Guidelines

How do I start?

Always check with your health care provider (HCP) to make sure you are safe to exercise. Patients with heart/blood vessel problems, retinopathy (eye problems), and/or nephropathy (kidney problems) may need to adjust their exercise program.

• Identify an activity you enjoy or add variety to make it fun!
• Wear comfortable shoes and socks — not too big or too small. Check your feet after exercise.
• Wear your medical ID tag
• Carry a source of emergency carbohydrate with you (an example is glucose tablets or gel)
• Stay well hydrated: drink plenty of water or other sugar-free beverages!
• Check your blood sugar before and after exercise.

Do not exercise if: Ketones present in blood or urine; blood sugar is less than 70; use caution if blood sugar is more than 300.

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Start slow and gradually increase the duration and/or intensity

	Increasing Duration	Increasing Intensity
Goal	30 minutes/day on 5 days/week	During exercise you should be able to talk, but not be able to sing
Starting Point	5-10 minutes of continuous activity	No resistance
Ways to Increase	Increase duration 5 minutes every other time you exercise. If you cannot increase exercise continuously, exercise more often; for example, walk 10 minutes in the morning and 10 minutes in the evening	Get arms involved: hold hand weights or raise arms above heart level Add weight: wear arm or leg weights to increase resistance Go faster: challenge yourself to increase speed gradually

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Low Blood Sugar Risks and Prevention

If you take Insulin or a Sulfonylurea (glipizide, glyburide, glimepiride), exercise may increase your risk of a low BG because it can increase insulin sensitivity. You may need to adjust food or medication based on your body's reaction to exercise. Insulin dosing varies. Contact your diabetes provider for recommendations before exercise.

Beware of delayed hypoglycemia: Exercise not only increases insulin sensitivity DURING exercise, but also for several hours after (up to 12-48 hours). This may result in "delayed hypoglycemia" or delayed low BG. Check your BG more often to see if this happens to you. This is especially important if you do something outside of your normal routine.

Carb intake adjustments for exercise: A good rule of thumb is 15 grams of "undosed" carbohydrate for every 45 minutes of exercise.
Also, take less insulin than usual for a snack before a meal just before exercise or if more than two hours since last meal/snack, or exercise is unplanned, have extra carb and protein snack as listed to prevent a low blood sugar.

Preventing Low BG before exercise	Treating Low BG after or during exercise
Crackers and cheese or Peanut butter		½ cup fruit juice
½ sandwich with turkey, cheese or PB		1 cup Gatorade
½ cup dry cereal with ½ cup milk		Skittles or fruit snacks
1 ounce pretzels and ½ oz nuts		3 glucose tabs
1 container light Greek yogurt		1 cup skim milk
Take less insulin before exercise

*If you do a lot more activity than normal you may need to have a bedtime snack, check BG overnight, or even lower your insulin dose overnight (i.e. temp basal on pump). Discuss your needs with your HCP.

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Check your blood glucose (BG) before exercise and after exercise

Blood Sugar	Action	Exercise Recommendation
Greater than 250 mg/dL	Check urine or blood ketones Drink water Talk with HCP about correcting high BG	Do not exercise if you have positive ketones or feel sick!
Less than 70 mg/dL	Treat low blood sugar After your blood sugar comes up, eat a snack with carb and protein	Exercise as planned Monitor blood sugar Keep source of glucose with you
Between 70-100	Consider eating a snack to prevent low BG	Exercise as planned
Between 100-250	No pre-exercise action required	Exercised as planned