As A Child/Adolescent With Diabetes, How Can Exercise Help Me?
Don’t let your diabetes slow you down! Not only is exercise fun, it can help you manage your diabetes. Here are a few ways exercise can help:
- Exercise can help lower your blood sugar.
- It makes it easier for your body to use your insulin.
- It keeps your blood flow strong and healthy. You might have heard that diabetics can have circulation issues…this is what they’re referring to and exercise can help with it.
- It keeps your overall body strong and healthy, so you can be like your favorite Teenage Mutant Ninja Turtle!
- It makes you feel good! Yeah!
Not only can you still participate in sports and activities that involve being physically active, you can excel in them! If you work hard, you will do just as well in your sport or activity as you would if you didn’t have diabetes. Did you know that Ty Cobb, Jay Cutler, “Smokin’ Joe” Frazier, and Billie Jean King all had/have diabetes? Here are some other world class athletes with diabetes:
- BaseballTy Cobb (MLB - Detroit Tigers)
Jackie Robinson (MLB)
Mark Lowe (MLB)
- BasketballChris Dudley (NBA - New York Knicks)
Gary Forbes (NBA - Toronto Raptors)
Jerry Stackhouse (NBA - Dallas Mavericks)
- Beauty PageantsSierra Sandison (Miss Idaho) 2015 Miss America semifinalist
- Boxing"Smokin' Joe" Frazier
Sugar Ray Robinson
- FootballOrlando Brown (NFL - Cleveland Browns and Baltimore Ravens)
Jay Cutler (NFL - Chicago Bears)
Mike Sinclair (NFL - Philadelphia Eagles)
- GolfKelli Keuhne (LPGA)
Michelle McGann (LPGA)
Sherri Turner (LPGA)
Scott Verplank (PGA)
Jo Ann Washam (LPGA)
- HockeyNick Boynton (NHL - Boston Bruins)
Bobby Clarke (NHL - Philadelphia Flyers)
Curt Fraser (NHL - Chicago Black Hawks)
- RowingChris Jarvis - National Championship and Olympic Canadian Rower
Sir Steven Redgrave - Olympic Gold Medalist Rower
- RunningAyden Byle - Ran 6521.5 km across North America
Missy Foy - Elite marathon runner; qualified for Olympic Marathon Trials and took second place in the US 50 Mile National Championships in 2007
- SkiingKris Freeman - Olympic cross country skier
- SnowboardingSean Busby - Professional snowboarder
- StrengthDoug Burns - Record-holding powerlifter and winner of Mr. California, Mr. USA, and Mr. Universe titles
- SurfingScott Dunton
- SwimmingScott Coleman - Swam across the English Channel
Gary Hall, Jr. - U.S. Olympic Gold Medalist; winner of 10 Olympic medals total (5 gold, 3 silver, and 2 bronze)
- TennisBillie Jean King
Arthur Ashe - Wimbledon Winner
- TriathlonsJay Hewitt - Ironman Triathlete and member of U.S. National Long Course Triathlon Team at the 2004, 2005, and 2006 World Championships
These are only some of the world class athletes with diabetes; the list is actually much longer. These diabetics didn’t let diabetes slow them down and neither should you!
What Do Parents Need To Know About Having A Child With Type 1 Diabetes Who Wants To Exercise?
Why It’s Good for Your Child
Exercise is a wonderful tool at your child’s disposal that can help him/her manage blood glucose levels and live a healthy, normal life. Having diabetes does NOT need to stop your child from being active, participating in, or even exceling in athletics. In fact, The American Diabetes Association Position Statement on Physical Activity and Exercise states:
All levels of physical activity, including leisure activities, recreational sports, and competitive professional performance, can be performed by people with Type 1 diabetes who do not have complications and are in good blood glucose control.3
Though the benefits outnumber those listed here, these are a few:
- Improved insulin efficiency
- Ability to more effectively manage blood sugar levels
- Reduced cholesterol levels and risk for heart disease, which is heightened in people with diabetes.1
- Increased blood flow to the extremities, resulting in improved circulation (poor circulation is a common complication in long-time diabetics).
- Lowered risk for other diabetes-related complications such as joint problems, vision loss, kidney failure, and more.1
- Increased awareness – Your child’s knowledge of and ability to manage his/her diabetes will increase.
- Empowerment – Your child will feel more in control knowing he/she has the power to manage diabetes.
If you and your child arm yourselves with the knowledge to manage diabetes before, during, and after exercise, your child will reap a wealth of benefits from doing so.
Basic Principles
Test before, during, and after exercise
One of the best things you and your child can do is get used to testing – A LOT. Your child should test his blood sugar before, during (if the exercise will last longer than 30 minutes), and after exercise. This will help you establish a baseline from which to determine how much insulin and/or carbohydrates he needs to maintain normal blood sugar levels.
