The Basics Of Physical Activity With Type 1 Diabetes | Cornerstones4Care®

How Active Should Someone With Type 1 Diabetes Be?

According to the ADA, children with diabetes should participate in at least 60 minutes of physical activity each day. 

Adults aren’t off the hook either—the ADA recommends that adults with type 1 diabetes should work at least 30 minutes of moderate activity into each day. Of course, some people with physical limitations may not always be able to do this, but they should talk to their diabetes care team about safe ways to stay as active as possible. 

Not athletic? Don’t like organized sports? Don’t worry. There are lots of other fun ways to stay active, such as walking or dancing, or even doing volunteer work that involves movement. Walking can be a great way for people with type 1 diabetes to get moving, especially for those not used to being physically active. 

Walking is an ideal way to get started because:

  • It is relatively safe. Just pay attention to where you are going and obey lights and traffic rules 
  • It can fit into an average day. Try doing errands on foot rather than taking the car, especially if living or working in a town or city where things are located close together 
  • It is inexpensive. Got a pair of comfortable sneakers or walking shoes? Okay, then you have all you need to start walking! No? Then go out and get a pair! You don’t need to have pricey athletic shoes—just ones that fit comfortably 
  • It can be made harder or easier to work with your current fitness level. Just getting started? A stroll through the neighborhood is fine. Want more of a challenge? Find a large park with some hills and rugged terrain 
  • It’s heart-healthy. Walking even 30 minutes a day, 5 times a week can benefit the heart and lungs 
  • It’s a great way to go places. It may take you a little longer than if you drove there or went by public transportation, but it can save you money and give you a chance to slow down and really see things. An experienced walker can walk 1 mile in 10 to 12 minutes. A pace of 4 miles per hour or 15 minutes per mile is a good goal to work toward. But it can take someone who is not used to it a while to work up to that rate. In the beginning, it may take 30 minutes to walk a mile 

There are other little ways to fit physical activity into the day. For instance, try taking the stairs instead of using the escalator, or get off the bus a stop earlier so there’s a slightly longer walk than usual.

Customize an activity plan 

The diabetes care team can help you (or the person you care for with type 1 diabetes) create a physical activity plan that’s safe and comfortable. As physical fitness improves, the plan will need to be re-evaluated every now and then to keep it both interesting and challenging. 

Testing blood sugar

Taking part in nearly any activity lasting 30 minutes or more will affect blood sugar. That’s why it is important to check blood sugar before, during, and after being active. Checking blood sugar reveals a pattern of how certain activities affect your blood sugar.

  • Before exercise – always test blood sugar levels before exercise 
    • If the blood sugar reading is less than 100 mg/dL, you may need an extra carbohydrate snack, such as a piece of fruit or a few crackers. Then test 15 to 30 minutes later. Don’t start exercising until blood sugar is above 100 mg/dL
    • Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation
  • If the blood sugar reading is less than 300 mg/dL and there are no ketones present, then it is okay to exercise with caution, but keep checking blood sugar occasionally during exercise  
  • During exercise – it may be necessary to test during activity, especially if exercising for a long time. A snack may be needed during exercise if blood sugar levels are low 
  • After exercise – exercise generally (but not always) lowers blood sugar, so it is a good idea to test afterwards, too. Blood sugar levels can go too low if you exercise for long periods or on an empty stomach

Prepping for physical activity

Depending on the level of activity you are attempting, doing 1 or all of the following may be helpful in avoiding lows and highs.

Avoiding lows during and after physical activity

  • Eat something first. Consider having a carbohydrate-containing snack before being active. Doing physical activity on an empty stomach can cause low blood sugar. It may also be necessary to reduce the insulin dose for the meal eaten before being active
  • Eat something after. Include long-acting carbohydrates such as fruit or bread in the meal after exercise (to reduce the risk of low blood sugar [hypoglycemia] afterwards) 
  • Plan ahead for insulin and food needs. This may take some trial and error as well as the help of the diabetes care team. Adjusting the insulin dose and food intake to how much physical activity is planned can help keep blood sugar in a safe range 
  • Stop if there are any warning signs of low blood sugar (hypoglycemia). Just going “5 minutes more” can be dangerous. Take a moment to eat or drink something with a high level of carbohydrates
  • Keep “emergency carbs” close at hand. Make sure to have a fast-acting carbohydrate snack around when being active. If the person with diabetes feels like they have low blood sugar (hypoglycemia), he or she will need to stop to have a fast-acting carbohydrate snack or drink before they resume. This can be a sports drink, fruit juice, glucose tablet, or hard candy 
  • Monitor later, too. Blood sugar levels can drop even 16 to 24 hours after physical activity because the body uses blood sugar to replace sugar that has been used by the muscles 

