Course:KIN366/ConceptLibrary/Type1Diabetes

Movement Experiences For Children
KIN 366
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Instructor:	Dr. Shannon S.D. Bredin
Email:	shannon.bredin@ubc.ca
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Type 1 diabetes (also referred to as Juvenile diabetes) is an unpreventable autoimmune disease that is most often diagnosed during childhood and adolescence (Public Health Agency of Canada, 2011). It accounts for approximately 5-10% of all diabetes cases (Daneman, 2006). It occurs when the pancreas cannot produce insulin and therefore cannot regulate blood glucose levels (Canadian Diabetes Association [CDA], 2015). Insulin acts to lower glucose levels when in a hyperglycemic state. Without insulin comes a life-threatening buildup of blood glucose (CDA, 2015).

Cause

The direct cause of type 1 diabetes has not yet been determined, but researchers believe it has to do with genetic and environmental factors affecting the immune system (Public Health Agency of Canada, 2011). Family history may contribute to type 1 diabetes, as those with a type 1 diabetic sibling or parent are slightly more susceptible to developing the disease (Mayo Clinic Staff, 2014b).

Symptoms and Diagnosis

Type 1 diabetes symptoms may appear rapidly and suddenly. The usual symptoms include an increase in thirst and urination, unexplained weight loss, heightened hunger, blurred vision, and abnormal fatigue and/or bedwetting (Mayo Clinic Staff, 2014a).

Upon contracting symptoms, a doctor will likely be able diagnose type 1 diabetes through a glycated hemoglobin (A1C) test. Through this test, an average of previous months blood glucose levels can be determined. Type 1 diabetes will be diagnosed if the test shows a heightened level of blood glucose of 6.5 percent or higher (Mayo Clinic Staff, 2014c).

Treatment

Treatment for type 1 diabetes includes monitoring blood glucose levels, taking insulin, watching carbohydrate intake and maintaining a healthy diet and exercise plan. It is recommended to avoid spikes in blood glucose levels. Ideally a type 1 diabetic will use food consumption and insulin injections to keep blood glucose levels stable throughout the day and night. Guidelines for blood glucose levels are within 3.9 to 7.2 mmol/L before meals and under 10 mmol/L two hours post-meal (Mayo Clinic Staff, 2014d).

Blood glucose levels are tested throughout the day, especially before eating or engaging in physical activity. To take blood glucose, a diabetic will use a lancing device to prick the finger and draw blood. The blood will be transferred onto a deposable test strip that has been inserted into the blood glucose monitor. The monitor will read the blood glucose level and, in seconds, show the number on the screen. This reading helps diabetics decide if insulin is currently needed (American Diabetes Association, 2014).

Insulin can be given through an injection or delivered via an insulin pump worn on the outside of the body. With injections, different types of insulin can be used throughout the day. These types of insulin include rapid-acting and long-acting insulin and are given multiple times a day. The other option for insulin delivery is an insulin pump, which has a catheter inserted into the abdomen and the connected pump worn on the outside of the body. Upon eating, you must input your carbohydrate intake and current blood glucose into the pump program (Mayo Clinic Staff, 2014d). The pump responds by giving you the appropriate insulin dosage based on your programming.

Statistics

• As of 2013, over 3,000,000 people have diabetes in Canada, of which 5-10% have type 1 diabetes (CDA, 2013).

• Of the diabetic children and youth in Canada, between 1 and 19 years old, 90% have type 1 diabetes and 10% have type 2 diabetes. Although type 2 diabetes is preventable, research suggests that both types are increasing among youth (Public Health Agency of Canada, 2011).

Risk Factors

Type 1 diabetics are at risk for long-term complications involving cardiovascular disease, nephropathy, and retinopathy (Public Health Agency of Canada, 2011). Nephropathy (kidney disease) and retinopathy (damage to retinal blood vessels) are more prevalent in diabetics that have less controlled blood glucose and have had the disease from a young age. (Mayo Clinic Staff, 2012; Medicine Plus, 2015) In addition, there are immediate complications that can arise due to the dependence on insulin. Life-threatening events can occur if too much or too little insulin is given. In the event of too much insulin, missed meals, or increased physical activity without proper carbohydrate consumption, hypoglycemia can affect cognitive functions and even verbal IQ. If too little or no insulin is present when needed, a diabetic can become hyperglycemic and enter diabetic ketoacidosis (DKA). DKA, while completely preventable, is the number one cause of death among type 1 diabetic children (Public Health Agency of Canada, 2011).

