Insulindependent diabetes mellitus

In healthy children, insulin levels decrease with exercise so that glucose can be liberated from stores in the liver and blood levels are maintained despite an increase in glucose uptake into the exercising muscle. Children suffering from insulin-dependent (type 1) diabetes mellitus have to inject insulin into the subcutaneous fat tissue. In consequence, insulin is liberated at a constant rate from the subcutaneous injection site, irrespective of glucose demand. Since insulin sensitivity increases during and following exercise, these children are at a high risk of experiencing severe hypoglycemia with exercise, resulting in a loss of consciousness or epileptic seizures. Low blood glucose levels have been described for up to 24 h following exercise in patients with insulin-dependent diabetes. In a survey of parents whose children had suffered from severe hypoglycemia, many parents blamed preceding exercise as trigger. Children should therefore be advised to measure blood glucose before exercise and intermittently thereafter. They should avoid exercise when blood glucose is low and ingest additional carbohydrates before, during and after exercise. In preparation for prolonged activities, the insulin dose should be reduced. However, periodic drinking of a carbohydrate beverage provides more flexibility, as the amount can be modified as the activity progresses [75]. To teach a patient the individual effect of a specific exercise on blood glucose, a simulation of the activity under medical supervision may prove helpful.

Children with type 1 diabetes mellitus may, however, not only experience hypoglycemia with exercise. When insulin levels are insufficient, exercise may lead to ketoacidosis. Therefore, not only low but also high blood glucose levels may indicate possible risks of subsequent physical activities.

It is important to realize that a well-educated patient with diabetes may participate in nearly any sport. There are patients who have achieved world-class performance in various sports.

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