Experts Release First Exercise Guide for People with Type 1 Diabetes

A group of international experts created the world’s first standardized guidance to help people with type 1 diabetes exercise safely.

The guide details the importance of exercise in people with type 1 diabetes, but acknowledges the risk of hypoglycemia—low blood sugar. “Understandably, fear of hypoglycemia is one of the strongest barriers to incorporating exercise into daily life,” the guidance says.

“In general, we see that aerobic exercise—jogging, cycling, etc.—causes sharper drops in glucose compared with resistance exercise or interval exercise,” Peter G. Jacobs, PhD, co-author of the guide and an associate professor in the Department of Biomedical Engineering at Oregon Health & Science University, tells Verywell. “And steeper drops in glucose can also occur if a person is exercising soon after a meal when they have a large amount of insulin in their body to cover the meal that they have consumed.”

The guidance specifically lays out information to help both people with type 1 diabetes and their medical providers lower the risk of hypoglycemia from exercise.

Othmar Moser, PhD, lead author of the guidance and professor of exercise physiology and metabolism at the University of Bayreuth, tells Verywell that he and his co-authors decided to create the guidelines to help make the process of exercise as safe as possible for people with type 1 diabetes. “Different studies show that the major fear of people with type 1 diabetes is a fear of passing out during exercise,” he says. "This should help."

The New Guidance

The guide specifically breaks down advice based on the best steps to take before, during, and after exercise, including the use of a glucose monitor.

“I would always recommend using a glucose monitoring system—a small sensor at your abdomen or upper arm and have it display on your mobile phone or reader every five minutes,” Moser says. “It makes it quite easy to monitor your glucose regularly.”

Before exercise

• Know the type, intensity, and duration of exercise
• Consider the timing of the exercise
• Figure out how much insulin to use in advance
• Target a sensor glucose range

During exercise

• Sensor glucose ranges should be between 126 mg/dl and 180 mg/dl, and should be slightly higher for people with an increased risk of hypoglycemia
• If sensor glucose levels are elevated, do insulin correction
• Exercise should be stopped if blood glucose levels are below 70 mg/dl. If they’re below 54 mg/dl, exercise should not be restarted

After exercise

• During the first 90 minutes after exercise, it’s best to have a glucose range of 80 mg/dl to 180 mg/dl
• If insulin correction is needed due to high sensor glucose levels, a glucose monitor alarm should be set at 80 mg/dl

How Exercise Impacts Type 1 Diabetes

The American Diabetes Association (ADA) recommends that people with type 1 diabetes get regular physical activity. “Exercise provides benefits to all people, including people living with type 1 diabetes. It can help maintain healthy body mass index, strength, and fitness,” Jacobs says. “It can be beneficial specifically to people living with type 1 diabetes as it can help them improve their glycemic control and can reduce their total daily insulin needs.”

Exercise can “dramatically and drastically increase the quality of life” in patients with type 1 diabetes," Moser says.

Like the new guidance, the ADA also recommends that people with type 1 diabetes check their blood sugar before, during, and after exercise, but the organization doesn’t give targeted blood glucose ranges.

Moser urges people with type 1 diabetes to view exercise as a part of their treatment, along with using insulin and eating a healthy diet. And, most importantly, he says, people with type 1 diabetes shouldn’t be scared to exercise. “A couple of years ago, it was difficult for people with type 1 diabetes to perform exercise [over hypoglycemia fears] but these days it’s possible,” he says. “Our hope is that everyone with type 1 diabetes will be physically active and exercise.”