EXERCISE THERAPY IN CHILDREN WITH INSULIN-DEPENDENT DIABETES MELLITUS

胰岛素依赖型糖尿病（insulin-dependent diabetes mellitus，IDDM）儿童运动治疗困难，因为皮下注射胰岛素会产生非生理代谢紊乱，使其在运动中或运动后发生低血糖。这些困难进行了研究，在心肺功能，代谢稳定性，肾血流动力学。我们发现，他们在急性负荷的跑步机运行，虽然糖尿病女孩往往表现出较低的最大耗氧量和儿童与胰岛素依赖型糖尿病被发现有低激活的肾素-醛固酮系统的耐受性良好。由于他们在运动过程中没有明显的代谢紊乱，并且耗氧量与心率呈线性相关，因此在各种运动活动中应用便携式心率监测仪。根据预期的能量消耗，每30分钟计算一次补充食物。晨起高血糖和酮尿已成为运动抑制的指标。然而，我们的研究结果清楚地表明，高血糖本身表现出良好的相关性，夜间低胰岛素血症的肝脏胰岛素样生长因子结合蛋白（IGFBP-1）的血清水平的建议。轻度的丙酮尿症也有相同的发病机制。因此，他们通过正常的早餐和胰岛素注射得到了很好的调整，除非他们表现出其他明显的疾病症状。习惯性运动的长期影响已经在心肺适应性和血糖控制方面进行了评估。慢性并发症如糖尿病肾病尚不能评估，但可通过沿着习惯性运动评估肾素-醛固酮系统的轻度功能障碍。

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.