19 Nov Managing blood sugar and exercise in kids with type 1 diabetes

Australia has one of the highest rates of Type 1 Diabetes across the globe. Unlike Type 2 Diabetes, it’s more common in younger people, with half of those diagnosed aged under 30. For parents whose children are living Type 1 Diabetes, managing active play, exercise, insulin and blood sugar levels can be tricky.

In this blog, we look at some tips and tricks for parents. From encouraging children to be more active to managing the highs and lows of diabetes, we’re here to help!

What is Type 1 Diabetes?

Type 1 Diabetes is an autoimmune disease characterised by the body’s inability to produce insulin from the pancreatic beta cells. Insulin injections are required to enable the fuel we obtain from carbohydrate-based food to be stored as energy. This ensures that important bodily processes can carried out.

Diabetes in younger Australians

Type 1 is the most common type of diabetes for younger Australians, and it’s often diagnosed in childhood or adolescence. 141 out of every 100,000 children aged under 14 are diagnosed with Type 1 Diabetes.

Although Type 2 Diabetes is more common in adults, children and adolescents can also be diagnosed. Prediabetes in younger populations has become a more common challenge faced by patients, families, parents and care providers. Being physically active early in life can help to reduce the risk of developing Type 2 Diabetes later.

Exercising with diabetes

Exercise is safe for people with diabetes, and parents and caregivers should encourage their children to be active as part of their diabetes management.

The benefits of exercise for diabetes management and overall general well-being include:

• Reduced reliance on insulin as exercise has an insulin like effect
• Improvements in insulin sensitivity can last for 24-72 hours after exercise, depending on the intensity and duration of activity
• Increased lean muscle mass provides more space for glucose to be stored as glycogen. This ensures plenty of energy is available for when it is required during exercise or other activities
• Muscle contractions increase GLUT4 translocation, the main insulin dependent transporter responsible for glucose transport into muscles
• Improved body composition associated with reduced fat mass and increased fat free mass
• Better social engagement, mental well-being and stress management
• Reduced risk of developing diabetes related complications later in life

How much exercise should children with diabetes do?

The physical activity guidelines suggest that children and adolescents (aged 5 to 17) should aim to do 60 minutes of moderate to vigorous intensity aerobic exercise daily. This can be broken up into small bouts of exercise throughout the day.

Furthermore, muscle and bone strengthening activities like weight training, climbing, swinging bodyweight exercises and yoga should be performed at least three days each week. Remember, physical activity should be fun and engaging!

There should also be a conscious effort to limit periods of sedentary behaviour as much as practically possible, with no more than 2 hours of screen time daily.

The challenges of managing blood sugar

Whilst regular physical activity and exercise is important for managing blood glucose levels, balancing this with regular daily insulin injections can be a significant challenge for the individual, family and their healthcare team. It’s important to avoid blood sugar levels getting too high (hyperglycaemia) or too low (hypoglycaemia).

Hyperglycaemia: Without insulin, glucose levels can increase to dangerous levels. Hyperglycaemia can lead to severe diabetes ketoacidosis, often as a result of illness or infection. Diabetes ketoacidosis occurs most often in individuals with Type 1 Diabetes and occurs when the liver converts fat to energy as a result of increasing hyperglycaemia and insufficient insulin within the body.

Hypoglycaemia: This occurs if too much insulin is present within the body or carbohydrate intake is insufficient in meeting the demands insulin or physical activity.

Both have their own causes, specific signs and symptoms and considerations that need to be met in order to ensure the safety of the individual.

Managing Hypos and Hypers

Here are some tips to balance the highs and lows of exercise if your child is living with Type 1 Diabetes and taking regular daily insulin injections.

• Avoid exercise at the peak of insulin action
• Injecting insulin local to the predominant muscles used throughout the activity will likely increase insulin absorption rates.
• Warmer temperatures are likely to increase the rate of insulin absorption, ensure adequate hydration through regular water breaks during sport.
• Ensuring fast acting carbohydrate snacks like orange juice poppers or jellybeans are available for the treatment of hypoglycaemia.
• Consider the effect of insulin sensitivity in the 12-24 hours following exercise, exercise has an insulin like effect and therefore the risk of hypoglycaemia is more pronounced in this window of time following activity.
• Consider morning exercise as opposed to evening exercise where possible. Research has shown that exercise in the morning confers a lower risk of Delayed Onset Hypoglycaemia (DOH)
• If exercising in the evening, consider a low GI carbohydrate snack prior to bedtime (eg, greek yogurt with mixed berries or a glass of milk or wholegrain toast with spread).
• ExCarbs is a fantastic online resource parents can use to better understand the specifics of carbohydrate and insulin adjustments for their child around exercise!
• It is important to note that depending on the child’s size, daily energy expenditure, amount of insulin they are taking – carbohydrate intake will vary and subsequently shouldn’t be approached on a one-size fits all basis.
• Speak to an Accredited Practising Dietitian (APD) or Credentialled Diabetes Educator (CDE) if you are interested in more specific adjustments to carbohydrate or insulin doses during physical activity or sport.

Where to get more advice

Accredited Exercise Physiologists (AEP) are allied health professionals trained in the delivery of tailored exercise interventions to treat, manage or prevent the development of chronic conditions like diabetes. For more information on accessing an AEP in your local area, click here.

Written by Hayden Kelly. Hayden is an Accredited Exercise Physiologist at Diabetes NSW and ACT.