Physical Activity Influences

There is speculation over whether or not exercise benefits type 1 diabetics. There are challenges that diabetics face when becoming involved with physical activity and exercise. Hypoglycemia is the most prominent issue with type 1 diabetics and physical activity. Aerobic or endurance exercises prove to have the most affect on blood glucose levels plummeting. This extreme drop is due to an increase in glucose uptake by skeletal muscles. A drop is also seen in more sporadic, higher-intensity exercise, but it is to a lesser degree. Most children’s activities involve both anaerobic and aerobic energy systems (Lumb, 2014).

Hypoglycemia can also affect type 1 diabetic children long after exercise completion. Exercise can surge glucose uptake into muscles for up to 16 hours after, causing a potential risk for diabetic children to enter hypoglycemia in their sleep. Therefore, to reduce the risk of nighttime hypoglycemia, a diabetic child should have blood glucose testing before bed and in the middle of the night. A child could also become hypoglycemic during the night after being sedentary throughout the day, although it is more likely after having done physical activity (The Diabetes Research in Children Network Study Group, 2005).

Improvement in cardiovascular fitness of diabetic children can help reduce their future susceptibility to cardiovascular disease. Exercise also results in enhanced insulin sensitivity, which is highly beneficial. The less insulin a child can receive with unaltered effects on blood glucose levels, the better. In addition, physical activity assists in decreasing blood pressure of type 1 diabetic children (Elswick, Kavookjian & Whetsel, 2007).

Children with type 1 diabetes can lead a very active and healthy life as long as they take precautions. Testing blood glucose levels prior to engaging in physical activity is very important. If levels are lower than 5.6 mmol/L, a child should consume additional carbohydrates before beginning exercise (Lumb, 2014). To minimize nighttime hypoglycemia, an increase in carbohydrates should also be taken before bed (The Diabetes Research in Children Network Study Group, 2005). Complex carbohydrates, or those that are accompanied by proteins (such as in chocolate milk) are good options as these will not create an immediate spike in blood glucose but rather a long, more steady delivery.

It may be beneficial, when beginning a new exercise program or sport, to monitor and log the blood glucose levels and carbohydrate intake of the diabetic before and after activity. A log may show trends in spikes and falls of glucose levels and therefore allow for future preparation when participating in the same or similar activity (The Diabetes Research in Children Network Study Group, 2005).

Practical Applications and Tips

Children living with type 1 diabetes should not feel opposed to participate in physical activity because of their disease. In fact, they can live a very active and healthy life if they, and their parent or guardian, consistently manage the disease appropriately. Testing blood glucose levels before and after exercise (and potentially during, depending on duration of exercise) and supplementing with appropriate carbohydrates will help to control spikes and drops of glucose levels. As previously mentioned, overnight hypoglycemia is a risk factor but can be managed through carbohydrate consumption prior to bed and mid-night testing. As the child will be sleeping throughout the night, it is often the parent or guardians’ responsibility to wake up and test the child’s blood glucose level. If the level is in a normal range, the child can remain asleep throughout the process. If the child’s blood glucose level shows signs of hypoglycemia or hyperglycemia they may need to be woken up to consume carbohydrates or inject insulin.

When a type 1 diabetic child wishes to participate in physical activities a parent or guardian should ensure the following is addressed:

• If the activity is a new sport or type of exercise that the child has not participated in before, a log of glucose monitoring should be kept before and up to 12 hours following activity. Multiple entries involving the same activity can display trends that could be helpful for the future (Silverstein et al., 2005).

• If blood glucose levels are lower than the appropriate range prior to activity, approximately 10-15 grams of carbohydrates should be consumed before beginning the activity (Silverstein et al., 2005).

