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Learn more about exercising safely with specific diabetes complications. There are a exeecise simple things Diabrtes can do to help prevent injuries, dehydration, and hypoglycemia when exercising. Don't let fear of an injury stop you from exercising with these quick safety tips!
Your health care provider should support you in your efforts to become more active. Step one: see your doctor. If you found this article helpful in your diabetes journey, please consider supporting the American Diabetes Association ADA.
The ADA is the leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. With your financial support, we can advance our mission to prevent and cure diabetes and to improve the lives of all people affected by diabetes.
Learn more about how you can support the ADA. Breadcrumb Home You Can Manage and Thrive with Diabetes Fitness Get Started Safely. Blood glucose blood sugar and exercise The impact of physical activity on your blood glucose will vary depending on how long you are active and many other factors.
Exercising with diabetes complications Exercise is important, even if you're living with diabetes complications. Injury-free exercise safety tips There are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising.
See your doctor Your health care provider should support you in your efforts to become more active.
: Diabetes and exercise safety| Sports, Exercise, and Diabetes | On this page. If the medication schedule is complex, a pill organizer or written outline may be helpful for remembering to take specific medications at specific times. Otherwise, for physically fit patients, a shorter duration of more vigorous aerobic exercise is recommended. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more. filter your search All Content All Journals Diabetes Spectrum. In general, the best time to exercise is one to three hours after eating, when your blood sugar level is likely to be higher. Metformin-associated lactic acidosis: current perspectives on causes and risk. |
| ACSM Publishes New Recommendations on Type 2 Diabetes and Exercise | Exercise consensus guidelines and position Meal planning Carbohydrates for endurance mention significant aafety as ssafety strategy to reduce wafety risk Testosterone boosting supplements exercise-associated Diabeted during exercise 11 — In general, Carbohydrates for endurance reduce the Cauliflower and egg fried rice of hypoglycemia during Diabetez, pump suspension may not Diahetes as effective as setting a higher exercise target at least 1—2 hours before the onset of exercise By being prepared and knowing how to follow your diabetes management plan, you'll be able to prevent diabetes problems during exercise. Financial Assistance Documents — Minnesota. Some research has found it may help to incorporate short sprints or high-intensity intervals into aerobic workouts to reduce the drop in your blood sugar level. Dale Morrison. Am J Physiol Endocrinol Metab. |
| Key Points | Having a snack with slower-acting carbohydrates after your workout can help prevent a drop in your blood sugar. You should also check inside your shoes before wearing them. Vigorous activity: breathing is slightly uncomfortable, carrying on conversation requires maximal effort. There is a problem with information submitted for this request. If you are at risk of type 2 diabetes , exercise can be part of a healthy lifestyle that can help to reduce this risk. Diabetes, exercise and ketoacidosis People with type 1 diabetes are at risk of developing a build-up of ketones ketoacidosis if they are unwell or have forgotten to take their insulin. |
Diabetes and exercise safety -
Many exercise recommendations for type 1 diabetes were developed initially for people using multiple daily insulin injections or insulin pump therapy. This article highlights recommendations and practical strategies for using AID around exercise in type 1 diabetes.
A recent systematic review and meta-analysis demonstrated that AID systems also moderately improve TIR during exercise and physical activity compared with standard of care 1. With AID technology, advanced algorithms and automation of insulin dosing can remove some of the guesswork around daily glycemic management.
However, exercise and regular physical activity continue to challenge the accuracy of continuous glucose monitoring CGM systems and the ability for AID systems to maintain glucose levels in the target range.
This obstacle is, in part, the result of the variable physiological responses associated with differing types, intensities, and durations of exercise, combined with the individual variance in response to activity.
Conversely, each commercially available AID system has slightly different functionality and features that, in turn, require individualized approaches to prepare for exercise.
This article summarizes the practical uses of AID technology and its safety benefits during and after exercise for youth and adults with type 1 diabetes. During exercise in people without diabetes, insulin secretion drops rapidly to facilitate glucose release from the liver to match the rate of glucose uptake into the working muscles.
However, for individuals with type 1 diabetes who are undertaking exercise, plasma insulin concentration cannot be decreased rapidly at the start of exercise and might even rise in the systemic circulation 5. Indeed, it has been demonstrated that rapid reductions in insulin delivery provided by AID algorithms in response to declining blood glucose levels with exercise do not correspond to equally rapid changes in circulating free insulin levels 6.
