Here's how to exercise safely and avoid low blood sugar.
Ready to get your exercise on? Good for you! Moving more is one of the best things you can do for your diabetes. (Learn about the benefits of exercise for diabetes here.) Physical activity not only helps you lose weight and get fit, but it also helps lower your A1C (a measure of blood sugar control) and can improve your stress levels, sleep, and overall health. That said, having diabetes means you need to take certain precautions to avoid low blood sugar and other complications. Here’s what experts recommend to stay safe while exercising with diabetes.
1. Check with your doc. If it’s been a while since you’ve worked out, it’s a good idea to go in for a checkup. Your doctor will examine you and evaluate which, if any, tests you might need before you get the OK to exercise. They’ll check for any complications—related to your heart/ blood vessels, eyes, kidneys, feet, or nervous system, for instance—that may arise from certain types of exercise. Anyone over the age of 50 should have an electrocardiogram at minimum, says Minisha Sood, MD, an endocrinologist in New York City. If you get winded easily or have any chest pain, your doctor may also recommend you get a stress test. These tests are important because they’ll determine if, when, and at what intensity it’s safe for you to exercise. Diabetes is an important risk factor for heart disease, you’ll want to make sure your ticker is in tip-top shape before you tax it with cardio workouts.
2. Monitor your blood sugar. To prevent hypoglycemia, you should check your blood sugar before, during, and after exercise, every time you go—especially if you’re just starting or increasing the intensity of your workouts. “The danger is that, with exercise, as the cells take up the blood sugar from the bloodstream it can cause hypoglycemia or low blood sugar,” says Joan Pagano, an exercise physiologist in New York City. If your blood glucose exceeds 240 mg/dL, you should check your urine for ketones. If ketones are present, don’t exercise—doing so may actually cause your blood sugar go higher.
3. Stash snacks in your gym bag. To prevent hypoglycemia, it’s wise to keep diabetes-friendly snacks in your exercise bag to boost your blood sugar if needed. “If you feel shaky or confused at any time, you should stop the exercise and have a snack of crackers, fruit juice, or candy,” says Pagano.
4. Stay hydrated. “If you’re dehydrated your sugars are going to get very concentrated, so be [sure you’re drinking water] throughout your exercise routine,” says Sandra Arévalo, RDN, CDE, a spokesperson for the American Association of Diabetes Educators. Aim to drink about 2 cups of water two hours before working out, and about ½ to 1 cup every 20 minutes during.
5. Check and care for your feet. People with diabetes are more susceptible to foot problems because of poor blood flow and nerve damage. Make sure to wear comfortable, supportive shoes, and check your feet for cuts or injuries after you work out, says Pagano.“These can be very difficult to heal when there’s not a lot of circulation going to that part of the body,” she says.
6. Don’t forget strength training. You might be focused on cardio to lose weight if you have diabetes, but resistance training (using weights, machines, or your own body weight) two to three days a week is key. “When you resistance train you increase your lean muscle mass, which improves your insulin levels overtime, and that benefit lasts beyond your time with the weights,” says Dr. Sood. (Here’s more on the difference between strength and cardio for weight loss.)
Just get started. In general, experts recommend about 150 minutes of exercise per week (30 minutes a day, five days a week), but don’t be intimidated by that number. It’s OK to start small and work your way up. “If a patient can’t do [150 minutes per week], then I may ask them to get a Fitbit or a Fitbit equivalent and aim for 10,000 steps a day. Even modest exercise is good for your cardiometabolic health,” says Sonal Chaudhry, MD, an endocrinologist at NYU Langone Health.
Sandra Arevalo is a spokesperson for the American Association of Diabetes Educators and Academy of Nutrition and Dietetics and director of nutrition services and community outreach at South Bronx Health Center.Joan Pagano
Joan Pagano is an exercise physiologist in New York City.Minisha Sood
Dr. Sood is a board-certified endocrinologist in private practice in New York City and an assistant professor at Hofstra School of Medicine.Sonal Chaudhry
Dr. Chaudhry is an endocrinologist at NYU Langone Health in New York City.
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When people with diabetes
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it's good to think about
a couple of things.
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If you're beginning an exercise program
after you've had a long hiatus from
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exercise and you are diabetic,
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you really need to see your doctor.
If someone with Type 2 diabetes is very
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sedentary, sometimes testing is
advisable before they start exercising.
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There are cases when someone has had
a heart attack after starting to exercise
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when they've been sedentary for years.
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So anyone over the age of 50
should have an EKG at minimum,
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which is an electrocardiogram, and
that can be done in a doctor's office.
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And if they're having any
symptoms of feeling winded or
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they can't walk as far as they used to or
climb stairs like they used to,
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maybe even people who have unusual
chest pain or chest sensations.
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They may want to go a step further and
have stress testing before they start
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an exercise program.
One thing that people with diabetes
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need to know is that it's important to
monitor their blood sugar before, during,
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and after exercise.
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Especially if you're just
starting an exercise program or
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you're changing your program or you're
upping the intensity of your program.
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Because the danger is that with exercise,
as the cells take up the blood
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sugar from the bloodstream, it can
cause hypoglycemia, or low blood sugar.
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If you feel shaky or confused at any time,
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you should stop the excercise and
have a snack of crackers, fruit juice,
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Drink water, keep hydrated.
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If you dehydrate, your sugars
are gonna get very concentrated.
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So be drinking throughout your
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It would be a great idea to check
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your feet after you work out to make
sure that you don't have any injuries,
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you didn't get burned,
you don't have any cuts.
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Because these can be very difficult to
heal when there's not a lot of circulation
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going to that part of the body.
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resistance training requires you
to use your skeletal muscle.
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And by using those muscles
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blood sugar into the muscles,
you're lowering your insulin levels, and
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you're also improving your metabolism.
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Many times when you do aerobic exercise,
you may burn calories in that setting, but
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the calorie burn doesn't continue
after you leave that activity.
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When you resistance train,
you increase your lean muscle mass
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which improves your insulin levels over
time and that benefit lasts even beyond
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your time with the weights.
In general, most patients should just
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move more, they should just be more
physically active most days of the week.
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The official recommendations
are 150 minutes of weekly exercise.
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If a patient can't do that,
then I may ask them to get a Fitbit or
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a Fitbit equivalent and
aim for 10,000 steps a day.
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Even modest exercise is very good for
your cardiometabolic health.
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Electrocardiogram (ECG or EKG). New York, NY: American Heart Association, 2015. (Accessed on January 5, 2018 at http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Electrocardiogram-ECG-or-EKG_UCM_309050_Article.jsp#.Wk5X6lQ-fVo)
Pre-Exercise Evaluation and Assessment. Diabetes in Control, 2013. (Accessed on January 5, 2018 at http://www.diabetesincontrol.com/pre-exercise-evaluation-and-assessment)
High Blood Glucose: What It Means and How to Treat It. Joslin Diabetes Center. (Accessed on January 5, 2018 at http://www.joslin.org/info/high_blood_glucose_what_it_means_and_how_to_treat_it.html)
Diabetes Diet, Eating, & Physical Activity. National Institute of Diabetes and Digestive Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity)
Resistance Training for Exercise and Fitness. American College of Sports Medicine, 2013. (Accessed on January 5, 2018 at https://www.acsm.org/docs/brochures/resistance-training.pdf)