A guide to safe exercise for people with Diabetes

Exercise plays an essential role in diabetes management, helping control blood glucose, improve cardiovascular health, and maintain a healthy weight. However, to ensure safety and achieve optimal results, people with diabetes need to follow specific principles and precautions when exercising. This article provides detailed guidance to help people with diabetes engage in physical activity in a scientific and safe manner.

1. What People with Diabetes Should Know

• Exercise helps improve insulin sensitivity, allowing the body to use insulin more effectively to absorb glucose and thereby achieve better blood glucose control.
• Regular physical activity can reduce the risk of developing type 2 diabetes in people at high risk.
• Maintaining a long-term exercise program can be challenging and requires appropriate support and guidance from healthcare professionals.

2. Benefits of Exercise for People with Diabetes

2.1. Blood Glucose Control

Physical activity increases the muscles’ ability to absorb glucose, helping reduce blood glucose levels. This is particularly important for people with diabetes because it improves insulin sensitivity, allowing the body to use insulin more effectively. Regular exercise can help stabilize blood glucose levels, reduce the need for medication, and prevent long-term complications of the disease.

2.2. Improved Cardiovascular Health

People with diabetes are at increased risk of cardiovascular disease. Exercise helps strengthen the heart muscle, lower blood pressure, improve cholesterol levels, and enhance blood circulation. These benefits contribute to a significant reduction in the risk of stroke and heart attack.

2.3. Weight Management Support

Maintaining a healthy weight is a key factor in diabetes management, particularly for type 2 diabetes. Exercise helps burn calories and build muscle mass, thereby enhancing the body’s metabolism. Effective weight management can improve blood glucose control and reduce stress on the joints.

2.4. Improved Mental and Cognitive Health

In addition to physical benefits, exercise also has a positive impact on mental health. Physical activity helps release endorphins, improve mood, and reduce stress and anxiety. For people with diabetes, coping with the disease can cause psychological stress, and exercise is an effective tool for maintaining a positive mindset and mental clarity.

3. Suitable Types of Exercise

3.1. Aerobic Exercise

These are exercises that increase heart rate and breathing, such as brisk walking, jogging, swimming, cycling, or aerobic exercise. People with type 2 diabetes should engage in 30–60 minutes of moderate-intensity aerobic activity per day, or at least 150 minutes per week, without going more than 2 consecutive days without exercise.

3.2. Resistance (Strength) Exercise

These exercises help increase muscle strength and muscle mass, such as weightlifting, using resistance bands, or bodyweight exercises (push-ups, squats). Resistance training at least 2–3 times per week for all major muscle groups can improve insulin sensitivity and blood glucose control.

3.3. Combined Exercises

Combining aerobic and resistance exercises is considered the most effective approach for controlling blood glucose and improving overall health in people with diabetes.

3.4. Flexibility and Balance Exercises

Exercises such as yoga, tai chi, or gentle stretching help improve flexibility and balance and reduce the risk of falls, which is particularly important for people with peripheral neuropathy complications.

3.5. Daily Physical Activity and Reducing Sitting Time

Reducing prolonged sitting by standing up and walking around lightly every 30 minutes can also help improve blood glucose control, even when a person is already exercising sufficiently.

4. Principles of Safe Exercise

4.1. Pre-Exercise Screening

Before starting any new exercise program, people with diabetes should consult a doctor for thorough screening, particularly for cardiovascular complications or other health problems that may affect exercise safety.

4.2. Blood Glucose Monitoring

Checking blood glucose before, during, and after exercise is very important, especially if the person is taking insulin or medications that may cause hypoglycemia.