Avoiding highs during and after physical activity

  • Match insulin dose to how much activity is being done. Blood sugar levels can also go too high if there is too much physical activity and/or insulin levels are too low. What happens is that the nerves signal the liver to release stored glucose, which can cause a rapid rise in your blood sugar levels
  • Make sure not to start out too high! A high blood sugar level can rise even higher because of exercise
  • Check for ketones. If blood sugar is too high, the body might produce ketones, and a dangerous condition called ketoacidosis can result. Check your blood sugar before and after exercising to avoid high blood sugar
  • Going for the long haul? If the workout is very intense or continues for a long time, it may be necessary to eat during or after physical activity. A low-fat snack that has 15 to 30 grams of carbohydrate may help. Repeat this snack based on blood sugar levels 
  • Know which way blood sugar is going! Start checking 90 minutes before starting an activity. If checks show that the blood sugar level is going down (even if it is still in a safe range), a snack may keep it from going any lower. This is particularly important when starting an activity where it will be difficult to stop and check blood sugar in the middle of doing it 
  • Planning for longer activities. When longer periods of physical activity are planned, it’s a good idea to bring an extra long-acting carbohydrate snack along. This can be fruit, such as a banana, a cereal or fruit bar, bread, or milk. However, it may be better in some cases to decrease insulin doses for planned activities, rather than increasing calories. Always check with the diabetes care team before adjusting insulin doses

Play it safe

Before starting a physical activity or exercise program, talk to the diabetes care team and get a medical evaluation if they feel it is necessary. A thorough evaluation can help health care professionals create a personalized activity program that can maximize results while minimizing risks. 

The need for caution is especially true for people with type 1 diabetes who are already experiencing some long-term diabetes-related health problems. However, having these conditions doesn’t mean that people with type 1 diabetes shouldn’t exercise—or can’t get health benefits from it—but it is wise to talk to the care team first. Here are some exercise recommendations from the ADA for people with diabetes-related health problems.

Diabetes-  Related Health Problem  

Avoid

Try

  Advanced eye    problems

  Pounding or jarring exercises,  high-impact sports, heavy  lifting, or breath-holding  activities 

  Low-impact activities like walking,  swimming, low-impact aerobics,  stationary cycling  

  Neuropathy  (in  combination  with  vascular  problems) 

  Repetitive weight-bearing or    high-impact activities like  prolonged walking or jogging 

  Non–weight-bearing activities like  cycling, swimming, arm chair  exercises, light weightlifting, yoga,  tai chi  

 Kidney  problems 

 Heavy lifting or intensive  exercise that results in blood  pressure increase

 Light-to-moderate daily activities,  low-intensity aerobic activity, light  weightlifting 

 High blood  pressure 

 Heavy lifting

 Dynamic exercises that use large,  lower-extremity muscle groups 

Please talk to your health care provider about these and other diabetes-related issues.

Here are some safety tips for physical activity:

  • Avoid exercising in extreme heat, humidity, or cold
  • Bring a fast-acting carbohydrate snack with you in case your blood sugar drops too low 
  • Wear a medical ID bracelet or necklace 
  • Protect your feet. Wear comfortable shoes and socks that fit
  • Check your feet after being active for any bruises or blisters 

Got a “Couch Potato” Kid?

Some kids love sports and staying active. But many others spend way too much time sitting and staring at TV, computer, or video game screens. Want to get your child moving?

Need a Little Coaching?

One of the many type 1 diabetes support program resources you can access is the Cornerstones4Care® Diabetes Health Coach. This online program can help people with type 1 diabetes build the healthy habits and skills they need to manage their diabetes care.