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Exercising with Diabetes

Everyone, including most people with diabetes, can benefit from exercise. Exercise can help control blood sugars, particularly in Type 2 diabetics, but it can also worsen your sugar levels if you are not in good control. It’s important that you speak to your doctor before beginning any exercise program.

Exercise allows muscles to use more insulin, which can help control blood sugar, but also can increase the risk of hypoglycemia (low blood sugar). Hypoglycemia can occur during exercise and even up to 24 hours after exercise. It is very important that diabetics at risk know the signs of hypoglycemia, which commonly include dizziness, nausea, headache, and problems with concentration. If an athlete develops any symptoms of hypoglycemia, activity should be stopped immediately and food or drink containing sugar should be consumed. Ideally, the blood sugar level should be checked. An athlete should not return to the activity immediately after a hypoglycemic episode even if blood sugars normalize, but should seek the advice of a physician prior to returning to the activity.

Otherwise healthy athletes with well-controlled Type 2 diabetes (not on insulin), can generally exercise without restriction once they’ve consulted with a doctor. These athletes are generally at low risk for hypoglycemia; however, they are at an increased risk of heart and kidney disease. While most medications used in the treatment of Type 2 diabetes are safe for those who exercise, some can have serious side effects, especially dehydration occurring. Therefore, it is particularly important for diabetic athletes to maintain proper hydration, and also to discuss with their doctors the potential side effects of their specific medication.

Type 1 diabetics, and those with Type 2 who require insulin, need to closely monitor their blood sugars during exercise. It is important to have a carbohydrate rich meal 2-3 hours prior to any prolonged (>30 minutes) exercise. Many doctors and nutritionists advocate that this meal should ideally consist of low glycemic index foods, which are absorbed more slowly.

In most cases, pre-exercise insulin doses need to be decreased, sometimes as much as 70-80% (this depends on several factors including planned duration of exercise, conditions, and time until exercise). For every hour of exercise, approximately 40-70g of carbohydrates should be ingested. This will vary with the conditions and intensity of training. If possible, blood sugars should be measured during activity; this is especially critical if the activity is a new one. It is imperative that diabetic athletes wear a medic alert bracelet and carry sugar, or glucose, in a form that can be rapidly absorbed (for instance, gels or hard candies). For longer activities, diabetics should consider having an exercise partner, or at a minimum notifying others of the planned activity and route.

Athletes with diabetes can exercise and compete at a high level. To ensure safe participation please consult a physician who has experience treating diabetes in athletes. Sport Medicine physicians in your area can be found at www.AMSSM.org.

Matthew Gammons, MD
Killington Medical Clinic
Killington, VT 05751