Young Children – Keeping them Active

Physical activity and exercise are good for young children with T1D, just like they are for older kids and adults. Some benefits are^{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 hard because they have sudden bursts of activity. There isn't a lot of research on this, but the following tips can help families get ready for activity and manage their child's glucose levels well.

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, whether they have diabetes or not, should be active throughout the day. This is important for them to grow and develop well. Caregivers should encourage children to be active during playtime.

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 glucose levels and how to treat them
Infusion sites or CGMs getting pulled off
Preparing for bursts of energy
Learning how to use exercise settings
- Example: exercise mode if using Automated Insulin Delivery
Keeping glucose levels stable during activity
Managing diabetes away from home
- Examples: childcare, school, etc.
Toddlers (ages 1-3) should aim for at least 30 minutes of activity each day.

Tips to support young children with T1D around physical activity:

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

Watch your child closely because they might not be able to tell you if they feel low.

Keep track of 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: Log start and end glucose level, treatment of lows, and grams of carbohydrates given.

Consider setting a higher glucose target (exercise mode) if your 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}

Make sure your child is within a safe glucose range before activity.

- - - Example: Starting activity with glucose level around 150-200 mg/dL may help reduce the 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 the start of activity, consider a small carbohydrate snack.

Give 5-15 grams of carbohydrates for every 30 minutes of exercise and check glucose levels often.

If your child's glucose is below 100 mg/dL during exercise, give them complex carbs until it goes over 100 before continuing.

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

For unexpected exercise, give your child snacks with carbs or low glucose treatments.

- - - Examples: juice boxes, fruit snacks, or glucose tablets.

Pack different snacks and extra supplies for caregivers outside of home.

Tips for Young Children

Tips to support young children with T1D around physical activity:

References