Exercise for people with type 2 diabetes (Part 2)

Exercise for people with type 2 diabetes (Part 2)

Exercise risks

People with diabetes may be on a therapeutic program that includes medications, nutritional guidelines and regular exercise. Exercise helps decrease blood glucose concentrations, potentially reducing or eliminating insulin doses. Because of the critical importance of managing blood glucose levels, clients with diabetes must be under effective therapeutic care before beginning an exercise program. And they must understand how activity and medications affect their blood glucose levels for a program to be safe and effective for them.


When training someone with diabetes, health and wellness professionals should develop an understanding of the condition, exercise needs and precautions to minimize risks of injury. For example, ADA cautions people with any type of diabetes about exercising if their fasting blood glucose is more than 300 mg/dl.


In another example, foot problems may require some individuals with diabetes to do non-weight bearing activities, i.e. swimming, water aerobics or cycling. Damage caused by peripheral neuropathy, which affects the nerves to the toes, feet, legs, hands and arms, may also necessitate non-weight bearing exercise. That’s because peripheral neuropathy results in a loss of feeling in the extremities and can cause foot deformities, gait changes and balance problems. (Descriptions of common diabetes-related conditions are available online from the National Diabetes Information Clearinghouse. See “Resources” on page 9 for more information.)


In particular, professionals working with clients who have type 2 diabetes need to know the symptoms of hypoglycemia and emergency procedures to follow, if necessary.


Hypoglycemia. The greatest exercise risk to people with diabetes is hypoglycemia or low blood sugar levels. Hypoglycemia can lead to a life-threatening loss of consciousness. According to ADA’s exercise safety tips, people with type 2 diabetes “controlled by meal planning and exercise usually don’t have problems with low blood glucose.” However, those who take insulin or oral diabetes medicine, in particular sulfonylureas, may have low blood sugar levels both during and after exercise. (For more information, see “Medicines for people with type 2 diabetes” on page 8.)


An individual’s risk of developing low blood glucose is greatest after high-intensity or long duration exercise. But this reaction can take place even 12 or more hours after a workout, says ADA. To help prevent hypoglycemia, a person must time medications carefully (e.g. ACSM recommends injecting insulin at least one hour before exercise), ensure adequate food intake (see below) and monitor blood glucose levels before and after exercise, as well as during longer exercise sessions or when trying a new activity.


Health and wellness professionals should learn to recognize the warning signs of hypoglycemia and monitor clients with diabetes carefully (see “Hypoglycemia: signs and symptoms” on page 4 for a list). If someone becomes hypoglycemic, he or she needs a rapidly absorbed sugar source immediately, i.e. a half-cup of fruit juice or regular soda, two teaspoons of sugar or raisins, or six jelly beans or hard candy. If the individual loses consciousness or if the person’s symptoms do not respond to rest and sugar, the professional should contact emergency services right away.


Hypoglycemia: signs and symptoms

Watch for the following warning signs and symptoms of hypoglycemia, or low blood sugar levels, in clients with diabetes:

  • Extreme fatigue
  • Excessive sweating
  • Headache
  • Trembling or shakiness
  • Weakness
  • Slurred speech
  • Poor coordination
  • Feeling faint
  • Loss of consciousness
  • Seizure
  • Pale, moist skin
  • Full, rapid pulse
  • Tremors
  • Elevated blood pressure
  • Nervousness
  • Palpitations
  • Excessive hunger
  • Irritability and other abrupt
  • mood changes
  • Impaired concentration
  • and attentiveness
  • Mental confusion
  • Drowsiness


Be prepared to provide a sugar source to a client immediately if he or she starts experiencing hypoglycemia. Rapidly absorbed carbohydrates include a halfcup of fruit juice or regular soda, two teaspoons of sugar or raisins, or six jelly beans or hard candy. Contact emergency services right away if the individual loses consciousness or if his or her symptoms do not respond to rest and sugar.



  • Gordon, N.F. “Diabetes Your Complete Exercise Guide.” Cooper Clinic and Research Institute
  • Fitness Series. 1993. Champaign IL: Human Kinetics


This article is provided courtesy of the International Council on Active Aging www.icaa.cc