The Innovation Center for Children's Diabetes de Sant Joan de Déu offers us these recommendations when a child with diabetes will perform physical exercise:

- Consult with a diabetes specialist doctor.

- Measure the glucose before and after exercise.

- Add a ration of carbohydrates before exercise if glucose is in an ideal strip (80 - 140 mg/dl).Thus we will prevent glucose levels from falling during physical activity.If the exercise is prolonged more than an hour, we will offer carbohydrates every hour until the end of the activity.

- For every hour of intense exercise to offer the child 1-2 rations of carbohydrates.

- The only way to know if the child needs a carbohydrate supplement is measuring his blood glucose levels before exercise.

- Take into account when insulin begins to take effect, when it will reach its maximum action peak and when its action will end to calculate for how long the blood glucose levels will continue to lower.

- Call the diabetes team responsible for its treatment if the child has low blood glucose levels frequently, during or after exercise.

What to do with insulin when physical exercise is performed?

- When starting a regular exercise program.We must assess the insulin dose based on glycemic controls during and after exercise.

- If the child is more active for a long time.It may be necessary to reduce the insulin dose by 20 - 50 %, for example, skiing during a whole day.It should be consulted with the diabetes team.

- If the child shows a high glucose level immediately after a short period of intense exercise.It is a normal response caused by the effect of a greater amount of adrenaline.

- If the child continues to exercise.Blood glucose will return to the level prior to exercise or fall below.At the same time the muscles will use glucose to produce energy.It is necessary to perform blood glucose controls every two or three hours after an intense exercise.

- If the glucose level decreases several hours after finishing an intense or prolonged exercise.The child may need less insulin before and after exercise or more food before, during and after exercise to avoid night hypoglycemia.This reaction is called "delayed effect" of the exercise and can last up to 24 hours.This curre when glucose passes from the bloodstream to the muscles to replace the glucose that they usually keep in the form of glycogen.

Security Councils

A child should not exercise if he is sick and has ketones in the urine, because this can raise blood glucose levels and cause an accumulation of ketones.In that case, the Urine ketone test must be done.

Before initiating a physical activity, the glucose level suits between 120 - 180 mg/dl.If the blood glucose level is high (& GT; 250 mg/dl), it is convenient to administer a rapid action insulin supplement that allows the muscle to take advantage of the organism's glucose during the sport.

To prevent hypoglycemia during the night or during the early morning after intense and prolonged exercise, we can offer the child a ration or more hydrates before going to sleep if blood glucose is below 120 mg/dl.For another occasion we must assess the dose of insulin.