Successful diabetic athletes

The Olympic athlete is an icon of superior physical, mental, spiritual fitness, and discipline. Kris Freeman, 2010 U.S. Olympic cross-country skier, best exemplifies this type of athletic persona. Exercise and type 1 diabetes is a balancing act for the Olympic and non-Olympic athlete that can never be perfected. The feat is challenging for any athlete, let alone an individual with type 1 diabetes.

Long endurance sports such as cross-country skiing, distance cycling, and marathon running can deplete the muscle stores of glucose that may take up to 18-24 hours for the body to replace. If the muscles lose the glucose stores the energy is gone and the race is over (also called hitting the wall). Kris Freeman has trained intensely through trial and error using multiple variables to best determine any situation he may confront and how to balance his diabetes management to pursue the best outcome.

What should I do if I experience hypoglycemia?

Everyone with diabetes should be prepared to treat hypoglycemia, but people with type 1 are at the highest risk for hypoglycemia. People with type 2 are less likely to have issues with hypoglycemia during or after exercise, unless they are on insulin or an insulin secretagogue.

If you experience hypoglycemia during or after exercise, treat it immediately. Use the same process as you would any other time of the day:

Have at least 15-20 grams of fast-acting carbohydrate (sports drinks, regular soda, or glucose tabs are all good ideas).
Wait 15-20 minutes and check your blood glucose again.
If it is still low and your symptoms of hypoglycemia don’t go away, repeat the treatment.
After you feel better, be sure to eat regular meals and snacks as planned to keep your blood glucose level up.

If you want to continue your workout, you will usually need to take a break to treat your low blood glucose, depending on what activity you are doing and how much insulin you have circulating in your bloodstream. If you do stop exercising, check to make sure your blood glucose has come back up above 100 mg/dl before starting to exercise again.

Keep in mind that low blood glucose can occur during or long after physical activity. It is more likely to occur if you:

Take insulin or an insulin secretagogue
Skip a meal or don’t eat something within 30 minutes to two hours after stopping
Exercise for a long time
Exercise strenuously

If hypoglycemia regularly interferes with your exercise routine, talk to your doctor about adjusting your treatment plan. Your provider may suggest eating a small snack before you exercise or they may make an adjustment to your medication(s).

How can I overcome my barriers to exercise?

If you’re not active, it’s likely that you have at least one barrier or reason why. Perhaps you’ve never been very active. Maybe you’re afraid that your blood glucose level will drop.

Think about what is keeping you from being active and then check out some of our solutions to the most common barriers to physical activity. Is there a solution for you?

I don’t have time to exercise for 30 minutes a day.

Think about your day – do you have available time slots? Take advantage of any extra time that you may have and pencil in a workout. If you find yourself waiting for the kids to finish practice or watching their game from the sidelines, use that time to take a walk or pace while you watch.
Do as much as you can. Every step counts. If you’re just starting out, start with 10 minutes a day and add more, little by little. Work up to at least 10-minute sessions, three times a day. You can also try for 15-minute sessions twice a day.
Make physical activity part of your daily routine. For example, walk or bike to work or to the store, exercise while you watch TV, take the stairs instead of the elevator, or do something active with your family to spend time together.

I’ve never been active.

Don’t discount your everyday activities. You may be more active than you think. Housekeeping or mowing the lawn counts as activity. Being active is more than just planned exercise.
If you have never been active or have not been active for a while, it is important to start slowly. If you feel unsure about your health, check with your health care provider before making big changes in your exercise plan.
Starting slowly is important and so is choosing activities that you enjoy. Over time, the activities you do will get easier. You will even find that you can increase the duration and/or intensity.

I’m too tired after work.

Find a time when your energy is highest. You could plan to do something active before work or during the day. For example, you could try walking for 30 minutes during your lunch break a few days each week or hitting the gym early in the morning.
Remember that increasing the amount of physical activity you do will actually increase your energy.

I don’t have the right clothes.

Wear anything that’s comfortable as long as you have shoes that fit well and socks that don’t irritate your skin.

