Whether your child has type 1 or type 2 diabetes, exercise can play a crucial role in managing their condition. It promotes a healthy lifestyle and can also allow them to socialize with their peers.
More than 350,000 Americans under age 20 have diabetes. Over 300,000 have type 1 diabetes, an autoimmune disease that occurs most often in young people but can develop at any age.
Physical activity for children with diabetes requires a bit more planning and tracking to avoid hypoglycemia, or incidents of very low blood sugar. However, they can still participate.
“We want to make sure kids with diabetes know that they can do anything that their peers can do,” says Eden Gade, PT, DPT, a physical therapist at UPMC Children’s Hospital of Pittsburgh who supports children with diabetes. “We want them to stay involved in doing all the things that they love to do.”
Potential benefits of exercise for kids with diabetes include:
- Building strong bones and muscles.
- Helping prevent obesity.
- Improving blood sugar levels.
- Improving gross motor development.
- Improving overall wellness.
- Improving sleep.
- Maintaining heart health.
In this Q&A, Eden discusses how physical activity helps diabetic children, safe sports and exercises for children with diabetes, managing insulin during physical activity, and more.
Q: Can You Tell Us What You Do and Describe Your Role at UPMC Children’s?
A: My role really is just about helping kids live active, healthy lives that they enjoy while feeling empowered to help manage their condition.
At their initial diagnosis, patients and families receive three days of education, primarily with our diabetes educators and dietitians. Beginning in 2023, I also began meeting with patients and families. My focus is on helping them understand how physical activity fits into diabetes management.
At the very beginning, I provide a handout based on the American Academy of Pediatrics’ recommendations. It covers how often kids should be active and what types of activities are appropriate for different age groups. During my visit, I also do a quick screening that looks at strength, range of motion, balance, and sensation, just to make sure that the kids are ready and safe to participate in activities.
Every family and child is different, so I try to tailor my education as needed and address any concerns early on. Ultimately, I want families to know that exercise isn’t something to be afraid of with diabetes; it’s something to be embraced with the right tools and guidance.
Q: What Is the Role of Exercise in Managing Diabetes?
A: Physical activity in general plays such an important role in diabetes management. It helps with glycemic control for both type 1 and type 2 diabetes but also helps overall health and quality of life.
Regular movement helps improve insulin sensitivity. It supports heart health, builds strong bones, improves sleep, helps prevent obesity, and can give an overall sense of well-being.
Especially with the younger kids we see, too, it’s not just about structured exercise. It’s about play, participation, and making sure that every child feels supported and able to keep up with their peers as well.
Q: Is There Any Difference in the Impact of Physical Activity for Type 1 Diabetes Compared to Type 2?
A: The impacts of physical activity are similar. The approaches to take for safe exercise can change depending on insulin dosing, and that’s where the diabetes care team comes in a little bit more to provide education on how to understand and manage those situations, so kids don’t have to sit out of the things they love.
With type 1 diabetes, they’re not producing insulin or not producing enough insulin, whereas with type 2, they have insulin resistance. So, it’s in type 2 where those lifestyle modifications commonly have a greater impact on diabetes management and can even help to prevent, delay, or reverse type 2. With type 1, they’re always going to need insulin, but lifestyle changes can help prevent the development of any other comorbidities and support overall health and wellness.
Q: How Does Physical Activity Help Children With Diabetes?
A: I think the big thing is that it can really improve glycemic control. You still may need insulin, but it can have a really positive impact on insulin sensitivity and overall glycemic control. It also helps kids keep up with their peers, maintain a healthy lifestyle, and incorporate healthy habits early on to support both physical and emotional health.
Physical activity is one of the best tools we have to support both physical and emotional health.
Q: Does Exercise Lower Blood Sugar?
A: It really depends on the type of exercise and activities. In addition, your blood glucose response to exercise can vary depending on your starting glucose level, the intensity of activity, the length of time you are active, and any changes you may have made to insulin doses.
One thing I educate on is keeping an activity log to monitor glycemic response with various activities because every body is so different and every child is different in how their body responds to activity.
In general, aerobic or cardiorespiratory exercise — the ones that can get your heart rate up, and make you breathe quicker, like walking, running, jogging, swimming, biking — tend to lower glucose levels. So, you may see that hypoglycemia occurs with those activities.
More stressful activities, such as competitions or shorter sprint activities, can actually increase blood glucose levels. Adrenaline can play a part in raising glucose levels. To learn how different activities affect you, you should check your blood glucose before, during, and after an exercise session. You can keep that log, or, with new technology, some continuous glucose monitoring devices can track activity within the device itself. It gives the diabetes care team a little bit better idea of how that child’s body responds to activity to help families problem-solve in a practical way and give the families the confidence to manage those situations safely, so kids don’t have to sit out of the things they love.
Q: Is There Any Added Concern With Exercise for Type 1 Diabetes?
