol
■ Symptoms of low blood sugar
– Shakiness, nervousness, anxiety, clamminess or excessive
perspiration, irritability or impatience, confusion, rapid heartbeat,
extreme hunger, nausea/dizziness, sleepiness, anger, blurred
vision, lack of coordination, seizures, and unconsciousness
■ Treatment
– 15 grams of fast-acting carbohydrates such as 4.5 ounces of juice
or non-diet soda, glucose tablets, gel tubes, cake icing, or candy
– Extreme Cases
■ Glucagon Emergency kit may need to be administered by another
individual
■ Glucagon stimulates the liver to release stored glucose into the
bloodstream when blood glucose levels are too low 10

11. ■ Causes of Hyperglycemia
– Not enough insulin used to cover carbohydrates during
meal, not enough long-acting/basal insulin, using expired
insulin, not injecting insulin properly, being less active than
normal, illness or infection, stress or anxiety, and certain
medications
■ Symptoms of high blood sugar
– Extreme thirst/hunger, fatigue, blurry eyesight, numbness or
tingling of feet, unexpected weight loss, frequent urination,
sensation of “feeling overheated”, and being easily irritated
■ Treatment
– Insulin therapy or adjust insulin dosages
– Fluid replacement (helps dilute sugar in blood)
Hyperglycemia; > 140 mg/dl
11

12. Insulin Types
■ Basal Insulin (long-acting)
– Slow, continuous trickle of insulin that stays at a low
level in the blood at all times
■ Humulin and Novolin
■ Levemir, Lantus, & Toujeo
■ Bolus Insulin (fast-acting)
– Large bursts of insulin that are released as blood
glucose rises, typically after meals
■ Humalog, NovoLog, Apidra
12

13. Basal vs Bolus Insulin
13

14. Insulin Treatment
■ Syringes or Multiple Daily Injections (MDIs)
■ Pump Therapy or Continuous Subcutaneous Insulin Infusion
(CSII)
14

15. The Sport of Wrestling
15

16. History of Wrestling
■ Oldest traces of wrestling date back to 13,000 B.C. of cave
drawings found in France
■ Beni-Hassan tombs have over 400 pairs of wrestlers
carved on walls and ceilings dated back to 1900 B.C.
16

17. History of Wrestling
■ Ancient Greeks viewed wrestling as much more than a
sport
– Was viewed as a science and divine art
17

18. Sport of Wrestling
■ Fédération Internationale de Luttes Associées (FILA)
– Set standards and regulations for all international wrestling events
■ FILA recongnizes 2 different wrestling styles:
– 8 International Wrestling Disciplines
■ Greco-Roman
■ Freestyle
– Folk
■ Backhold (Europe), Cumberland (England), catch-as-catch-can
(England), kurash (Uzbekistan), gusteengiri (Tajikistan), kuresh
(Siberia), lotta campidanese (Italy), pahlavani (Iran), pehlwani (India),
penjang gulat (Indonesia), schwingen (Switzerland), shuai jiao
(China), ssireum (Korea), and scholastic (United States) 18

19. Diabetic Wrestlers
19

20. Conner Lefever
■ Fort Wayne, Indiana
■ Diagnosed in 8th grade
■ Symptoms
– Frequent urination
– Blurred vision
– Felt terrible while wrestling
■ Accolades
– 2-time High School Indiana State Place Winner; 8th and 4th
– 3-time NCAA Division III Qualifier
– 174 lb NCAA Division III Champion
20

21. Travis Pascoe
21
■ Originally from Idaho
■ Diagnosed at age 15
– 425 mg/dl
■ Symptoms
– Frequent urination
– Lost weight without trying
– Wasn’t feeling “normal”
■ Accolades
– 3-time Washington High School State Champion
– NCAA Division I All-American
– 13th on Nebraska’s All-time Win List

22. Jake Pooton
22
■ Mount Airy, Maryland
■ Diagnosed at age 2
– Blood glucose above 900 mg/dl
■ Symptoms
– Flu-like symptoms
■ Accolades
– 3-time Maryland High School State Place Winner; 5th, 4th, & 1st
– Maryland State Champion; finished with 142-24 record
– Sophomore High School All-American

