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New Guidelines Aim to Help People With Diabetes Exercise Safely

diabetic woman getting ready for a run

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Key Takeaways

  • Although regular exercise can help with diabetes management, those with the condition have to be careful with activity since it can change blood sugar levels.
  • New guidance from the American Diabetes Association and other organizations provides insight on how exercise affects diabetes.
  • Those with diabetes should understand factors like time of day and exercise intensity in order to best manage their condition.

One of the most common pieces of advice for people with diabetes is to exercise since it can help lower blood sugar levels and also lose weight. But since diabetes medications already keep blood sugar low, the wrong amount of exercise can put someone with diabetes at risk for hypoglycemia, when the body begins running out of glucose for energy.

This concern has led to the development of a new landmark agreement among international experts, providing guidance on how diabetics can use glucose monitoring devices to exercise safely.

Geared toward those with type 1 diabetes, but relevant for those with type 2 as well, the guidance outlines areas like:

  • Carbohydrate consumption
  • Safe glucose thresholds 
  • Use of monitoring devices

Guideline Basics

The new advice suggests using continuous glucose monitoring during exercise, but researchers note that due to the complexity of these systems, both individuals with diabetes and their healthcare professionals may struggle with their interpretation of information. That's one of the main reasons the statement was developed.

It provides clear guidance on levels both during and after exercise. For example, the agreement notes:

  • Target sensor glucose ranges should be between 7.0 mmol/l and 10.0 mmol/l and slightly higher for those with an increased risk of hypoglycemia.
  • If sensor glucose levels are elevated, individuals should monitor blood ketone levels, and insulin correction may be performed.
  • Exercise should be suspended if sensor glucose level reaches <3.9 mmol/l and, if below 3.0 mmol/l, exercise should not be restarted.

Tracking Should Continue Beyond Exercise

In addition to blood sugar management, there are plenty of other benefits to exercise that may have a tangential connection to diabetes but improve wellness overall, potentially easing diabetes symptoms—effects like better sleep, improved immune response, more energy, less sugar cravings, and lower stress.

But as the recent guidelines note, there needs to be ample awareness and monitoring around any type of activity.

Joshua Scott, MD

Both types of diabetes, Type 1 and Type 2, benefit from exercise, especially if weight is an issue, but they have to be careful in terms of when and how that exercise happens.

— Joshua Scott, MD

"Both types of diabetes, Type 1 and Type 2, benefit from exercise, especially if weight is an issue, but they have to be careful in terms of when and how that exercise happens," says Joshua Scott, M.D., primary care sports medicine physician at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. "That's especially true when you put medication into the equation."

Not only can exercise lower blood sugar in the moment, but it can also continue to tamp down glucose for up to 24 hours after exercise.

"Hypoglycemia can possibly be late onset, so they might be fine while exercising, but then hours later, they have a crash," says Scott. "That means they could bottom out by doing this thing that's supposed to be so good for them."

Fuel Yourself Before and After

In addition to using a device to monitor glucose levels during and after exercise, a significant part of diabetes control is understanding pre-workout and post-workout nutrition options as well.

"A pre-workout snack or meal containing carbs is much more likely to provide the quick energy your body needs to have an effective workout than a supplement," says dietician McKenzie Caldwell, R.D.N., who has diabetes nutrition as one of her specialties. "Depending on intensity, length, and timing of your workout, as well as medication or insulin, how you eat to fuel a workout may differ slightly from your overall eating pattern to manage diabetes."

McKenzie Caldwell, RDN

Depending on intensity, length, and timing of your workout, as well as medication or insulin, how you eat to fuel a workout may differ slightly from your overall eating pattern to manage diabetes.

— McKenzie Caldwell, RDN

Protein, fiber, and fat that keep blood glucose from spiking after a balanced meal with carbs may work for those who aren't on insulin or who are doing a low-intensity workout, she notes. But this may need to be tweaked. For example, someone who is on medication and up for a HIIT workout may need to eat more simple carbs before exercise to keep blood sugar from getting too low.

In terms of post-workout options, Caldwell recommends the "rule of 15," which means 15 grams of carbs within 15 minutes after you end an exercise session. Combine it with protein, she adds, and you'll get muscle-building benefits as well.

What This Means for You

Exercise has numerous health benefits regardless of whether or not you're a diabetic, but as with adopting any new habit that could affect your health, be sure to check with your primary care doctor or endocrinologist to get guidance based on your specific situation.

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