There is a clear relationship between insulin deficiency and these chronic complications of diabetes. More specifically, it is unclear if tight control of sugar levels in the blood favorably influence the natural course of the neurovascular manifestations of diabetes (DCCT Research Group, 1988). Still, the fact to avoid fluctuations in blood glucose concentrations outside the normal range, is considered an important goal for most physicians caring for these patients.
The observation made by McMillan (1979) that physical activity has been recommended for the treatment of diabetes mellitus from “time immemorial” is probably not an exaggeration. Historians have marked the relationship between exercise and diabetes as early as 600 BC, when the Indian doctor Sushruta prescribed physical activity for patients with this disease. Among his successors, who were also convinced of the benefits of regular exercise on diabetes, were the Roman doctor Celsus and the prominent Chinese Yuan-Fang Chao, who practiced during the Sui Dynasty in 600 AD. What these doctors saw was a better sense of well being in patients with diabetes, and the subsequent demonstration that physical activity may lower blood glucose levels in this disease, suggested another reason to include exercise in their treatment. When Lawrence (1926) noted that physical activity improved the hypoglycaemic effect of insulin administered, regular exercise has become a key element in the triad in the treatment of diabetes: insulin, exercise, and diet (Joslin, 1959).
The enthusiasm for exercise was based on the premise that the effects of glucose decreased by physical activity would improve metabolic control, thereby improving the quality of life of patients with diabetes. A scientific assessment of the relationship between exercise and diabetes, made in the past two decades, he has supported only a part of such hopes, but in the overall analysis, regular exercise continues to play an important role in the health of these children and adolescents.
In addition to any specific effect of exercise on diabetes, children with this disease deserve to enjoy, like young non-diabetics, the same social and health benefits of regular physical activity. Still, fear of the metabolic changes during exercise which could precipitate a hypo-or hyperglycemia causes many children with diabetes avoid physical activity. Physicians have the opportunity to contribute to the welfare of these patients by helping them to adapt their treatment so as to allow safe participation in sports events.
Poor Metabolic Control
When the diabetic child performs exercises under conditions of poor metabolic control with insulin deficiency and hyperglycemia, the metabolic response to exercise and the risks are completely different (Horton, 1988) (Table 1). Low insulin levels allow further breakdown of liver glycogen to glucose and fatty acid mobilization, but peripheral consumption of glucose by the muscle is impaired. Worsens hyperglycemia and ketoacidosis occurs: that is, exercise can raise the poor metabolic control. Now, the line input is working fine, but the energy substrate can not enter the muscle cell exercise. In this state, intense exercise is contraindicated, and when blood glucose levels exceed 250 to 300 mg / dl, diabetic control needs to be improved with additional insulin before sports participation. Therefore, the diabetic patient, needs to be aware of their metabolic control before intense physical activity