23. Kenneth Stank
23
■ Harrisburg, Pennsylvania
■ Diagnosed in 9th grade
– Blood sugar above 500 mg/dl
■ Symptoms
– Lost 10 pounds unexpectedly
– Terrible cramps
– Felt sluggish/fatigued all the time
– Could not quench thirst
■ Accolades
– 2-time PA AAA High School State Place Winner; 8th and 6th
– High School Record of 127-35

24. General Diabetic Wrestling Questions
24

25. Insulin Pens/Syringes Vs
Insulin Pump Therapy
■ Both methods have their own advantages and
disadvantages
25
Insulin Pens/Syringes
■ Greater mobility
■ Cleanliness
■ Less accurate control
Insulin Pump Therapy
■ Greater BS control
■ Basal suspension
■ Risk infusion-set getting
ripped out/damaged
CL - “During days of wrestling competitions I switched off between my
insulin pump and taking shots with syringes. This is because there are
sometimes where the cannula comes out from under my skin and I might
not realize it.”

26. Infusion Set Sites
■ Common sites
– Abdomen, hips and buttocks, outer thighs, back of
arms, and breast tissue
– Should be changed every 2-3 days
■ Prevent infection
■ Prevent scar tissue build-up 26
“Clock Rotation”
“M” or “W” Rotation

27. Infusion Sites for Wrestling
■ Optimal placement for wrestling
– Rotate between left and right outer buttocks
■ Additional Adhesive is recommended
– SkinTac
27

28. What was the most important factor for
best managing your blood sugars?
■ All subjects agreed that routine was the most important factor
■ Consistent routine assists with:
– Insulin estimation
– Blood glucose consistency and patterns
28
KS – “Routine is huge to me. Every time I got ready for a match, I tried
to do the same things.”
JP – “By allowing myself to repeat everything I do throughout the day,
this makes it easier for me to see any patterns being created with my
blood sugars. “

29. Diet and Nutrition
29

30. Glycemic Index
30
■ Measures how a carbohydrate-containing food raises blood
glucose
– Fat and fiber tend to lower the G.I. of foods
– More cooked or processed the food = higher G.I.
■ Food with a high G.I. raises blood glucose more than a lower G.I.
– Low G.I. Foods (55 or less)
– Medium G.I. Foods (56-69)
– High G.I. Foods (70 or more)

31. Glycemic Index Chart
31

32. Glycemic Index
32

33. Do you pay attention to the
G.I. of Foods You
Consume?
■ CL – “I’ve never really paid attention to the G.I. in foods.
I’ve mostly just counted carbs.”
■ TP – “I just count carbohydrates.”
■ JP – “I simply count carbohydrates.”
33

34. Have you ever supplemented any part of your
diet to help optimize your blood sugar and
performance (i.e. protein, vitamins, minerals)?
■ Cinnamon pills
– In 1 study, reduced blood sugar levels by 24%
– Lowers insulin resistance
■ Alpha lipoic acid, bitter melon, chromium picolinate, &
fenugreek
– Also shown to reduce blood sugar levels
– Decrease insulin resistance
■ Multi-vitamins & Vitamin C
– Prevent illness
34
TP – “No. I just like to get the nutrition that I receive from food.”

35. Follow a strict diet?
■ High-protein diet
– Less chance of glucose fluctuations and spikes
35
CL – “I never took any supplements. I get all of my nutrients through the food
that I was eating for breakfast, lunch, and dinner as well as what I ate for
snacks.”