A: I think one of the biggest concerns families have early on is safety. They worry especially about going low with blood sugars or having hypoglycemic events.
A big part of what the team teaches and what we go over is how to prepare for activity safety. Making sure the child is checking their glucose levels before, partway through — especially if it’s a prolonged activity — and after.
In children of all ages, exercise is often unplanned. Being prepared with snacks to reduce the risk of hypoglycemia and knowing the signs of hypoglycemia are important.
It’s a learning process for the team itself and for the kids and families. So, a big takeaway is that our team is always available. If there are ever questions or concerns, we’re always a phone call away.
Q: What Exercises Are Safe for Children With Type 1 Diabetes?
A: Every activity is safe with some planning ahead and knowing how your blood glucose and body respond to exercise. A little bit of that can be trial and error. So, using those tools of keeping an activity log, talking with the care teams, and those kinds of things can be helpful. We don’t want kids to be afraid of exercising. We want them to continue to participate and stay active. So, nothing’s really considered an unsafe activity; it’s just knowing how to manage it properly.
Q: Can Kids With Type 1 Diabetes Play Sports?
A: Definitely! There are actually a lot of professional and high-level athletes out there who have type 1.
Q: Should Children With Diabetes Track Their Blood Sugar During Exercise?
A: Yes, it’s recommended to monitor before, partway through, and after exercise. So, if activity is around 60 minutes, then at that halfway point — every 30-ish minutes — you should be checking those numbers. The one plus now with technology is that with a continuous glucose monitor, a parent from the sideline could be watching their numbers all throughout.
It’s also helpful as kids get older, learning what their lows feel like. So, that way, they can kind of be like: “Oh, I’m getting kind of shaky — I should step out. That way, I can check it and make sure I’m good to keep going.”
Q: How Important Is It to Educate Others — Coaches, Gym Teachers, Etc. — to Be Mindful?
A: I think it is extremely important to educate coaches and gym teachers about diabetes management so that kids can safely and confidently participate in sports and physical activity. It is recommended, if the parents aren’t going to be there, to have that designated supervision — whether it’s a coach or another parent to help the child troubleshoot to promote full participation or know how to give emergency medication if needed to prevent serious complications — having somebody on the sideline that knows how to approach and can treat it, too.
Proper understanding of blood glucose monitoring, recognition of hypoglycemic and hyperglycemic responses, and the ability to act in an emergency not only promotes safety but also reduces stigma and prevents unnecessary restrictions, allowing children to engage confidently with their peers.
Schools have an obligation to provide safe and inclusive environments. Knowledgeable staff help meet these requirements.
Q: What Should Parents Know About Recovery After Exercise?
A: Big things are getting good nutrition afterward to support muscle recovery, getting good hydration, but then also just knowing that exercise in the short term can affect glucose numbers for up to 24 hours, especially after really rigorous activity.
So, especially if they’re increasing activity beyond what they typically do, or they’re in a competition setting, just keeping a closer eye on their numbers — even overnight, too — just to make sure that they’re not dropping.
If you are having consistent lows or highs with activity, I recommend reaching out to your diabetes care team to determine what adjustments may need to be made.
Q: Are There Exercise Guidelines for Kids With Diabetes?
A: Kids with diabetes should follow typical guidelines for any of their peers. The American Academy of Pediatrics recommends:
For ages 6- to 17-year-olds, participating in at least an hour of moderate to vigorous activity every single day, including strength-related exercise at least three days a week.
It doesn’t have to be all at once. It could be smaller bursts throughout the day.
For our younger kids, it’s going to look a little bit different. For ages 3 to 5, it’s trying to get 180 minutes of active play throughout the day, or about 15 minutes for every hour that they’re awake.
Q: How Can Parents or Caregivers Learn More About Exercise for Kids With Diabetes? Do You Have Any Recommended Resources?
A: That’s a great question. The American Diabetes Association has some really great caregiver handouts of different activities to help get their kids involved.
But then, hopefully, my role as physical therapist growing within this education process, at least within the Pittsburgh area, is that I can be another resource for families as well.
So, if they ever have questions or concerns about how to safely start activity or what types of activities are appropriate for them, I can be that resource as well. My hope is that families walk away feeling empowered and supported, knowing there’s a team here to guide them every step of the way.
Q: What Else Should Parents Know?
A: Families play a huge role — it’s important for them to be a role model for their kids to help to create those healthy lifestyle habits early on. Doing things as a family — whether it’s walking the dog or taking family walks after dinner — starting those healthy habits now can go a long way, and kids are more likely to stay active if parents join in or encourage them.
November is Diabetes Awareness Month, and it’s a great reminder that living with diabetes is more than figuring out your numbers, but it’s also about living a full and active lifestyle. The goal isn’t perfection, it’s finding ways to move every day that feel fun and sustainable.