Diabetes and Your Child: Safe Exercise

Exercise plays a big role in managing your child's blood sugar. It helps reduce the amount of glucose (sugar) buildup in the blood. This buildup is called high blood sugar (hyperglycemia) But, too much exercise can cause your child's blood sugar to get too low. This is called low blood sugar (hypoglycemia). That's why it's important to watch your child's blood sugar closely when they exercise. You will have to balance exercise with food and insulin to make sure your child is in their target range for blood sugar.

Exercise is a key part of your child's overall health and lifestyle. Children ages 6 to 17 should get 60 minutes of moderate to vigorous physical activity each day. Include muscle and bone strength training at least 3 days a week.

The best way to manage your child's blood sugar during exercise is to plan for it. These are some other things you can do to help keep your child safe during exercise:

• At first, check your child's blood sugar before, during, and after exercise to see how it's affected by exercise. Then check your child's blood sugar before and after each exercise session.
• Teach your child how to notice critical symptoms and how to manage their diabetes.
• Have your child eat a snack before exercising when their blood sugar is below target range. Try half a sandwich, a piece of fruit, or an energy bar.
• Don't use carbohydrate sources high in protein, such as milk or nuts. These may increase the insulin response to carbohydrates.
• Check that your child's fast-acting glucose tablets and emergency glucagon kit are nearby. Glucagon is a shot that raises blood sugar quickly. Ask your child's doctor about nasal glucagon.
• If your child's blood sugar is 250 mg/dL or above, test for ketones. If ketone levels are high, don't let your child exercise. Call your child's doctor. If ketone levels are low, your child may do mild to moderate to intensity exercise. Don't let your child do intense exercise until blood sugar levels are below 250 mg/dL. Intense exercise may make blood sugar levels go higher.

Blood sugar can get low when your child exercises. Lows can last up to 8 hours after exercise. That's why checking your child's blood sugar before and after playing sports is so important. Here are some other tips for making sure your child is safe during sports:

• Tell coaches that your child has diabetes.
• Give your child's coach a list of low blood sugar symptoms. Also, give instructions on what to do when the child has a low. Be sure the coach knows when to call 911.
• Pack high-carb snacks for your child. This could be a granola bar and a sports drink.
• Check that your child has fast-acting sugar, such as glucose tablets or a snack, on hand in case their blood sugar gets low. Be sure the coach knows where the snacks and tablets are kept.
• Ask the coach to keep snacks, glucose tablets, and glucagon in the team sports bag. Make sure the coach or another adult is trained to use the glucagon.
• Don't let your child practice or play in a game if their blood sugar is too high and ketones are present. Again, be sure the coach knows about ketones and that your child should not exercise if they are present.

Your child's blood sugar can get low when they are away from home. Have your child wear a medical ID that says they have diabetes and whom to contact in case of an emergency. Here are some tips to keep your child from having lows when they are away from home:

• Tell the parents of your child's friends about your child's diabetes. If your child doesn't mind, you can also teach their friends about diabetes.
• Teach your child's friends and their parents how to spot and treat lows. Treating lows means using meals, snacks, and fast-acting sugar sources, such as glucose tablets or juice, to raise blood sugar back up to the target range.
• Pack prepared meals and snacks, when possible. This will make it easier for other parents to help your child prevent lows. Include a note telling the parent when your child should eat.
• Check that your child and the adults in the home where they are visiting can reach you right away, if needed.
• Talk to the parents about the dangers of severe low blood sugar. Also, tell parents when to call 911.

For more information about diabetes, visit these websites:

• American Diabetes Association
• Children with Diabetes
• Juvenile Diabetes Research Foundation
• Endocrine Society