I’m too shy to exercise in a group.

Choose an activity you can do on your own, such as following along with an aerobics program on TV or going for a walk.
Remember that the everyday activities you do on your own like gardening and household chores get you moving and help burn calories.

I don’t want to have sore muscles.

Exercise shouldn’t hurt if you go slowly at first. Choose something you can do without getting sore.
Make sure you warm up and cool down.

I’m afraid my blood glucose level will drop too low.

The people who need to be most careful about lows are people with type 1 diabetes and those who are on insulin or insulin secretagogues. If you’re taking a medication that could cause low blood glucose, talk to your health care provider about ways to exercise safely.
Always be prepared. Make sure you’ve got some regular Gatorade, glucose tabs, or another fast-acting carbohydrate to treat a low if one should occur. Wearing a diabetes ID is another important safety precaution. (See our “12 Quick Safety Tips“)

Walking hurts my knees.

Try chair exercises, swimming, biking, or an elliptical machine. These and other low-impact exercises may be less painful.

It’s too hot outside.

If it’s too hot, too cold, or too humid, walk inside a school or a shopping center.
Think of some other activities that are always available regardless of the weather like using a stationary bike, indoor aerobics classes, yoga videos at home, indoor swimming, stair climbing, calisthenics, or dancing.

I’m afraid I’ll make my condition worse.

Remember that getting enough physical activity is important for everyone’s general health – whether you have diabetes or not.
Remember that exercise helps lower A1C and has many other health benefits. (See our list of the benefits of physical activity.)
If you have certain complications from diabetes and are unsure about your health, talk to your doctor before making any big changes to your fitness routine.

I can’t afford to join a fitness center or buy equipment.

Do something that doesn’t require fancy equipment, such as walking, jogging, calisthenics, or using water bottles for weights.
Jumping rope and resistance band exercises are other activities that only require one piece of inexpensive equipment.
Look for inexpensive resources in your community like community education programs, park and recreation programs, walking trails, school running tracks, or worksite wellness programs. Your employer is another place to check for discounts on gym membership or reimbursement for fitness-related activities

Exercise is boring.

Find something you enjoy doing.
Mix it up. Try different activities on different days, and make sure you pick an activity that you enjoy!
Exercise with someone else to keep you company.
If you can, try exercising while listening to music or watching television.

I don’t really know how to exercise.

Select activities that require few skills, like climbing stairs, walking, or jogging.
Take a class and develop new skills.

I don’t have the motivation to exercise.

Invite a family member or friend to exercise with you on a regular basis. You can also join an exercise group or class in your community.
Remember all of the benefits that come with being physically active.
Make a plan so you decide when you will do each type of activity. Be sure to set realistic goals and make a plan so you know what you are working toward.

What if I don’t feel like exercising today?

Here are a number of things you can do which will already increase your daily exercise.

Walk around while you talk on the phone.
Play with the kids.
Get up to change the TV channel instead of using the remote control.
Clean the house.
Work in the garden or rake leaves.
Take the dog for a walk.
Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one.
Park at the far end of the shopping center parking lot and walk to the store.
At the grocery store, walk down every aisle.
At work, walk over to see a co-worker instead of calling or emailing.
Take the stairs instead of the elevator.
Stretch or walk around instead of taking a coffee break and eating.
During your lunch break, walk to the post office or do other errands.

Using a pedometer

A pedometer is an inexpensive tool that counts your steps when you clip it to your belt or waistband. You can buy one at most athletic stores or you can order one online.

Use It Regularly

At the end of each day, check your pedometer and record your steps for the day.

Make sure you reset it to “0” the next morning before clipping it on.

Keeping a record of your steps can help you gauge how much activity you are getting or how far you are walking each day.

It also gives you a starting point to help you set goals. You can gradually increase your steps or the minutes you walk each day from there.

For example, let’s say you find that you usually take around 3,500 steps during the day after wearing your pedometer for a week. You can try to increase your daily average by 500 steps every of couple weeks until you hit 7,500 steps per day. You can go even higher than this if you want.

