Aaron: To be honest, you’re one of the main reasons why I started Between the Lines. I thought it would be really cool to interview you. To give a little background, I play lacrosse and football and I have Type 1 Diabetes myself. I want to see how other athletes prepare for games and practices, and how they manage their diabetes while they do all of that. Seeing you succeed and make it to the NFL has really inspired me as I’ve followed you since you were drafted and I heard your story for the first time. So I’m just really curious how you manage it.
Mark: For sure, that’s a great question. As you know, having Type 1 Diabetes everyday is different. Everybody is a little bit different. Take what I say, and some things might be great and some things might not work for everyone. For me, a lot of what I do is making sure I know what my numbers are. I wear my Dexcom which gives me my numbers 24/7 so I’m able to see my trends, are they going up or down. That’s been big for me. I also have a Tandem pump which has been awesome. It’ll also kind of help me out and if my numbers are going high it’ll give me some insulin or if I’m going too low it’ll lay off a little bit. It’s stuff like that that just makes it easier so I don’t have to think about it as much. For me a lot of it is also diet. Before practice, I need to realize what I can and can’t eat. I probably shouldn’t eat pizza or pasta just 2 hours before I go out and play at practice or a football game. I’m usually eating something that’s a little bit lighter. For breakfast I try to eat eggs and a banana and that’ll be all I have before practice. Some people may need a little bit more carbs but that’s what works for me. I think it’s great to have a routine as a Diabetic, it definitely makes it easier. Every day that you have a routine, you kind of know what to expect. Even though every day is different, that routine can definitely make a difference in helping you manage your diabetes as an athlete.
Aaron: How old were you when you were diagnosed?
Mark: 9 years old.
Aaron: How do you manage your blood sugar while you're playing?
Mark: I take off my pump while I’m playing. I clip on and off and I keep it on as long as possible. I probably have it off for about 2 to 2.5 hours during that time period.
Aaron: Do you plug in at halftime, each quarter, or do you stay unplugged the whole game?
Mark: I didn’t mention this earlier, but when I was playing football and I was off the pump forever, my dad and I were trying to figure out what to do to keep my numbers from going so high. When you have the pump off, you don’t get that basal rate or background insulin. So, my dad being a doctor kind of looked some stuff up. He looked at long distance runners, those guys are off their pumps for long periods of time. Something that they do and that I do now is give a 75% Lantus or long acting insulin dose and 25% of basal [through my insulin pump]. That 75% that I give myself through the long acting insulin, allows me to be off of my pump for hours at a time and really not experience much drop off. I mean I may experience it a little bit but that’s why I’m checking during practice and things like that.
Aaron: Do you do that through an injection or is that through the pump too?
Mark: Every morning I take about 24 units of Lantus through injections.
Aaron: Have you ever gone too low or high in a game? What would or have you done?
Mark: It definitely has happened to me and like I said, every day is different, every game is different. I’ve gone low and high in practice and that just happens. I try to be as stable as I can, but it is what it is. For me I don’t really have lows during games, I’m very on top of it. Football is what I love to do, it’s my job, it’s something that is very important to me so I make sure that I’m constantly checking. I’ll be high sometimes during a game. My range is probably from 90 to 180. If I get above around 220 and I see my numbers going up, I’ll give some insulin. I’ll clip my pump back on and I’ll give 2 or 3 units of insulin and it usually goes back down. I don’t get low during games, just practice usually. I try to be as stable as possible for both.
Aaron: Do you think that adrenaline is a part of that reason why you don’t go low?
Mark: I think so, just emotions and everything definitely have some impact. Some people think that adrenaline makes their blood sugar go high. For me, adrenaline tends to make my blood sugar a little more stubborn and nothing feels like it's working. For example, I’ll eat my breakfast and give myself a bunch of insulin and it’s not going anywhere. I think that’s just adrenaline and all the emotions on gameday. So yea, I think adrenaline definitely has an impact that makes me go a little bit higher.
Aaron: Has there ever been a specific time in the last few years where you haven’t been able to go in because your blood sugar was out of range?
