Insulin injection site selection and cognitive factors associated with diabetes mellitus in children

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Science Teaching


Exercise, Children, Diabetes, Insulin injection


Exercise, Children, Diabetes, Insulin injection

Subject Categories

Public Health


The purposes of this dissertation were to: examine the effect of pre-exercise insulin injection site on post-exercise blood glucose (BG) concentration in children with insulin dependent diabetes (IDDM) (physiological component); and, to explore the knowledge and attitudes related to diabetes mellitus (DM) and exercise guidelines of selected children with IDDM, parents of IDDM children, and physical education (PE) teachers (survey component).

In the physiological component, 14 normally active IDDM children (8 male, 6 female) completed 2 treadmill exercise bouts (30 minutes at 65% of V0$\sb2$ peak) using either an arm or leg insulin injection site prior to exercise. Although exercise prompted significant ($p<.05$) BG reductions over time (60 minutes post-exercise), a 2-way ANOVA indicated that BG values were not significantly different ($p=ns$) between injection site trials. However, leg injection resulted in 7 cases of post-exercise hypoglycemia as compared to 2 cases of hypoglycemia with arm injection. It was concluded that similar trends in BG concentration are observed for up to 60 minutes post-exercise whether an arm or leg injection site was used, and that the greater incidence of post-exercise hypoglycemia, occurring between 60 to 120 minutes post-exercise following leg injection (as compared to arm injection), may have been due to a difference in insulin receptor mechanics in exercising muscle.

In the survey component, 25 IDDM children, 28 parents, and 32 PE teachers completed the 20 item Diabetes & Exercise Knowledge and Attitude Test (DEKAT) along with a brief informational survey of their personal background and IDDM history. Responses to the DEKAT indicated that noticeable knowledge deficits of DM and exercise guidelines were present in all three groups, with overall scores on the knowledge items being 36.0% for IDDM children, 26.4% for parents, and 23.1% for PE teachers. A chi square analysis indicated that there was a significant difference between groups on overall score for the knowledge items and that IDDM children and their parents performed better on level-1 knowledge items (basic concepts) than on level-2 and level-3 items, which required the application of basic DM and exercise concepts to a daily DM management regimen. The DEKAT also uncovered several DM and exercise concepts that appeared to be: well understood; poorly understood: or, in need of resolution by future research.


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