Athlete Profile: Alyssa Hayter

Most of us have come to think about improving our nutrition and health only as we’ve gotten older and wiser. Sure, Mom always told us we had to eat all our vegetables before dessert, and we always knew that eating a ton of junk food was not going to help us grow big and strong. But when I was a kid, I didn’t think about my food choices too much.  I certainly wasn’t worried about carbohydrate intake or how it would make me feel if I ate too much or too little.

After meeting and getting to know Alyssa Hayter and her family, I now realize that there are many children and teenagers whose daily lives revolve around making meal decisions, because good choices keep them safe and healthy.  Alyssa doesn’t track her carbohydrate intake to improve her body composition or performance on the soccer field. She does it to manage her diabetes. She needs to ensure that she stays healthy, because she’s got some big athletic dreams.

One afternoon when Alyssa was just four years old, her parents noticed that her behaviour was off.  They couldn’t keep her cup full enough and Alyssa was either downing a drink or rushing to the washroom.  Although she showed no other indication of being sick, Alyssa’s parents sensed that something was wrong. They took her to the hospital.  Only a few hours later, Alyssa was diagnosed with diabetes mellitus type I and received an injection of insulin — the first of thousands of doses that she must now endure for life.

At such a young age, all of the responsibility for managing this disease fell to Alyssa’s family and the nurses that came in every day to give her the shots. To maintain an adequate level of insulin in her little body, Alyssa needed four shots a day — two in the morning and two with supper –- and her parents quickly became diligent observers and moderators of Alyssa’s nutrition and activity levels.  Over the years, there were a few scary moments when the insulin levels got off track, but fortunately these were rare and everyone adjusted to the new norm.

By the time Alyssa was eight and more aware of what having diabetes meant, her doctor suggested that she switch over from daily injections to a subcutaneous insulin infusion pump.  Instead of large boluses of slow-acting insulin given at set times of the day, the pump can be programmed based on individual intake and activity to release a continuous infusion of rapid-acting insulin.  When the user correctly inputs the appropriate information, the pump closely mimics a normal functioning pancreas, offering good blood glucose control and thereby reducing the risk of complications from fluctuating levels of insulin.

The pump is so small and easily concealed, a casual observer might not even notice it. In fact, the first few times I was with Alyssa for a meal, I thought she was just playing with her MP3 player.  A disposable reservoir holding the insulin is contained within the pump; when the user releases a dose, the insulin runs through a tube to the cannula inserted under the skin.  Every three days, Alyssa’s mom helps her to replace the subcutaneous needle and the reservoir.

Each time Alyssa is ready to eat, she quickly pricks her finger to draw a sample of blood to test the levels of circulating glucose.   She must also estimate the approximate levels of carbohydrates she can eat based on the food type and portion size.  For many of the foods Alyssa eats regularly, she has a good idea what this number is, but for newer foods or meals eaten out, she has a small handbook that can provide the information she needs.  Alyssa then inputs both her blood glucose and estimated carbohydrate intake to the pump, which delivers the appropriate dose of fast-acting insulin that will offset her intake.

Alyssa’s family knew that switching to a pump was not without risks.  Without longer-acting insulin, there is a risk that Alyssa may not get sufficient insulin if the pump becomes defective or damaged, which can happen more easily when the user is active in rougher sports.  However, they were also confident that with some education and support, having the pump would help to make Alyssa feel more independent. She can monitor and adjust her own levels of insulin, and have a bit more flexibility with her meals, activity, and sleep. All of these are important things when you’re a kid, especially when you’re a kid that likes to play hard.

In the four years since she’s been on the pump, there have been no major issues, and the transition has gone very well.  Even though the pump gives Alyssa a bit more freedom to compensate for higher carbohydrate foods, her approach is to manage the disease as best she can with her food choices and by eating frequently throughout the day.

Alyssa’s school is on a balanced day schedule, where instead of one long lunch, the students get two full nutrition breaks.  Typically her day starts with a low-sugar cereal and milk. At her first break, Alyssa will have water, a granola bar and soup or a salad with lots of vegetables. At second break, it’s usually more water, a piece of fruit and a yogurt.  Once she gets home from school, a light snack tides her over until dinner, which is usually something like chicken with rice and a vegetable.  Alyssa’s never had much of a sweet tooth so desserts and candy aren’t a normal part of her nutrition but along with salads and fish, one of her favourite meals is pasta, a dish she can now enjoy because she can control her insulin levels easily.

The pump has also allowed Alyssa to be as active and competitive as she is.  She started some sports when she was just four or five years old. Now at 13, Alyssa has already become quite an accomplished year-round athlete.  Though she spends a lot of her free time playing tennis and sailing in the summer, and skiing throughout the winter, she is a dedicated cross-country runner, competitive soccer player, and a prominent member of a Tween A Ringette team (girls aged 13 and 14 years old) that will be competing at the Provincial Championship Tournament this upcoming weekend (March 21-22).  Depending on what sport she’s playing, Alyssa will sometime leave the pump on or, opt to take it off if there’s an increased risk of damage.  She generally leaves it on for ringette or running, but will take it off on the soccer field or any time she’s in the water.

Before a game or practice, Alyssa always checks her blood glucose levels.  If the reading indicates that her blood sugars are a little high, she usually doesn’t dose with insulin, knowing that she’ll be using the extra sugars for energy once she starts playing.  If levels are a little low, Alyssa will be sure to have some juice or a light snack. This ensures that she doesn’t have to make nutrition around her games and practices too complicated.  By checking before and immediately after each session, Alyssa can easily keep her levels in check and most often only has to drink water during activities.

Her careful self-monitoring helps, but Alyssa has also learned to stay in tune with her body, and recognize when her blood sugars are off balance with insulin.  When her blood glucose is too high, Alyssa feels thirsty, hyper, and like she has too much energy.  Because she drinks water all day long, she knows when her thirst is stronger than normal.  On the other hand, when sugars are too low, Alyssa feels tired and lethargic.  She has become so tuned in to the subtle sensations of sugar and insulin balance that most times, she can guess what she needs to do in order to rebalance without even checking with a finger prick.

Alyssa’s awareness and confidence with managing her symptoms has been critical to helping her stay on top of the diabetes, but there have been some challenges along the way.  In particular, she’s struggled with the ways that others have reacted to her, and the experience of feeling embarrassed or different from her friends.

After students would crowd around as she did the finger prick and were overly curious about her pump, Alyssa stopped checking her levels when she was at school.  She started relying on the consistency of her meals and how she felt as levels fluctuated instead. This way, she felt she wasn’t on display as she quickly administered the dose of insulin from her pump.  Luckily, since the pump tracks and trends the finger prick readings, Alyssa’s mom caught on that Alyssa wasn’t inputting these numbers. With the support of her family and friends, Alyssa decided that she wasn’t going to let embarrassment or a little extra attention directed at her stop her from doing what she needed to do to stay healthy.

Alyssa’s close friends and family have been instrumental in helping her fit in and feel like diabetes does not need to control her life.  The people closest to Alyssa treat her the same as they would anyone else.   The one exception is her best friend Erinn, who always carries around extra juice or snacks in case Alyssa needs them, and has gotten good at knowing when Alyssa is a little low or high.

Though she often wishes she could enjoy Slushies in the summer with her brother and sister, or not have to worry about finger pricks and insulin levels, Alyssa has accepted that this is just the way it is and is okay with it. For Alyssa, being able to stay healthy, active and competitive in the things she loves to do is well worth the little extra effort to choose healthier foods and diligently count those carbs.

Alyssa rips it up on the ski hill