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Patient Instructions

Exercise is as important as any medicine for managing your diabetes and your health, in general. It can help in these ways:

• It helps you lose weight, if you are overweight.
• It helps prevent weight gain.
• It lowers blood sugar without medicines.
• It reduces your risk for heart disease.
• It reduces stress.

Be patient. It may take several months after you start exercising before you see changes in your health.

See also: Managing your blood sugar

While exercise can help you manage your diabetes, your doctor and nurse should make sure your exercise program is safe for you.

Call your doctor if:

• You feel faint, have any chest pain, or feel short of breath when you exercise.
• Your feet feel numb or painful, or you have sores or blisters on your feet.
• Your blood sugar gets too low (less than 60 mg/dl) or too high (higher than 250 mg/dl) during the day.

If you take medicines that lower your blood sugar, exercise can make your blood sugar go too low. Ask your doctor or nurse for help planning your exercise program to prevent this problem.

Some types of exercise, such as heavy weight lifting, can make your eyes worse if you already have diabetic eye disease (retinopathy). Get an eye exam before starting an exercise program to make sure the exercise you choose will be safe for you.

See also: Diabetes - eye care

Start slowly with a walking program. Walk for 5 or 10 minutes at first if you are out of shape.

Try to set a long-term goal of 30 to 45 minutes of fast walking at least 5 days a week. Do more if you can. Other aerobic exercises, such as swimming or exercise classes, are also good choices.

Wear a medical alert bracelet or necklace that says you have diabetes. Make sure coaches, teammates, and others you exercise with know you have diabetes. Always have fast-acting carbohydrates with you. Carry emergency phone numbers with you.

Drink plenty of water before, during, and after exercising. Try to exercise at the same time of day, for the same amount of time, and at the same level of exertion. This will make your blood sugars easier to control.

When you exercise, check your blood sugar often:

• Before exercise
• During exercise, if you are exercising for more than 45 minutes
• Right after exercise and later on. Exercise can make your blood sugar drop 12 hours or more after you are done.

If you use insulin:

• Ask your doctor about the best time to eat before exercise.
• Do NOT inject your insulin in a part of your body that you are exercising (legs when running, arms when swimming).

Have a snack nearby that can raise your blood sugar quickly. Examples are:

• 5 or 6 hard candies
• 1 tablespoon sugar, plain or dissolved in water
• 1 tablespoon honey or syrup
• 3 glucose tablets
• 1/2 can regular, non-diet soda
• 1/2 cup fruit juice

Have a larger snack or more frequent snacks if you will be exercising harder than usual or for longer periods of time.

If exercising is causing a lot of low blood sugars, talk with your doctor. You may need to lower your insulin or other diabetes medicine dosage.

If your blood sugar is less than 100 mg/dl before starting to exercise, eat a snack first.

Do not exercise if your blood sugar is over 300 mg/dl. Talk with your doctor about how to get your diabetes in better control.

You might not feel pain in your feet because of your diabetes. If you have a sore or blister, you may not notice it. Call your doctor for any changes on your feet. Small problems can become serious if they go untreated.

Always check your feet for any blisters, sores, lumps, redness, or cuts in the skin before and after exercise.

When you exercise wear:

• Socks that draw moisture away from your feet.
• Comfortable, well-fitting shoes made for the activity you are doing

See also: Diabetes - taking care of your feet

American Diabetes Association. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008 Jan;31 Suppl 1:S12-54.

Physical activity and diabetes: What I need to know. National Diabetes Information Clearinghouse. March 2008. NIH Publications No. 05-5180.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.