When you have a young child with diabetes you are always on high alert. Normal protective parenting instincts are elevated. Simple things that you took for granted have to be worried about and planned for.
Every snack and meal, every activity has to be considered. Surprises such as a faulty pump or Continuous Glucose Monitor (CGM) or a child’s snack sneaking have to be dealt with. It feels like you’re on a roller coaster of highs and lows. You’re even on alert when your child is sleeping.
It is difficult not to be a stressed-out, nervous wreck. But you must take care because how well you manage your child’s diabetes now has health implications and also future repercussions for how they will manage their diabetes.
Your approach, management, and tone matter because they will define and inform your child’s future diabetes management. They will inherit this responsibility so you want to pass on the skills to manage it with care. You are setting the framework for their future health and well-being.
One way to build a successful framework is with routines. Routines are beneficial because the behavior pattern is repeatable and will become a habit. Also, when you also incorporate and acknowledge the unknown and unpredictable within a routine you prepare your child to handle the unexpected.
A routine my daughter and I started was a weekend run. It was important to encourage physical activity and to make sure she knew her diabetes should never hold her back.
We started slow. A half-hour run with lots of breaks built in. I would keep the route a surprise or we would plan it together. Mixing it up kept things interesting and fun. We added stops at playgrounds, vistas, sights, or even snacking destinations.
I made sure to involve her in the planning of what to bring. From water and snacks to her diabetes supplies. It was a balance of bringing what we needed and also a little extra in case of emergency. This gave her experience with planning and preparing; important skills because any trip, even the smallest, requires bringing her phone, PDM, and snack supplies.
Any activity with a child that has diabetes is a balance of fun and seriousness. Depending on the age of your child it is important to think about how much of the serious stuff you share with them. With a young child perhaps it is best to limit them to the route planning and prepping and leave the management of blood glucose levels to you. As they get older you can begin talking about blood sugar and exercise and different strategies for management.
Managing one’s blood sugar levels during exercise is always tricky. Consulting with your child’s Endocrinologist or Diabetes Team about strategies for insulin management before, during, and after exercise is always a good idea. With their advice, you can formulate different scenarios and strategies to prepare yourself and your child.
We would always begin by taking note of my daughter’s starting blood sugar level, and avoid exercise when her blood sugar was too low or high. It is best to wait for blood glucose levels to moderate before setting out.
If your child’s levels are good, it might be beneficial to cut the basal for the time of exercise if they have an insulin pump. Knowing how much to cut and for how long is a great question for their Diabetes Team. We found that even with the recommendations there was still the trial and error of learning how your child’s blood sugar levels vary with exercise. Sometimes her levels would go up before exercise or a football/soccer game because of nerves and then drop during the game or run. Being prepared with lots of water and snacks is critical for highs or lows.
Another important skill for your child to learn is listening to their body and being aware of how exercise affects blood sugar levels. It’s great to have a C.G.M. but the best judge is how they are feeling and their ability to anticipate lows.
When they are in the middle of a game or race it isn’t always convenient to check their phone so knowing their body is best. The GCM often lags behind true blood glucose levels so is not a perfect gauge.
Another pitfall to avoid is your child pushing themselves too far when their blood sugar is falling, making it even harder to recover. Awareness and monitoring of their blood sugar and how they are feeling is critical. Teach them that it is okay to stop or take a break if they feel low. It’s far better to catch the low or prevent the high before they happen.
Post-run is a great time for a treat and breaking down how the run went. Talk about what could be done better and also plan for recovery from exercise. Eating a good post-exercise meal/snack and hydrating is a must. Keeping an eye on post-exercise blood sugar is important as well. After exercise levels might drop but then rise again.
Another strategy with physical activity is to stop before your child is ready to. It is hard to judge the timing of stopping, but ending before they get tired or discouraged is a good idea. Jimmy Connors said his grandmother, who began his tennis training, would always stop before he wanted to and was unswerving in this.
He would argue to keep training but she never wavered. This fueled his desire to come back the next day and train harder. Always leave a little gas left in the tank!
By starting a simple routine like the weekend run your child can learn a lot about how to manage their diabetes. They will begin building a framework that will serve them throughout their lives.