One of the tricky things about handling type 1 diabetes is managing blood sugar levels during and after physical activity. As parents and caregivers of kids with type 1, we all know this! Food brings blood sugar levels up, insulin brings blood sugar levels down. We finally get the basal rates and bolus ratios figured out, and then we throw exercise into the mix and everything changes! (Not to mention all the other things that affect blood sugar levels, like illness, hormones… I won’t even get into all of these!) It’s a frustrating dilemma.
As a child, Kaitlyn was very sensitive to sugar and insulin and less sensitive to physical activity. I would rarely adjust insulin amounts during P.E. or when she was out playing sports, because her blood sugar levels would stay mostly stable. In fact, on the occasions when we allowed extra snacks for physical activity, she would often go high, so we were very careful not to give too many free carbs in these cases.
Not every kid is like this, though — my nephew with type 1, James, has always dropped like a rock with physical activity since he was really little. It was not uncommon for him to go through 3, 4, even 6 juice boxes in one outing, because he would burn through the sugar so quickly. Maybe the difference was the fact that James was a very high-energy kid, and Kaitlyn was pretty calm. I remember sitting by the pool with my sister-in-law Jen and watching her bring juice box after juice box to James while he went splashing through the pool; meanwhile, Kaitlyn swam and played and didn’t need anything extra. Just having her insulin pump removed for a while was enough to counteract the physical activity. At the time, I was pretty smug thinking that we had it all figured out.
Fast-forward to the last few years, and everything has changed. I finally understand the difficulty that comes with these crazy, exercise-induced blood sugar drops! It has become increasingly difficult to manage as Kaitlyn enters the teenage years. Not much has changed with the amount of exercise she does — she’s still in P.E. for an hour and a half every other day at her middle school, and she’s currently running for the track team after school. The way her body reacts to the exercise is totally different, though — she drops a lot and quickly, and she stays low sometimes for a few hours after exercise. A few weeks ago, she missed almost her entire track practice sitting on the sidelines because she had a stubborn low that just didn’t want to go up. Slowly, we’re figuring out what works for her body. It’s not perfect yet, but here are some strategies we’ve learned:
Check blood sugar a lot.
This is an absolute must. During physical activity, blood sugar levels can move so quickly that the typical checks every couple of hours are not enough. CGM (continuous glucose monitor) systems are really helpful with this, but I also have Kaitlyn check with a finger stick and meter every time she stops to take a break — usually a few times each hour. Her kit is right there with her water bottle, so she can quickly check every time she takes a drink.
Give extra juice and snacks before, during, and after exercise.
Like I said before, it’s not completely perfect, but Kaitlyn stays in a much better range when she has some fast-acting sugar as well as some slower-acting carbs before she begins to exercise. She usually has juice (one to two small boxes) and a small meal (like a peanut butter sandwich) 20 minutes or so before she begins. She also carries extra candy and juice boxes in case she goes low during practice or after.
Set a higher blood sugar target.
Typically, the doctor will set a target blood sugar number to aim for throughout the day. During exercise, however, it can be good to set that target to a higher number for safety reasons. Kaitlyn wears a pump now that is integrated with her CGM. We can change the blood sugar target to a higher number, which will reduce insulin given during exercise.
Have someone watching.
If a parent cannot be at P.E. or sports practice, someone should be assigned to be watching. Kaitlyn has her teacher and nurse at school, but she also has a friend assigned to stick with her like glue during P.E. class. We’ve also talked to her track coach and friends, who are always watching for signs of lows and asking her how she’s doing.
Figure out what works for your child.
Every person responds to exercise differently. School nurses, friends, or blogs can spark ideas, but the bottom line is that you and your doctor have to figure out how your kid responds to exercise and what works for them. There’s not one set formula for everyone.
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring. Jen and Kim are real moms of kids with type 1 diabetes and have been compensated for their contributions to this site.