Regular exercise is an essential component in in managing diabetes in adults and children alike. It helps to lower glucose (blood sugar) levels, which is especially important for children with type 2 diabetes.

Poorly controlled glucose can lead to numerous long-term complications in diabetic individuals, such as heart conditions and kidney disease. Acute glucose irregularities can cause immediate problems such as seizures and a diabetic coma.

All children must employ certain safety measures when exercising, such as wearing the appropriate safety equipment and avoiding dehydration. However, diabetic children must take additional precautions, such as adhering to their diabetes care plan, which may recommend adjusting meals, snacks, insulin and antidiabetic agents before exercise. Those who use an insulin pump need to ask their physician whether the device should be disconnected or removed during physical activities.

As advised by their physician, diabetic children may need to perform glucose monitoring before, during and after exercise to ensure that the levels are not too low (hypoglycemia) or too high (hyperglycemia).

If their glucose level is too low, patients should follow the treatment plan established in advance by their physician, such as taking glucose tablets or eating a sugary snack. Activities should begin or resume only when glucose returns to an acceptable level, as determined by another test with the glucose meter.

The physician may recommend that if glucose is too high, the child should perform a ketone test.  Ketones are toxic byproducts produced when the body burns stored fat instead of glucose for energy. Hyperglycemia and ketosis can cause a life-threatening complication called diabetic ketoacidosis, which typically involves a severe lack of insulin. Left untreated, diabetic ketoacidosis can lead to coma and even death.

Children with diabetes should learn to recognize warning signs of hypoglycemia, hyperglycemia and diabetic ketoacidosis. Signs and symptoms of hypoglycemia may include dizziness, shakiness, sweating, hunger and headaches. Children with hyperglycemia may experience excessive thirst, fatigue, blurred vision or excessive urination. Ketoacidosis is often accompanied by nausea, weakness, abdominal pain, dehydration and heavy, labored breathing (Kussmaul breathing).

Additional exercise precautions for diabetic children include:

• Notifying teachers, coaches, youth leaders and teammates about a child’s diabetes, and teaching faculty and friends how to handle a diabetic emergency. Parents and guardians should also supply all appropriate school staff members with copies of the child’s care plan.
  
  
• Wearing a medical ID tag or bracelet to indicate the child has diabetes.
  
  
• Adjusting insulin injection sites to reflect the type of activity. For example, when bicycling avoid injecting insulin into the thigh because it will be absorbed more quickly than if injected into the arm.
  
  
• Carrying a backpack or duffel bag containing the following items:
  
  
• Hard candy, a juice box and glucose tablets
  
  
• Cheese and crackers, a sandwich or another nutritious snack
  
  
• A glucose meter, glucose and ketone test strips and related suppliesplies
  
  
• A large water bottle
  
  
• A pencil and paper or digital device to record glucose levels
  
  
• Emergency information, including parental and physician contact information
  
  
• Protective gear such as a helmet, knee pads and goggles
  
  
• Performing routine foot care and skin care. This includes checking for blisters and other injuries both before and after exercise. Children with diabetes need to wear cotton socks and comfortable athletic shoes to protect the feet. Foot care is especially important for people with diabetes because the disease can lead to many foot problems, such as ulcers.
  
  
• Wearing sunscreen while exercising outdoors. Sunburns and heat stroke can promote dehydration and affect glucose levels.