36. Wrestling Practice
36

37. Exercise’s Effect on Blood
Sugar
■ Moderate-intensity activity typically lowers blood glucose levels
■ Studies have shown that intense activity, such as a burst-style
sport like wrestling, can actually lead to an increase in blood sugar
– Body goes into a “fight or flight mode”
– “Activates the sympathetic nervous system” –
diabeteshealth.com
– Forces the liver to release its stored emergency glucose
37

38. Hyperglycemia Prior to
Practice
■ Glucose levels above 240 mg/dl
– Check for Ketones in urine
– Administer insulin
■ Lower dosage than normal
■ Do not exercise until blood sugar is below 240 mg/dl
– Glucose levels can elevate even higher – diabetes.org
38

39. How would you ensure proper blood
sugars prior and during wrestling
practice?
■ Test, test, and more blood testing
– 1 hour before
– 30 minutes before
– Immediately before practice begins
■ Allows individual to notice blood glucose trends
■ Test blood sugar 1-2 times during practice
– Test when feeling irregular
■ Trial and Error
■ Make sure blood sugar is slightly elevated prior to practice
– 150 – 200 mg/dl
39

40. ■ 3 out of 4 interviewees stated their blood sugars would drop
dramatically during practice
– Length of practice
– Intensity of practice
■ Sip small amounts of sports drink during practice
– Don’t over-drink
– Keep fast-acting carbohydrates near by
40
How would your blood sugar typically
respond from activity from practice?
KS – “One of the most important things is having your wrestling coach
understand the signs of a low or a high. This way he can see if you’re
starting to get sluggish, you need to check your sugar. “

41. Hyperglycemia During
Practice
■ Uncommon
■ Administer insulin with syringes/pens
– Pump takes longer
– Lessen dosage
41

42. Weigh-Ins
42

43. Did you have a dedicated
“after-weigh-in” meal?
■ ROUTINE
■ Eat the SAME meal every time after weigh-ins for better
insulin/glucose estimation
43
CL – “I did have a dedicated after weigh-in meal that I ate after every single
weigh-in.”
TP – “Yes, every meal after weigh-ins was the same.”

44. Weigh-Ins
■ Eat as much of post weigh-in meal prior if weight permits
– Takes approximately 2 hours after meal for glucose to
stabilize
■ Only one hour in between weigh-ins and match start time
■ Administer insulin as early as possible
– Take a lower dose of insulin as compared to normal
– High is better than low
44
KS – “You still need to take insulin to cover the food you’re eating, but you don’t
want to take too much and risk a low while wrestling.”

45. Competition Day(s)
45

46. Competition Day(s)
■ Nerves, anxiety, and stress
– Difficult to control
– Contribute to higher blood sugars
■ Epinephrine - stress hormone increases blood glucose –
Webmd.com
■ TEST , TEST, TEST
– Bring extra test strips
■ Test blood sugar 15-25 times on competition day
46
CL – “I would say I would at least check it 20-25 times the day of a tournament.”

47. Competition vs Practice
■ Blood sugar would typically increase from matches
– Adrenaline
– Nerves/anxiety
OR
– Liver releasing stored glucose because “fight of flight”
mode
■ 7 minute matches compared to hour long practices
– INTENSE
47
CL – “I have noticed that during matches my blood sugar would normally
increase. Most of the time I would go into my matches around 160 mg/dl and
when I would check after my matches it could be up to 230 mg/dl.”

48. ■ Minimal Carbohydrate Intake on Competition Day(s)
– Prevents glucose spiking
48
Competition Day(s)
JP – “I try to eat minimum amount of carbohydrates during meals because I
have determined that by consuming more carbohydrates, you have a bigger
scale of sky-rocketing up or going low with more insulin-intake.”

49. Once Wrestling has
Concluded
■ Delayed Onset Hypoglycemia/ Post-Exercise Hypoglycemia
– Activity causes the body to be more sensitive to insulin up to 48
hours after exercise – diabetes.com.uk
■ “Heavy exercise can have increased risk of middle-of-the-night
hypo’s unless you eat a big bedtime snack” – healthcentral.com
■ Preventing a Delayed Low Blood Sugar
– Large bedtime snack
– Reduced basal (long-acting) insulin
– More blood glucose testing than normal
49
CL – “Normally I would just
set my temporary basal rate
a 0% for a few hours when I
went to bed to keep it from
dropping when I first went
to sleep. “