• Before exercise: Ideally, blood glucose should be between 5.0–13.9 mmol/L (90–250 mg/dL). If blood glucose is too low (<5.6 mmol/L or <100 mg/dL), a small amount of carbohydrate should be consumed before exercise. If it is too high (>13.9 mmol/L or >250 mg/dL), ketones should be checked and caution should be exercised.
• During exercise: Monitor periodically if exercising for more than 45 minutes or at high intensity.
• After exercise: Check blood glucose after exercise to adjust food intake or medication if necessary, as blood glucose may continue to decrease for several hours after physical activity.

4.3. Adequate Hydration

Drinking enough water before, during, and after exercise is very important to prevent dehydration, especially in hot environments or during high-intensity exercise.

4.4. Appropriate Clothing and Footwear

Wear comfortable, well-fitting shoes and clean socks without seams that may cause friction to protect the feet. This is particularly important for people with peripheral neuropathy complications.

4.5. Warm-Up and Cool-Down

Always spend 5–10 minutes warming up gently before exercise and 5–10 minutes cooling down and stretching after exercise to reduce the risk of injury and help the body recover.

5. Things to Avoid and Special Precautions

5.1. Hypoglycemia

This is the most common complication of exercise in people with diabetes, particularly those using insulin or sulfonylureas.

• Signs: Trembling, sweating, dizziness, intense hunger, rapid heartbeat, and confusion.
• Prevention: Adjust insulin or medication doses, have a carbohydrate snack before exercise, and carry fast-acting sources of sugar (candy, soft drinks) for prompt treatment. Strength training may help reduce the risk of exercise-induced hypoglycemia in people with type 1 diabetes.

5.2. Hyperglycemia

In some cases, high-intensity exercise can temporarily increase blood glucose levels. If blood glucose is above 13.9 mmol/L (250 mg/dL) and ketones are present in the urine, exercise should be avoided until blood glucose decreases and ketones disappear.

5.3. Hyperthermia

People with diabetes may be more susceptible to hyperthermia due to impaired thermoregulation. Avoid exercising outdoors on excessively hot or humid days, and always stay adequately hydrated.

5.4. Diabetes-Related Complications

• Diabetic retinopathy: Avoid exercises that place strain on the eyes, such as heavy weightlifting or activities involving a risk of head impact.
• Peripheral neuropathy: Protect the feet and avoid exercises that place excessive pressure on the feet or pose a risk of injury. Non-weight-bearing exercises such as swimming and cycling may be more suitable.
• Cardiovascular disease: Patients should undergo thorough screening by a cardiologist before starting an exercise program, particularly if they have a history of heart disease.

5.5. Medication Interactions

Some diabetes medications may affect the body’s response to exercise. Discuss with your doctor whether medication doses or the timing of medication administration should be adjusted around exercise sessions.

6. When Should You Consult a Doctor?

People with diabetes should consult a doctor or healthcare professional before starting any new exercise program, especially if they:

• Have recently been diagnosed with diabetes.
• Have diabetes-related complications (heart, kidney, eye, or nerve disease).
• Have other underlying medical conditions.
• Are taking insulin or medications that may cause hypoglycemia.
• Experience any unusual symptoms during or after exercise (chest pain, dizziness, shortness of breath, nausea).

7. Medical Review & References

Medical Review:

• Medical consultation: Dr. Le Nhat Truong – Department of Endocrinology, University Medical Center Ho Chi Minh City

References:

• [1] Mahesh B. Borhade; Kanica Yashi; Shikha Singh. (2025). Diabetes and Exercise. StatPearls. Accessed: 2025-12-07.
• [2] Colberg Sheri R., Sigal Ronald J., Yardley Jane E., et al. (2016). “Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association,” Diabetes Care, 39(11), pp. 2065–2079. Accessed: 2025-12-07.
• [3] Kanaley J. A., Colberg S. R., Corcoran M. H., et al. (2022). “Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine,” Med Sci Sports Exerc, 54(2), pp. 353–368. Accessed: 2025-12-07.
• [4] Mayo Clinic. (n.d.). Diabetes and exercise: When to monitor your blood sugar. Accessed: 2025-12-07.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.