She didn’t miss a word when she stepped to the sidelines to check her blood sugar before the match at James Enochs High School last October.
“It’s 144, I’m good to play,” said Abby when she read her glucometer. The 17-year-old athlete with Type 1 diabetes said if her glucose is too high, she connects her insulin pump. If it’s too low, she grabs a snack before the game.
Being a teenager is not easy, dealing with a chronic disease is difficult, being a competitive athlete is demanding. The three together is the trifecta of challenges, but not a show-stopper for Abby or two other local student athletes, Allison Stiles and Chayse Lewis.
Abby has been active in sports for as long as she can remember. In addition to volleyball, she is also on Downey High’s basketball and softball teams.
During the last basketball season, she was feeling run-down, lost 20 pounds and had an unquenchable thirst. Her coaches noted she wasn’t performing to her usual abilities and encouraged her to get a checkup.
At the doctor visit, Abby’s blood sugar was in the 500s, well above the normal of 100. She was diagnosed with Type 1 diabetes.
After a few days at Valley Children’s Hospital, Abby said she felt ready to deal with her illness.
She went straight from the hospital discharge to her team’s game at Modesto Christian High School. Although she couldn’t play, she suited up to show support for her team. Abby said she also wanted to be there to feel more like her “normal” self.
“Once you get diagnosed, you just do what you gotta do,” said Abby, who this year was third on the team in scoring and second in rebounding.
She said it wasn’t hard to adapt to the frequent needle sticks. She knew the routine because her best friend has Type 1 diabetes.
“The hardest thing with being diagnosed has been learning to balance my new schedule,” said Abby. “I have to allow extra time before doing things just in case I have a problem, like my glucose is low.”
“It’s frightening to have a child with a chronic illness,” said Melissa Van Diepen, Abby’s mother, “I’m constantly worried: Is she gonna be OK?”
Van Diepen said for the first few months after Abby’s diagnosis, she watched her every move when she was playing, to see if she was shaky, unsteady or showing other signs of low blood sugar.
Abby uses two devices inserted under her skin, a continuous glucose monitor and an insulin pump, to manage her diabetes. However, she occasionally still needs to do needle sticks.
Her coaches and teammates are all informed about her disease and how to use glucagon, the emergency rescue medicine in case she passes out from low glucose.
Even with her concerns, Van Diepen said being athletic is “part of their family fabric” and she knew Abby had to keep playing. Both of Abby’s parents were competitive athletes in high school, and her younger sister, Maddie, is a sophomore on the basketball, water polo and swim teams at Downey.
More kids with chronic diseases
One in four American kids has a chronic illness, according to the Centers for Disease Control and Prevention. The CDC defines chronic diseases as conditions that last at least one year and require ongoing medical attention, limit the activities of daily living or both.
Having a chronic disease poses many challenges, physically and mentally, for an adolescent, as well as their family members, and they’re magnified for student athletes.
One big problem is the added hurdle for becoming independent, a normal milestone of adolescence.
“Teenagers are trying to establish their independence,” said Dr. Adesuwa Obasuyi-Yeh, “but these adolescents still need additional support from their parents, which can be a point of contention.”
Obasuyi-Yeh is a child and adolescent psychiatrist at Kaiser Permanente in Stockton.
“Most difficult (for me) is that I can’t contact the providers myself,” said Abby, “so I have to rely on my parents, which adds to everyone’s stress.”
For some parents, fear about their children’s health is one of their biggest burdens. Because of the worry, some parents become overprotective, making it harder for teens to launch their independence.
But the independence on the court — or field — is one more reason the teens love sports.
Allison Stiles, a 16-year-old athlete at Ceres High School, echoes Abby’s can-do attitude.
She is on the Ceres High volleyball and track teams, and last year also was on the basketball team.
Allison was diagnosed with von Willebrand’s disease when she was already very active in sports. With this genetic bleeding disorder, the bloodstream is missing one of the proteins that helps blood to clot. Without clotting, life-threatening bleeding can occur with an injury.
“She was only 8 when the heavy menstrual bleeding started,” said Meliesa Stiles, Allison’s mother, “We knew that wasn’t normal.”
