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Diabetes and Exercise: Training Clients With Diabetes

It’s no secret that diabetes is a major health threat, not just in the US but globally. Over 30 million people in the US alone have diabetes (that’s about 10% of the population) and it affects more than 380 million people worldwide. The sheer numbers make the likelihood of you meeting, knowing, or maybe even having a client who’s diabetic pretty significant. I would encourage you to try to understand the basics of diabetes so that if and when a diabetic client walks through your door, you know how to assist them optimally in their fitness journey.

diabetes-exercise-christelDiabetes 101

Type 2 diabetes is the most prevalent type of diabetes. People with Type 2 diabetes often produce insulin, but their body is either not able to utilize it, or they don’t produce enough to lower their blood sugar to the normal range. The initial form of treatment is often a series of lifestyle changes such as changes in diet and exercise, but can also be medication.

Exercise will impact the effect of some types of Type 2 diabetes medication, increasing the risk of exercise-induced hypoglycemia (low blood sugar). If your client is taking one of these types of medication (like insulin or sulfonylureas and meglitinides), they need to understand the way in which it will impact their blood sugars and inform you of what to do should their blood sugar go low during an exercise session. For more information about what your client should tell you about their diabetes, please see my article “What to Tell Your Personal Trainer About Your Diabetes

Type 1 diabetes accounts for about 5-10% of the diabetic population and is an “autoimmune” disease. People living with Type 1 diabetes do not produce insulin and must inject insulin daily to survive. Blood sugars should be measured several times a day to maintain stable blood sugars within the normal range. Exercise will impact how sensitive someone is to insulin, thereby increasing the risk of exercise induced hypoglycemia (low blood sugar).

As with people living with Type 2 diabetes, people living with Type 1 diabetes need to understand how exercise will impact their blood sugar and take precautions to lower the risk of high or low blood sugars. If low blood sugar occurs, and it most likely will at some point, glucose should be administered as quickly as possible. As a general rule, steady state cardio will most likely decrease blood sugars while sprints and heavy resistance training has the potential to increase blood sugars.

Working with a client living with diabetes

If you start working with a client who has diabetes, make sure to first understand the type of diabetes they have and how they treat it. Don’t be afraid to ask questions, but don’t assume you know more than they do either. People with diabetes experience enough stigma and receive enough unsolicited and unfounded suggestions on how to manage their care as is. It’s your responsibility to manage their exercise routine, not their diabetes, so if you ask them about their diabetes, ask in order to learn and expand your knowledge base, and let them and their medical team manage the disease.

As with any client, but especially with clients living with diabetes, always ensure that they have had a recent medical checkup and have been cleared by their doctor to exercise. Some diabetic complications will dictate the level of activity which is safe for the client, and this should not be taken lightly.

If they are on a medication that can potentially make their blood sugars drop during exercise, I recommend the following:

  1. christel-blood-sugarHave a conversation with the client about their typical low blood sugar symptoms – symptoms can vary from person to person, and knowing their individual symptoms could help prevent an extreme case of low blood sugar, which could ultimately lead to seizures, coma or even death
  2. Make an agreement with them that you can ask if they feel ok and if their blood sugars are in range – in the heat of the moment (like during exercise) low blood sugar symptoms (like fatigue, anger, extreme perspiration) can sometimes be more easily detected by a bystander
  3. Discuss how you can support them in case of low blood sugar – different people will require different levels of support. Some might need you to get them a juice or glucose tabs if they don’t carry any with them, while others can manage by themselves
  4. Adjust the type and duration of exercise to match their immediate needs – sometimes type and duration of exercise should be adjusted to prevent high or low blood sugars.In general sprint drills or heavy resistance training will tend to increase blood sugars, while steady state cardio will, for the most part, decrease blood sugars. So, if a client comes in with blood sugars higher than their desired range you might want to start them out with steady state cardio before moving to resistance training or sprints
  5. Always have immediate access to a diabetes emergency kit – optimally, your client should carry their diabetes emergency gear with them (fast acting carbs, like juice or glucose tabs, and a blood sugar meter) in the gym. If they are more advanced gym goers/athletes who know when their blood sugars might go low and how exercise affects them, they can store it in their locker, but regardless, the emergency kit should always be within reach to prevent dangerously low blood sugar situations.

Diabetes and exercise: the benefits your client can expect

Aside from the general health benefits of adopting an exercise regime, people with diabetes will experience other health benefits, such as improved insulin sensitivity and consequently reduced need for insulin or other blood sugar medications.

As mentioned, Type 1 diabetes is chronic and there is no cure. However, improved insulin sensitivity as a result of an increased activity level will most often make the disease easier to manage. As insulin sensitivity is increased, the amount of insulin needed to keep blood sugars within range will decrease. If combined with a healthy diet, with focus on low glycemic carbs, it can even become easier to limit the daily blood sugar fluctuations that are results of meals and hormones.

Some people living with diabetes might not see these benefits immediately, since it can take some time to get used to managing an improved insulin sensitivity. But, as your client gets more accustomed to being active and learns more about how their body responds to exercise, it will get easier and they will start to reap the fruits of their labor both when it comes to body composition, overall health and diabetes management.


I highly recommend that you educate yourself on the different types of diabetes and how they affect exercise and optimal nutrition. I recommend completing the Diabetes Training Program from the Diabetes Motion Academy as part of your yearly re-certification curriculum.

em>Reprinted with permission from Christel Oerum. Originally published on TheFitBlog.com

Christel Oerum is a blogger, certified personal trainer, fitness model, and diabetes advocate. She has been living with type 1 diabetes since 1997 and at an early stage decided that it wasn’t going to slow her down. Her motto is “There is Nothing You Can’t do With Diabetes”. She writes about Health, Fitness and how to be Fit With Diabetes on TheFitBlog.com. She also trains people with diabetes from across the globe, online and in person, and supports them in meeting their fitness goals. Follow Christel on Facebook or Instagram.

MFN Contributing Author