Exercise in children and adolescents with diabetes

In the 1950s, Joslin proposed that exercise is the third essential component in blood glucose regulation for persons with type 1 diabetes after insulin and dietary management. Although most studies have shown little impact upon hemoglobin A1c (HbA1c) levels (1–3) (B), the benefits of exercise go far wider: weight control, reduced cardiovascular risk, and an improved sense of well-being (4) (B). Postmeal exercise can be a valuable way to minimize postprandial glycemic spikes (E). For some, participation in physical activity is somewhat sporadic and related to leisure, school, or work. For others, daily exercise is a part of an overall training or conditioning program. Children and adolescents with diabetes should derive many of the same health and leisure benefits as adults and should be allowed to participate with equal opportunities and with equal safety. Diabetes should not limit the ability to excel in a chosen sport.Many famous athletes have proved this, e.g., Sir Steve Redgrave the five times Olympic gold medal winning rower, Gary Hall the US Olympic gold medal swimmer atAthens,WasimAkram is a Pakistani cricketer at the international level, Major League baseball player Jason Johnson, Ironman triathlete Bill Carlson, and female pro golfer Mimmi Hjorth. The topic most commonly discussed with families with regard to exercise is avoidance of hypoglycemia, but prevention of acute hyperglycemia/ketoacidosis may become a concern as well (5) (C). While this chapter is intended to address the issue of blood glucose regulation during various forms of sports and exercise, it is important for diabetes professionals and parents to appreciate that the demands of day-today physical activity will also have to be considered if a young person is going to participate in any activity that for them is unusually strenuous or prolonged.