“How often should my kid be exercising with type 1 diabetes?”

13-year-old boys are usually active and like active dynamic plays outdoors. Supervised sport activity recommended 2-3 times per week. Baseball, Soccer, Ice hockey, or tennis lessons are perforable. Important to have meals with protein shortly before games and have a Glucerna snack handy.

Having T1 diabetes is NOT a limitation to anything anytime. He can do whatever he wants and as frequent as he wants. However he must check his blood sugars frequently to see what happens with his levels during exercise. Even better if he wears a continuous glucose monitor to track his blood sugars during exercise.

Regular physical activity have multiple benefits to our health. Physical activity includes all movement that increases energy expenditure, whereas exercise is planned, structured physical activity. Though any form of physical activity will have a positive effect on our health, when exercise is moderate or vigorous in intensity it becomes much more beneficial to our overall health and wellbeing.
The benefits of regular exercise include some of the following:
-Increase life expectancy by 2-10 years depending on the type of activity performed.
-Prevent weight gain or help maintain ideal weight
-Prevents obesity and insulin resistance (metabolic syndrome)
-Prevents loss of cognitive function.
-Increase self esteem
-Protect our cardiovascular system
- prevent or lower level of depression or anxiety
-Help us sleep well
-Prevent high blood pressure and stroke
-Improve insulin sensitivity and lower our blood sugars with without diabetes.
-Help us move around with ease
-Prevent or delay arthritis
- Help us maintain strong muscles and bones
-Prevent certain types of cancers
-Boosts our energy
-Helps us to socialize with people
-It gives us enjoyment and fun
Physical activity can be light, moderate or vigorous in intensity, depending on the extent to which they make you breathe harder and your heart beat faster.

