Children Being Active with Diabetes Tom Laing Accredited Exercise Physiologist Overview Importance of regular Physical Activity (PA) Recommendations Timing Considerations & Implications Physical Activity in Children Important for a child’s: • Healthy growth and development • Brain function and development • Fundamental movement skill development • Mental and social wellbeing Building healthy habits early, reduces risk of diabetes-related complications later in life. Recommendations • 0-5 years • 5-12 years • 13-17 years Department of Health www.health.gov.au 0-5 Years Activity: • Birth to 1 year: supervised floor based play • 1-5 years: 3 hours per day Screen Time: • Under 2 years: None • 2-5 years: <2hours per day All children 0-5 should not be inactive for more than 1hr at a time. Department of Health www.health.gov.au 5-12 Years & 13-17 Years Activity: • Minimum of 60 minutes per day • Moderate and vigorous intensities Sedentary Behaviours: • Limit screen time to <2hours per day • Break up long periods of sitting Department of Health www.health.gov.au When is the Right Time to be Active? Getting the Time Right When a child is active will depend on many factors. We should encourage children to be active whenever they can at any time of their day. Understanding timing implications will help to make activity safe. Exercising at Different Times of the Day Why does exercise decrease BGLs? 1. The body utilizes glucose for fuel. 2. Helps insulin to work better (increases insulin sensitivity). 3. Allows muscle cells to absorb glucose on their own, independent of insulin. 4. After exercise, the body needs to replenish muscle glycogen stores (up to 24 hours). This can mean there is a reduced requirement for insulin during and after exercise Delayed Onset Hypoglycaemia (DOH) • The “exercise effect” can last for 12-16 hours post exercise (even up to 24hrs in some cases) • This can increase the risk of delayed onset hypoglycaemia episodes during this time • The time of day activity occurs will determine when a person is at increased risk of hypoglycaemia Action: Understand your child’s response to exercise Example • 14-year-old female with T1D of 2yrs duration • Experiencing low blood sugar levels beginning 1–2 hours after exercise in the evening • 3-days CGM data gathered International Journal of Pediatric Endocrinology 2013, 2013:8 Time of Day • Morning exercise (BEFORE BREAKFAST)  Less likely to experience low BGLs • • • • Insulin levels are generally low Cortisol levels are generally higher at this time of day This means body is more insulin resistant Increased risk of Hyperglycaemia  HOWEVER if exercise is of extended duration without eating • ↑ hypo risk due to a lack of fuels after fasting overnight Exercise at Other Times of the Day • Exercising after meals Greater risk of hypoglycaemia - Insulin adjustments - Additional carbohydrate intake - A combination of the two - ‘At risk’ time will vary with time of exercise Type of exercise • Activities that typically decrease BGLs include: low to moderate intensity & performed over longer durations (> 30 mins) Endurance type sports Prolonged walking, running, high-volume sports and activities Low fitness levels can also play a role Type of exercise • Activities that typically increase BGLs include: Short duration, high intensity activities Activities that involve fast and/or powerful movements: sprinting, jumping, weightlifting Competition stress, heat stress, dehydration & high pre-exercise BGLs can also contribute Other Considerations • Peak insulin action • Injection site • Omitting insulin • Competitive sports Take Home Messages The best time to be active is ANYTIME • Knowledge is power • Record patterns • Insulin adjustments • Additional carbohydrate intake Additional Resources Caring for diabetes in Children and Adolescents (Chapter 11: Exercise and Sports) - Edited by Geoffrey Ambler and Fergus Cameron Diabetic Athlete’s Handbook - Dr Sheri Colberg Website http://www.ext1d.com.au/ - Allan Bolton (AEP) Thank You Further information:  Diabetes NSW Customer Care line: 1300 136 588  Department of Health www.health.gov.au