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Overview of Diabetes Mellitus, Type 1

This condition is due to an autoimmune destruction of the insulin-secreting beta cells of the pancreas. This destruction can be rapid, resulting in this condition presenting in childhood or developing slowly with an initial presentation during early adulthood. The condition results in insufficient levels of insulin to transport glucose into cells, which leads to utilization of fats and proteins as sources of energy, causing severe weight loss and fatigue. Excessive metabolism of fats results in a state of ketoacidosis that can become life-threatening. Clients need ongoing assessment of their blood glucose levels to ensure tight control is maintained, with a proper balance of exogenous insulin, food intake, and exercise.1 Those who do not control their insulin levels will have limited endurance and develop severe fatigue from increased ketones in the blood stream. Children with this condition who do not have adequate control of their food intake and insulin levels may restrict their physical activities to prevent episodes of ketoacidosis and other complications. Long-term control of hyperglycemia is assessed by the percentage of glycated hemoglobin known as the A1C test.

Criteria for Tight Diabetes Control

Insulin levels kept between 70 and 130 mg/dL before meals.

Insulin levels at less than 180 mg/dL 2 hours after starting a meal.

A1C level less than7%.

Use of an insulin pump or multiple injections of insulin per day.

Comorbidities to Consider

  • Risk of atherosclerosis, retinopathy, neuropathy, and kidney disease

Client Examination

Keys to Examination of Clients

  • Discuss with these clients how to control their blood glucose levels and how to schedule their insulin dosages during the day with an exercise program.

  • Clients with previous hypoglycemic episodes are at greater risk for having uncontrolled drops in blood glucose levels, which may be exacerbated with exercise activities.2

  • Exercise and exercise testing are contraindicated when a client's blood glucose level is greater than 300 mg/dL.

  • Screen clients for signs of hypertension, blurred vision, and poor balance before starting an exercise program.

Recommended Baseline Testing of Fitness Levels

  • Treadmill or cycle ergometer exercise test or a 6-minute walk or run test can be used to assess aerobic fitness.

  • Assess the strength of large-muscle groups with weight-lifting and fitness equipment.

  • For clients with no previous exercise experience, you will need to address with them their preparedness and self-efficacy for starting and maintaining a regular exercise program.3,4

Exercise Prescription


Type: Aerobic, aquatic, and recreational activities

Intensity: Moderate

Duration: 30–45 minutes

Frequency: Four to five times per week.

Getting Started


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