Brian Anderson
banderson@csm-institute.com
954-204-5428
"Improving the Day to Day of Athletic Healthcare"
Diabetes in Collegiate Sports Survey
This is a survey aimed at addressing mulitple issues surrounding diabetes in collegiate student athletes. Thank you in advance for your partiicpation.

School Classification: 

Number of Sports:

Number of Student Athletes:

Number of Student Athletes Diagnosed with Diabetes:

Number of diabetes related emergency situations in the last 5 years (at your institution):

Does you medical history form inquiry about diabetes status?

Do you obtain previous test results, physician reports, etc for athletes that have been previously diagnosed with diabetes?

Do you have a blood glucose monitor?

Do you obtain a "Diabetes Care Plan" for each student athlete with diabetes?   Care plan would include: blood glucose monitoring and insulin guidelines, treatment guidelines for hypoglycemia and hyperglycemia as well as emergency contact information.

Do you provide the following prevention strategies for hypoglycemic student athletes: blood glucose monitoring, carbohydrate supplementation and insulin adjustments?

Do you provide the following prevention strategies for hyperglycemic student athletes: blood glucose monitoring, insulin adjustments and urine testing for ketone bodies?

Are you familiar with the signs and symptoms related to hypoglycemia which include tachycardia, sweating, palpitations, hunger, nervousness, headache, trembling, dizziness and in serious cases where LOC, coma or death may occur?

Are you familiar with the signs and symptoms related to hyperglycemia without ketosis which include nausea, dehydration, reduced cognitive performance, sluggishess and fatigue?

Are you familiar with the signs and symptoms related to hyperglycemia with ketois which include Kussmaul breathing, fruity odor to breath, unusal fatigue, sleepiness, oss of appetite, increased thirst and frequent urination?

Ture of False:  For treatment of student athletes with mild hypoglycemia, we provide 10-15 g of carbohydrates (4-8 glucose tables or 2 tablespoons of honey), following by reassessing blood glucose levels immediately and 15 minutes thereafter.

True or False: Severe hypoglycemia is a medical emergency requiring activitation of EMS and a trained healthcare provider to administer glucagon.

Do you have a Glucagon Emergency Kit?

Are you familiar with the ADA (American Diabetes Association) guideline for athlete exercising during hyperglycemic periods?

Following a mild hypoglycemic or hyperglycemic event do your physicians determine safe blood glucose range for return to play?

Optional Information: If you would like a report on the results, you will need to complete the email section below:

School: 

Name:

Email:



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