Diabetes and exercise Summary Symptoms of hypoglycaemia are caused by low blood sugar. Hypoglycaemia can occur if you take your diabetes medication and then do not eat enough or exercise more than usual. If you experience early symptoms of low blood sugar before, during or after exercise, stop and eat or drink sugar (six or seven jelly beans or half a glass of fruit juice) immediately. If you experience hypoglycaemia often, you should visit your doctor. Severe symptoms such as drowsiness, unconsciousness or inability to swallow are a medical emergency. In an emergency, always call triple zero (000) and ask for an ambulance. Exercise is an important lifestyle choice for everyone. For people with diabetes or at risk of diabetes, exercise is still an important part of a healthy lifestyle. Exercise affects blood glucose, so if you have type 1 diabetes, you will need to monitor your blood glucose before, during and after exercise. For people who have type 2 diabetes, regular exercise can make any insulin your body produces more effective. This means you may need to speak to your doctor about whether you should alter your medication to avoid hypoglycaemia. Benefits of exercising with diabetes Exercise has well-known benefits for everyone, especially when combined with healthy eating. These health and wellbeing benefits are especially important to manage some of the long-term effects of diabetes. Exercise helps with: improving mood and sleep improving muscle strength and bone mass keeping blood glucose in the target range lowering cholesterol and blood pressure maintaining or achieving a healthy body weight reducing stress and tension. If you are at risk of type 2 diabetes, exercise can be part of a healthy lifestyle that will reduce your risk of developing diabetes. If you already have diabetes, exercise can help you to reduce your risk of heart disease and some of the other long-term effects related to diabetes. Before you exercise with diabetes Before you begin an exercise program, you should visit your doctor and discuss the exercise options that would best suit you and your lifestyle. If you have long-term complications of diabetes, such as eye or kidney damage, it may be best to avoid some types of exercise. Speak with your doctor about what would be best for you. People with diabetes are also at risk of dangerous foot problems such as ulcers that can lead to amputation. Ask Diabetes and exercise Page 1 of 5
your doctor about exercise that will reduce the stress on your feet. Avoid damaging your feet, especially if you are middle aged or older. Steps you can take to look after your feet during exercise include to always: wear well-fitting and comfortable shoes recommended by your podiatrist inspect your feet before and after exercise. If you do not feel well or you have found ketones in your blood or urine, do not take part in intense physical activity. If fasting blood glucose or urinary ketones are high, exercise can further increase blood glucose and ketone production, usually requiring treatment with insulin. Make sure you warm up before exercise, cool down and drink plenty of fluids to remain hydrated. Understanding exercise and blood glucose If you have diabetes, hypoglycaemia (low blood glucose) is more likely to occur during exercise, so monitor your blood glucose before, during and after exercise. Symptoms of low blood sugar (hypoglycaemia) vary in type and intensity, but early symptoms include: headache light-headedness and nausea mood change paleness and sweating weakness and trembling. If you do not treat hypoglycaemia and your blood glucose continues to fall, the symptoms can worsen to include: disorientation inability to drink or swallow inability to stand lack of coordination loss of consciousness seizures. A person with diabetes who is drowsy, unable to swallow or is unconscious is having a medical emergency. In an emergency, always call triple zero (000). To treat hypoglycaemia during exercise, eat or drink fast-acting sugar such as jelly beans or fruit juice. If you have early symptoms of hypoglycaemia, stop and take glucose immediately. To avoid hypoglycaemia after exercise, you may need to replenish your body s stores of carbohydrate after exercise. If you have hypoglycaemia during or after exercise, you should speak with your doctor. Hyperglycaemia (high blood glucose) can occur following intense exercise or competitive sports. During intense exercise, your body produces adrenaline and this will increase both blood glucose and ketone production. More exercise could lead to further increases in blood glucose and ketones. To treat hyperglycaemia, you would need to take extra insulin. Speak with your doctor. Exercise and type 1 diabetes Although exercise is part of a healthy lifestyle, if your blood glucose levels are high or fluctuating, it is best to avoid exercise until your blood glucose has stabilised. Exercise affects your blood glucose and it is important to understand how this works so you can help to manage your diabetes. Speak to your doctor about ways you can manage your blood glucose. Management can include: Diabetes and exercise Page 2 of 5