Testing before helps your child know where his blood sugar is to start with and, based on how much insulin he has in his system and whether or not he has recently eaten, he should have a good idea of whether his blood sugar is going up or down. If his blood sugar before exercise is low, or even normal, and is not likely going up, he will need to consume some carbohydrates before beginning exercise to fuel that exercise. If his blood sugar is high, and likely going to continue to climb, he will need to take insulin before beginning.
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Testing during is important for any extended period of exercise (usually lasting 30 minutes or more). Extended periods of exercise have varying effects on different people, and your child may need to make adjustments during exercise. For example, let’s say when he tested before the exercise, his blood sugar was normal and he assumed he didn’t need to make any major adjustments. Now, 30 minutes later, that pizza he ate for lunch and didn’t quite take enough insulin to counteract is kicking in and his blood sugar, even during exercise, has risen to 250 mg/dl. He is going to need some insulin to knock that blood sugar down – for the sake of both health and performance.
The opposite is also often true during exercise, because of the amount of carbohydrates the body needs to consume. Diabetic athletes must be wary of low blood sugar, and testing is the best way to determine this.
Testing after exercise will allow your child to know whether he needs to consume carbohydrates or inject insulin to keep his blood sugar in a normal range once the activity has stopped. Long, strenuous periods of exercise especially can continue to impact blood sugar for hours after the exercise is completed. For this reason, it is critical to monitor what is happening to your child’s blood sugar levels after exercise.
We recommend keeping a detailed exercise log. Not only will this help your child track his blood glucose levels before, during, and after exercise for that day, it will allow him to start to see trends in how his body reacts to exercise, insulin, and carbohydrates. Because everyone is different, there is no “one size fits all” formula for how much to eat, drink, or inject, so keeping a log and learning how your child’s body reacts is invaluable. Here is a sample log:
Before
Activity and Intensity:
Time of day:
Blood sugar:
Heart rate:
Food or drink consumed:
Insulin (type and dosage):
During
Time of day:
Blood sugar:
Heart rate:
Food or drink consumed:
Insulin (type and dosage):
After
Time of day:
Blood sugar:
Heart rate:
Food or drink consumed:
Insulin (type and dosage):
Be alert for hypoglycemia
Hypoglycemia (low blood sugar) is one of the primary reasons parents are hesitant to allow their Type 1 diabetic children to participate in exercise, but it doesn’t have to be! With careful monitoring (as discussed above) your child can get an excellent handle on how her body responds to exercise and will be equipped with the knowledge to respond to it appropriately. This will empower her to manage her disease (and likely other aspects of her life) with confidence.
A few tips for avoiding low blood sugar during exercise:
Pump users may want to suspend pump basal insulin during exercise, or lower the basal insulin rate. Studies have shown that kids who either turn off their pumps or reduce the basal insulin rate of their pumps during exercise are at a lower risk for hypoglycemia.
A 2006 study published in Diabetes Care journal tracked children from the ages of <10-18 who performed 75 min. of exercise at 4 p.m. (a typical after-school activity start time). The results of the study found that children who started exercising at a blood sugar level of 120 (mg/dl) or higher were at lower risk for hypoglycemia, but that blood sugar levels still needed to be monitored during exercise.
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Children who were given 15 g of carbohydrate during the study saw a blood sugar increase of only 20 mg/dl and more than 30% needed a second dose of 15 g to complete the exercise. The conclusion drawn from this was that 30-45g might be a more appropriate amount of carbohydrate for hypoglycemia in children during moderate, sustained exercise. However, researchers still agree that trial and error is the best method.2
Be alert for low blood sugar after exercise. Children who participate in moderate-intensity, sustained exercise need to be particularly alert for low blood sugar for up to 31 hours after exercise.3 This, of course, depends on the intensity and duration of the exercise. If your child participates during this type of exercise in the afternoon, be more aware of the greater potential for low blood sugar at night. You can greatly increase your likelihood of preventing this by testing your child’s blood sugar often after exercise and before they go to bed. Studies have suggested that, if your child uses a pump, suspending the pump’s supply of basal insulin during exercise reduces the likelihood of low blood sugar after exercise.2
Understand the basics of how the body reacts differently to different types of exercise
While the effects of sustained high-intensity exercise and continuous moderate-intensity exercise on blood sugar in Type 1 diabetics has been studied extensively, there is less conclusive evidence about how the body responds during “intermittent high-intensity exercise” (IHE). Most team/field sports, as well as the spontaneous play of children fall under the category of IHE.3 Here is what we do know about each of these types of exercise:
- More...High-Intensity Exercise
Activities like weight-lifting, that are sudden, intense, and cannot be sustained for long periods of time fall into this category. In most cases, Type 1 diabetics participating in somewhat sustained periods (~15 minutes) of high-intensity exercise are NOT at risk for low blood sugar; in fact, they may actually be more susceptible to high blood sugar. If your child consistently experiences high blood sugar after high-intensity exercise, she should increase her insulin dosage.3
Moderate-Intensity ExerciseThis encompasses most continuous, aerobic activities such as jogging, cycling, and swimming. It is well-established that Type 1 diabetics participating in this type of activity are at increased risk for low blood sugar during the exercise and for up to 31 hours after exercise.3 Don’t let this prevent your child from enjoying these activities, though! The good news is that because this is so well-researched, you and your child can be well-equipped to effectively manage blood sugar during this type of exercise.
