Exercise is important for people with type 1 diabetes, providing health benefits and helping to control blood sugar levels. But getting your child to play a sport also presents some special challenges and “a lot of trial and error,” said Bethy Elrod, a mother who lives outside Atlanta and whose 12-year-old twins both have type 1 diabetes.
Elrod’s daughter, Amalia, is a good swimmer and rides horses; her son, Sawyer, likes to play soccer and baseball. “I believe they can do anything they want to do,” Elrod said. “Type 1 diabetes should not be an excuse to give up sports.”
Here’s what you need to know about helping your child exercise safely.
Get your doctor’s approval to exercise
Before starting a new exercise program, all children need to have a physical exam and get approval from their doctor. Jane Chiang, MD, senior vice president of medical affairs and community information for the American Diabetes Association (ADA), said that for the most part, “there are no special exercise program restrictions for children or adolescents with type 1 diabetes.”
Understanding the physical effects of exercise
The effect of exercise on a child’s blood sugar levels depends on the type of exercise and the duration of the exercise. Sweating and stress can both have an impact. “We found that extreme exercise lowers blood sugar, but in competitive situations, the twins’ blood sugar levels go up,” Elrod says. But that’s not always the case. It’s important to watch your child carefully to understand how each activity affects him or her.
Prepare for exercise
Prepare your child with extra diabetes supplies. “Children with type 1 diabetes must be more prepared than children without type 1 diabetes,” explains Alison Massey, director of diabetes education at Mercy Medical Center in Baltimore. “It’s important for them to bring a blood glucose meter, snacks, water and glucose tablets or other carbohydrates to treat hypoglycemia that can be caused by exercise.”
Adjusting the insulin pump
If your child wears an insulin pump, consult your doctor to see if you need to adjust the insulin dose or release rate during exercise. With your doctor’s approval, your child can take it off for a short time during play or exercise. For example, Amalia was able to remove his insulin pump during swim practice, and Sawyer did not use his insulin pump during competition. “He had broken his insulin pump while sliding into a home run,” Elrod said, “so now he takes it off.”
Note blood sugar levels after exercise
Glucose can drop for up to 11 hours after exercise, sometimes even in the middle of the night. It’s important to discuss with your doctor how to prevent this. Eating a snack or adjusting basal insulin (when using an insulin pump) before bed may help.
Check blood glucose levels before, during, and after exercise
Before, during, and after each practice or game, your child’s blood glucose levels should be checked. A continuous glucose monitor can provide more detailed information. Exercising when there is not enough insulin in the blood puts your child at risk for diabetic ketoacidosis (DKA). If blood sugar is low, juice or glucose tablets can help raise blood sugar levels quickly. If blood glucose levels are below 100 mg/dl, the child needs a small carbohydrate snack (about 15 grams) to prevent hypoglycemia.
Be honest with others
All of your child’s guardians should be told about your child’s condition and treatment. Although children don’t want to be “treated differently,” especially older children, sometimes children need to be managed differently. “Sawyer’s coach will take him off the field if needed,” Elrod said. “If Amalia felt her blood sugar level was dropping, she would get out of the pool and check her blood sugar and take some glucose tablets.”
Wear medical information with you
Children should always wear medical information with them. Instead of a wallet card or key chain that can be easily lost or overlooked, choose a bracelet or necklace that can be worn on the body. “In an emergency, the more information rescuers know, the better they can assess the current situation,” says Macy. If a child wears an insulin pump, it can also be noted on the ID. Not everyone is familiar with this type of medical device.
Parents need to be supportive of their child’s participation in sports
It’s normal to worry about your child’s blood sugar getting too low during a basketball game. But parents need to encourage their child to participate in sports and let them know they can succeed. Parents should teach their children to monitor blood glucose levels, make sure supplies are available, and know the early signs of hypoglycemia and hyperglycemia. For children with type 1 diabetes, “knowledge is power,” Elrod said.