The Dos and Don’ts of Exercising with Diabetes

By K. Aleisha Fetters |

Follow these five rules to improve your blood sugar control without risk of injury.

woman ready to exercise

Exercise is one of the best things you can do for your health—especially if you have diabetes.

That’s because exercise naturally improves your body’s blood sugar control and insulin sensitivity while also reducing the risk of cardiovascular complications that can come with a diabetes diagnosis, according to the American Diabetes Association.

“When we exercise, our muscles use glycogen, which are carbohydrates stored in the liver and muscles,” explains Craig Primack, M.D., an obesity medicine specialist at Scottsdale Weight Loss Center. “Emptying these glycogen stores leaves space for newly consumed carbohydrates to go, naturally lowering blood sugar levels.”

To facilitate this process, control blood sugar levels, and make your body more sensitive to insulin (the hormone that allows cells in your body to use blood sugar for energy), experts recommend daily exercise. But if that’s not possible, try to avoid letting more than 48 hours elapse between sweat sessions, Dr. Primack says.

A good rule of thumb: “Do something most days of the week,” he says. “On lower-intensity days, aim for one hour of activity. On high-intensity days, 30 minutes.”

This is similar to the weekly exercise recommendation from the Centers for Disease Control and Prevention: at least 150 minutes of moderate-intensity aerobic exercise per week, 75 minutes of high-intensity aerobic exercise per week, or an equivalence combination of moderate- and high-intensity activity.

However, when you have diabetes, exactly how you approach your exercise time matters. Here, experts share the dos and don’ts of working out with diabetes.

Do: Talk to Your Doctor Before You Start a New Routine

Whether you’re newly diagnosed with diabetes or have had it for a while, it’s important to talk with your primary care physician, endocrinologist, or cardiologist about any unique considerations you need to make when exercising.

“If you have heart disease or long-standing diabetes, talk to your doctor about undergoing a cardiac stress test,” Dr. Primack says. “It measures the ability of your heart to withstand the stress of exercise, or your risk of suffering a cardiac event during exercise.”

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Don’t: Perform High-Impact Exercise

High-impact exercises, like running and jumping, are contraindicated in people with diabetes, especially those who might have peripheral neuropathy, says Margaret Eckert-Norton, Ph.D., R.N., a certified diabetes educator and an associate professor of nursing at St. Joseph’s College in New York City.

A side effect of diabetes, peripheral neuropathy is characterized by nerve damage and poor blood flow to the extremities. It can cause loss of feeling, increased risk of injury to the arms or legs, and a reduction in the body’s natural wound-healing processes.

According to a 2017 Diabetes Care review, half of people with type 2 diabetes develop peripheral neuropathy within 10 years of their diagnosis. In these people, performing high-impact exercises such as running and jumping increases risk of injury to already vulnerable tissues of the feet, Eckert-Norton says.

These low-impact workouts may be good options. Plus, don’t be afraid to modify activities or ask your instructor to reduce the impact.

Whatever exercise you choose, it’s important to examine your feet after each workout and care for any cuts or blisters immediately, Dr. Primack says. Wear shoes that fit well and are made for the kind of activity you do. This guide to finding your perfect pair can help.

Finally, call your doctor if a cut, sore, blister, or bruise on your feet or toes doesn’t improve after two days.

Do: Pay Attention to Your Blood Sugar—and Pack a Snack

It’s important to maintain stable blood sugar levels during your workout.

“Exercise naturally lowers blood sugar, while medications including insulin and sulfonylureas can worsen hypoglycemia [very low blood sugar] during exercise,” says Dr. Primack, who recommends testing and tracking your blood sugar before, during, and after exercise.

As a general guideline, aim to start your workouts with blood sugar levels between 90 and 250 mg/dL, he says. If levels are lower than 90, he suggests consuming 15 to 30 grams of simple carbohydrates before you start exercising. One slice of bread, a piece of fresh fruit, or six to 12 saltine crackers are all good options.

If you experience symptoms of low blood sugar during your workout, such as anxiety, weakness, and dizziness, test your blood sugar, and consume a small amount of carbohydrates if needed, Eckert-Norton recommends. But try not to overcompensate and spike your blood sugar too high.

“Look for patterns,” Dr. Primack says. “Question why your blood sugar went so low and how you can prevent the dip in the future. Maybe you need a little less insulin prior to your workouts.”

As always, talk to your doctor if you notice any patterns that can’t easily be explained, and follow any specific guidelines your doctor has recommended.

Don’t: Avoid High-Intensity Strength Training

Sticking to low-impact exercise doesn’t mean forgoing intensity. In one study of people with metabolic syndrome—a cluster of conditions including diabetes, high blood pressure, excess abdominal fat, and poor cholesterol or triglyceride levels—high-intensity resistance training was significantly better at reducing abdominal fat and improving cardiovascular health measures compared to moderate-intensity training.

Meanwhile, 2017 research published in Nutrition and Metabolism shows that strength training directly combats many of the metabolic changes that occur in muscles with type 2 diabetes.

Dr. Primack recommends engaging in strength training at least two days per week. Try this 30-minute total-body strength circuit, or if you prefer quicker sessions, this 10-minute strong-and-stable core workout is hard to beat.

To gauge intensity, use your rate of perceived exertion (RPE). On a scale from 1 to 10, with 10 being the hardest you can imagine working, aim to perform high-intensity resistance training at a 7 or 8. But remember: Before engaging in high-intensity exercise (cardiovascular or strength training), it’s important to talk to your doctor to make sure it’s safe for you.

Do: Prioritize Movement After Meals

While any exercise is better than no exercise, you may get bonus benefits when exercising after meals.

A 2016 study published in Diabetologia shows that in people with type 2 diabetes, walking for 10 minutes after breakfast, lunch, and dinner is better at regulating blood sugar levels than walking for 30 minutes all at once. This is likely because it helps your body more effectively use any excess blood glucose from carbohydrates, Eckert-Norton says.

You don’t have to schedule a full workout after each meal, but a quick walk around the block is better than collapsing on the couch. Download this free 10-minute walking audio guide to get inspired, or make it a social activity by inviting a loved one to walk with you.

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