A fairly standard recommendation is that if your child begins a moderate-intensity exercise in a normal blood sugar range, she should decrease her insulin dosage by 25% and consume 15-30g of fast-acting carbohydrate before beginning the exercise and at 30-minute intervals during the exercise, if the activity lasts less than one hour.3 However, keep in mind that this strategy may vary based on what your child has eaten that day, her general health, as well as other factors, so it is still important to test blood sugar often and keep a log to establish patterns. It is key to identify the change in the child’s insulin to carb ratio during this time frame. Knowing this has an enormous advantage. It helps make things predictable.
Intermittent High-Intensity Exercise (IHE)This includes most team or field sports (e.g. basketball, football, hockey, etc.) and most children’s spontaneous play. Though studies around this type of exercise have been somewhat inconclusive, several studies do suggest that IHE should not be handled the same way as either high-intensity or moderate-intensity exercise. In general, IHE seems to elicit a somewhat balanced glucoregulatory response, which in a nutshell means that participants in IHE are at a lower risk for low blood sugar during and after exercise as participants in moderate-intensity exercise, and at lower risk of high blood sugar after exercise as participants in high-intensity exercise.3
This prompts a couple of general suggestions:- 1) It may not be necessary to lower insulin dosage as much for a child participating in IHE types of activities.
- 2) Interspersing moderate-intensity exercise with short bursts of high-intensity exercise may lessen blood sugar drops.3
My own personal observation is duration and intensity contributes to a change in the insulin to carb ratio that’s so important to understand, because of its relationship with hypoglycemic reactions. And I’ve found it to be cumulative; for example, if your child has a x-country 5K race (not a big deal on its own), and then actively participates in a basketball game, this will start to impact that insulin to carb ratio. You need to be cognizant of the potential for a hypoglycemic reaction and….. the need to adjust your insulin and carbohydrate intake. Other examples would be a swim meet in the morning and then going home to the farm and exerting a significant amount of physical activity (especially upper body). Or a Saturday afternoon soccer game and then wrestling with friends. Or tearing around on bikes and then going to cheerleading practice and riding the bikes back home. Duration and intensity combined with upper body exertion will impact your insulin to carb ratio.
Again, every child is different and every day is different, so it is best to test often and keep a log.
Keep carbs handy
As we’ve already discussed, the greatest risk for Type 1 children participating in exercise is low blood sugar. This risk can be greatly reduced simply by ensuring that your child always has a go-to fast acting source of carbohydrates. Some might suggest that you make sure these are healthy carbohydrates, but honestly, if it’s my kid, I just want them to have something they can eat fast and that will do the trick fast! Fast-acting carbs that are quick (not to mention fun) to eat and easy to carry are things like M&Ms, Gu (or other energy gels), and cookies.
If your child is running or cycling, have him carry the carbohydrates with him. If he is participating in a team sport, make sure he has access to them on the sidelines.
Everyone is different
We cannot stress enough how important it is to remember that everyone is different. There is no magic formula or one-size-fits-all prescription for blood sugar control during exercise. Every child, every day, every activity is different. Keeping a detailed log and testing often will help your children determine their own personal traits and set them up for success.
- References
- 1. Colberg, Sheri R. (2009). Diabetic athlete’s handbook. Champaign, IL: Human Kinetics.
- 2. Tansey, Michael J., et al. “The Effects of Aerobic Exercise on Glucose and Counterregulatory Hormone Concentrations in Children with Type 1 Diabetes.” Diabetes Care 29.1 (Jan. 2006): n.p. Health & Wellness Resource Center. Web. 29 Jun. 2012.
- 3. Guelfi, Kym J., Timothy W. Jones, and Paul A. Fournier. “New Insights into Managing the Risk of Hypoglycaemia Associated with Intermittent High-Intensity Exercise in Individuals with Type 1 Diabetes Mellitus: Implications for Existing Guidelines.” Sports Med 37.11 (2007): 937-46.
