Diabetes is a chronic condition in which the body does not produce enough insulin or cannot use it effectively. Insulin is a hormone made by the pancreas that helps move glucose (sugar) from the bloodstream into the body’s cells. Glucose is then used for energy by the cells. When this process is disrupted, glucose stays in the blood, leading to high blood glucose levels, also known as hyperglycemia. High blood glucose level is a hallmark of diabetes (Cleveland Clinic, 2024).
Managing diabetes effectively involves a combination of healthy lifestyle choices, including regular exercise. Physical activity helps regulate blood glucose levels and contributes to overall well-being by promoting energy balance and cardiovascular health. When paired with balanced eating habits, exercise can significantly improve your body’s ability to use insulin and maintain stable glucose levels.
Benefits of Regular Physical Activity
According to the American Diabetes Association (ADA; n.d.-e), the benefits of regular physical activity for people with diabetes include:
- increased energy levels
- improved blood sugar control
- enhanced insulin sensitivity
- reduced stress
- greater emotional balance and overall sense of well-being
- enhanced self-assurance
- lower cholesterol levels
- effective weight management
- increased muscle strength
- lower blood pressure
- reduced triglyceride levels
- reduced risk of cardiovascular disease
- improved quality of sleep
Exercising with Diabetes: How to Stay Safe and Active
While regular physical activity is essential for managing your well-being, it is equally important to prepare appropriately to ensure your safety. The ADA emphasizes that people with diabetes should take precautions before, during, and after exercise to avoid complications while maximizing benefits.
Getting Ready to Exercise
Light-intensity exercise, such as walking or stretching, is fine for most people living with diabetes. If you don’t exercise regularly and are planning to engage in moderate or strenuous activities, consult your healthcare team before beginning a new exercise routine. They may recommend a physical exam to ensure your body is ready for increased physical activity and can help adjust your diabetes medications if needed. This is especially important because your blood glucose levels will change in response to physical exertion.
Once cleared by your doctor, start slowly and gradually build up your activity level. Begin with less intensity than you think you can handle; this allows your body to adapt safely. Walking is a great way to start, and you can increase the intensity (speed) or duration (length) of your walks gradually. You might also consider working with an exercise specialist familiar with diabetes to help you create a safe and effective personalized routine (ADA, n.d.-a).
Exercising Safely With Diabetes
Monitoring your blood glucose before and after exercise is crucial (Mayo Clinic Staff, 2024). Additionally, check your blood glucose levels after 30 min of exercise if engaging in longer or more intense workouts. This helps you understand how your body responds to different activities and prevents your levels from becoming too low or too high.
Avoid exercising if your blood glucose is:
- above 270 mg/dl, as this might indicate high ketone levels, which can be dangerous; or
- below 90 mg/dl, which increases the risk of low blood glucose levels (hypoglycemia). If your glucose is under 90 mg/dl, have 15–30 g of carbohydrates and check your blood glucose after 15 min to ensure your body is responding to the added carbohydrates.
A blood glucose range of 126–180 mg/dl is an optimal range prior to starting exercise, and 180–270 mg/dl is still a safe range for exercise. However, keep in mind that blood glucose levels could rise if you’re engaging in strength training or high-intensity exercise.
If at any time your blood sugar falls below 90 mg/dl, follow the 15/15 rule:
- Consume 15 g of fast-acting carbohydrates (e.g., four glucose tablets, one glucose gel tube, ½ cup of juice, ½ cup of regular (non-diet) soda, or 1 tablespoon of sugar or honey).
- Wait 15 min, then recheck your blood sugar.
- Repeat, if necessary, until your level is above 100 mg/dl before starting or resuming exercise (ADA, n.d.-f).
If your levels are outside the recommended range, take the necessary steps to correct them before starting your workout. Understanding how your body responds to physical activity is key to exercising safely and effectively with diabetes. Everyone’s response to exercise is different, so monitoring your blood glucose regularly helps you learn what works best for you.
If you plan to be active for an extended period, consider eating a small snack beforehand. This can help maintain stable blood sugar levels throughout your activity and reduce the risk of low blood sugar levels. Choose a snack that includes carbohydrates and a small amount of protein or fat to provide sustained energy (ADA, n.d.-c).
Be Prepared: What to Carry
Always carry a source of quick-acting carbohydrates during exercise so that you’re prepared in case your blood sugar levels drop. Good options include:
- fruit juice
- glucose gel or tablets
- a small packet of honey
- hard candies such as Life Savers or Jolly Ranchers
To correct low blood glucose, avoid sugar-free candy varieties and read the Nutrition Facts label to determine how many candies provide 15 g of carbohydrates. Having these on hand ensures you can treat low blood glucose quickly and continue exercising safely (ADA, n.d.-d).
Additional Safety Tips
- Stay well hydrated. Drink 7–20 oz of water 2–3 hr before exercise and 7–10 oz of water every 20 min during exercise.
- Exercise 1 to 3 hr after eating.
- Stop exercising if you experience pain, lightheadedness, or shortness of breath.
- Avoid alcohol and caffeine before and after workouts, as they can affect blood glucose levels.
- Wear a medical ID bracelet or necklace that indicates you have diabetes.
- Exercise with a partner when possible, especially during longer or more intense sessions. If you can’t exercise with a partner, let someone know where you’re going and when to expect you to return.
- Wear clean, well-fitting socks and footwear.
