Being active is important for kids with type 1 diabetes. It's good for their health and helps control blood sugar levels. But helping your child take part in a sport also brings some special challenges -- and “a lot of trial and error,” says Bethy Elrod, a mom living outside Atlanta whose 12-year-old twins both have type 1 diabetes. 

Elrod’s daughter, Amalia, is a competitive swimmer and rides horses. Her son, Sawyer, plays soccer and baseball. “I believe in letting them do whatever they want,” Elrod says. “Type 1 shouldn’t be an excuse to not do anything.”

Here’s what to know so your child can also stay active and safe:

Get the OK from your doctor. All kids need a physical before they start a new sport. They also need a doctor’s approval. In most cases, “there shouldn’t be any restrictions to what a child or teenager with type 1 diabetes can do,” says Jane Chiang, MD, senior vice president of medical affairs and community information for the American Diabetes Association.

Understand the impact. How the activity will affect your child’s blood sugar varies. It depends on the type of activity and how long your child does it. Sweating a lot can make a difference. So can feelings of stress. “We’ve found that extreme exercise drops blood sugar, but in competitive situations, [the twins’] levels go up,” Elrod says. But that’s not always the case. Watch your child closely to learn how each activity affects her.

Be prepared. Along with your child’s soccer cleats or ice skates, make sure she keeps extra diabetes supplies in her bag. “A child with type 1 diabetes has to be more prepared than children that don’t,” explains Alison Massey RD, director of diabetes education at Mercy Medical Center in Baltimore. “It’s important for them to bring their glucometer, snacks, water, and glucose tablets or another source to treat hypoglycemia to all their activities.”

Check blood sugar often. You child should check her blood sugar levels before, during, and after every practice or game. A continuous glucose monitor can give more detailed, current information. Not having enough insulin in her blood and exercising anyway can put her at risk for diabetic ketoacidosis (DKA). If her blood sugar is low, juice or glucose tablets can help quickly raise it. When it’s under 100 mg/dL, she may need a small carbohydrate snack (about 15 grams) to reduce the risk of hypoglycemia.

Adjust the insulin pump. If your child wears an insulin pump, check with your doctor to see if she needs to adjust the insulin or use a different rate during sports. With your doctor’s approval, your child may be able to take it off for short periods during games or workouts. For instance, Amalia takes off her pump during swim practice, and Sawyer goes without his during games. “He slid into home plate once and broke the clip,” Elrod says, “so now he keeps it off.”

Stay on alert after an activity. Blood sugar can drop as many as 11 hours after a workout –- and sometimes in the middle of the night. Talk to your child’s doctor about ways to prevent this. A nighttime snack or adjustment to her basal insulin (if she uses a pump) before bedtime could help.

Be open with others. Any adult who supervises your child should be told about her condition and how to treat it. While kids, especially older ones, don’t want to be seen as “different,” sometimes different treatment is necessary. “Sawyer’s coach lets him walk off the field if he needs to,” Elrod says. “If Amalia feels her levels getting low, she’ll get out of the pool, check her sugar, and eat glucose tablets.”

Get tagged. Your child should always wear a medical ID. Not as a wallet card or keychain, since these can be lost or overlooked, but on his or her body as a bracelet or necklace. “In the event of an emergency, the more information that the person helping knows, the better they can assess the situation,” Massey says. If your child wears an insulin pump, it may be helpful to note that on the ID, too. Not everyone is familiar with this type of medical device.

Give your support. It’s normal to worry that your child will have a low in the middle of a basketball game. But you need to encourage her to stay active and let her know she can succeed. Teach her to monitor her blood levels, keep supplies on hand, and know the early signs of hypoglycemia and hyperglycemia. When it comes to kids with type 1, “knowledge is power,” Elrod says.

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