Your Child Can Exercise Safely with T1D


Editor’s note: This content was originally produced by JDRF, shared here as part of the JDRF – Beyond Type 1 Alliance. You can find more valuable content about exercising with T1D in JDRF’s exercise guide.

All children need plenty of exercise and children with type 1 diabetes are no different, but managing blood sugar levels with your child’s activity can be a challenge. In this post and the accompanying video, learn helpful guidelines for when to reduce insulin, increase carbohydrate and respond to various blood sugar levels.  

In general, children should engage in one hour of moderate to vigorous physical activity each day. Ideally, that hour should include high intensity activities at least three days per week and strength-building activities at least three days per week as well. 

Most children do engage in regular physical activity. In a typical school day, they might participate in gym class, play at recess, walk from class to class and perhaps take part in after school sports. During childhood though, activity can be unpredictable—recess might depend on the weather, and gym class could be running a mile one day and learning how to throw a ball the next. 

Given those challenges, it’s critical to understand the importance of blood glucose monitoring, the challenges of nocturnal hypoglycemia (overnight low blood sugars) and how you can prevent and manage hypoglycemia associated with physical activity, especially activities that take place during and after school. 

Carefully monitoring blood glucose levels before, during and after physical activity is key to making decisions about insulin doses and food intake. 

The Best Way to Avoid Low Blood Sugars

To prevent drops in blood glucose levels that typically occur with physical activity, insulin doses can be reduced or carbohydrate intake can be increased. Insulin adjustments often require advance planning though, which can be challenging with unplanned or variable activity patterns. So it may be easier to provide extra carbohydrates, especially for school-based activities, like recess or gym class. 

  • During a school day, if a child is doing less than 30 minutes of low-intensity aerobic exercise soon after a snack or lunch, like running around the playground, additional carbohydrate typically isn’t needed. 
  • If a child is doing 30-45 minutes of moderate intensity exercise, such as playing soccer, an additional 10-20g of rapid-acting carbohydrates, like a 4oz juice box, three glucose tablets, or a packet of apple sauce, may be needed. 
  • For after school sports at predictable schedules, you can reduce the active insulin that is active during the practice. If activity is extended, like running extra laps or a game running long, 10-15g of additional carbohydrate for every 30 minutes of extended time is a good place to start. 

Responding to Blood Sugar Levels

Typically during a school day, your child will have their blood glucose checked multiple times with finger sticks or continuous glucose monitor (CGM). It’s really important to look at these blood glucose levels before engaging in physical activity and note the direction the blood glucose levels are headed if possible. 

Talk to teachers and coaches about approaches to avoid low blood sugars. As a rule of thumb for children, it’s great to begin physical activity at a blood glucose level of 5.5-11.1 mmol/L100-200 mg/dL. If the blood glucose level is 13.9-16.6 mmol/L250-300 mg/dL, it may be necessary to check for ketones in the blood or urine. 

If the blood glucose level is above 22.2 mmol/L400 mg/dL or if ketone levels are found in moderate to large amounts in urine, then children should not engage in physical activity and should receive extra insulin according to their healthcare plan. If ketone levels are found in small amounts in urine, then children should exercise with caution or as recommended by the healthcare team. 

For these and more tips and tricks for managing T1D while ensuring your child gets enough physical activity, watch the video below!