reducing your insulin dose before or after exercise, or at bedtime never completely avoiding insulin before exercise checking your blood glucose before, during and after exercise carrying jelly beans or fruit juice to treat hypoglycaemia caused by exercise. Stop and take fast-acting sugars immediately if you have symptoms of hypoglycaemia before, during or after exercise. If you experience hypoglycaemia, you should visit your doctor. Exercise and type 2 diabetes The pancreas of some people with type 2 diabetes still makes insulin, but that insulin does not reduce blood glucose as effectively. Exercise can make any insulin that your body does produce more effective. This can lower your blood glucose levels more than you were expecting and give you symptoms of hypoglycaemia. If this is happening, you need to speak to your doctor about whether you should alter your medication to avoid hypoglycaemia. You should carry jelly beans or fruit juice to treat hypoglycaemia when you exercise. Stop and take fast-acting sugars immediately if you have hypoglycaemia before, during or after exercise. If you experience hypoglycaemia, you should visit your doctor. Managing hypoglycaemia To avoid and manage hypoglycaemia, you can: understand what causes your hypoglycaemia and try to reduce the risk carry a hypo pack, with items such as jelly beans wear a medical bracelet so people know you have diabetes and may need urgent medical help keep a diary to monitor your hypoglycaemic events speak with your doctor if you are having symptoms of hypoglycaemia often make sure your family, friends, co-workers, school staff and carers can recognise hypoglycaemia and know how to treat it always carry fast-acting treatment for hypoglycaemia if you are taking insulin or certain types of diabetes medication carry pure glucose such as glucose tablets, glucose gel or Lucozade if you are taking medication called Acarbose (Glucobay ) for type 2 diabetes eat carbohydrates if you are drinking alcohol make sure your blood glucose level is above 4 mmol/l before you drive. Keeping a record of your symptoms It is a good idea to keep a diary that describes your symptoms, when they occur and what you are doing before and after they occur. Record all relevant information when you take your blood glucose levels, including: date time blood glucose test results diabetes medication and dosage diet and exercise information symptoms of hypoglycaemia. Hypo pack for hypoglycaemia A hypo pack contains information and items to treat hypoglycaemia. The hypo pack contents can include: your name a list of contents Diabetes and exercise Page 3 of 5
written description of the symptoms of hypoglycaemia written instructions for how to treat hypoglycaemia fast-acting carbohydrates such as jelly beans or fruit juice drinks slow-acting carbohydrates such as muesli bars, fruit bars and biscuits doctor, hospital and emergency contact details contact details for your nearest next of kin. If you are planning to engage in physical activity, consider taking along your hypo pack. Treatment for hypoglycaemia Hypoglycaemia is not an illness but it is a symptom of low blood glucose. If you are having hypoglycaemic episodes often, you should visit your doctor to discuss your record of symptoms and whether your diabetes medication needs changing or the dose needs adjusting. Treating early symptoms of hypoglycaemia Early milder symptoms can be treated with 15 20 grams of fast-acting carbohydrates such as: six to seven jelly beans three teaspoons of sugar or honey glucose tablets equivalent to 15 grams of glucose glucose gel equivalent to 15 grams of glucose half a glass of fruit juice half a can of soft drink. It is best if the source of carbohydrate does not contain protein or fats, because that will slow down the absorption of glucose and your blood sugar will not increase as quickly. Check your blood glucose 15 minutes after consuming the fast-acting carbohydrate. If levels remain under 3.9 mmol/l, take another 15 20 grams of carbohydrate and check your blood sugar after 15 minutes. Once your blood glucose is 4.0 mmol/l, you should eat or drink a slow-acting carbohydrate to stabilise your blood glucose. Potential snacks include: one slice of bread one glass of milk or soy milk one piece of fruit two to three pieces of dried apricots, figs or other dried fruit one tub of natural low fat yoghurt. Speak to your doctor for more information about the types of foods that would be best for you. Home glucagon kit If you are prone to severe hypoglycaemia, you should speak to your doctor about getting a glucagon kit for low blood sugar or hypoglycaemic emergencies. You and your family and friends will need to be trained in how to give the glucagon to someone having a hypoglycaemic emergency. Emergency first aid for severe hypoglycaemia A person with diabetes who is drowsy, unable to swallow or is unconscious is having a medical emergency. First aid steps include: Place the person on their side and make sure their airway is clear. Give an injection of glucagon, if available, and you are trained to give it. In an emergency, always call triple zero (000) and ask for an ambulance tell the operator the person is having a diabetic emergency. Wait with the person until the ambulance arrives. Diabetes and exercise Page 4 of 5
If they regain consciousness, give them carbohydrate to maintain blood glucose levels. Where to get help Your doctor In an emergency, always call triple zero (000) Emergency department of your nearest hospital NURSE-ON-CALL Tel. 1300 60 60 24 for expert health information and advice (24 hours, 7 days) Diabetes Australia Tel. 1300 136 588 St John Ambulance Australia (Victoria) Tel. 1300 360 455 This page has been produced in consultation with and approved by: Department of Health and Human Services Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions. For the latest updates and more information, visit www. Copyight 1999/2016 State of Victoria. Reproduced from the Better Health Channel (www.) at no cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission. Diabetes and exercise Page 5 of 5