This pharmacodynamic limitation of subcutaneous delivery of rapid-acting insulins, characterized by a delayed onset and offset of action 7 , 8 , limits the ability of AID systems to address the rapid changes in insulin requirements associated with exercise.
Faster-acting insulin aspart FiAsp , an ultra-rapid-acting insulin recently approved for use in some AID systems, has a more rapid onset and a shorter duration of insulin action 9 than insulin aspart.
However, this difference is not of a sufficient magnitude to meaningfully affect residual insulin action during exercise. A sufficiently responsive insulin with a rapid onset and short duration of action could address this obstacle to glucose control in people with type 1 diabetes who use AID.
However, no such formulation currently exists. In fact, complete restoration of the physiological responsiveness of insulin action may not be feasible when insulin is administered subcutaneously and not directly into the portal circulation.
Importantly, the currently recommended strategies for using AID systems to minimize hypoglycemia during and after exercise relate to the need to minimize the insulin on board IOB; active insulin in the body during times of heightened insulin sensitivity induced by exercise and associated contraction-mediated glucose uptake.
In situations when IOB cannot be minimized before or after exercise, carbohydrate supplementation is often required to offset the increased glucose usage in peripheral tissues. Commercially available AID systems still require some user interaction and, therefore, are sometimes referred to as hybrid closed-loop systems and not fully automated closed-loop systems.
With AID technology, user-initiated modifications to insulin pump settings may be necessary for exercise. For optimal use, certain AID strategies for exercise involve significant pre-planning e. Planning for exercise cannot only minimize IOB, but, when it includes setting a higher glucose target, may also reduce the need for supplemental carbohydrate intake before exercise, which is important for individuals who may be focused on weight loss, for example.
If exercise is likely to occur 1—3 hours after a meal, a reduction in the mealtime bolus may be compensated by increased insulin delivery by the AID system, still resulting in increased IOB during exercise. Fingerstick blood glucose checks may not be needed before exercise but may be suitable during rapid changes in glucose during exercise because of the potential increase in CGM lag time 29 , Exercise consensus guidelines and position statements commonly mention significant pre-planning as a strategy to reduce the risk of exercise-associated hypoglycemia during exercise 11 — Activities that are shorter in duration i.
People with type 1 diabetes who more commonly experience a rise in glycemia during or after exercise because of counterregulatory hormone responses that overcompensate for glucose utilization e. For these specific cases, the more prudent recommendation is to leave the glucose target on the AID system unchanged, because setting a higher glucose target may lead to significant hyperglycemia.
However, this strategy is dependent on the specific AID system being used and also currently lacks research evidence. Therefore, this recommendation is made with caution.
It may be helpful for diabetes care providers and diabetes educators to provide patients with additional resources and guidance on strategies for setting exercise targets Individuals with type 1 diabetes who are unsure about their typical blood glucose responses to exercise may benefit from additional information about more accurately determining exercise intensity.
Exercise consensus guidelines 12 , 13 demonstrate that aerobic exercise e. However, determining the exact exercise intensity may be difficult for some individuals. In such cases, a useful strategy is to advise patients not to focus on achieving a target heart rate during exercise, but rather to focus on their perception of the intensity i.
For example, it may be helpful to provide patients with a modified Borg scale of perceived exertion 17 — 19 of 0—10 and explain where aerobic and anaerobic activities typically fall on that scale Table 2.
Generally, aerobic activities may fall in the 2—8 range on the modified Borg scale, and anaerobic activities are more likely to fall in the 7—10 range, although there is some flexibility around the exact numbers.
The practical benefit of patients more accurately determining their exercise intensity is that they will recognize situations in which they will need to set a higher glucose target on their AID system e. We encourage people with type 1 diabetes to review their CGM data at the start, during, and after exercise to gain insights into the aforementioned strategy.
Another important tip is to understand that, depending on the AID system being used, the glucose level, and the glucose rate of change, setting a higher exercise target with AID generally alters basal insulin delivery but may or may not stop the AID system from initiating automated bolus delivery Table 3.
