Can my diabetic child join the school sports team?

Exercise in Patients with Type 1 Diabetes:

Type 1 patients usually begin in childhood and adolescence. In this age, it is very important not to look "different" from the peer group and it is very important to participate in game and team sports.

Regular physical activity, diet, and insulin are the cornerstones of diabetes management. Adjusting blood sugar levels for people with diabetes who do sports or exercise poses a serious challenge.

The role of the school is very important in promoting participation in sports and exercise. The attitude of the school and teachers towards the child with diabetes can have a significant impact on the child's motivation to participate in sports. Many diabetic children play sports at home with their friends. It is started to be exposed to various sports activities in physical education and sports lessons at school. The school team is often the first place to get a taste of competitive sport. Although rare, situations where diabetic children are recommended to stay away from sports at school, unfortunately, have a very negative impact on the personal confidence and development of these children. I believe these problems will decrease as the sports instructors trained on diabetes increase. The same is true for sports clubs. In the transition to adolescence, another challenge becomes more evident: computer games and social media effects… that is, as the child grows up, he becomes increasingly distant from sports. Children with diabetes lose their motivation more because exercise preparation and attention are issues. It is not easy to get motivated in this regard. First of all, parents and teachers should not lose their motivation. When diabetes is first diagnosed, it has the motivation to lead a normal life with the help of exercise, diet and medications, and it is very important to move forward without losing it. Motivation should be reinforced with examples such as basketball player Alper Saruhan, football player Nacho Fernandez, athlete Kate Hall.

Exercise does not improve blood sugar control in people with type 1 diabetes. Unless great care is taken to adjust carbohydrate intake and insulin dosage, it can lead to poor control.

The aim is to allow the diabetic child or adult to participate in the sport of their choice and to prevent any discrimination during school sports or playing in a team.

Recent studies show that all levels of exercise can be done by people with type 1 diabetes, including leisure activities, recreational sports, and competitive professional activities.

It should be emphasized here that high-intensity endurance exercises such as marathons, triathlons and cross-country skiing, which are known not to be very beneficial for the body, are not necessary.

Regular, moderate-intensity exercises are beneficial in patients with type 1 diabetes.

The advantages of exercise in type 1 diabetes are related to the cardiovascular system protective effects rather than blood sugar control.

Exercise is not a tool to improve blood sugar control in type 1 diabetes. On the other hand, regular exercise can increase insulin sensitivity in an overweight type 1 diabetic person and therefore facilitate blood sugar control.

Problems with blood glucose control in people treated with physically active insulin can be explained by imbalances between the plasma insulin level and the plasma glucose present.

Hypoglycemia:

Sudden blood sugar drop and related fainting are the main reasons of discrimination for diabetic children. This situation leads to exclusion of children from gymnastics or summer camps. Some children with diabetes hold back because of the need for regular blood sugar checks and the need to eat snacks at certain times or because of fear of having a hypoglycemic attack. Hypoglycemia can be seen during exercise or even 12-14 hours after exercise. This late-developing low sugar occurs with the coexistence of the body's desire to fill the glycogen stores on the one hand and the increased tissue sensitivity to insulin on the other. As the days of exercise increase, the need for insulin decreases gradually.

Physical exertion increases heart rate and sweating and can make it difficult to understand a hypoglycemic episode. When hypoglycemia is experienced it can also be difficult to remedy. Up to 40 grams of carbohydrate may be required to stop the activity. Exercise-induced hypoglycemia tends to recur and it may be necessary to give carbohydrates in the first half hour after starting exercise. Blood glucose levels should be measured frequently.

Hyperglycemia:
 Blood sugar rises in two ways in patients with type 1 diabetes.
a. Fast and sudden loaded exercises
b. If the person is insulin deficient

If there is ketone in the urine and hyperglycemia is observed, exercise should never be done. Exercise should be started after the metabolic imbalance is corrected with short-term insulins and no ketone remains in the urine.
If blood sugar is too high and there is no ketone in the urine, this is due to a moderate lack of insulin. The most common reason for this is carbohydrates eaten in the last meal, but stress can also cause it. In such a situation, exercise can be done. Make sure to drink plenty of fluids before, after and during exercise. Measure your blood glucose level 30 minutes after starting exercise and you should stop declining exercise and apply a correction insulin.

Short-term very intense exercises such as lifting weights also increase sugar levels. The risk of hyperglycemia is low in those with controlled diabetes. When intense explosive exercise is done in a short period of time, the energy expenditure is too high, which can cause hypoglycemia.

Strategy:

There are 2 important principles for exercise in type 1 diabetes.

Extra energy is consumed in 1st exercise

Exercise 2 increases insulin sensitivity, that is, it becomes easier for muscles to use sugar and the need for insulin decreases.

If you plan to exercise, you may have heard of the need to take type 1 extra carbohydrates and insulin dose adjustments, and you were aware of the risk of hypoglycemia.

However, do not underestimate the need to reduce the insulin dose. On the other hand, you need to get extra carbohydrates and know that the amount will not be less.

