EXERCISE THERAPY IN CHILDREN WITH INSULIN-DEPENDENT DIABETES MELLITUS

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Exercise therapy has been difficult to be introduced in children with insulin-dependent diabetes mellitus (IDDM), because the insulin injected subcutaneously produced unphsiologic metabolic mellieu in those patients, so that they are suffered from hypoglycemia during or after exercise. These difficulties were investigated in terms of cardio-respiratory fitness, metabolic stability, and renal hemodynamics. We found they were well tolerated during acute load by a treadmill running, although diabetic girls tended to show less maximal oxygen consumption and children with IDDM were revealed to have low activation of rennin-aldosteron system. Since they did not show significant metabolic disturbance during excercise, and showed liner corelationship between oxygen consumption and heart rate, a portable heart rate monitor was applied to them during various sport activity. Supplemental foods according to expected energy consumption were calculated on every 30 minutes basis.The contraindication to a sport activity has been difficult in the evaluation. The morning hyperglycemia and ketonuria have been criterion to inhibit to sports. Our results revealed, however, clearly that hyperglycemia itself showed good correlation to night-time hypoinsulinemia in the liver suggested by serum levels of insulin-like-growth factor binding-protein (IGFBP-1). The mild ketonuria were accounted for the same mechanisms. So that they were well adjusted by a ordinal breakfast and insulin injection, unless they showed other significant symptoms of illness. The long-term effects of accustomed exercise have been evalutated in progress in terms of cardio-respiratory fitness and glycemic controls. The chronic complication such as a diabetic nephropathy cannot yet be assessed, although mild malfunction of renin-aldosteron system may be evaluated along with a accustomed sports.