NATA Position Statement Review Part 7: Management of the Athlete with Type 1 Diabetes Mellitus 

Knowing the contents of NATA Position Statements is crucial for athletic trainers and students preparing for the Board of Certification (BOC) exam for several reasons. These statements represent the official stance of the National Athletic Trainers’ Association on a variety of important topics, providing evidence-based recommendations for best practices in athletic training. For both practicing professionals and those entering the field, these documents are essential for ensuring a high standard of patient care.

For athletic training students, the information within these position statements directly relates to the domains and tasks covered by the BOC exam. A thorough understanding demonstrates competency in applying current research and professional guidelines to real-world scenarios. It equips students with the specific knowledge and problem-solving skills needed to manage complex medical conditions, such as the one described in the position statement on Type 1 Diabetes Mellitus.

NATA Position Statement: Management of the Athlete With Type 1 Diabetes Mellitus

The NATA position statement on managing athletes with Type 1 Diabetes Mellitus provides a comprehensive set of recommendations for certified athletic trainers. The document is organized into several key categories to ensure a holistic approach to care.

Here is an overview of the key points:

• Diabetes Care Plan: Every athlete with diabetes should have a personalized care plan for practices and games. This plan should include guidelines for blood glucose monitoring, insulin therapy, a list of other medications, and protocols for recognizing and treating both hypoglycemia and hyperglycemia. The plan should also contain emergency contact information and ensure the athlete wears a medic alert tag.
• Supplies for Athletic Training Kits: Athletic trainers’ kits should be equipped with supplies for diabetes-related emergencies. These supplies, provided by the athlete or their guardians, should include a copy of the care plan, blood glucose monitoring equipment, sugary foods or drinks, a glucagon injection kit, ketone testing supplies, and a sharps container.
• Preparticipation Physical Examination (PPE): The PPE for athletes with Type 1 diabetes should include a glycosylated hemoglobin (HbA1c) assay every 3 to 4 months to assess long-term glycemic control. An annual examination is also recommended to screen for complications such as retinopathy, nephropathy, and neuropathy. The athlete’s physician determines any exercise limitations based on these screenings.
• Hypoglycemia: Athletic trainers should be familiar with the signs, symptoms, and treatment guidelines for mild and severe hypoglycemia. The document defines mild hypoglycemia as the athlete being conscious and able to follow directions, while severe hypoglycemia is when the athlete is unable to swallow, follow directions, or is unconscious. Treating severe cases requires a glucagon injection, and athletic trainers should be trained to administer it.
• Hyperglycemia: The statement advises athletic trainers and athletes to follow the American Diabetes Association (ADA) guidelines for avoiding exercise during periods of hyperglycemia. It also recommends that athletes drink non-carbohydrate fluids when blood glucose levels are elevated (above 180 mg/dL or 10 mmol/L) to prevent dehydration.
• Insulin Administration: Insulin should be administered subcutaneously, and intramuscular injections should be avoided. The document outlines precautions to take after insulin injection, such as avoiding heat-producing modalities and cold whirlpools over the injection site, as these can affect absorption rates. It also provides guidance for insulin pump users, including replacing infusion sets every 2-3 days and the impact of extreme temperatures on insulin action.
• Travel Recommendations: Athletic trainers should be familiar with the Transportation Security Administration (TSA) guidelines for airline travel with diabetes supplies. The position statement also advises athletes to carry twice the amount of medication and supplies needed, have prepackaged meals and snacks, and adjust insulin therapy for time zone changes.
• Athletic Injury and Glycemic Control: The document notes that trauma often causes a hyperglycemic state, which can impair wound healing. It recommends developing an individualized blood glucose management protocol for athletes with Type 1 diabetes during injury recovery to maintain near-normal glucose levels.