Similarities and differences for exercise among the available AID systems are described in more detail in Table 3. Commercial AID systems are often not transparent with regard to their algorithm design, so we present what is known based on limited marketing data.
In contrast, open-source AID systems feature algorithm transparency and are designed for flexibility in user customizations Of importance, the automated bolus correction feature will not resume until the exercise target is ceased.
In addition, insulin delivery is constrained by the increasing calculations of IOB. With the CamAPS FX system, there is a function called Ease-Off that is used to substantially reduce basal insulin delivery and temporarily raise the glucose target.
This system has an additional option to pre-program Ease-Off if users know that exercise will occur at a specific time of day. Updated and modified from refs. Received CE-marked approval in the European Union and United Kingdom and approval in Canada, Australia, and New Zealand.
Received CE-marked approval in the European Union and United Kingdom; only commercially available in Europe. Received U. Food and Drug Administration clearance; only commercially available in the United States. APS, artificial pancreas system. Given that commercially available AID systems use hybrid closed-loop technology i.
However, to date, limited research evidence exists around the optimal dose adjustments that should be applied before and after exercise.
Current guidelines follow similar strategies for both open-loop and AID systems. When such a significant level of pre-planning is not possible e. However, there is a caveat that AID systems may give extra insulin to make up the difference if glucose levels become elevated, so IOB at the onset of exercise may still be higher than desired.
Overall, more specific research is needed in this area to optimize the timing and amount of bolus insulin reductions with AID systems around exercise. For post-exercise adjustments, in general, exercise leads to increased insulin sensitivity for at least 7—11 hours after exercise 22 ; therefore, also applying these bolus reduction strategies with the meal after exercise may be recommended.
However, the increase in insulin sensitivity is dependent on the mode and characteristics of the exercise performed. Specifically, increases in insulin sensitivity after exercise are proportional to the intensity of exercise performed. Recent evidence demonstrates that vigorous resistance exercise that occurs in the evening increases hypoglycemia risk after the evening meal 39 vs.
control , whereas moderate-intensity exercise does not 10 vs. Thus, a reduction in the post-exercise meal bolus may be more strongly recommended for vigorous resistance exercise; however, further evidence is needed to determine optimal insulin dosing adjustments after exercise across a spectrum of exercise modes e.
evening and moderate-intensity vs. high-intensity exercise. Open-source AID systems allow initiation of temporary profiles and override presets that can temporarily reduce the aggressiveness of the carbohydrate-to-insulin ratio, which allows for accurate recording of carbohydrates The Control-IQ, MiniMed G, and Omnipod 5 systems do not allow users to make a direct reduction to mealtime bolus insulin delivery.
Therefore, a more common strategy with these systems is to enter fewer carbohydrates than those actually being consumed to allow the system to recommend a reduced bolus insulin amount.
With the CamAPS FX system, after users enter the carbohydrate amount and see the suggested bolus amount, they are able to tap on the bolus amount and change the dose e.
As discussed above, there is a caveat with AID systems that resulting hyperglycemia may trigger additional automated insulin delivery, which could occur later after the meal. If done before exercise, this could cause increased IOB at the time of exercise. With the Control-IQ system, an option for individuals with type 1 diabetes to reduce their mealtime bolus insulin would be to give a dual-wave bolus and then stop the extended bolus.
In most cases, AID systems manage post-exercise glycemia well overnight However, in some cases, if individuals with type 1 diabetes experience recurrent nocturnal hypoglycemia after exercise, setting an exercise target at bedtime may be a consideration to help increase glucose concentrations.
For example, with the MiniMed G and the Omnipod 5 systems, exercise targets can be set for a user-specified duration at bedtime. With Control IQ, currently there is no similar option i.
With the CamAPS FX system, users can set the Ease-Off feature at bedtime for a duration of time from 0 to 24 hours. Research evidence is still needed to determine the optimal duration and timing of exercise targets overnight.
Although setting exercise targets and reducing basal insulin with open-loop pumps or multiple daily injections well in advance of exercise are effective strategies to reduce hypoglycemia 23 — 25 , they require a significant level of forward planning and not surprisingly have recently been shown to be among the least-used strategies Therefore, additional practical recommendations are needed for situations in which individuals with type 1 diabetes cannot pre-plan in advance of activity.
