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Exercise

Tips for Young Children

Young Children – Keeping them Active

Physical activity and exercise in young children aged 5 and under with T1D have similar health benefits to older youth and adults, including Pivovarov, J. A., Taplin, C. E., & Riddell, M. C. (2015). Current perspectives on physical activity and exercise for youth with diabetes. Pediatric diabetes, 16(4), 242-255. https://onlinelibrary-wiley-com.laneproxy.stanford.edu/doi/full/10.1111/pedi.12272.:

However, managing blood glucose levels in younger children with diabetes can be challenging due to their spontaneous bursts of activity. While there is limited evidence-based research in this population, the following information can help families prepare for activity and manage their child's blood glucose levels effectively.

Did you know? Physical activity makes insulin work better in the body.

The Centers for Disease Control and Prevention (CDC)CDC. How much physical activity do children need? Centers for Disease Control and Prevention. Published June 30, 2023. Accessed May 8, 2024. https://www.cdc.gov/physicalactivity/basics/children/index.htm recommends: 

All children, regardless of diabetes diagnosis, should be physically active throughout the day. This is important for their growth and development. Caregivers of these children should encourage physical activity during play.

  • Toddlers (ages 1-3) should aim for at least 30 minutes of activity each day

  • Preschoolers (ages 3-5) should aim for at least 60 minutes of activity each day  American Diabetes Association. ADA. https://diabetes.org/health-wellness/fitness/exercise-and-type-1

Common concerns in children 5 and under:

  • Low blood glucose and how to treat it
  • Infusion sites and/or CGM getting pulled off
  • Preparing for bursts of energy
  • Learning and understanding exercise settings
  • Keeping blood glucose levels in a stable range during activity
  • Managing diabetes outside of home
    • Examples: childcare, school, etc.

 

Tips to support young children with T1D around physical activity:

Monitor blood glucose levels before, during, and after physical activity

Watch child more closely as they may not be able to verbalize a low

Keep track of blood glucose trends around activity over time Type 1 Diabetes in Children: Safe Exercise. HealthLink BC. Accessed May 8, 2024. https://www.healthlinkbc.ca/health-topics/type-1-diabetes-children-safe-exercise

        • Example: Logging start and end blood glucose, treatment of lows, and grams of carbohydrates given

Consider setting a higher glucose target (exercise mode) if child is on an AID system, ideally one hour before activity or whenever possible Chetty T, Shetty V, Fournier PA, Adolfsson P, Jones TW, Davis EA. Exercise Management for Young People With Type 1 Diabetes: A Structured Approach to the Exercise Consultation. Front Endocrinol. 2019;10. doi:3389/fendo.2019.00326

Ensure child is within safe glucose range prior to activity

        • Example: Starting activity with blood glucose around 150-200 mg/dL range may help reduce risk of lows Adolfsson, P., Taplin, C. E., Zaharieva, D. P., Pemberton, J., Davis, E. A., Riddell, M. C., ... & DiMeglio, L. A. (2022). ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatric Diabetes, 23(8), 1341-1372.
        • Pro Tip: If glucose is below 150 mg/dL at start of activity, consider a small carbohydrate snack

Provide around 5-15 grams of carbohydrates for every 30 minutes of sustained physical activity and monitor blood glucose closely

During activity, if child is below 100 mg/dL, consider giving complex carbohydrates until glucose is over 100 and resume activity

        • Examples: crackers with cheese, peanut butter, or small protein bars

Especially for unplanned activity, focus on carbohydrate feeding, or low treatments

        • Examples: juice boxes, fruit snacks, or glucose tablets

Prep a variety of low snacks, along with extra supplies, for caregivers outside of home