However any physical activity done for a good duration of time has good health benefit, the moderate and vigorous exercises have more pronounced health beneficial effect and that is what really accounts to our weekly exercise goal of 150 minutes.
Exercise can be, Aerobic, resistance or flexibility forms.
Aerobic activity can be light, moderate or vigorous. It takes more efforts to do vigorous activity than moderate or light activity.
For moderate physical activity, you can talk while you do them, but you can't sing
Moderate exercise includes:
-Walking briskly (about 3½ miles per hour)
-General gardening
-Dancing
-Bicycling < 10 miles per hour
-Playing golf
-Canoeing
-Playing Tennis
Vigorous exercise makes you breathe harder and make your heart beat faster. You can only say a few words without stopping to catch your breath Vigorous exercise includes:
•Running/jogging (5 miles per hour)
•Walking very fast (4½ miles per hour)
•Bicycling (more than 10 miles per hour)
•Heavy yard work, such as chopping wood
•Swimming (freestyle laps)
•Aerobics
•Basketball (competitive)
•Tennis (singles)
Resistance exercise:
Resistance exercise is exercise geared towards strengthening the bones and muscles. These include activities like push-ups and lifting weights, jumping, are especially important for children and adolescents by producing force on the bone that promotes bone growth and strength.
Flexibility or balancing exercise includes stretching, dancing, yoga, martial arts, seat-ups, and tai taekwondo. This activity enhances physical stability and flexibility and reduces risk of injuries.
Moderate and vigorous physical activities can be chosen or can be combined to meet the minimum weekly recommendation of physical activity. Moderate physical activity requires twice the a mount of time to achieve similar out come as vigorous activity. Light physical activity does not contribute towards the recommended weekly exercise requirement.
Strength (resistance) activity and balance (flexibility) activity should be performed at least 2-3 times a week in combination to moderate or vigorous physical activity, or separately. Physical activity should not laps more than 2 days in a row. It should last more than 10 minutes at a time.
The duration of time for the required weekly physical activities varies with age group. The recommendations only state about the minimum weekly time, type and intensity of the physical activity. Physical activity is recommended from the walking age to the age (2 years to 64 years of age.The United states Agriculture department, states that, the health benefits you gain from being active are far greater than the chances of getting hurt. Physical activity should be performed in a safe environment.
There are three levels of recommendations based on the age group.
1) children from walking age, usually 2 years old to 5 years old should be active intermittently several times a day. This will promote growth and development. A child should be active in a safe environment several times a day to enhance growth of the body build strong muscle and bones. Physical activity will also enhance the child's cardiovascular and brain development.
2) School age children and adolescent (6-17years) should have aerobic physical activity at least an hour day of moderate to vigorous intensity. They should also have activities for muscle-strengthening, like climbing, and bone-strengthening activities, like jumping at least 3 days a week, and flexibility activity like, gentle stretching, dancing, yoga, martial arts at least 3 days a week.
Sports activity is vital in a growing child to enhance the growth and development properly. It is also important that exercise is performed in a safer environment under supervision in children. Sports activity should be done as a group. This will enhance social life and has the highest benefit in longer life expectancy than when done individually. Certain sports that involve two or more people such as tennis, badminton, golf, and cycling promote longer life according to some European studies. However any sports activity will have a positive health benefit and longevity than sedentary life style. Children and adults should exercise beyond their weekly recommended time of over an hour daily. Usually doubling the weekly recommended time will have a greater effect.
3) Adults, 18 -64 years, are recommended, a minimum of 150 minutes of moderate aerobic physical activity or 75 minutes of vigorous physical activity a week. However increasing aerobic active for 5 or more hours each week can provide even more health benefits. The sports activity should be spread
for over at least 3 days a week. Each aerobic activity should be done over 10 at a time. Resistance and balance activities, like push-ups, sit-ups and lifting weights, should be done at least 2-3 days a week.
The same recommendations of physical activities are applicable for diabetic patients. Exercise is specially helpful in preventing or delaying type 2 diabetes. Exercise helps control blood sugars, improves cardiovascular system, lowers blood pressure and prevents obesity and helps with weight loss.
Regular exercise also has considerable health benefits for people with type 1 diabetes. It improved cardiovascular fitness, muscle strength, insulin sensitivity, lowers blood sugars, lowers insulin requirement, lowers HBA1c, etc..). Type 1 diabetic have more challenges with sports activity. Because these involve insulin regimens, food intake for exercise, and maintaining normal or nearly normal blood glucose levels before, during, and after activities and the prevention of hypoglycemia. These factors can be a barrier to physical activity in type 1 diabetic patients. During exercise diabetic patients react to physical activity differently with great variability. Some will have high blood sugar in response to stress hormones (adrenalin and glucagon), and many others will develop low blood sugars during and after physical activity. Therefore, exercise recommendations, should be tailored to meet the specific needs of each individual.
Moderate and vigorous exercise can modify insulin action on the liver and muscle. Vigorous aerobic exercise increases muscle glucose uptake up to fivefold through insulin-independent mechanisms. After exercise, glucose uptake remains elevated by insulin-independent method for up to 2 hours. Also the insulin-dependent mechanisms becomes more sensitive to insulin, up to 48 hour if exercise is prolonged (30-60 minutes). This can replete the glycogen storage in the muscle and liver. Improvements in insulin action may last for 24 h following shorter duration activities (20 min) if the intensity is elevated to near-maximal effort intermittently.
Type 1 diabetics should participate in any sports activity like their none diabetic counter part as long as frequent blood glucose monitoring and frequent insulin and carbohydrate adjustment are performed for safer physical activity.
Some of the recommendations are:
1) Since the benefit of physical activity is much greater physically active in children and adults with type 1 diabetes should be recommended to all.
2) Blood glucose responses to physical activity in all people with type 1 diabetes are highly variable (higher and low) different adjustments to cars and insulin should be made.
3) Frequent blood glucose checks are required to determine carbohydrate intake and insulin dose adjustments.
4) Insulin users can exercise using either basal-bolus injection regimens or insulin pumps though there are advantages and disadvantages to both insulin delivery methods.
5) Continuous glucose monitoring during physical activity can be used to detect hypoglycemia when used as an adjunct rather than in place of capillary glucose tests.
Carbohydrate adjustment during physical activity should be managed as follows:
1) If blood glucose is 90 mg/dL
eat 15–30 g carbohydrate or weight and age specific amount, before exercise.
If activities is brief in duration (<30 min) or at a very high intensity (weight training, interval training, etc.) may not require any additional carbohydrate intake
For prolonged activities at a moderate intensity, consume additional carbohydrate, as needed.
2) 90–150 mg/dL
Start consuming carbohydrate at the onset of most exercise (∼0.5–1.0 g/kg body mass per h of exercise), depending on the type of exercise and the amount of active insulin.
3)150–250 mg/dL
Initiate exercise and delay consumption of carbohydrate until blood glucose levels are <150 mg/dL
4) 250–350 mg/dL
Test for ketones. Do not perform any exercise if moderate-to-large amounts of ketones are present.
Initiate mild-to-moderate intensity exercise. Intense exercise should be delayed until glucose levels are <250 mg/dL because intense exercise may exaggerate the hyperglycemia.
5) ≥350 mg/dL
Test for ketones. Do not perform any exercise if moderate-to-large amounts of ketones are present.
If ketones are negative (or trace), consider conservative insulin correction (e.g., 50% correction) before exercise, depending on active insulin status.
Initiate mild-to-moderate exercise and avoid intense exercise until glucose levels decrease.
6) Alternatively, basal insulin regiments can be lowered if exercise is more than 30 minutes. Depending on the blood glucose level, duration and intensity of the exercise, 20-50% reduction of basal insulin could be considered 30-60 minute before exercise to prevent hypoglycemia. For patients with insulin infusion pump lowering the basal insulin or suspending it for a couple of hours be an alternative to consumption of carbohydrates if blood sugars are <150mg/dl before exercise. It is very important to perform frequent blood glucose testing when implementing insulin and carbohydrate adjustments. Glucose sensors should only be used as adjunct but should not replace the capillary blood sugar testing.
Exercise is beneficial for people with type 1 diabetes (all ages). It is associated with many health benefits that include improvement in cardiovascular fitness, better bone-health and enhanced physical and psychological well-being and longevity. diabetic patients should exercise at least twice the recommended time of weekly exercise (150 minutes of moderate or 75 minutes of vigorous) for adults and more than an hour a day for children with various strengthening and balance activities, spread at least over 3 days a week.
They need to pay special attention to the blood sugars, with more frequent blood sugar testing, and adjusting their insulin and carbohydrates accordingly. When the blood sugars are high >250 mg/dl before start of the exercise and there are little or no ketones, some insulin (half of the usual correction dose) should be administered and blood glucose monitored frequently. When ketones are moderate to large no exercise should be performed until the ketone clear with insulin and hydration.