• Parents should confirm that school administrators and coaches understand the potential dangers of hypoglycemia during exercise and what to do if an emergency occurs. In the event of a hypoglycemic state, the child should drink juice or take glucose tablets immediately. Therefore, the child should always have at least one of these supplements on hand in case of emergency (Silverstein et al., 2005).

• A decrease in insulin prior to planned physical activity is a better way than increasing calories to control a child’s glucose levels throughout exercise (Silverstein et al., 2005).

• “A minimum of 30-60 minutes of moderate physical activity” is recommended for children with type 1 diabetes (Silverstein et al., 2005).

If the previous points are addressed, a diabetic child can healthily enjoy an active life. The “benefits of [an active diabetic child’s life] include a greater sense of well-being, help with weight control, improved physical fitness, and improved cardiovascular fitness, with lower pulse and blood pressure and improved lipid profile” (Silverstein et al., 2005).

References

American Diabetes Association. (2014, October 6). Checking Your Blood Glucose. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html

Canadian Diabetes Association (2013, April). Diabetes. Retrieved from https://www.fraserhealth.ca/media/Diabetes-Facts-2013-CDA.pdf

Canadian Diabetes Association. (2015). Living With Type 1 Diabetes. Retrieved from http://www.diabetes.ca/diabetes-and-you/living-with-type-1-diabetes

Daneman, D. (2006, March 11). Type 1 Diabetes. The Lancet, 367 (9513), 847. Retrieved from http://ac.els-cdn.com.ezproxy.library.ubc.ca/S0140673606683414/1-s2.0-S0140673606683414-main.pdf?_tid=f08dfabc-becf-11e4-b316-00000aacb361&acdnat=1425076283_967778f8f4537726ff79d61201cb1ec5

Elswick, B. M., Kavookjian, J., Whetsel, T. (2007, November/December). Interventions for Being Active Among Individuals With Diabetes. Sage Journals, 33 (6), 982. Retrieved from http://tde.sagepub.com.ezproxy.library.ubc.ca/content/33/6/962.full.pdf+html

Lumb, A. (2014). Diabetes and Exercise. Clinical Medicine, 14 (6), 674-675. Retrieved from http://www.clinmed.rcpjournal.org/content/14/6/673.full.pdf+html

Mayo Clinic Staff (2012, March 27). Diabetic Retinopathy. Retrieved from http://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/basics/definition/con-20023311

Mayo Clinic Staff. (2014a, August 2). Symptoms. Retrieved from http://www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/symptoms/con-20019573

Mayo Clinic Staff. (2014b, August 2). Risk Factors. Retrieved from http://www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/risk-factors/con-20019573

Mayo Clinic Staff. (2014c, August 2). Tests and Diagnosis. Retrieved from http://www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/tests-diagnosis/con-20019573

Mayo Clinic Staff. (2014d, August 2). Treatments and Drugs. Retrieved from http://www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/treatment/con-20019573

Medicine Plus. (2015, August 5). Diabetes and Kidney Disease. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000494.htm

Public Health Agency of Canada. (2011, December 15). Diabetes in Canada: Facts and Figures From a Public Health Perspective. Retrieved from http://www.phac- aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres- 2011/chap5-eng.php

Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman, F., Laffel, L., … Clark, N. (2005, January). Care of Children and Adolescents With Type 1 Diabetes. American Diabetes Association, 28 (1), 196. Retrieved from http://care.diabetesjournals.org.ezproxy.library.ubc.ca/content/28/1/186.full.pdf+html

The Diabetes Research in Children Network Study Group. (2005, October). Impact of Exercise on Overnight Glycemic Control in Children With Type 1 Diabetes Mellitus. The Journal of Pediatrics, 147 (4), 533. Retrieved from http://ac.els-cdn.com.ezproxy.library.ubc.ca/S0022347605004002/1-s2.0-S0022347605004002-main.pdf?_tid=1549e4da-be0b-11e4-931c-00000aab0f02&acdnat=1424991734_f59a32a98d08db019de59c776edac4dd