Korean J Pediatr 2011;54(2)45:-50 • DOI: 10.3345/kjp.2011.54.2.45 47 antioxidants, and trace elements but are recommended to consume fresh fruits and vegetables in sufficient quantities equivalent to those required by other healthy children. Dietary recommendations for children and adolescents with T1DM are basic healthy eating habits that should be applied to all children and adults9, 13). Therefore, these dietary recommendations can be applied to all members of families with children with T1DM, and if all family members change their dietary habits together, this will improve the effectiveness of nutritional therapy14). Exercise therapy In T1DM treatment, the importance of exercise has long been emphasized. However, children and adolescents with T1DM exhibit quite diverse blood glucose responses to exercise. Blood glucose responses to exercise not only are different among different individuals depending on insulin sensitivity but also appear diversely in each individual, and thus it is important to exercise without inducing hyperglycemia or hypoglycemia15). If nondiabetic individuals exercise, their insulin secretion will decrease, and glucose- counterregulatory hormones will increase to maintain constant blood glucose levels. However, those with T1DM have disorders in glucose-counterregulatory hormone secretion and rely on parentally administered insulin16). Therefore, individuals with T1DM are likely to have low blood glucose levels during or after exercise17). In particular, those who use insulin excessively at ordinary times easily encounter low blood glucose states with low-intensity or short- duration exercise and thus tend to avoid exercise altogether. In fact, any form of exercise continued for longer than 30 minutes can induce low blood glucose levels and thus requires appropriate insulin control and food supply18). Therefore, when exercising, the duration and intensity of exercise and blood glucose levels before exercise should be considered. However, competitive exercise may increase blood glucose due to the action of psychological stress, and anaerobic exercise may increase blood glucose levels due to adrenal responses15). Excessive carbohydrate consumption during exercise frequently increases blood glucose levels. If exercise is performed in hypoinsulinemic states, hyperglycemia or ketosis might be induced after exercise. However, if the timing of exercise, amount of insulin, and preexercise food consumption are maintained within certain limits, intermittent aerobic exercise for 30–60 minutes will not drastically alter blood glucose levels. In particular, exercise performed after meals can help to minimize postprandial glycemic excursions. Although some studies reported that lower HbA1c levels were maintained when the frequency of regular physical activity was higher19, 20), some studies could not prove a direct relationship between exercise and HbA1c levels21, 22). Although a few studies did not produce evidence of the assumption that continued aerobic exercise would prevent chronic complications of diabetes23), many studies revealed the possibility that aerobic exercise could prevent cardiovascular or other chronic complications24-26). We know that exercise is beneficial to everyone in not only controlling body weight and remarkably reducing cardiovascular risks but also in increasing vitality in daily life, and thus regular exercise is essential to improving health. Therefore, it is believed that opportunities for diverse exercise should be provided to children and adolescents with T1DM to prevent them from losing interest in exercising. Diabetes self-management education systems For the successful control of diabetes, diabetes self-management education is essential. For effective implementation of this education, guidelines such as “National Standards for Diabetes Self-management Education”27), “Position Statement on Individualization of Diabetes Self-management Education”28), and “Management of Children with Diabetes in the School Setting”29) are provided. In Korea, national unified education guidelines for children and adolescents with T1DM are not provided at this point. Several hospitals that operate type 1 diabetes care centers are implementing diabetes self- management education programs. Diabetes self-management education programs should include the following components. First, it should define what diabetes is. In particular, the characteristics of type 1 diabetes should be explained and its differences from type 2 diabetes regarding pathogenesis, clinical characteristics, treatment regimens, and nutritional therapy should be explained. The patients should be taught practical skills such as how to perform insulin injection, glucagon injection, blood glucose testing, and urine ketone testing, and the rationale for these practices should be known and explained. The patients should receive nutritional education through nutritionists. The importance of exercise in the treatment of type 1 diabetes and measures to respond to changes in blood glucose levels during exercise should be explained. The patients should be educated on hypoglycemia and hyperglycemia and appropriate measures to respond to the occurrence of either must be explained. Methods to set targeted blood glucose levels and achieve treatment goals should be explained. Methods to control blood glucose levels on special days such as days when they are sick or travelling should be taught. Important matters in relation to diabetes control in school should be sufficiently explained, and homeroom teachers, school nurses, and school exercise trainers should be provided with opportunities for education on important matters when they care for children with T1DM. Through gatherings of