Patient case 5.

Adolescent patient playing in a football tournament for a week, with sustained levels of physical activity each day (e.g., 6 h)

Name: Thomas	A1C: 7.1% (54.1 mmol/mol)
Age: 14 years	ICR: 1 unit per 10 g and 1 unit per 15 g (pre- and post-exercise)
Body weight: 53 kg
Current MDIs: Degludec with insulin aspart (18 U and 26 U)
Case history   Thomas is an avid footballer, and in addition to physical education classes, he has football practice once a week (ca. 90 min) and on most weeks, a 60-min match. Recently his team was invited to participate in an overseas football tournament. He would be away from home for 4 days. During this time he will play approximately 5–7 h of football a day. While his parents are keen that Thomas participates in the tournament, they are concerned he may neglect his diabetes care and are particularly concerned regarding possible hypoglycemia. Should hypoglycemia happen while he is away, his parents are concerned that this may lead to a reluctance to participate in future tournaments or sport in general. This would likely impact his physical and mental well-being
Guidance   While Thomas is experienced with taking responsibility for his BG levels and the adults responsible for his care on the trip are familiar with his condition, given the combination of travel, higher levels of exercise, and potentially unregulated diet necessitate consideration and careful planning   Adequate provision of BG test strips, high glycemic index snacks, and hypoglycemia remedies (e.g., glucose tablets) is essential [48]   As the week includes some periods of moderate- to high-intensity exercise, it is recommended that 3 days before the tournament his degludec dose is reduced by 30%, with any hyperglycemia managed by bolus corrections   Flash glucose monitoring was recommended to facilitate timely glucose checks