insulin

FAQ: Exercising with diabetes

As a parent, you obviously want what’s best for your child – but what is really best when it comes to exercise and children with diabetes? Riekie Human tells us what you need to know (adults can learn a little something, too!).

Although experts agree that it’s crucial for kids with diabetes to exercise, you need to make sure they’re doing it safely. Thankfully, it’s easier than you think… We got all the answers from experts in the field.

What kind of exercise should my child do?

“The most helpful exercises encourage muscle contraction and increase the effect of insulin.” What does that mean? The exercise helps more glucose to be transported out of the blood stream and into the cells to be used: body weight exercise and resistance training are particularly good at this. However, young children should take part in all kinds of exercise, particularly cardiovascular for the development and health of the heart, lungs and lipid profiles (cholesterol), and team sports to encourage skills and develop confidence. Sarah Hall, Biokineticist at Wellness in Motion, Morningside

Ball sports are especially good for children with diabetes. “They involve a combination of exercises like jogging and sprinting, and research has found that this is best for stability in blood sugar levels.” Contact sports like karate can be tricky, especially for children with insulin pumps, as the pump could get damaged – and the same applies to horse riding. Andrew Heilbrunn, Head Biokineticist at the Centre for Diabetes and Endocrinology (CDE) in Houghton

What time of day should my child exercise?

The best time for kids with diabetes to exercise is before breakfast and before supper. “They’re less likely to hit lows at those times. Before breakfast, they’ll be quite insulin-resistant and are unlikely to experience a drop in blood sugar.” The worst time to exercise? An hour or two after meals, when insulin in the system can cause more frequent lows.

Andrew Heilbrunn

How long should my child exercise for?

That depends on the child: what they’re capable of and how fit they are. “The general recommendation is 1 to 2 hours, but take into account the type of exercise, your child’s age and their fitness level. And remember to limit exercise to 30 to 45 minutes if it’s a new sport or type of exercise – and then closely monitor their blood sugar levels, before and after exercising.”

Sarah Hall

What else do I need to know about exercise and diabetes?

It’s important to give the coach a list of symptoms of high and low blood sugar, as well as detailed instructions of what to do if your child goes low. “A child with low blood sugar will be irritable, have a headache and blurry vision, and generally feel horrible.” If your child’s blood sugar is too high, they will feel tired and thirsty.

Dr Claudine Lee, GP

If your child exercises for more than one hour, any time of the day, they should have a protein snack, like full-cream yoghurt or small yoghurt-coated rice cakes, before going to bed. “Sustained energy overnight is crucial, as it prevents hypos between 2 and 4am. “Also, always have a quick-acting sugar snack on hand (fruit juice, sweets or honey) to treat low blood sugar, and make sure the coach knows how to use a glucagon pen in case of emergency.

Andrew Heilbrunn 

Ask the expert: Sarah Hall, Biokineticist Studies have shown that children with Type 1 or Type 2 diabetes are generally less physically active than those without: the exact opposite of what the situation should be!

Some advantages of increased physical activity for children with diabetes:

  • Better health
  • More confidence
  • An improved response to insulin and blood sugar control
  • A greater awareness of diabetes and their bodies
  • The prevention of conditions associated with diabetes, like obesity and heart disease
  • Improved weight management

Top Tips

  • Don’t let your child exercise if their blood sugar is too high: over 16mmol/l or too low: under 4mmol/l, or if ketones are present.
  • Make sure your child’s blood sugar is in the target range before exercise, in order to avoid low blood sugar.
  • Talk with your doctor about lowering your child’s insulin dose before exercise, if necessary.
  • Inject insulin before exercise in a site other than the body parts about to be used. For example, if your child will be running, don’t inject in the legs.
  • Watch for symptoms of low blood sugar for 12 hours after exercise, especially if it’s a new kind of exercise.
  • Make sure your child drinks water so they don’t get dehydrated.
  • Choose something fun for you and your child to do together and they’ll learn that getting active is just as enjoyable as relaxing. You could go to dance classes, swim, learn to surf, take up yoga, go on hikes, play tennis or even join a soccer team. There’s even something called laughter yoga if you really want to have a good time.

How to support a friend with diabetes

“One of my best friends is a Type 1 diabetic and she often skips taking her insulin to keep her weight down… I know this is going to cause her long-term damage, but I don’t know how to convince her to look after herself better. Any advice?” Sune Terblanche.

Dear Sune,

One of my favourite quotes is by Seneca: “One of the most beautiful qualities of true friendship is to understand and to be understood.”  How lucky your friend is to have you. Teenagers are inclined to focus on one thing and not see the bigger picture. Your friend is most probably also feeling the peer pressure of other girls to be thin.

Teenagers are sometimes just tired of medicine as well. They get frustrated and even feel embarrassed by having diabetes and having to test and take shots and make excuses for not eating cake and drinking cooldrinks. At some stage they just decide to stop using insulin. Stopping insulin makes it easy to lose weight which seems like the ultimate solution.

Without insulin, the body cannot break down sugars from food to use as energy. So it breaks down fat already stored and flushes out the excess sugar through the urine. This leads to weight loss, but it also causes nerve damage, damaged eyesight, kidney damage and osteoporosis, amongst other things.

Being a good friend isn’t always easy, but taking the time to look after a lasting friendship is worth every ounce of effort. The big thing is to be honest. To be a good friend and get her trust, you have to be honest about your feelings and her actions. If you’re honest about how you feel, that will open up direct lines of communication with her and help her talk to you about skipping insulin and how you can help her stop doing this.

