Current perspectives on physical activity and exercise for youth with diabetes

Abstract

Regular physical activity (PA) for youth with diabetes improves cardiorespiratory fitness, body composition, bone health, insulin sensitivity, and psychosocial well-being. However many youth with diabetes or pre-diabetes fail to meet minimum PA guidelines and a large percentage of youth with diabetes are overweight or obese. Active youth with type 1 diabetes tend to have lower HbA1c levels and reduced insulin needs, whereas activity in adolescents at-risk for type 2 diabetes improves various measures of metabolism and body composition. Insulin and nutrient adjustments for exercise in type 1 diabetes is complex because of varied responses to exercise type and because of the different times of day that exercise is performed. This review highlights the benefits of exercise and the established barriers to exercise participation in the pediatric diabetes population. A new exercise management algorithm for insulin and carbohydrate intake strategies for active youth with type 1 diabetes is presented.

Management of diabetes mellitus in children and adolescents: engaging in physical activity

“…Studies have shown that lifestyle intervention has been associated with improved glycemic control in adolescents who have impaired glucose tolerance. Experimental studies support this, showing improved glycemic control along with improvement in fasting insulin levels (29,41,42). The management of exercise in patients with T2DM is focused primarily on behavioral aspects by establishing routines that promote regular physical activity and reduce sedentary activity.…”

“…Delayed hypoglycemia is most often due to an increase in insulin sensitivity post-exercise. It may also be related to decrease in counter-regulatory response or lack of insulin adjustment prior to exercise (29). Close monitoring for glycemic control for sports participation requires increased blood glucose monitoring and this may become a barrier in sports participation.…”

“…Disposable Infusion "sets" or "pods" along with an insulin reservoir are changed every 2-3 days, and catheter tubing can then infuse into the subcutaneous space providing the insulin delivery. The use of insulin pumps may be associated with lower rates of early, severe, and delayed hypoglycemia if appropriate insulin rate adjustments are made (29). Early hypoglycemia can be prevented by suspending or decreasing the basal rate during exercise.…”

“…Early hypoglycemia can be prevented by suspending or decreasing the basal rate during exercise. The risk of nocturnal hypoglycemia can be reduced by decreasing or even suspending basal rate during exercise, followed by a temporary basal rate reduction of at least 20% for the next several hours or overnight (29). A common time for children and adolescents to exercise is after school, although this is often associated with nocturnal hypoglycemia, typically occurring between midnight and 2 AM.…”

“…There is also the added opportunity for managing individuals at risk for developing T2DM if they are identified early enough with a diagnosis of impaired glucose tolerance or prediabetes. Puberty is a time of relative physiologic reduction in insulin sensitivity and of the added behavioral component of physical inactivity which can both increase the risk of obesity and tendency towards developing T2DM (29). The optimal time to intervene in at-risk children is in childhood prior to starting of puberty.…”