Self-monitoring adherence to physical activity in children and adolescents with type 1 diabetes.

Monitoring blood glucose is essential for good diabetes control and even more important when participating in sports. Many variables can have an effect on blood sugar response to aerobic or anaerobic activities. A moderate exercise produces an average fall in plasma glucose of approximately 40% of baseline values. The majority of hypoglycaemia episodes occurs in children with pre-exercise plasma glucose concentrations < 120 mg/dl, therefore it is advisable to achieve a blood glucose level of at least 120 mg/dl if not higher before starting an exercise in order to prevent hypoglycaemia episodes. Since 15 g of oral glucose result in only about a 20-mg/dl rise in glucose concentrations, 30-45 g of oral glucose may be more appropriate to treat hypoglycaemia during exercise. A sufficient adherence to the physical activity prescribed by the health care professionals it easy to find in the children with Type 1 diabetes. According our experience, 60 per cent of the children report to spend on average 1 hour daily for exercise, proving so to consider physical activity beneficial in the treatment of diabetes mellitus. Glycate haemoglobin levels in these motivated patients were better than in children exercising sporadically and shortly either at school or in the spare time. Although the health care professionals effort, only half of the patients referred to monitor blood glucose levels before, after or before and after the exercise. Only one third of the patients reported to regularly adjust insulin dosage to own response to physical activity. Two third of the patients referred to consume added carbohydrate to avoid hypoglycaemia.

Outside-hospital assistance for children and adolescents with type 1 diabetes mellitus.

Telephone care, Telemedicine, Home care and Diabetic Camps are the most useful ways for Paediatricians to transfer diabetic care outside the hospital. These provide children with diabetes and their parents with an effective and practical tool to solve directly arising therapeutic problems and improve their quality of care and life. The advantages for the National Health Care System could be macroscopic: according to some studies, the Telephone care service allows to save 85% of the hospitalisation costs for children with acute metabolic intercurrent illnesses-related derangements. Telemedicine service, based on telephone line relying on the Internet technology, is a complementary tool to follow children and adolescents with diabetes in out-patient clinic. The rare experiences in this field report a reduction in insulin doses and an improvement of metabolic control and quality of life. The Home care service has to be performed by a nurse and has to be useful for patients and parents to organize the management of diabetes at home and to improve therapeutic adherence. Diabetic camps give the opportunity to children and adolescents with diabetes to verify, outside the family and under health professionals' supervision, their ability to manage the disease, and to increase own self-esteem.

Breakfast habits of 1,202 northern Italian children admitted to a summer sport school. Breakfast skipping is associated with overweight and obesity.

Very little is known about the differences in breakfast of children performing physical activity in the morning. This paper analyzed the breakfast habits of 747 boys and 455 girls, distributed in 2 homogeneous age groups, 6-10 and 11-14 year-old, participating in a Summer Sport School. Children were asked whether, when, where, how and with whom they consumed breakfast; who prepared meals; what they ate and drank; what they did during breakfast. Weight, height and BMI were recorded. Seventy-eight percent of children usually had breakfast, but 22% reported skipping breakfast. In the non-breakfast consumer subjects, 27.5% were overweight and 9.6% obese vs 9.1 and 4.5% respectively in breakfast eaters. Bakery products (76%) and milk (71%) were the most frequently consumed foods. Only 15% of parents encouraged their children to consume additional foods at breakfast before exercising, and 42% of children believed that this extra nutrition was unnecessary. In 80% of cases, the chief decision-maker for breakfast was the mother, the father played little part (1%). During breakfast, 48% of children ate and drank in silence, 26% played with brothers and sisters, 18% watched television and only 8% talked with parents. A high prevalence of over-weight and obesity was found among non-breakfast consumer children. Breakfast omission in children exercising conflicts with their increased energy requirements and may be connected to the trend of parents and children to under-estimate the importance of breakfast for nutritional balance and for environment promotion of physical performance.