Oxfordshire Children’s Diabetes Service
Children’s Hospital, Oxford OX3 9DU
Horton Hospital, Banbury OX16 9AL
Primary School PE and Sports with Diabetes
Regular physical activity is encouraged for all children and young people and has
important long-term health benefits. For children with diabetes, exercise can also be
challenging when it comes to blood glucose management.
Keeping blood glucose levels in the target range during exercise needs extra
consideration. Exercise may cause blood glucose levels to go up or down depending on
the individual, the type, duration and timing of exercise after food. The best way to
understand this is through regular checking, before, during and after exercise. Seeing
what is happening to blood glucose (BG) levels shows you the best way of managing them
for your child.
BEFORE AND DURING EXERCISE
It is important to check your BG levels before you exercise. Aim for the BG to be between
6 and 8 mmol/l before you start.
If BG is 6-8 mmol/l
This is an ideal place to start exercise. You will probably not need any extra carbohydrate.
If BG is below 6 mmol/l
If your BG level is below 6 mmol/l before you start exercise, have a small snack containing
10g slower-acting carbohydrate (e.g. cereal bar, small banana).
If this occurs during exercise - use 10g fast-acting carbohydrate (e.g. 150ml Lucozade
Sport, 3 dextrose tablets)
If exercise is being done within 2 hours of a meal you may need to reduce the insulin dose
given at that meal to keep your BG level above 6 mmol/l and prevent the need for extra
carbohydrate before and during exercise. However, only do this if you notice that your BG
levels regularly fall below 6 mmol/l or you hypo during the exercise (but not on other days).
If you are hypoglycaemic (BG below 4 mmol/l) before you start exercise, treat the hypo as
usual and go on to exercise once your BG has recovered to above 6 mmol/l. Be aware
that you are more likely to have a hypo again before or after the exercise.
If BG is high (above 14 mmol/l)
Muscles don’t work so well if BG levels are high and the BG levels may then go even
higher during and after the exercise.
If your BG level is more than 14 mmol/l, check for ketones.
Please email any comments you may have about this document to: Mary.Cheeseman@ouh.nhs.uk
Paediatric Diabetes Team, September 2014
Review May 2016
2
If your ketone level is more than 0.5 mmol/l, do not exercise but give an insulin correction
dose and wait for the ketone level to fall below 0.3 mmol/l before exercising.
If your ketone level is less than 0.5 mmol/l go ahead and exercise, but drink plenty of water
or sugar-free drinks before and during your activity.
AFTER EXERCISE – Always check your BG level as soon as possible after exercise.
BG may be high or low
High BG levels (most common after short bursts of exercise such as sprinting) –
 Should return to normal within a few hours.
 If not then correct as usual with extra insulin (although you may only need half the
usual dose).
 High BG levels may be the result of having too much carbohydrate before or during
exercise. Try having a smaller snack or less sports drink, and check the BG level
so you can work out how much extra carbohydrate you actually need.
Low BG levels may occur up to 6 hours after exercise (most commonly after long periods
of activity or swimming).
 This happens as the body replenishes stores of glucose used up during exercise.
 If hypos occur, treat them in the usual way and check that BG levels have come up
above 5 mmol/l once treated.
 If you notice this happening regularly then consider one of these options –
o reducing meal time insulin in the time period 4-6 hours following exercise.
o a snack containing a mix of fat and protein and 10-15g carbohydrate (e.g.
yoghourt tube or 200ml milk, or cheese and crackers) IMMEDIATELY after
exercise.
 Young children will use up their body stores of glucose easily and exercise later in
the day is likely to cause lows during the night.
o a small bed time snack (10-15g carbohydrate) is important to prevent nighttime hypos especially following afternoon or evening exercise. This may
require reduced or no insulin depending on the individual response.
IN REALITY
Most primary school children are on the go all the time and PE lessons do not significantly
increase physical activity so you may not need to adjust the insulin or give extra snacks.
Regular blood glucose checking will give you the information you need to make this
decision.
On the other hand, during after-school sports clubs or activities, and sometimes during
playtime, children are more likely to be more active. This may affect blood glucose levels
and need adjustments to carbohydrate and insulin.
Regular blood glucose checking is absolutely essential for you to understand your child’s
diabetes and blood glucose response to different exercise and activities
If you have any questions about this then please discuss it with your diabetes team.
Please email any comments you may have about this document to: Mary.Cheeseman@ouh.nhs.uk
Paediatric Diabetes Team, September 2014
Review May 2016