My four an a half year old nephew was diagnosed with diabetes at the age of 11 months, is doing well, and we are thinking about sending him to karate classes to help with exercise, safety, self-esteem and new friendships, but a friend of mine who has a black-belt at times has had broken toes. Our concern is the possible future effects that constant foot injuries may cause him in adulthood. Do you feel this is a safe sport? What are the best foods or drinks that help a young child maintain a safe sugar level while participating in sports?

Please ask have your nephew’s parents to talk with his diabetes team about any reservations they might have regarding karate participation and potential foot injury. Certainly, there is the risk for injury in almost every sport, and yet the benefits of participation well outweigh the risk in almost every situation, particularly for kids (and adults!) with diabetes. There is no particular contraindication that I am aware of, but it is a good question to ask.

Your nephew’s family will need to develop a plan for managing diabetes around exercise in consultation with his diabetes team. It will most likely work best with a combination insulin dosage decrease and food management approach. If available, a dietitian with a background in pediatric diabetes management might be most helpful in this situation.

As a general recommendation, 15-30 grams of carbohydrate are recommended to maintain blood glucose levels for every 30 minutes of exercise. This will vary depending on exercise intensity, insulin levels and peak times. A well balanced snack prior to exercise containing both complex carbohydrates as well as protein may help to maintain blood sugar levels for a longer period of time. Some people have done well with the uncooked cornstarch products to prevent hypoglycemia. These options can be discussed with with your nephew’s dietitian.

Testing more frequently before, during and after exercise will assist in patterning the blood sugar response. This will allow the parents or caretakers to make decisions regarding more or less food intake as needed to prevent hypoglycemia.

DMW