Mark: Not in games. In games, I’ve never had that happen to me. In high school I have. There were moments where I was a little low or I was way too high and I needed like 5 minutes to just get some insulin or sugar in. That was definitely something that I’ve had to learn. In practice, for sure, there’s been countless times where I’ve been super low and just needed 5 minutes to get that gatorade in and let it kick in my system. I would say that it does happen, I don’t let it happen to me on gameday because like I said, I’m super focused on it. If you look at practices, I’m not perfect and I don’t think anybody is. This is a disease where you can’t be perfect because every day is different and everybody is different. Things happen, and this has definitely happened to me before.
Aaron: Do you ever notice that after games your blood sugar drops?
Mark: 100%. Like I said, on game day I think my numbers are kind of stubborn. They’re usually pretty level but they might start going up at the end and then I’m giving insulin and it just drops off. I’m so depleted, I’ve wasted everything that I’ve had. A football game is very taxing. If you think about the amount of energy you put into it, physically, emotionally, everything you have in your body is going out into that game. So there’s been tons of time where my blood sugar just drops off after games. For me and my family, if my mom and dad aren’t in Baltimore at the time, they’re super worried about what my numbers are going to do when I’m asleep. So I just have to make sure that I’m extra careful and maybe grab something to eat before I go to bed.
Aaron: Right. What are some of the specific snacks or drinks that you use to treat lows?
Mark: Recently, I’ve drank a lot of orange juice or gatorade when I have it around. In Baltimore, we have it around everywhere. Since I was diagnosed, I’ve always carried around a little Diabetes bag, I call it my D-Bag. What I would always carry in it is fruit snacks. I’d always have a little bag so I’d know how to react, and each of those fruit snacks had about 20 to 24 carbs per pack. That was something that I’ve used but I’ve tried to be a little bit more healthier with the orange juice and gatorade.
Aaron: Yea me too, I kind of carry a little drawstring bag with me everywhere I go.
Mark: That’s like my lifesaver man. I can’t tell you how many times that thing has saved me. Do you carry a tester kit and everything in it too?
Aaron: Exactly, yeah. Usually a meter, a gatorade, some Welch’s fruit snacks, and that’s about it.
Mark: Yeah that’s like a life saver man.
Aaron: How have you told your coaches and/or teammates about your Diabetes in the past?
Mark: A lot of times early on, growing up, my mom, like all moms are, they’re super concerned. My mom went to my coach and let him know what was going on so I didn’t have to do that as much until I got to college. My teammates have always been super involved. Whenever I’m testing my blood sugar they’re always coming over and asking “hey can I test my blood sugar” and I’m like “I gotta change out the needle for you come on bro”. All my teammates have always been super supportive, especially my close ones. They take it upon themselves to understand what I’m going through. Obviously it's hard to exactly understand unless you have Type 1 Diabetes. They’ve been really good about knowing if I’m okay. One of my teammates would be able to look at my face and if I was a little off or pale he’d ask me if I was okay. And usually he was right about if I was low or not. Sometimes I’d be stubborn about it because he was always right. When I got to college and the NFL, you’d be surprised by how many people are affected by Type 1 Diabetes. Once someone hears that you are a T1D, they kind of understand a little bit, but it just takes you to say a little bit more like telling them what you’re going through. “I’ve got Type 1 Diabetes, I have to test my blood sugar and if I’m acting weird I might need a little bit of time and I need you to be there and give me that time because this is something serious and this is my health”.
Aaron: Agreed. Do you have any other advice or anything you want to share to newly diagnosed athletes with T1D?
Mark: I would say for anyone that’s diagnosed with T1D, to never give up and never have that doubt that just because you’re a T1D you’re not going to be able to be as good as somebody else. Go out and chase your dreams. That’s in sports, that’s in football, lacrosse, or whatever it may be. Go out and do it because this disease is not going to stop you. There’s been plenty of people that have Type 1 Diabetes and still go out there and be at the top of their sport. If you try hard enough, and you work hard enough, anything is possible.
Aaron: Agreed, that’s awesome. Thank you so much Mark.
Mark: Appreciate you, Aaron. It was great to meet you.
Aaron: Great to meet you too Mark. I’ll be rooting for you.