Physical activity in type 1 diabetes mellitus in children

Abstract

Physical activity is one of the fundamental cornerstones in the treatment of diabetes¹. Children and adolescents who follow exercise guidelines have more favorable measures of adipose mass, promote mental, social, mental cardiometabolic health, fitness, better cognitive development and healthy eating patterns². The WHO recommends that children from 5 to 17 years old should perform at least 60 minutes a day of physical activity (PA) of moderate to vigorous intensity, especially aerobic throughout the week. Meanwhile, vigorous aerobic activity for muscle and bone strengthening should be incorporated at least 3 times a week and sedentary time should be limited³. Children and adolescents with DM 1 and DM 2, due to their condition, have less cardiorespiratory fitness and lower levels of physical activity than the general population, making it essential to encourage this population to perform physical activity and thus improve cardiorespiratory fitness. It is possible to identify barriers that cause them to do less PA than their peers, the main ones being fear of hypoglycemia and losing control of blood glucose levels, these fears are repeated in different age groups¹.

Depending on the type of exercise to be performed: aerobic, high intensity or mixed, one could estimate what variation blood glucose could have, although many other factors that modify it must be considered. Taking this into account, recommendations can be given for modifying insulin, according to the type of exercise, duration , meal time and amount basal and bolus insulin¹.

In recent years, with the advancement of technology, especially in Continuous Glucose Monitoring, whether in real time or intermittent scanning, and the creation of guidelines and consensus, individual decision-making has improved. These instruments, combined with the person's experience with exercise and the risk of hypoglycemia, make it possible to more accurately establish the optimal minimum level to begin exercise, and also in the hours after it, adjusting the level of the alarms to avoid or reduce hypoglycemia⁴.