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KEY POINTS
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Having diabetes means that there is too much glucose (sugar) in your child’s blood. The body breaks down some of the foods your child eats into glucose. The blood carries the glucose to the cells of the body. Your child needs some glucose in his or her cells for energy, but too much or too little glucose in your child’s blood causes symptoms and is not good for your child’s health.
Diabetes is caused by a problem with the way your child’s body makes or uses insulin. Insulin is made by the pancreas, which is an organ in the upper belly. Your child’s body uses insulin to help move glucose from the blood into the cells. When your child’s body does not make enough insulin or has trouble using the insulin the body makes, glucose cannot get into the cells, and it builds up in the blood.
Exercise helps your child in many ways:
The best exercise is activity that your child enjoys. It’s easier to make a habit of exercising if your child enjoys the activity. If your child has eye problems, talk to your child’s healthcare provider before your child starts a new activity. Boxing, jogging, or weight lifting may increase the risk of eye injuries.
Warming up and cooling down
Muscles that are warmed-up before exercise are more flexible and less likely to be injured. Brisk walking, easy jogging, or jumping jacks are good ways to get muscles warm and ready to go. After your child’s muscles are warmed up, he or she may also want to stretch. Stretching after exercise is more important than stretching before exercise. It decreases the risk for being sore or injured. When your child is ready to stop, it’s good to cool down by gradually slowing down the activity.
Aerobic exercise
Aerobic exercise is any physical activity that increases breathing and heart rate. This is important because it helps keep your child’s heart and lungs healthy. Examples include walking, swimming, riding a bike, and dancing. If your child has nerve damage or foot problems, it’s best to avoid walking long distances and treadmill or step exercises. Instead, your child can try activities such as bicycling or swimming.
A healthy goal for children is to exercise for 60 minutes every day, in addition to regular activities. Your child doesn't need to do 60 minutes of activity all at once. He or she can do shorter periods, at least 10 minutes each time. Your child should aim for a moderate level of effort that lets him or her talk while moving, but without getting out of breath.
Strengthening
Exercise to strengthen all major muscle groups, including legs, back, chest, belly, and arms, is recommended for most people. It includes weight lifting, stair stepping, doing sit-ups or push-ups, and exercising with large elastic bands. Strength training can help your child control his or her blood glucose. Muscle mass burns more calories than fat, so as muscle increases, so does your child’s ability to burn calories. A healthy goal is to do strengthening exercises on 2 to 3 days each week, and skip at least 1 day in between these days. However, this kind of exercise can be harmful if your child has certain medical conditions such as high blood pressure. Always check with your healthcare provider about the best exercise program for your child.
Flexibility
Flexibility exercises can help your child move about more easily and have better posture. Being flexible makes it easier to do many activities and it decreases the risk of getting hurt. Examples include stretching, yoga, and tai chi.
Try to set a good example by regularly exercising yourself. It helps if you can have fun with your child in the activity.
If your child has type 1 diabetes, vigorous physical activity should be avoided if urine or blood tests are positive for ketones. If your child has a large or moderate amount of ketones, exercise can raise the ketone level even more. Check the urine for ketones before exercise if your child is not feeling well or his or her blood glucose is staying higher than recommended by the healthcare provider. Your child can usually still exercise when blood glucose is high as long as he or she feels well and there are no ketones in the blood or urine.
Avoid exercise when it’s very hot or very cold. Ask your child’s healthcare provider if there are other times when your child should not exercise such as when your child feels sick or has a fever.
If your child is taking insulin or other diabetes medicines that can lower blood glucose, you need to be careful that his or her blood glucose doesn’t get too low during exercise. You can avoid problems by keeping good exercise records and learning:
Check blood glucose levels before, during, and after exercise.
This is especially important if your child has just been recently diagnosed with diabetes, is starting or changing an exercise program, or has had a change in medicines. Keep careful records of your child’s exercise and blood tests. If your child does the same exercise at the same time of with the usual meal schedule, usual insulin dose, and a similar starting blood glucose level, you will learn the effect of exercise on your child’s blood glucose. You will know how insulin and snacks need to be adjusted to avoid low blood glucose. In the records include:
Check blood glucose levels every few hours until bedtime. Your child’s blood glucose may stay lower than usual for several hours. Delayed hypoglycemia means that your child has low blood glucose several hours after the exercise is over. It may happen as much as 3 to 12 hours after exercise. It may cause an insulin reaction in the middle of the night. It’s not understood why this happens in some children who use insulin to help control their blood glucose.
Eat before and during exercise.
If your child is going to exercise around mealtime, your child should eat the meal before exercising. It’s best to exercise 30 to 60 minutes after a meal or snack.
Have extra snacks available during exercise.
If your child exercises within an hour after a meal, an extra snack may not be needed. If your child is not physically fit, the blood glucose may drop more quickly than if your child were fitter. If the blood glucose is low, your child needs a larger snack than when the blood glucose is high. The type of snack may depend on the length of the activity.
Extra water is also important, especially in hot weather. A general rule is to drink 8 ounces of liquid for every 30 minutes of vigorous activity. Liquids such as milk, sports drinks, and fruit juices help replace water, salts, and carbs.
You may need to change the insulin dosage or injection (shot) site.
Before your child tries a new activity, talk with your healthcare provider about any changes that might need to be made in your child’s insulin doses. Your child should avoid exercising when insulin is working at peak level because that is when it is keeping the blood glucose at its lowest level. Your provider can tell you when your child’s insulin is at its peak. Talk to your child’s provider about adjusting the insulin dose to fit your child’s exercise needs and schedule.
Your child’s activity and where the insulin is injected can affect how quickly your child absorbs the insulin. Exercise increases blood flow in the part of the body that is moving. The increased blood flow causes a faster absorption of insulin.
Make sure others know.
Your child should wear a medical alert bracelet or necklace. If your child is on a team, it’s important for teammates and the coach to know about the diabetes. Make sure the coach and teammates know where sugar snacks are kept. When your child has a low blood glucose level during a sporting event, he or she needs to rest at least 15 minutes after eating some sugar to let the blood glucose go up.
Temperature can make a difference.