Safety Guidelines & Precautions
Essential information for safe exercise with diabetes
Avoid exercise during peak insulin action
Always start with a light warm-up and cool down at end
Avoid exercising in extreme cold or hot temperature
Always use proper footwear for exercising and check feet daily
Important to Remember:
These precautions are essential for all aerobic exercises including walking, running, cycling, and swimming. Follow them consistently for safe exercise practice.
Timing Your Meals
Try eating 1-1½ hours before exercising
Emergency Supplies
Carry juice, glucose tablets, or hard candy with you during exercise
Stay Hydrated
Drink plenty of water before, during, and after exercise
Treatment Steps:
Take 15-20 grams of fast-acting carbohydrates:
- Glucose tablets or hard candy
- 4 oz (½ cup) of juice
- 3 tablespoons of raisins (about ½ cup)
- 1 tablespoon of honey or jelly
Re-check blood glucose after 15 minutes
If still below 70 mg/dL, repeat treatment
Once blood glucose is normal, eat a small snack
This helps prevent another drop in blood sugar
Important:
Blood glucose can drop more than one hour after exercising. Monitor your levels carefully after workouts, especially if exercising before bedtime.
Fasting Blood Glucose
For people with diabetes, fasting blood glucose should be:
Below 126 mg/dL (6.99 mmol/L)
This measurement is taken after at least 8 hours of fasting
Over 250 mg/dL + alcohol smelling breath (ketones)
DO NOT EXERCISE - Exercise should be postponed
Over 250 mg/dL + NO alcohol smelling breath (no ketones)
DO NOT EXERCISE - Do not exercise before eating and normalizing levels
Type 2: Over 400 mg/dL
DO NOT EXERCISE - Blood glucose too high for Type 2 diabetes
Type 1: 300 mg/dL or more
Wait 5-10 minutes and re-test. If not coming down, DO NOT EXERCISE
Under 100 mg/dL
Eat a snack (20-30 grams medium glycemic index carbohydrate)
Under 70 mg/dL
Postpone exercise, eat and continue monitoring. Consult physician.
100-240 mg/dL
SAFE RANGE - Proceed with exercise
Reference: American College of Sports Medicine's Resource Manual for Guidelines for Exercise Testing and Prescription, 6th edition. Philadelphia: Lippincott, Williams & Wilkins; 2010. p.611
Common Symptoms Before, During or After Exercise:
Diabetic Patients May Experience:
- Excessive changes in blood pressure during exercise
- Rapid drop in blood pressure after exercise (orthostatic hypotension) - may cause dizziness
- Bursting of blood vessels in the eyes (retinal hemorrhage)
- Alcoholic breath smell (ketosis)
- Very low blood glucose with insulin users (may experience dizziness, confusion, blurred vision, head ache, weakness)
- Foot ulcers in those with nerve ending damage (diabetic neuropathy)
Do NOT inject insulin into the exercising limbs!
If blood glucose is under 100 mg/dL (5.55 mmol/L) before or after exercise
It is recommended you consume 20-30 g of carbohydrates 30 minutes before or immediately after exercising.
If blood glucose drops below 70mg/dL (3.89 mmol/L)
Consult your physician before continuing your exercise program.
Peripheral Neuropathy
If you experience loss of protective sensation in feet, do not engage in high impact activities such as running, walking or jumping. Go for low impact activities such as swimming, cycling, reclined cycling, rowing, chair exercises or the elliptical trainer.
Moderate to Severe Non-Proliferative or Proliferative Diabetic Neuropathy
Avoid activities or exercises that elevate blood pressure such as power lifting, heavy lifting, or heavy contact sports. Also avoid holding your breath when exercising or lifting weights. Good options are swimming, walking, low-impact aerobics.
Do NOT exercise if you experience any of the following:
- Exercise not recommended during peak insulin action
- Exercise before going to bed may not be appropriate - glucose levels can suddenly drop more than one hour after exercising. If exercise can only be done at night, eat extra carbohydrates.
- Dizziness or lightheadedness
- Disorientation
- Blurred vision
- Feel chest pain (consult your physician)
- Experience nausea
- Unusual muscular weakness
- Unusual or extreme fatigue
- If you develop a fever
- If you notice a foot infection (regularly check your feet or have them checked)
Important Reminder
Always consult with your healthcare provider before starting any new exercise program. These guidelines are general recommendations and should be personalized based on your specific medical condition and needs.
Guidelines adapted from AHA/ACSM recommendations and diabetes exercise therapy research