Encourage Children with Type 1 Diabetes to be Active

Beth McNamara Health Guide
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    I read, and read, and read all of the articles on the Internet about the "very active" or just plain "active" and "athletic," children with Type 1 Diabetes and how they are managing the potential lows that come with intense bursts of activity or prolonged periods of exercise.


    But my teenage diabetic son has the opposite problem: he doesn't like to move, is far from "very active," and has little desire to be athletic or highly active. Don't get me wrong, my son is fearless in the face of new activities. He has tried several sports, some typical and others more novel, including fencing, tae kwon do, baseball, swimming, soccer, tennis, and golf. However, he didn't find a real passion for any these, and instead prefers more sedentary activities, like reading, writing and even building computers.

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    I wrestle with how to motivate a kid who frankly is not programmed to want to move. My son has never liked to be active, almost from the day he was born. He was the last kid in his daycare to learn to walk, instead coercing his fellow playmates to retrieve toys for him. Even today, he will determine, literally, how much energy it will take him to pause a television show he is watching to get up off the couch, walk to the refrigerator to get a glass of water. If he can reduce the number of steps and movement it takes him by alternating his path to the fridge, he'll do it. He even has calculated how many calories he burns per hour texting his friends (which has been estimated at 40 calories per hour) to include this activity in his exercise regime. Yet we hope that bit by bit, brick by brick, we can instill lifelong habits into our son's routine so that exercise becomes more of a norm than the exception.


    My husband and I have tried many different strategies to get him to make exercise a part of his day-to-day routine. Fear. Strong-arming. Forcing. Carrot and stick. Leading by example.We have rearranged our schedules as a family so that we focus more on our meals and what we are eating and ensuring that we are eating meals together, as well as who has exercised and when. The rearranging has included paring back on organized sports, activities, and other commitments to make the time to manage our health and exercise both individually and as a family.


    What works to get my son to exercise?  As I mentioned above, little bit of everything. I've had to go back to my psychology and business management classes and figure out what motivates him. Extrinsic motivators, specifically fear, have some impact: Fear of ending up in the hospital again works. Fear of having a high risk of heart disease has a little impact. Fear of losing his ipod or cell phone for the day - and, then he's off like a streak of lightening to ride his bike or lift weights!


    Making my son aware of how exercise helps lower his blood sugar over an extended period of time impressed him some, at least initially. My husband sat down with him, and using the example cited in H. Peter Chase's Understanding Diabetes (the "Pink Panther Book,") explained how someone's blood glucose levels are lower in days that one exercised versus days that one does not exercise, keeping insulin doses and carbohydrate intake the same, and the levels of glucose not only had an initial dip immediately following activity, but remained lower for up to 14 hours than those levels on sedentary days.


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    With this in mind, my son did an experiment: he tested his blood and then exercised. He retested his blood and found that he did experience lower blood glucose (BG) levels right after he worked out. He then tested himself throughout the day, and found that his BG was indeed lower throughout the entire day. The experiment impressed him, and he now makes a little game of seeing how much a particular exercise, like lifting weights or bike riding, impacts his BG levels.


    In addition to making him aware of how exercise can help him, my husband and I have taken the opposite approach and want my son to understand the consequences of Type 1 Diabetes and how not taking care of himself can potentially contribute to health problems, which many of us know includes heart disease, nerve damage, kidney disease, and eye problems. Using this type of motivational approach is a bit like the scared straight philosophy. However, considering that kids with Type 1 have so much to bear with their day-to-day management, I tend to shy away from using this conversion by fear method too readily.


    A psychologist I know recommended motivation using positive reinforcement when deploying the "carrot and stick" approach. This means that instead of me saying: "If you don't exercise today, you will lose your access to Facebook," I say: "Once you've taken a good hard walk for 40 minutes, you can use Facebook for 40 minutes. If you make it for 60 minutes, then you can use Facebook for 60 minutes." This makes my son feel more accountable for his actions, and gives him a goal to work for.


    Leading by example has helped some. Fortunately, my husband and I have a fairly regimented exercise routine; we each make time to work out three to four times a week for about 45 minutes. We're not in training for any notable event, but it does help for all of our sons to see their parents practice what they preach, plus we benefit from overall health and stress maintenance. Too, our middle son is active and likes to move.


    Lastly, we have discussed my son's exercise goals with his diabetes management team, including his endocrinologist, nurse practitioner, and CDEs (certified diabetes educators). Each visit they ask him how his exercising is going, and inquiry how well he is meeting the exercise goals that he set forth for himself during the last visit. My son's nurse practitioner has encouraged him with a positive reinforcement: if he exercises during the day after school, he will not have to give himself a shot of insulin to cover his afternoon snack. The potential of eliminating an insulin injection has been one of his best motivators.


    I've found no "silver bullet" of a motivator to get my son to exercise without being scared, coerced, bribed, or what ever to do so. I'm hoping that maybe someone else has found a "magic potion for motivation."



Published On: May 14, 2009