What I Learned About Coaching Athletes with Type 1 Diabetes

As an endurance coach, I'm always looking for ways to better support the athletes I work with. Recently, I completed a course on coaching participants with Type 1 Diabetes (T1D), and one of the biggest takeaways was the importance of communication.

Before the course, I understood that athletes with Type 1 Diabetes could participate in sport at every level. I have worked with athletes who have T1D, identified through medical declarations, and have seen them test their glucose levels during sessions. It was those moments that prompted me to learn more.

What I didn't fully appreciate before doing this course was just how individual Type 1 Diabetes can be. Some people have glucose ranges that differ from others, and preferred treatments for hypoglycaemia can vary too. A glucose gel in a first aid kit may be useful, but it is never quite the same as an athlete's preferred treatment. T1D athletes also undergo extensive planning behind the scenes before a training session even begins. Athletes themselves are the true experts in managing their own condition.

Athletes with T1D are constantly balancing insulin, food intake, and exercise. They may be planning when to eat, how much carbohydrate to take on board, how much insulin to administer, and how a particular training session might affect their blood glucose levels. This highlighted the value of providing athletes with advance notice of upcoming session content, whether it is a hard, fitness-focused session or a lighter, more technical one. Technology such as Continuous Glucose Monitors (CGMs) can provide real-time information and trends, but even with these tools, there is still significant decision-making involved for the athlete.

One of the key lessons from the course was that two people with Type 1 Diabetes are rarely exactly the same. The symptoms they experience, their preferred treatments for low blood glucose (hypoglycaemia), how they administer insulin, and even their normal glucose ranges can vary considerably. As coaches, this means that our role is not to become diabetes experts, but to understand what is normal for the individual athlete in front of us.

This reinforced something I already value in my coaching: the importance of a good medical declaration and open conversations. I always use a medical declaration form before working with an athlete, but this course reminded me that the form itself is only the starting point. The real value comes from the conversation that follows.

One question from the course that I particularly liked, and will now ask athletes with T1D, is:

"What would you like me to know about your diabetes, and how can I best support you?"

I think this opens the door to understanding an athlete's needs without making assumptions or drawing unnecessary attention to their condition. The information can then be recorded and stored appropriately.

The course also introduced an Individual Sport Action Plan (ISAP). This is a simple, single-page document that can be completed quickly and stored confidentially. Personally, I will keep these alongside incident report forms in my first aid kit.

The ISAP includes:

·       The athlete's name and, where appropriate, parent or guardian contact details.

·       The diabetes equipment they use, such as insulin pens, pumps, Continuous Glucose Monitors (CGMs), or blood glucose monitors.

·       Their usual or preferred glucose range. While many people may work within a range of around 4–10 mmol/L, this is highly individual and can also be influenced by training and competition.

·       Their personal signs and symptoms of both hypoglycaemia and hyperglycaemia.

·       Their preferred treatment protocol for a hypo.

·       Their preferred actions for managing a hyper.

·       Emergency contact information and a clear emergency action plan.

The course also provided a straightforward flow chart for managing both hypo- and hyperglycaemic situations. I printed this and will keep it alongside my SLSGB Nudge Cards (small reminder cards) in the first aid kit.

Another key lesson was recognising that the athlete is usually the expert in managing their own diabetes. Most people with Type 1 Diabetes know exactly what to do when their glucose levels move outside their target range. However, situations can arise where thinking becomes clouded, particularly during a diabetic episode. In those moments, it can be incredibly valuable if a coach understands the athlete's usual signs and knows how to support the agreed action plan.

The course also highlighted that distinguishing between a hypo and a hyper is not always that obvious. Symptoms can overlap, which is why understanding an individual's usual signs and how/where to measure them is so important. One example discussed was that increased trips to the toilet can be associated with hyperglycaemia, whereas this would not typically be expected during a hypo.

I also realised that many of the natural breaks we already build into sessions  - water breaks, regrouping points, or recoveries between sets, even transitions - provide excellent opportunities for informal check-ins. A simple, "How are things looking?" can sometimes be all that's needed.

From a practical safety perspective, the course prompted me to review my first aid preparations. I already carry some glucose in my first aid kit, but I will now make a point of asking T1D athletes whether they carry their preferred hypo treatment and whether they would like me to carry it for them or keep a backup available.

Another change I will make is to keep my own blood glucose testing kit in the first aid kit. In reality, most athletes with T1D manage their glucose levels exceptionally well and will usually have their own monitoring equipment with them. However, in the unlikely event of an emergency, being able to check blood glucose levels could provide valuable information and support decision-making while following the athlete's agreed action plan or awaiting further medical assistance.

A useful reminder was that safety is a partnership. The athlete brings expertise in their own body and diabetes management, while, as a coach, it’s my role to provide session structure, demonstrate awareness, foster calm decision-making, and offer support. Often, as an athlete, I have felt that the most helpful thing a coach can do is simply provide time, space, and privacy.  Now, when I coach an athlete with T1D, I will ensure this so they can manage their condition.

My biggest takeaway from the course is that coaching athletes with Type 1 Diabetes is often less about medical knowledge and more about communication, preparation, and trust. By asking the right questions, listening carefully, and having simple plans in place, coaches can help create an environment where athletes with Type 1 Diabetes can train, compete, and enjoy sport with confidence.

Education doesn't make us medical experts, but it does make us better coaches. And ultimately, that's what matters.

I would fully recommend this course to anyone working with athletes, particularly coaches. It provides practical, realistic guidance that can help make sport safer, more inclusive, and more enjoyable for everyone involved.

Looking back, I hope I have always done the right thing by athletes with Type 1 Diabetes, but this course has certainly highlighted areas where I can improve my normal approach. If nothing else, it has reinforced the importance of listenin

g, asking the right questions, and recognising that the athlete is often the expert in their own condition.

Thank you to Emma and Louis for designing and delivering such a practical and thought-provoking course.