50. Conclusion
■ Don’t wrestle through the extreme “highs” or
“lows”
– Hypoglycemia unawareness
■ No “best method”
■ Make sure someone knows how to treat you in case
of an emergency
■ Find what works for YOU
– Trial and Error 50

51. Moving Forward…
■ “Artificial Pancreas could be ready in 2017 for Diabetics” –
CNBC
– Annetta Miller
■ Closed loop system that runs continuous algorithms
– Continuous glucose monitoring
– Insulin secretion
– Glucagon
51

52. Questions?
52

53. References
■ http://www.athleticscholarships.net/history-of-wrestling.htm
■ https://unitedworldwrestling.org/organization/history
■ http://www.experimentsinmotion.com/motion-gallery/89/Egyptian+burial+chamber+mural/
■ http://ic.galegroup.com/ic/whic/ReferenceDetailsPage/ReferenceDetailsWindow?failOverType=&query=&prodId=WHIC&w
indowstate=normal&contentModules=&mode=view&displayGroupName=Reference&limiter=&currPage=&disableHighlight
ing=false&displayGroups=&sortBy=&search_within_results=&p=WHIC%3AUHIC&action=e&catId=&activityType=&scanId
=&documentId=GALE%7CCX3205100359&source=Bookmark&u=mlin_s_orrjr&jsid=b456a358b12d7d06545df65c4445f44
e
■ http://www.spokesman.com/stories/1998/feb/05/needles-and-pins-diabetes-no-match-for-determined/
■ http://health.usnews.com/health-news/patient-advice/articles/2015/05/13/teens-with-type-1-diabetes-how-to-cope-and-
when-to-seek-help
■ http://www.joslin.org/info/why_is_my_blood_glucose_sometimes_low_after_physical_activity.html
■ http://www.healthcentral.com/diabetes/c/110/8630/delayed-exercise/
■ http://integrateddiabetes.com/Articles/exer/delayed%20onset%20hypoglycemia%20article.pdf
■ http://www.diabetes.co.uk/sport-and-hypoglycemia.html
■ http://insulinnation.com/living/5-tips-to-better-exercise-with-type-1-diabetes/
■ http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-
diabetes.html?referrer=https://www.google.com/
■ http://www.humankinetics.com/news-and-excerpts/news-and-excerpts/insulin-levels-during-exercise-critical-to-
performance
■ https://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7245
■ http://www.everydayhealth.com/diabetes/understanding/diabetes-mellitus-through-time.aspx
■ http://diabetes.diabetesjournals.org/content/50/2/217.full
■ http://www.defeatdiabetes.org/diabetes-history/ 53

54. References
■ http://www.healthline.com/diabetesmine/the-kerfuffle-over-new-names-for-type-1-and-type-2-diabetes#1
■ http://www.diabetes.org/diabetes-basics/type-1/
■ https://www.nlm.nih.gov/medlineplus/ency/article/000305.htm
■ http://www.diabetes.co.uk/blood-glucose/honeymoon-phase.html
■ http://iuhoosiers.com/coaches.aspx?rc=1364&path=wrestling
■ http://www.spokesman.com/stories/1998/feb/05/needles-and-pins-diabetes-no-match-for-determined/
■ http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html
■ https://nfb.org/images/nfb/publications/vodold/pancreas.htm
■ http://www.endocrineweb.com/conditions/type-1-diabetes/type-1-diabetes-causes
■ http://www.webmd.com/diabetes/features/type-1-diabetes-misconceptions
■ http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/causes/con-20034795
■ http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/complications/con-20034795
■ http://www.diabetesnet.com/diabetes-control/low-blood-sugars/hypoglycemia-unawareness
■ http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/treatment/con-20034795
■ https://www.youtube.com/watch?v=_OOWhuC_9Lw
■ http://www.childrenwithdiabetes.com/sports/TravisPascoe.htm
■ http://www.cnbc.com/2016/03/30/artifical-pancreas-could-be-ready-in-2017-for-type-1-diabetics.html
54