- Be aware that insulin use, skipped meals, or prolonged activity can increase your risk of low blood sugar (Centers for Disease Control and Prevention, 2024; ADA, n.d.-f; Graham, 2017).
After Exercise: Recovery and Monitoring
After physical activity, monitor your blood glucose, especially if you exercised at a greater intensity or for a longer duration than usual. Low blood sugar can occur up to 24 hr later, so check your levels frequently and be ready to treat any lows. Inspect your feet after each workout for blisters or cuts.
As your activity level increases, be sure to check in with your healthcare team. Your medication or meal plan may need to be adjusted to match your new routine.
How Much Should I Exercise?
The Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2018) recommend that adults aim for at least 150 min of moderate-to-vigorous aerobic exercise each week, preferably spread throughout the week. Physical activity is noted to slow or delay the progression of chronic illnesses, including type 2 diabetes.
Examples of aerobic exercises:
- brisk walking, jogging, or running
- hopping, skipping, or jumping rope
- swimming and water aerobics
- cycling
- dancing
- exercise classes like step aerobics, Zumba, or kickboxing
In addition to aerobic exercise, resistance training (e.g., weights, resistance bands, body-weight exercises) that incorporates all major muscle groups should be done two or more times each week to help build and maintain muscle mass (ADA, n.d.-b).
Examples of resistance exercises:
- exercises that use your own body weight for resistance, such as squats, lunges, pushups, pullups, and planks
- exercises using resistance bands, weight machines, or free weights
- some forms of yoga and tai chi
- carrying heavy loads, such as groceries
- climbing stairs and walking up hills
Special Considerations
People who have diabetes-related complications or conditions, such as hypertension, retinopathy, nephropathy, or neuropathy, will also benefit from physical activity. However, there are special considerations when you’re exercising with diabetes-related complications or conditions.
People with diabetes and complications should also aim to meet the general physical activity recommendations of 150 min per week of moderate activity (e.g., brisk walking, water aerobics).
If you haven’t exercised recently or are starting a new type of exercise, consult with your healthcare provider first to ensure that the exercise and activities are appropriate for your condition.
Here are a few additional tips to keep in mind when exercising with complications.
Exercises to Avoid
- high-intensity interval training (HIIT)
- vigorous-intensity sports or heavy weightlifting
- exercises that require holding your breath
- outdoor workouts in extreme heat or cold
- sprinting
- isometric exercises (e.g., planks, wall sits)
- jarring movements or head-down positions
- activities with extreme pressure changes (e.g., scuba diving)
Things to Try
- warming up before and cooling down after exercise
- staying hydrated
- starting with simple activities like walking
- doing short physical activity sessions (5–10 min) a few times a day
- building up to light aerobic activities (like walking or dancing)
- including light resistance training (cans, a water bottle, or hand weights can be used for resistance training to build muscle strength)
- doing chair exercises if standing or walking is difficult—chair exercises can help improve circulation and strength while reducing the risk of falling
Stop Exercising If You Experience
- irregular pounding or heartbeat
- chest pain
- dizziness or nausea
- shortness of breath or gasping
- cold sweats or clamminess
- anxiety or tension
- spots in your vision
It’s important to always start slowly and listen to your body when you exercise with diabetes and complications.
Summary
Consistency and enjoyment are key. Choose activities you like and can stick with. Talk to your healthcare provider before starting a new routine. Your ideal activity level may vary based on your current medications, health status, and physical abilities (ADA Professional Practice Committee, 2024).
References
American Diabetes Association. (n.d.-a). Fitness: See your doctor. https://diabetes.org/health-wellness/fitness/see-your-doctor
American Diabetes Association. (n.d.-b). Fitness: Weekly exercise targets. Retrieved June 30, 2025, from https://diabetes.org/health-wellness/fitness/weekly-exercise-targets
American Diabetes Association. (n.d.-c). Health & wellness: Blood glucose and exercise. https://diabetes.org/health-wellness/fitness/blood-glucose-and-exercise
American Diabetes Association. (n.d.-d). Health & wellness: Exercise and glucose levels in diabetes. https://diabetes.org/health-wellness/fitness/why-does-exercise-sometimes-raise-blood-sugar
American Diabetes Association. (n.d.-e). Health & wellness: Fitness. https://diabetes.org/health-wellness/fitness
American Diabetes Association. (n.d.-f). Low blood glucose (hypoglycemia). Retrieved June 30, 2025, from https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose
American Diabetes Association Professional Practice Committee. (2024). Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes—2024. Diabetes Care, 47(Suppl 1), S77–S110. https://doi.org/10.2337/dc24-S005
Centers for Disease Control and Prevention. (2024, May 15). 10 surprising things that can spike your blood sugar. https://www.cdc.gov/diabetes/living-with/10-things-that-spike-blood-sugar.html
Cleveland Clinic. (2024, January 17). Insulin. Retrieved July 1, 2025, from https://my.clevelandclinic.org/health/body/22601-insulin
Graham, K. (2017, November 27). 6 things to consider when working with clients with type 2 diabetes. American Council on Exercise. Retrieved July 24, 2025, from https://www.acefitness.org/resources/pros/expert-articles/6854/6-things-to-consider-when-working-with-clients-with-type-2-diabetes/
Mayo Clinic Staff. (2024, January 9). Diabetes and exercise: When to monitor your blood sugar. Mayo Clinic. Retrieved July 24, 2025, from https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697
U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans, 2nd edition. Retrieved July 24, 2025, from https://odphp.health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines
