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March 31, 2020

Exercise and Sports, Hypoglycemia

Question from North Brunswick, New Jersey, USA:

Our 30-month-old grandson is a happy, active child who enjoys running and playing out of doors. He was diagnosed less than a year ago with type 1 diabetes and wears a CGM. Within minutes of being at a park or playground, his blood sugar begins to drop rapidly, at times, 20 mg/dl every 5 minutes, which brings him to impending lows or low within 20 to 30 minutes of arriving. Is this because he is excited to be there and much more active? He becomes irritable and cries and, also, he doesn’t want to leave. So, in addition to the low, what started out as a positive and fun family experience deteriorates quickly to an unhappy, negative one for everyone. We do carry snacks. He is treated; we all go home and he goes inside. This upset and fear is also preventing the family from travelling too far from home on outings. Do you have any suggestions as to what we could do before leaving for an outing to prevent this? At what blood sugar with a strong downward trend would you begin treating (80 mg/dl [4.5 mmol/L]? 100 m/dl [5.6 mmol/L]?). We also confirm the blood sugar with a finger stick. How would you suggest treating a low blood sugar or a severe downward trend with impending low blood sugar so that he doesn’t have to return home, but perhaps rest a bit and return to the activity he is enjoying?


From: Dr. Stuart Brink

The first problem from your question is the implication that he is going to play at playgrounds when the coronavirus is pandemic. He shouldn’t; the rest of family shouldn’t, etc. While the coronavirus is not thought to be so dangerous very children, he can get exposed, become infected, even if not deadly ill himself, but then expose all other members of the family – and especially those over 60 years old who get exposed and get very, very ill and have greater risks of dying. Because the U.S.is not self-quarantining like recommended, the number of cases is increasing faster than other places of the world, like Korea, who did the stay at home and stay at distance much better with better consistent advice.

For the hypoglycemia, you should be discussing this with his diabetes team. If this is happening over and over, then it is not from exercise since you are describing hypoglycemia very quickly before exercise effects kick in. Nevertheless, since you document this with blood sugar readings and he has symptoms, I would PREVENT the hypoglycemia by giving him a small glass of juice just before going for activity. (Activity can be in the house or in the backyard – but not public or school playground while we are trying to battle the virus.) Any simple sugar snack can be used in this fashion, but not with chocolate/high fat since that would slow down the effect. You can experiment with different amounts of simple sugars ahead of the activity and within a few days should be able to figure out the proper amount to prevent the hypoglycemia itself. If there is more hypoglycemia AFTER activity as well as in its early phases, then might need a fruit or yogurt or something similar to prevent the latter hypoglycemia, too.