If you want to make a correct exercise planning, you should take into account the duration of the effort to be spent, the intensity, how long it will start after the last meal, the time of the day, and the blood insulin level during the exercise. If a new activity is to be done, blood sugar levels should be recorded frequently.
• After the last meal or insulin dose, a break of 2-3 hours is required. This reduces the possibility of hypoglycemia. Of course, if this is done with classical insulin, not analogous, it would be more appropriate to take a 4-hour break or to reduce the insulin dose may be a solution.
• Since insulin levels change throughout the day, it is necessary to record when and how much insulin is required to exercise.
• Record the type of insulin you use at what time and at what level in the blood, and make a daily blood insulin level map.
 Dose adjustments will be required to reduce the risk of hypoglycemia during hours when insulin levels remain high in the blood.

Exercise intensity is also very important. Intensity can be determined both by time and by the number of heartbeats. We define the durations as short (six 20 minutes, medium (20-60 minutes), long (more than 60 minutes). With personal tables, it is possible to know that there is balance with 10 grams of extra carbohydrate intake in cases where the heart rate does not increase more than 60 percent above the resting level. The charts are very useful for knowing how much insulin should be reduced and how much carbohydrate should be increased.

Insulin pump therapies are also available and may have advantages in establishing a foundation.

 

 

 

Recommendations for exercise and insulin injection:

• Inject the insulin as usual.
Be especially careful not to make insulin intramuscularly
• Learn to adapt (reduce) the insulin dose based on exercise type, duration and timing.
• Take blood glucose measurements frequently, especially during unfamiliar activities.
• The amount of energy required depends on the intensity, duration and type of exercise performed.
• Total energy requirement should be adjusted according to age, gender and body weight.
• Young athletes need additional energy for growth and development.
• When weight reduction is required, this should be done gradually, following a reasonable weight loss program.
• Carbohydrate amounts should be given in proportion to body weight and the level of activity to be done. For 3-5 hours of regular activity a week, 4-5 grams of excess should be taken per kilogram. In other words, it can be planned to give 300 g more to 60 kg. In moderate exercise, 5-7 grams per kg is calculated in excess. In those who exercise heavily, this amount increases up to 10-12 grams per kg.
• For protein, it is not recommended that more than 20 percent of the energy consumption of people with diabetes should be protein. 1 gram of protein per kilogram is recommended. Of course, since proteins are often mixed with fat, calculations should be made carefully. Protein powders etc. are not required.
• The amount of fat is suggested to be less than 35 percent of the meals.

Fluid intake:
The daily fluid requirement of sedentary people is 2-3 liters.
Sweat losses with exercise should definitely be compensated by taking fluid. Not feeling dehydrated before exercising does not mean that your fluid intake is sufficient. You can think of the fluid lost as 1.2-1.5 times the actual fluid lost during exercise, taking into account breathing, sweat and urine.
When it is not possible to weigh before and after exercise, another good indicator of fluid loss is seeing the volume and color of urine produced. Pale and abundant urine usually indicates that the athlete is taking enough fluid; Dark and sparse urine is an indication that more fluid is required. Lack of water can cause an increase in body temperature, dizziness, nausea, tiredness or heat stroke and should not be confused with symptoms of hypoglycemia.
• Drinking approximately 400-600 ml of water 2 hours before exercise provides sufficient hydration.
• Water, isotonic fluids, sometimes even carbohydrate fluids for blood sugar level adjustment.
• It is necessary to make sure that enough fluid is taken during exercise. Small but frequent drinking prevents stomach swelling.
• For exercises that will last more than 1 hour, it is necessary to take 150-200 ml of fluid every 15-20 minutes. 6-8 grams of carbohydrate in sports drinks can be beneficial for both blood sugar level supply and hydration.
• Liquids must contain sodium salt in exercises lasting more than 2 hours.
• Consuming too much water is not recommended because it causes weight gain.
• Taking 1.5 mg of caffeine per kilogram towards the end of exercise has been shown to improve performance.
• There is no benefit in taking amino acid or glycerol supplements during exercise.
• After exercise, more fluid should be taken than is lost.

Sports Drinks:
These are products produced to give both liquid and carbohydrates to the athlete. It has been observed that athletes consume more flavored fluids. There are different types according to before, during and after exercise.

There are 3 types of formulations:
Hypotonic
Isotonic
Hypertonic

 

During exercise:

• Check the blood glucose level when appropriate.
Hypoglycemia may develop due to excessive consumption of sugar or excess insulin during exercise.
• Exercises longer than 30 minutes may require extra carbohydrates and / or reduce insulin.
• Taking carbohydrates before exercise can also be beneficial during exercise, issues such as abdominal bloating and sports rules will affect both carbohydrate selection and intake timing.
• Medication and serums required to treat hypoglycemia should be accessible at all times.
• Use sports shoes
• Exercise should not be done in extremely hot and cold conditions
• Feet should be checked after each exercise
• Exercise should not be done when sugar control is not good.

After exercise:

The course of blood sugar levels should be checked frequently.
Consume 1.0-1.2 g of carbohydrate frequently immediately after exercise (0-4 hours)
• This is especially important when there are only 4-6 hours between training sessions. Snacks containing high glycemic index carbohydrates can be better tolerated during this period due to decreased appetite after exercise.
• Natural muscle damage during exercise disrupts glycogen storage, but increasing carbohydrate intake for the first 24 hours partially offsets this.
Low glycemic index foods can be consumed in the recovery period after exercise.