You owe it to your friend to start a conversation about it. Being honest is different from being so blunt that you’re hurting your friend. Try not to nag or police her, but use opportunities to point out to her what she is doing to herself. Reinforce the fact that you care about her and ask her how you can help. Remind her that she is brave enough to face the challenge that diabetes has brought into her life. Remind her that everyone is an individual.

– Jeannie Berg, Diabetes Educator

 

Tips for parents of diabetic children

“My son is a Type 1 diabetic, but I don’t want to be overly protective and make him feel he can’t do anything. Do you have any tips for parents of diabetic children, and how to make life normal?’ Sam Shongwe.

Dear Sam,

The first thing you must realise is that a child with diabetes is still a child. He should not be treated differently than a child who does not have diabetes. Granted, you have more issues to cope with – like good food choices, insulin and testing – but these things shouldn’t stop him from having a normal, happy childhood.

The first thing to do is make sure he is safe at school. Let a responsible person know what his diabetes involves so that they can keep an eye on him. By doing this you won’t have to keep phoning him or the school to make sure he is okay: this will only embarrass him and make him withdraw from friends and fun.

Remember, he can also play sports and take part in physical activities just like any other child: you just need to plan – first talk with his doctor, and then help him with the routine of glucose testing, planned eating, and insulin. Work out a plan that he’s happy and comfortable with.

Encourage your child and allow him to socialise. Let him do parties, sports, sleepovers and camps if he wants to. Discuss a back-up plan with him when he does, but try to let him do his thing.

Most importantly, help your child to become more independent by getting him to take an active part in his diabetes care while he’s still young. Encourage him to solve problems and make choices with you about adjusting insulin doses, for example. Help him create a good lifestyle so that his diabetes doesn’t become too difficult to manage and hijack his life. Self-care is the key to developing any child’s independence and self-esteem: it’s important to get your child involved in self-care as soon as he is able to – with your supervision, of course.

Finally, recognise your limit of control. Accept that you cannot watch over him all the time, stand back and allow him more independence as he becomes more confident and responsible. It’s the same with any child: if they prove their responsibility, they get more independence.

– Jeannie Berg, Diabetes Educator

 

Teenagers and diabetes

“My teenage son doesn’t want to take his insulin. He rebels against it as if it’s something only I want him to do, not something he needs to do to keep him alive. What can I do?” Jesca Ncube.

Dear Jesca,

Even the brightest, smartest and most driven of teens have a hard time dealing with the day-to-day demands of diabetes. Having diabetes is often the one thing that trips them up.

They feel that their freedom is compromised. They are stuck in a zone where they are constantly asked about their blood sugar and as a result some lie about testing and taking shots: they suddenly experience a sort of “freedom” by lying and getting away with it. A wake-up call is usually when they land up in hospital. Most diabetics are prepared to try and do something to prevent that from happening again.

Because we live in a fast moving world, today’s teens have little time for themselves. Many teens are stressed, tired, and often have difficulty keeping up with the things they want to do, never mind the things they don’t want to do. Teens are risk-takers and struggling for independence – within this struggle, taking care of their diabetes is definitely not a priority.

So to answer your question:

The most important thing is to stay involved.

  • Try and coach your teen into some kind of “contract” between the two of you regarding his insulin. Encourage him and make him accountable. Ask him what is helpful for you to do and what is not. Listen carefully.
  • Find a health-care provider he likes and let him be educated about diabetes and the optimal treatment. Get him to meet up with other teens who are also living with diabetes.
  • If the shots are bothering him, find out why exactly and see if you can change things to make a difference.
  • Find out if he could be a good candidate for an insulin pump. Teens love technology and they usually do very well with pumps because they are growing up in a world exploding with new technology.
  • Never be afraid to seek counseling. A teen might refuse to look after himself because he is depressed.
  • This is the difficult part: you as a parent know the importance of insulin in your teen’s life. Try to explain it to him and ask him to work with you. Baby steps.

The good news is that most teens who have periods of giving up on their diabetes care eventually mature and start to do better again. Be your teen’s best friend: best friends do not judge and always stand by you.

– Jeannie Berg, Diabetes Educator

 

 

 

10 Fast facts about insulin

All you need to know about your medication – and how to store it.

  1. Insulin is a hormone that controls the amount of glucose in the blood. It acts as the “key” that lets glucose (from food) leave the blood and enter the cells of the body.
  2. People with diabetes either do not make enough of their own insulin (Type 1 diabetes), or the insulin their body makes is not as effective as it should be (Type 2 diabetes). As a result, most people with diabetes need to take medication, in tablet form or insulin injections.
  3. While it is often possible to control Type 2 diabetes with diet and exercise at first, eventually insulin will be necessary for most people with Type 2, as diabetes is a progressive condition.
  4. There are three different kinds of insulin: short-acting, long-acting and combination.
  5. Short-acting insulin is taken at mealtimes to cover the glucose released from the food that is being eaten.
  6. Long-acting insulin has a slow release and works as a basal (background) insulin for a number of hours – it is usually taken once or twice a day in addition to short-acting insulin.
  7. Combination insulin is a mixture of long-acting and short-acting insulin, often prescribed to Type 2 diabetics.
  8. Insulin must only be taken on prescription from a doctor, as it is essential to take the right dose (prescribed for you) at the right time.
  9. Storing insulin correctly is important: it should not get too hot (over 30°C) or freeze. Spare insulin should be kept in the fridge, and the pen you are using can be kept at room temperature for 1 month. Always keep insulin out of direct sunlight.
  10. Learning how to inject properly will make the injections as pain-free as possible.