Exercise is an important part of managing diabetes. It can help improve blood sugar control, reduce cardiovascular risk factors, promote weight loss, and improve overall fitness. However, certain precautions need to be taken when exercising with diabetes to avoid potentially dangerous blood sugar fluctuations or injuries. Knowing what types of exercise to avoid can help keep your diabetes management on track.
Why exercise caution with certain exercises?
There are a few key reasons why care should be taken with exercise selection for people with diabetes:
- Blood sugar fluctuations – High impact activities can rapidly lower blood sugar. Resistance training can raise blood sugar. These fluctuations can lead to hyperglycemia or hypoglycemia if medication and diet are not balanced correctly around exercise.
- Injury risk – Those with longstanding diabetes are at increased risk for complications like retinopathy or neuropathy that may increase injury risk with certain exercises.
- Cardiovascular risk factors – Exercises like heavy weightlifting can spike blood pressure. Those with heart disease risk may need to avoid such exercises.
- Foot care – Those with foot neuropathy or poor circulation need to avoid excess impact to feet.
Consulting with your physician and diabetes care team can help identify if any specific exercise precautions are needed for your individual health status. Monitoring blood sugar before, during, and after exercise is also advised to understand your body’s response.
Exercises to Avoid with Diabetic Retinopathy
Diabetic retinopathy is a common complication of diabetes affecting the eyes. It damages the small blood vessels in the retina causing them to swell and leak fluid or blood. Retinopathy can progress to blindness if left unchecked.
Those with moderate to severe retinopathy may need to take precautions with exercises that significantly increase eye pressure or pose risk for eye trauma:
- Heavy lifting like squats or deadlifts
- Straining abdominal exercises like sit ups
- Yoga poses like inversions that increase eye pressure
- Jouncing exercises like jogging or aerobics
- Contact sports with risk for eye injury
Always consult your ophthalmologist about safe exercise with diabetic retinopathy. Lower impact cardio or walking are generally safe alternatives to maintain fitness.
Exercise Cautions for Peripheral Neuropathy
Peripheral neuropathy is nerve damage that commonly affects the feet and legs of people with diabetes. It can cause pain, numbness, tingling, and loss of sensation in the extremities. Those with neuropathy need to take precautions with exercises that place heavy demands on the feet and legs:
- Running or jumping activities like basketball that impact the feet
- Agility exercises like plyometrics with rapid stopping/starting
- Heavy weight-bearing exercises like squats
- Balance poses like tree pose in yoga
Low impact exercises like cycling on a stationary bike or swimming are safer alternatives. Properly fitted footwear and padded mats can also help reduce injury risk. Those with significant neuropathy should consult a podiatrist.
Avoiding Exercise with Foot Ulcers
Those with severe peripheral neuropathy can develop foot ulcers. Ulcers are open sores that form, usually on the bottom of the feet. Any pressure or trauma to ulcerated areas can impede healing. Individuals with current foot ulcers should avoid:
- All weight-bearing exercises like walking, running, aerobics
- Lower body strength training like leg presses
- Any activity without proper padded footwear
- Soaking feet in hot tubs or pools
Upper body ergometer training or seated arm cycling are safer options to maintain activity when foot ulcers are present. Consult your podiatrist about any exercise with active foot ulcers.
Avoiding Exercise with Diabetic Complications
Those with longstanding diabetes can develop a number of different complications that may require exercise modifications including:
- Heart Disease: Avoid exercises that spike blood pressure like heavy weightlifting. Focus on low to moderate intensity and heart rate.
- Kidney Disease: Avoid dehydration and overexertion that can worsen kidney function. Drink fluids and monitor intensity.
- Gastroparesis: Avoid exercises that aggravate nausea like crunches or inversions.
- Orthostatic Hypotension: Avoid rapidly standing from seated/lying positions which can cause dizziness.
Discuss any diabetic complications with your physician and tailor an exercise plan accordingly.
Hypoglycemia Risk with Exercise
Vigorous exercise can rapidly lower blood glucose levels leading to hypoglycemia if insulin dosing or carbohydrate intake is not properly balanced. Some types of exercise that pose higher hypoglycemia risk include:
- High intensity cardio like running over 30 minutes duration
- Sustained activities like singles tennis over 1 hour
- Sports with intermittent sprints like soccer or basketball
- Exercising in heat and humidity which speeds glucose utilization
Checking blood glucose before, during, and after exercise and consuming carbohydrates as needed can help manage hypoglycemia risk. Those on insulin pumps may need temporary basal rate adjustments to reduce insulin delivery during activity.