Allison has three older sisters and no one had such heavy bleeding. She also has an older brother.
Despite her doctor’s initial warnings, Allison hasn’t let the disorder stop her from participating in competitive sports.
“We always have the fear of ‘What if?’” said Stiles, “We all are scared for our kids, but we can’t take away things because of ‘What if.’”
“Sports are my whole life,” said Allison, “so I thought I’d just keep going but be careful.” However, she said being careful all the time is her biggest challenge.
Her passion for sports was obvious to her doctors, so they worked with her to develop a treatment regimen to make it feasible for her to keep playing.
During her period, Allison takes 16 pills a day and uses a nasal spray medicine to help prevent severe bleeding.
Although Allison has had multiple minor injuries and bruises, she hasn’t had any serious bleeding problems. Her biggest sacrifice to the disease: She had to quit softball. She was a catcher, which is one of the riskiest positions for injury.
Allison had to tell her coaches about her condition, in case of an injury, because she requires special medications to stop any bleeding. Forfeiting some medical confidentiality is another hurdle for the teens.
Kelly Heese, Allison’s volleyball coach at Ceres High, was informed about her condition but said she didn’t need to change any routines for Allison.
“She’s a great all-around athlete and she’s determined to get the job done, ” said Heese.
Abby and Chayse Lewis also inform their coaches and teammates about their diabetes, in case of an emergency.
“I tell anyone. If anything happens, they have to know,” said Chayse.
For Chayse, a junior at Ripon High School, dealing with insulin wasn’t new, but being a competitive athlete was.
He was diagnosed with Type 1 diabetes when he was 3, but didn’t start playing football until he was a freshman. He plays offensive and defensive lineman positions and also runs tracks.
“It’s fun, I love playing it, and I love bonding with all of my teammates.”
Chayse said playing football has helped him manage his diabetes, including better control of his blood glucose. He said his biggest challenge is making sure his blood sugar numbers are good, so he can continue to play.
Like Abby, he uses a continuous glucose monitor and an insulin pump, which he removes during games. So at halftime, he has to do needle sticks to check his glucose.
“If my blood sugar is low, I’ll drink or eat something,” said Chayse. He carries Gatorade and granola bars at all times.
“He loves the camaraderie and his grades are up,” said Robin Armstrong, Chayse’s mother. “It has done wonders for his confidence. I couldn’t take that away from him.”
However, she said it has been a struggle at times.
“He’s in high school and doesn’t always want to pull out his gear (insulin and glucose monitor) and be different,” said Armstrong.
Her concerns illustrate another challenge for teens with illnesses: It’s almost impossible for them to not stand out, especially if they have to care for their illness in public view.
Adolescents worry about being judged by others and want to fit in with their peers. Trying to hide their illness or denying the need for medications can jeopardize their health.
“Teens prioritize things that give them joy in the moment,” said Obasuyi-Yeh. “They don’t think about the consequences of not taking their medicines.”
Some teens tire of dealing with their disease and the medical system, which contributes to the poor compliance with medical care often seen during adolescence.
“I worry about burnout,” said Dr. Nadia Sattar, a pediatric diabetes specialist at Valley Children’s Hospital.
Success on and off the field
The physical and mental health benefits of sports participation for youth are well established, including higher self-esteem, fewer risk-taking behaviors, improved mental well-being and lower risk for obesity and heart disease.
Student athletes also have better academic performance, higher graduation rates and improved mastery of essential life skills, as compared to peers not in organized sports, according to Australian researchers.
Although there is limited research, the converse may also be true — being a competitive athlete may offer advantages for improving medical care.
“As an athlete, I have that discipline,” said Abby, “I’ll get things done regardless of my circumstances.”
Perhaps the discipline of being an athlete sets the framework for following doctors’ orders or the passion to play is a strong motivation to adhere to medical care.
“Student athletes have certain commitments to conditioning and caring for their bodies,” said Obasuyi-Yeh, “(They’re) more adept at managing their time and responsibilities and that helps with managing their medications.”
This story was produced with financial support from The Stanislaus County Office of Education and the Stanislaus Community Foundation, along with the GroundTruth Project’s Report for America initiative. The Modesto Bee maintains full editorial control of this work.