Diabetes and Physical Activity in School

Diabetes and Physical Activity in School

Children with diabetes should be able to participate fully in school sports and physical education activities,attend field trips, and participate in all team sports. With increased awareness of diabetes
and new approaches in its management,participation in physical education is now the norm. Since children spend about seven hours a day at school, it is essential to handle any diabetes-related challenges that arise during the school day, including any that involve exercise.
Understanding the short- and long-term effects of physical activity on diabetes—whether on the playground, in a physical education class, or during team sports—is important for students and their families as well as for school personnel. Knowing the relationship between food, insulin, blood
glucose level, and physical activity will greatly reduce the incidence of problems and enhance the benefits of physical activity for students with diabetes.

The Benefits of Physical Activity:

Exercise and team sports allow children with diabetes to improve their social skills and gain self-confidence. They may want to participate in team sports such as soccer and Little League baseball, or noncompetitive activities, such as swimming and bicycle riding. Such participation promotes socialization, peer acceptance, and positive self-esteem. Exercise improves general fitness, strength and cardiovascular endurance and lowers blood pressure and lipids; it also has a profound, and positive, effect on diabetes by improving insulin sensitivity, reducing glucose levels, and reducing long-term morbidity. In children with type 2 diabetes, in particular, exercise helps to decrease fat weight and increase muscle mass, contributing to increased insulin sensitivity.

The Physiology of Exercise:

-In people without diabetes

 increased glucose utilization during exercise triggers an array of homeostatic responses. Insulin secretion typically declines, and concentrations of counter-regulatory hormones that raise blood glucose (glucagon, growth hormone, catecholamines, and cortisol) may rise, increasing liver glucose production. In people who have type 1 diabetes, there is no endogenous source of insulin to modulate, and some counter-regulatory mechanisms may be impaired, particularly after several years of diabetes.

-People with diabetes 

who exercise may have a decreased need for, or better utilization of, exogenous insulin, and thus may enjoy a decrease in diabetes medications usually, insulin. The acute effect of exercise is increased extraction of glucose from plasma. The blood glucose and hormonal response to exercise depends on the initial blood glucose level, insulin dosage, timing and content of meals/snacks, duration and intensity of the exercise, and fitness level, but mostly on the availability of insulin.
Because the person with type 1 diabetes has no endogenous source of insulin, the most common problem encountered during exercise is hypoglycemia (low blood sugar).
A regular exercise program can improve insulin sensitivity, thereby reducing blood glucose levels at times other than during exercise. Likewise, in people with type 2 diabetes, regular exercise can reduce insulin resistance and improve glucose tolerance.

Challenges of Physical Activity

Hypoglycemia

Students with type 2 diabetes who manage the disease by meal planning and physical activity are not at risk for hypoglycemia while exercising. Those with type 2 diabetes who use insulin or some other
hypoglycemic drug are at risk for hypoglycemia, and the precautions necessary for students with type 1 diabetes apply to these children.
Hypoglycemia in children with type 1 diabetes is frequently brought on by physical activity (as a result of reduced plasma glucose, increased insulin sensitivity, and depletion of glycogen stores in muscle). It can occur during, immediately after, or many hours after physical activity; however, it can be avoided. Depending on the nature of the activity and its timing relative to the child’s meal and insulin schedule, hypoglycemia can be prevented by:
■ monitoring glucose levels before and after exercise,
■ adjusting insulin dose, and/or
■ supplemental snacking before, during, or after activity.
Physical activity also appears to enhance absorption from the insulin injection site, particularly from exercising arms and legs, contributing to the risk of hypoglycemia.
The abdomen is, therefore, the best site for.