At what blood glucose level should my son not participate in Physical Education? At times his readings are between 3.0 and 4.7 mmol/L [54-85 mg/dl], even though he has a juice, it doesn’t raise much higher that 4.7 mmol/L [85 mg/dl]. At present the students are participating in track and field.

As diabetes healthcare professionals, we emphasize the importance of adjusting the diabetes management plan to enable participation in physical activity of every type. A blood sugar level prior to exercise of 100-120 mg/dl [5.5-6.6 mmol/L] or lower will generally require additional carbohydrate unless an immediate reduction in insulin is possible (e.g., suspending the basal rate of an insulin pump). With a glucose level of 3.0 and 4.7 mmol/L [54-85 mg/dl] prior to exercise, your son will require a fast-acting source of carbohydrate to both treat/prevent the low blood sugar and provide enough energy for activity participation.

General guidelines recommend 15-30 grams of carbohydrate for every 30 minutes of moderate intensity exercise to maintain blood sugar levels. It is important to recognize that this will vary dependent upon a number of variables including pre-exercise blood sugar levels, previously measured glucose changes as a result of exercise, and current insulin therapy. Exercise occurring at a time when insulin action is peaking, for example, may require more carbohydrate then typical.

Generally, track and field event training requires substantial energy expenditure and may therefore require increased carbohydrate supplementation. Communication with your son’s Physical Education teacher/coach may be of assistance in estimating class intensity.

Consistent low blood sugars prior to, during, or after exercise may be best addressed with a reduction in insulin. Speak to your son’s physician about reducing his insulin to allow his participation in Physical Education. You also have the option of increasing carbohydrate intake at the meal or snack just previous to exercise participation. Diabetes does not have to stand in the way of your son’s participation in and enjoyment of sports and activity.

DMW