Exercise is beneficial for most people. But it is especially important for people with diabetes. It does not matter how old you are or how
long you have had diabetes -- it can still help you better control your blood glucose and overall health. What is important is that you pick an exercise that you enjoy.As a rule, people with diabetes are
encouraged to exercise regularly for better blood sugar control and to reduce the risk of cardiovascular complications. There are precautions that you should know and take, however, to insure exercise
results in maximum health benefits without any negative consequences. In general, there are 4 areas of safety to consider with exercise. Exercise precautions are designed to help people with diabetes
avoid problems which can result from unwise exercise choices:
Can occur if a person who is taking blood sugar lowering medication has:
- Eaten too little carbohydrate (fruit, milk, starch) relative to the exercise
- Taken too much medication relative to the exercise
- Combined effect of food + medication imbalances relative to the exercise
Those who do not take diabetes medications do not need to take these precautions. Precautions to take if you take insulin or oral diabetes medication:
- If your blood sugar level is less than 100 mg/dl prior to exercise, take a carbohydrate snack prior to beginning the exercise. A good rule of thumb is to add 15 grams of
carbohydrate (1 Carbohydrate Exchange) to your usual diet for each 30 minutes of moderate exercise, or for each 15 minutes of intense exercise.
- If your blood sugar level is higher than 100 mg/dl before exercise, it is probably not necessary to take the carbohydrate snack before a light exercise session, but you may
need extra carbohydrate 1/2 hour to 2 hours following the exercise. Add 15 - 30 grams of carbohydrate (1 - 2 Carbohydrate Exchanges) to the next meal or snack if your blood
sugar dips below 70 mg/dl within an hour or more following exercise. If you experience hypoglycemia, follow the Carbohydrate Treatment guidelines. Follow up with your
doctor. You may be advised to lower your medication on days you exercise if your blood sugar levels are well-controlled and usually within target range.
- For long duration and/or high intensity exercise sessions, plan extra carbohydrate snacks during the activity. An additional 15 to 30 grams of carbohydrate is suggested
each 30 - 60 minutes of exercise (e.g., soccer game, hiking, biking, skating, etc.)
- Always carry a fast-acting carbohydrate food (juice, hard candy, raisins) or glucose tablets when exercising in the event blood sugar drops too low and hypoglycemia symptoms develop during exercise.
- Wear an ID which identifies you as having diabetes whenever you are exercising alone (or anytime) so that others may help you appropriately in the event something
unexpected happens. (Timi Links above go to: Carbohydrate Exchanges...the 1 page summary Carbohydrate Treatment section for hypoglycemia Hypoglycemia section of acute complications)
Severe Hyperglycemia
(with or without Ketoacidosis) |
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Can occur when:
- Too little insulin is available to counteract the liver's production of sugar which is stimulated by exercise hormones
- Too little insulin is available to assist glucose enter muscle cells quickly during exercise
- Too much fat is utilized for exercise because sugar is unable. Ketones levels rise in the blood.
Precautions to take:
Do not exercise if:
- You take insulin without checking your blood sugar.
- If your blood sugar is above 250 mg/dl, test for ketones in your urine. If ketones are present, do not exercise. Ketones indicate that your insulin supply is too low. Take
insulin as advised by your doctor. Wait for blood sugar to come down and ketones are no longer present before exercising. Be sure to follow the precautions above to avoid
low blood sugar during or following exercise. Do not inject insulin near a muscle that will be getting a "good workout". Increased blood flow into the area will change the
speed of absorption and your insulin peak may come earlier than expected.
- You are sick with a flu, infection or other illness that is worsening blood sugar control.
If your blood sugar is above 250 mg/dl but no ketones are present, choose a light to moderate exercise (walking, light biking) instead of a high intensity one (running, weight lifting, tennis).
If blood sugar does not come down with exercise, call your physician for advice. Drink plenty of water before, during and after exercise to stay well-hydrated.
Foot Problems can occur when:
- Shoes fit poorly
- Socks are not worn or are not absorbent
- Friction or pressure points develop on feet
Precautions to take:
- Inspect feet daily for signs of friction or pressure sores. Speak with your physician, podiatrist or diabetes educator about proper foot care procedures.
- Buy shoes which are well-made for the type of exercise you do and which fit you. Consult a shoe retailer who specializes in exercise foot wear.
- Buy cotton, absorbent socks.
Eye Problems can worsen when:
- Excessive strain or exertion causes blood pressure to rise
- Quick, jarring, jerking movements cause sudden, sharp head motion
Precautions to take If you have retinopathy:
- Avoid isometic and heavy weight lifting exercise.
- Avoid exercise with jarring movements such mountain biking, sky diving, gymnastics, martial arts, boxing, etc.
Kidneys Problems can worsen when:
- Excessive strain or exertion causes blood pressure to rise
- Hydration is poor due to perspiration, heat and poor water intake.
Precautions to take:
- Drink plenty of water before, during and after exercise to stay well-hydrated.
- Avoid heavy weight lifting.
Cardiovascular events are more likely to occur when:
- Cardiovascular disease exists but is undiagnosed and precautions are not followed.
- Cardiovascular disease is diagnosed but precautions are not followed
Precautions to take
- Before beginning a new exercise program, or advancing a previously light exercise program, have a medical evaluation which includes medical history, physical exam,
and, if over 40 years old or if you have had diabetes for 10 years or more, exercise tolerance testing.
- Start exercise training slowly, 3 to 4 times per week have a 15 to 20 minute exercise sessions. Build exercise tolerance and endurance gradually.
- Over 4 to 6 weeks, build up the frequency and length of your exercise periods. While not exactly correct for everyone, a general guideline for an effective exercise program
is 5 to 7 times per week, 30 to 60 minutes of moderate intensity exercise (brisk walking, biking, swimming).
Consult your doctor before starting any exercise program.
If you are over 35 you may need a stress test. Test your blood glucose before and after exercise. Do not exercise if blood glucose is over 240 and there are ketones in your urine.
If blood glucose is over 240 but no ketones are present, you should follow these guidelines:
- Type I: Do not exercise if blood glucose is 300 or more
- Type II: Do not exercise if blood glucose is 400 or more
Plan exercise to prevent low blood sugar reactions
- Exercise 1 - 1 1/2 hours after eating
- Check blood glucose before and after exercise and follow snack guidelines
- Always carry a carbohydrate snack with you (Glucose tablets, juice, etc.)
- Drink plenty of fluids
- Wear shoes and equipment that fits well
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