Hyperglycemia Risk with Exercise
On the flip side, anaerobic exercises that rely heavily on glucose as a fuel source can increase blood sugar levels and risk hyperglycemia if medication is not adjusted properly. Examples include:
- Weight/resistance training
- Short maximal sprints like 100 meter dashes
- Competitive sports with bursts of high intensity like basketball
- Heavy exertion with minimal fitness level
Checking glucose levels before and after exercise and administering short acting insulin if levels are elevated can help counteract this rise in glucose. Those using insulin pumps may need a temporary basal increase during the activity.
Exercise Cautions for Those Using Insulin or Other Diabetes Medications
Those using insulin or certain oral diabetes medications like sulfonylureas have an increased risk of hypoglycemia associated with exercise. Some tips for safer physical activity include:
- Test blood glucose before, during, and after exercise
- Consume 15-30g fast acting carbohydrates if glucose drops below 70 mg/dL
- Reduce prandial insulin for meal preceding exercise
- Decrease basal insulin delivery by 20-50% while exercising for pump users
- Exercise with a partner aware of hypoglycemia symptoms & treatment
- Have fast acting carbohydrates on hand during activity
- Check glucose levels at night to catch any late onset hypoglycemia
Precautions for Those New to Exercise
Those who are sedentary, elderly, or new to exercise routines should take particular care when starting a regimen, especially if complications are present. Some tips include:
- Start with light intensity exercise like walking 5-10 minutes
- Gradually increase duration and intensity over several weeks
- Monitor blood glucose and heart rate closely
- Stay well hydrated and listen to your body
- Exercise with a partner or in supervised program if possible
- Wear medical ID and carry emergency glucose
- Stop if feeling dizzy, weak, nauseous, or having pain
Beginning an exercise program too aggressively can lead to hypoglycemia or injury. Work closely with your healthcare provider when first getting active.
Examples of Safer Exercise Options for Diabetes
While some care needs to be taken with exercise selection, physical activity is a cornerstone of diabetes management. Some examples of safer exercise options include:
- Walking – Low impact with low hypoglycemia risk
- Stationary cycling – Low impact cardio option
- Water aerobics – Reduced joint stress
- Seated exercises – Minimal orthostatic hypotension issues
- Yoga – Can modify to avoid poses that increase eye pressure
- Strength training with lighter weights – Improves insulin sensitivity
- Tai Chi – Good for balance
- Golfing with cart – Lower intensity walking
Aim for at least 150 minutes per week of moderate aerobic activity with some resistance exercises 2-3 times per week for optimal diabetes health. Mix up activities to help keep exercise interesting.
Key Takeaways on Exercising Safely with Diabetes
- Consult your physician about any exercise restrictions needed for your individual health.
- Monitor blood glucose carefully before, during and after exercising.
- Adjust insulin doses and carbohydrate intake to match activity levels.
- Wear proper footwear and avoid high impact activities if you have neuropathy.
- Stay well hydrated and listen to warning signs like dizziness or nausea.
- Progress slowly when trying new exercises or intensities.
- Always have emergency glucose supplies on hand.
- Choose lower impact activities like walking, swimming, or cycling if complications are present.
While some caution is needed, exercise is a key part of the treatment plan. Working with your healthcare team can help make physical activity safe and effective for optimizing diabetes management. Be sure to monitor warning signs and adjust insulin and carbohydrate intake to match your activity routine.
References
American Diabetes Association. (2022). Exercise and Type 1 Diabetes. Diabetes Care, 45(Supplement 1), S135-S139. https://doi.org/10.2337/dc22-S009
Colberg, S. R. (2017). Exercise and Diabetes: A Review of the Evidence. Current diabetes reports, 17(12), 125. https://doi.org/10.1007/s11892-017-0958-5
Joslin Diabetes Center. (2022). Blood Sugar and Exercise. https://www.joslin.org/info/blood-sugar-and-exercise.html
Mayo Clinic. (2021). Diabetes and Exercise: When to Monitor Your Blood Sugar. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697