Remember, the more active you are, the more benefits you’ll see from exercise.

Walking

Walking is a great way to get fit.

Here are some advantages of walking for exercise:

It doesn’t require a gym membership or fancy equipment – it’s totally free!
It’s an easy place to start since most of us do it every day – there’s no learning curve!
It has been shown to improve blood pressure, cholesterol, stress, and depression.
It can help to promote weight loss and reduce your risk for other chronic diseases like heart disease and dementia.
It is enjoyable and something you can do with others.
It is a safe and generally risk-free form of physical activity.
It is a form of exercise that is easy to keep up – there are lots of places you can do it!

If you’re not used to being active, you can start with 10 minutes of walking each day and build as your fitness improves.

When you begin, find a comfortable pace and try to add about three to five minutes to your daily walking time each week. A good goal to shoot for is at least 30 minutes of brisk walking, five days a week.

Start out by keeping track of how much you currently walk for a few days. Use a pedometer or a watch to determine how many minutes of walking you already do or how many steps you take.

What’s important is that you take it one day at a time and build up your walking stamina at a pace that’s comfortable for you.

Quick Tips for Walkers

Warm up first by walking in place or start out walking at a slower pace than normal for 3-5 minutes.
Stretch for 5-10 minutes after you warm up or after your walk to help you stay more flexible.
Keep good posture. Gaze forward, not down at the ground, with your chin level and head up.
Stay hydrated by drinking throughout the day before you begin your walk.
Wear shoes designed for walking or exercise for greater comfort and to prevent injuries.

Once you are used to your walking routine, don’t be afraid to take it to the next level. Here are some ways you can change up your walking routine to keep improving your fitness:

Pick up your speed for short intervals throughout your walk to get your heart rate up.
Increase the distance of your walks to build endurance.
Walk both faster and farther, and add some hills to your workout.
Switch up your routine. Do a faster, shorter walk some days and longer brisk walk other days.
Try going with a friend some days and bring music for others.

Injury free exercising – 12 tips

Here are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising:

Talk to your doctor about which activities are safest for you. Your doctor’s advice will depend on the condition of your heart, blood vessels, eyes, kidneys, feet, and nervous system. 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.
Avoid doing activity in extremely hot or cold temperatures. Choose indoor options when the weather is extreme.
Drink plenty of water before, during, and after activity to stay hydrated.
If you feel a low coming on, be ready to test for it and treat it. Always carry a source of carbohydrate with you so you’ll be ready to treat low blood glucose. This is especially important if you are on insulin and have type 1 diabetes.
If exercising for an extended period (more than an hour or two), you may want to have a sports drink that provides carbohydrates. Be careful to check the nutrition facts though, you may need to water down the drink so that you don’t have too much, which can cause your blood glucose to spike.
Wear a medical identification bracelet, necklace, or a medical ID tag that identifies you as someone with diabetes in case of emergency, and carry a cell phone with you in case you need to call someone for assistance.
Activities should be energizing but not overly difficult. Use the “talk test” to make sure you are not pushing yourself too hard. If you become short of breath and you can’t talk, then slow down. This is most important when you are just starting to increase the activity in your routine. As you become fit, you’ll be able to exercise at a higher intensity and chat with others while you do it.
Take care of your feet by wearing shoes and clean socks that fit you well.
You should also check inside your shoes before wearing them. Socks that are made out of a material that reduces friction and pulls moisture away from your skin can also help protect your feet.
Carefully inspect your feet before and after activity for blisters, redness, or other signs of irritation. Talk to your doctor if you have a foot injury or a non-healing blister, cut, or sore.
Stop doing an activity if you feel any pain, shortness of breath, or light-headedness. Talk to your doctor about any unusual symptoms that you experience.

Exercising with complications

If you want to know more about exercising safely with specific diabetes complications, take a look at the list below.

This can serve as a guide to what types of activity might work for you.

