Regular exercise offers many benefits for diabetic children and teens, including control of weight and glucose (blood sugar) and improved cardiovascular functioning.
In addition, consistent physical activity helps young people with prediabetes delay or prevent the onset of type 2 diabetes and can help those with type 1 diabetes prevent double diabetes. With planning and preparation, children can be as physically active as their nondiabetic peers.
Parents and guardians should take an active role in ensuring that diabetic children exercise regularly and appropriately by encouraging physical activity and acting as role models. They should schedule a pre-workout checkup with a physician before enrolling the child in a sport or exercise program. Additionally, parents should notify authorities such as school nurses and coaches that their child has diabetes, and provide copies of the child’s diabetes care plan.
All children must take certain safety measures when exercising, such as wearing a helmet for certain sports. However, children with diabetes need to take additional precautions, such as performing glucose monitoring and adjusting meals, snacks and insulin therapy or other medications. Such steps can help prevent complications such as hypoglycemia and hyperglycemia.
Experts often recommend that diabetic children and teens participate in cardiovascular exercise for 30 to 60 minutes each day. Examples of cardiovascular activities include bicycling, swimming, skating and playing basketball. Strengthening exercises are also beneficial. Activities should be accompanied by a warm-up period, stretching and a cool-down period.
About exercise & diabetes in children
Having diabetes affects a child’s life in many ways. However, young people with diabetes can be as physically active as their nondiabetic peers. With proper planning and preparation, regular physical activity is an essential component in the management of diabetes.
Most diabetic children have type 1 diabetes, an autoimmune disorder that destroys the insulin-making cells of the pancreas. Insulin is a hormone that the body needs to use glucose (blood sugar) for energy. Excess weight has traditionally not been considered a factor in the development of type 1 diabetes, but recent research suggests that obesity may cause an earlier onset. In addition, patients with type 1 diabetes who are sedentary and gain weight can develop insulin resistance and double diabetes.
With the growing incidence of childhood obesity, an increasing number of children and teens have prediabetes and type 2 diabetes, metabolic disorders that are strongly associated with excess weight, abdominal fat and insulin resistance. Other forms of pediatric diabetes include secondary diabetes, which is due to another condition such as cystic fibrosis or Down syndrome, and maturity-onset diabetes of the young (MODY).
Regular exercise helps children with diabetes:
Achieve and maintain a healthy weight
Control glucose and prevent hyperglycemia
Avert or lower insulin resistance and hyperinsulinemia
Improve cholesterol levels
Reduce high blood pressure
Enhance cardiovascular functioning
Exercise also may help prevent or delay the need for antidiabetic agents in children with type 2 diabetes, and may allow for a lower dosage of insulin for patients who require insulin therapy, according to a physician’s recommendations.
Physical activity also plays a key role in delaying or preventing type 2 diabetes in children. Children can reduce the likelihood of developing type 2 diabetes by incorporating just 30 to 60 minutes of physical activity into their daily routine. Additionally, regular exercise can help all children:
Improve sleep and reduce fatigue
Reduce stress
Improve coordination and flexibility
Eliminate boredom
Boost self-esteem
Increase socialization
Establish positive lifelong habits that reduce the risk of health problems in adulthood, ranging from cancer to sexual dysfunction
Role of the parent or guardian
Parents and guardians need to take an active role in ensuring that children with diabetes are exercising frequently and appropriately. Parents should schedule a pre-workout checkup with an endocrinologist or pediatrician before enrolling the child in a new sport or exercise program. The physician will review the child’s diabetes care plan, which includes general information such as diagnosis date and emergency contacts, as well as:
Instructions on how and when to check glucose (blood sugar) levels
Instructions on how and when to take insulin and/or antidiabetic agents
Glucose guidelines, including the acceptable range for exercise
A schedule of meal and snack times, including any necessary adjustments for exercise
Instructions on how to handle a complication such as hypoglycemia or insulin shock
The pediatrician will also discuss appropriate activities with the adult and child, and remind them about exercise precautions specific to diabetes.
Parents and guardians should notify certain school staff or youth leaders, such as nurses, teachers, coaches, scout leaders and church group leaders, of their child’s condition. It is a good idea to provide all relevant personnel with a copy of the child’s diabetes care plan.
Additionally, the parent should make arrangements with staff regarding the storage of the child’s diabetes equipment and supplies, such as insulin administration devices (e.g., insulin pen), glucose meters and ketone test strips. If glucagon is to be administered in case of a hypoglycemic emergency, the appropriate personnel should be trained in how to inject this medication.
Some children do not enjoy or seek out exercise. Parents and guardians can promote physical activity of diabetic children in a variety of ways. These include:
Speaking with the child’s school about increasing scheduled active time for students
Involving their child in activity programs with community organizations
Volunteering to help revitalize community playgrounds
Encouraging the child to enroll in dance or martial arts classes, or trying out for a team sport.
Replacing computer and television time with active family time, such as a family bike ride
Walking the child to school or encouraging bicycle riding
Planning family vacations that involve physical activities, such as walking tours or horseback riding
Praising their child for performing household chores such as mowing the lawn, raking leaves or shoveling snow
Setting a good example for the child by exercising regularly, eating a nutritious controlled-calorie diet and practicing other good health habits
Some children continue to resist physical activity. Parents should try to determine the cause of their child’s exercise aversion. Obese children, for instance, may feel embarrassed when they have to wear a team uniform. It is a parent’s responsibility to assist their diabetic youngster in identifying and participating in enjoyable activities.
Exercise precautions for diabetic children
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.
Exercise recommendations for diabetic children
Experts often recommend that children with diabetes, if cleared by their physician, engage in some form of cardiovascular (aerobic) exercise for 30 to 60 minutes a day to achieve maximum benefits. Inactive children should begin with just a few minutes of exercise each day, and work their way up to 30 to 60 minutes of daily exercise. People who can talk during exercise, but are breathing too heavily to sing, are generally exercising at the right intensity level.
Cardiovascular exercise, often called aerobic exercise because it signals the body to take in additional air, increases a child’s heartbeat and breathing rate. Examples of child-friendly cardiovascular activities include:
Children with diabetes also benefit from anaerobic exercise, which involves short periods of intense exertion followed by rest periods. Anaerobic exercise does not help burn fat. Instead, it helps to build muscle, which allows the body to burn more calories while performing cardiovascular activities. Anaerobic activities include:
Sit-ups
Push-ups
Pull-ups
Lifting weights
Recent research indicates that regular strengthening exercises can, like cardiovascular activity, help teens prevent type 2 diabetes.
To reduce the risk of injury, children should not exercise cold muscles. Rather they should first warm up their muscles by engaging in a low-intensity activity such as walking at a leisurely pace for about 10 minutes, followed by a brief period of gentle stretching to promote flexibility. Children should end their workout with another stretching session followed by a brief cool-down period, which generally consists of a similar low-intensity activity. The cool-down period helps prevent muscle strains and fluctuations in blood pressure.
People with diabetes should always consult their physician before beginning a new sport or exercise program.
Questions for your doctor
Preparing questions in advance can help patients and their loved ones have more meaningful discussions with healthcare professionals regarding their condition. Patients or their parents may wish to ask their doctor the following questions related to exercise and diabetes in children:
Can you clear my child to start or alter an exercise program?
How will exercise help my child control or prevent diabetes?
What adjustments to the self-care routine should my child make when beginning an exercise program?
Will my child need increased monitoring of glucose, blood pressure or anything else when participating in an exercise program?
What kind of exercises should my child do? Are there any that should be avoided?
How will exercise affect my child’s meal plan?
What effect will exercise have on my child’s blood sugar?
Are there any extra precautions my child should take when exercising?
How often should my child perform glucose monitoring while exercising?
What should my child do if there are possible symptoms of hypoglycemia or another problem?
If my child uses an insulin pump, should it be removed during physical activities?