Eating carbohydrates before the start of exercise is one of the more commonly used strategies to reduce the risk of hypoglycemia The type and amount of carbohydrates consumed before, during, and after exercise should be tailored to the specific activity. AID systems work to increase TIR and thereby lower overall mean glucose concentrations.
Therefore, with an overall lower glucose target day-to-day, there may be an increased risk of hypoglycemia during exercise if no changes are made to prepare for exercise With a lower starting glucose level, it is imperative that some of the previously discussed strategies e.
However, if no adjustments are made to the AID system and the pre-exercise glucose level is below this target range for activity, additional carbohydrate feeding is recommended.
It is important to differentiate hypoglycemia prevention strategies for exercise from hypoglycemia treatment strategies for exercise with AID systems.
Specifically, lower carbohydrate intake is often suggested for hypoglycemia treatment in those who use AID technology. This is because the AID algorithms anticipate hypoglycemia and cut back insulin delivery preemptively.
Increasing your activity level is great for your diabetes and for your overall health, but it should be an enjoyable and safe experience. Here are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising:.
Breadcrumb Home You Can Manage and Thrive with Diabetes Fitness Injury-Free Exercise — 11 Quick Safety Tips. Here are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising: If you have never been active or haven't been active for a while, start slowly.
If you feel unsure about your health, talk to your health care team about which activities are safest for you. Still, many people with diabetes can do the same activities as someone without diabetes.
Warm up for 5 minutes before starting to exercise and cool down for 5 minutes after. Your warm up or cool down should be a lower intensity than the rest of your time exercising.
This helps get your blood flowing and warms up your joints. You may be told to test your blood sugar with a finger stick before, during or after exercise. If you receive insulin through an automated insulin delivery system, talk with your healthcare professional about that.
Ask how to keep your blood sugar in a healthy range for exercise. This is key if you usually don't notice symptoms when your blood sugar is low — a condition called hypoglycemia unawareness. Do not exercise if you've needed help with recovering from serious low blood sugar in the past 24 hours.
Below are some general guidelines for blood sugar levels before exercise. This is a caution zone. Your blood sugar may be too high to exercise safely. Before you work out, test your urine for substances called ketones.
The body makes ketones when it breaks down fat for energy. The presence of ketones suggests that your body doesn't have enough insulin to control your blood sugar.
If you exercise when you have a high level of ketones, you risk a dangerous health problem called ketoacidosis. Ketoacidosis can be life-threatening. It requires urgent treatment. Ketoacidosis can happen to anyone with diabetes, but it is much more common with type 1 diabetes.
Instead of exercising right away if you have ketones, take steps to lower high blood sugar. Then wait to exercise until your ketone test shows an absence of ketones in your urine. During exercise, low blood sugar is sometimes a concern. It's mainly a risk for people with diabetes who take insulin or other medicines linked to low blood sugar levels.
If you're planning a long workout, check your blood sugar every 30 minutes. This is key if you're trying a new activity or increasing the intensity or length of your workout. Checking every half-hour tells you if your blood sugar level is stable, rising or falling.
That way, you can get a sense of whether it's safe to keep exercising. Checking every 30 minutes may be a challenge if you're doing outdoor activities or playing sports.
But you need to take this safety measure until you know how your blood sugar responds to changes in your exercise habits. Eat or drink something with about 15 grams of fast-acting carbohydrate to raise your blood sugar level, such as:.
Check your blood sugar again 15 minutes later. If it's still too low, have another gram carbohydrate serving. Then test again in 15 minutes. If you haven't finished your workout, you can continue once your blood sugar returns to a safe level.
You may need to have more snacks or a meal to raise it to that safe range. Check your blood sugar as soon as you finish exercising.
Check it again throughout the next few hours. Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood. The tougher your workout, the longer it will affect your blood sugar. Low blood sugar can happen even 4 to 8 hours after exercise.
Having a snack with slower-acting carbohydrates after your workout can help prevent a drop in your blood sugar. These types of snacks include a granola bar, trail mix and dried fruit.
If you do have low blood sugar after exercise, eat a small snack that has carbohydrates. For example, you could have fruit, crackers or glucose tablets. Exercise is great for your health in many ways. But if you have diabetes, testing your blood sugar before, after and sometimes during exercise may be just as important.
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