Heart Disease

Be careful with: Very strenuous activity, heavy lifting or straining, isometric exercises, exercise in extreme heat or cold.

Beneficial Activities: Moderate activity such as walking, daily chores, gardening, fishing. Moderate dynamic lifting, stretching. Activity in moderate climate.

High Blood Pressure

Be careful with: Very strenuous activity, heavy lifting or straining and isometric exercise.

Beneficial Activities: Most moderate activity such as walking, moderate lifting, weight lifting with light weights and high repetitions, stretching.

Nephropathy

Be careful with: Strenuous activity.

Beneficial Activities: Light to moderate daily activities such as walking, light household chores, gardening, and water exercise.

Peripheral Neuropathy

Be careful with: High-impact, strenuous, or prolonged weight-bearing activities such as walking a long distance, running on a treadmill, jumping/hopping, exercise in heat or cold, weight-bearing exercise when you have a foot injury, open sore, or ulcer.

Beneficial Activities: Light to moderate daily activities, exercise in a moderate climate, moderate weight-bearing activities that are low-impact (e.g. walking, cycling, swimming, chair exercises). Moderate weight-bearing exercises like walking are okay once foot ulcers have healed.

Those with peripheral neuropathy need to have appropriate footwear and should check their feet every day.

Autonomic Neuropathy

Be careful with: Exercise in extreme heat where dehydration can occur, activities requiring rapid changes in movement that may result in fainting. Talk to your doctor before starting an exercise program – you may need an exercise stress test.

Beneficial Activities: Mild to moderate aerobic activities and resistance training, but increase the length of time you exercise slowly. Follow your doctor’s recommendations.

Retinopathy

Be careful with: Strenuous exercise, activities that require heavy lifting and straining, breath holding while lifting or pushing, isometric exercise, high-impact activities that cause jarring, head-down activities.

Beneficial Activities: Moderate activities that are low impact (e.g. walking, cycling, water exercise), moderate daily chores that do not involve heavy lifting, straining, or the head to be lower than the waist.

Peripheral Vascular Disease

Be careful with: High-Impact activities.

Beneficial Activities: Moderate walking (may do intermittent exercise with periods of walking followed by periods of rest), non-weight-bearing exercise: swimming cycling, chair exercises.

Osteoporosis or arthritis

Be careful with: High-Impact activities.

Beneficial Activities: Moderate daily activities, walking, water exercises, resistance exercise (e.g. light lifting activities), stretching

Diabetes and exercise: When to monitor your blood sugar

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.

Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.

Diabetes and exercise pose unique challenges, too. Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations.

Before exercise: Check your blood sugar before your workout

If you’re taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it’s safe to exercise.

Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

Lower than 100 mg/dL (5.6 mmol/L): Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.

100 to 250 mg/dL (5.6 to 13.9 mmol/L): You’re good to go. For most people, this is a safe pre-exercise blood sugar range.

250 mg/dL (13.9 mmol/L) or higher: This is a caution zone. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate 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 ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your test kit indicates a low level of ketones in your urine.

300 mg/dL (16.7 mmol/L) or higher.: Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

Before you start exercising speak to your doctor

Before jumping into a fitness program, get your doctor’s OK to exercise — especially if you’ve been inactive. Discuss with your doctor which activities you’re contemplating and the best time to exercise, as well as the potential impact of medications on your blood sugar as you become more active.

During your visit:

Tell your provider if you have any pain in your chest.
Talk with your provider about joint or bone problems that make it difficult for you to exercise.
Ask about how increasing your activity level might impact any medicines you take for diabetes, blood pressure, and/or heart conditions.
Ask what exercises are safe for you and what you need to avoid.
Ask if there are times when you should avoid activity.

Your health care provider should help support you in your efforts to become more active.
If you have other health conditions besides diabetes, such as heart disease, issues with your vision/eyes (retinopathy), or nerve problems (neuropathy), you may have some limitations when it comes to physical activity. Your doctor can tell you what exercises are best for you and what activities to avoid.