Going Back to your son:
Your son has type 1 diabetes. He can participate in any physical activity as his non diabetic peers. He should participate in daily physical activity with at least over an hour of moderate to vigorous exercise at least 5 days a week. light physical activity such as walking or doing home chores do not count towards these recommendations. Regular physical activity will have a great health benefit in type 1 diabetics. It improves cardiovascular health, prevents, high blood pressure, excessive weight gain, mood disorders, certain cancers, prevents chronic complications of diabetes that can shorten life expectancy by about 10 years, brings happiness and enhances socialization and longevity.
When he is exercising you should pay special attention to his blood sugars, insulin regimens, and carbohydrate needs. These things need to be balanced all the time. More frequent blood sugar testing is essential regardless of whether you have a blood glucose sensor or whether he is on insulin pump or multiple injections a day or other insulin regimens. Before, during or after exercise you should adjust his insulin regimens and his carbohydrate needs as indicated. His body may respond with low or high blood sugars. There is a lot of variability to the response of glucose to exercise. Every one is a text book for him/her self. Howeve most people will have low blood sugars when performing moderate to vigorous physical activity especially if done over 30 minutes duration. And may experience late hypoglycemia up to 24 hours depending on the duration of time, intensity of physical activity, or situation. With time you will learn how his body responds to exercise and you will be comfortable managing his diabetes. If his blood sugars are low you will treat with appropriate amount of carbohydrates or lower his insulin or do both appropriately. When his blood sugars are high you will treat with about half the correction before and after activity as long as he has little or no ketones. If he has moderate or large ketone treat those first be fore any physical activity with at least 20% more insulin and hydration. When ketones resolve he can participate in sports. As long as he is not sick or have moderate or large ketones he can participate in sports activity while correcting his high or low blood sugars.
So the answer to your question is therefore, he can participate in sports more than 5 days a week as needed and more than an hour of moderate to vigorous intensity with at least 3 days of balance and resistance activity under supervision. He can participate in competitive sports activity if he is interested like his none diabetic peers as long as the blood sugars are monitored and appropriate action is taken consistently. Usually twice than the recommended time of physical activity will be more beneficial for good health and longevity. A healthy and balanced is a vital component for good health and longevity.
Please discuss these issues with you doctor. He/she will help you in managing your son's diabetes during sports activity.
Good Luck
References for further reading
1) https://www.choosemyplate.gov/physical-activity-amount
2) Diabetes Care 2016 Nov; 39(11): 2065-2079.
3) Diabetes Care 2016 Nov; 39(11): 2065-2079.