Physical education protocol

Hello, my son is starting PE next week and he is nervous he hates doing extra testing at school, it is his first year with the pump ( omnipod) he has never had major issues with gym lows before, this is his third year with diabetes. last year he had gym right before lunch so he just tested at lunch and didnt have any issues, this year gym is in the middle of his morning and he tends to run on the low side before lunch, our orignal plan was to have him test before gym and have a 15 carb juice, he will most likely be running around 150-200 at that time but might need the extra carbs to get him through until lunch. our other thought suggested by another mom was to turn his basal down 1 hour pre and during PE perminantly until PE is over. this sounded great to jacob because if we did this he wouldnt necessary need to test unless he felt low. i am at a loss with his fear of being different and of others seeing him treat a low or do anything different at school. i'm trying to keep things easy for him but also want to keep him safe. i also plan on giving him some extra protein in the am to keep him going. any thoughts would be appreciated! amy

Any chance his PE time could be moved to either first thing in the morning or after lunch? . Instead of juice, we usually use some sort of protein bar, or a combination of fruit and crackers - this seems to have a little more staying power than the juice, and doesn't spike their blood sugar.

Although lowering his basal is an option, it shouldn't prevent him from testing before PE Our endo is adamant that this be done, as they can go low pretty quickly with exercise and they need to be sure they are in range before exercising (or driving for that matter).

My younger son has the same testing anxiety issues in public. We have tried our best to have him overcome this, but for now, have written it into his 504 plan that he is allowed extra time to test and afforded privacy to do so.

Good luck! Patti

I would insist on testing before PE unless it is directly after snack or meal time. Having said that, in our experience juice works well for PE because the spike hits just as they are needing it for exercise. The other trick we have been using for swim practice is nursing a small Gatorade over the course of the practice. He could do the same over his PE period. We turn down my son’s basal for swim practice, but not for PE - he does not expend as much energy during PE, but he is only in 5th grade. For a middle or high school period, I would likely have him turn down for just the PE hour if the exercise is heavy.

One of the challenges of gym is that the amount of physical activity will vary from day to day. Some days are very intense and some days are fairly light. My daughter has learned that at least for her that she needs to test before and after PE and adjust accordingly. We have a plan in place for her which varies according to the intensity of the physical exercise. Unfortunately, at least in our case, testing is not an option.

One day in October I got a call to come to the school. That morning she had a timed one mile run. After the run, she hit a low of 42 and she could not get her BG to rise above 60. I called her endo and directed us to suspend her basal until her BG was over 100. She also suggested that we give her some complex carbs in addition to the simple carbs. I stayed with her until she stabilized and it took almost 3 hours and the consumption of over 200 carbs to get her BG above 100.

For her, on most PE days, a temp basal with a 30% reduction for 3 hours is the right adjustment, but testing allows her to adjust to the specifics of that day.


Hi Amy, Sophia ALWAYS tests before exercise (and sometimes after) but lowering her basal rate an hour prior to activity and for a hour after decreases her lows. It just keeps her from having to take MORE time away from her peers/activity by having to "test, snack, test, ok, you can play now but you only have 5 min left" and it keeps her pretty stable. Hope that helps.

This is what we do as well. We have a reduced basal for PE, but my son has to check as well. He has to report his blood sugar to the PE teacher - who trusts that my son knows what to do about it, but it keeps him accountable. Have you considered a CGM? That has made a huge difference to how often my son actually checks. If the CGM says he's in the 150-200 range for example, he usually won't check.

This is one of the best arguments I can make for insisting on a 504 plan at school. A child with T1D needs a special accommodation so that he or she can have the same school experience as his/her peers. That includes PE, and in some cases PE is a graded class so participation is a must. I also like the idea of identifying 1 or 2 kids in the class to act as a "diabetes buddy" in PE so they can sort of know what to look for in your child and alert an adult. It's not putting a responsibility on another kid, but rather an act of camaraderie and kindness that many kids are perfectly happy and willing to do. This helps dispel some of the 'different treatment' thing, too, when others are vested in the safety of their classmate.
That being said, my daughter also wants to avoid extra testing at school. Her teacher takes a juice out to PE with them and Maxine just sucks it down if she needs it. Then her teacher calls the health clerk to test her after PE. THIS IS IN HER 504 PLAN: SOMEONE COME TO HER SO SHE DOESN'T HAVE TO TRAIPSE ALL OVER SCHOOL TO TEST. She's in 5th grade. When she starts junior high next year, we will switch to a granola bar type thing because PE is longer.