Exercise and Type 1 Diabetes: Control Blood Sugar Levels (2023)

While insulin shots are necessary to regulate blood sugar levels, physical activity significantly stabilizes those levels.

In this article, we’ll dive into the relationship between exercise and type 1 diabetes for controlling blood sugar levels.

Type 1 diabetes is a chronic condition where your immune system mistakenly attacks the pancreas’s beta cells, which are normally responsible for insulin production. Because of this, your body will produce little to no insulin.

Without sufficient insulin, your blood sugar can rise to dangerously high levels. You might suffer complications like stroke, heart disease, eye damage, and kidney problems.

You usually rely on insulin injections to manage your blood glucose levels to prevent these from happening. This is the reason type 1 is often called “insulin-dependent diabetes mellitus.”

As a type 1 diabetic, you need to follow different strategies for effective blood glucose management. These strategies are usually diabetes plans that include insulin doses, proper nutrition, weight management, and, most importantly, exercise training.

Having type 1 diabetes would mean you’ll likely develop insulin resistance, where your body’s cells can’t absorb excess blood sugar. It’s usually caused by an unhealthy diet and a sedentary lifestyle.

Regularly exercising can prevent insulin resistance and make you more insulin-sensitive (more on this later).

So, diabetic or not, any form of physical activity affects your blood glucose control. Not only can it have a positive impact on your insulin sensitivity but also on your glucose metabolism, blood pressure, and other bodily functions.

Exercising affects your body and blood glucose concentrations depending on whether you have diabetes.

For example, when a non-diabetic engages in physical activity, their pancreas produces and secretes less insulin because their body doesn’t need as much to function.

Adults with type 1 diabetes, on the other hand, don’t experience much change in their insulin output when they exercise. This is mainly because of impaired insulin production, so most of the insulin in their body comes from insulin injections.

Another significant difference is how your body interacts with blood sugar.

With non-diabetics, exercise activates the non-insulin-dependent glucose transfer, which means the body pushes glucose into cells to be burnt for energy, but without the help of insulin.

Type 1 diabetics, on the other hand, rely on their circulating insulin levels to burn glucose during exercise. The more you exercise, the more the insulin burns excess glucose in your blood.

Several studies show that exercise has a positive effect on insulin levels and efficiency. Physical activity increases your insulin sensitivity, which helps your body regulate blood sugar levels more effectively. This is useful for both type 1 and type 2 diabetics, who often suffer from insulin resistance.

Exercise also helps with weight management, especially in overweight or obese patients. As you lose excess or unhealthy weight, your body’s insulin sensitivity increases, improving your overall diabetes management.

Hence, exercise directly and indirectly improves insulin sensitivity, allowing you to get the most out of your insulin doses.

With time and regular exercise, your doctor might lower the doses or frequency of your insulin regimen. They might no longer have to prescribe oral diabetes medication to improve insulin sensitivity.

Exercise doesn’t affect all diabetics alike. Each patient’s blood sugar level has a different response according to factors such as:

• Fitness level: Less fit Patients might experience sharp drops in blood sugar while exercising. 
• Type of exercise: Aerobic exercise can lower your blood sugar, while anaerobic exercise can raise it depending on intensity and duration. 
• Insulin on board (IOB): Your insulin on board, or the amount of insulin in your blood from your last bolus insulin dose, affects your blood sugar levels during exercise. 
• Food: The timing and contents of your last meal before exercise. 
• Weather: Exercising in hot and humid weather causes blood vessels to dilate and blood sugar to drop. 
• Hydration: Dehydration causes high blood sugar. 
• Time of day: Your insulin sensitivity changes throughout the day, being lower in the morning than in the afternoon or evening.

In addition to improving insulin sensitivity, here are other benefits of exercise:

• Lowers blood sugar levels: Physical activity forces your body to burn more stored glucose for energy. As such, it reduces your blood sugar levels and improves your glycemic control. 
• Reduces insulin requirements: Improved insulin sensitivity and lower blood sugar levels can reduce your daily insulin doses. 
• Enhances cardiovascular health: Regular exercise can lower blood pressure, improve cholesterol levels, and reduce the risk of heart disease, all common problems with type 1 diabetes. 
• Promotes weight management: Exercise helps you lose excess weight, improving your glycemic control. 
• Increases energy levels: Regular physical activity can reduce fatigue, which is a common symptom of type 1 diabetes.

When creating an exercise plan for type 1 diabetics, it’s important to start slow and steady so it can positively affect your health and prevent burn out.

Try to incorporate different forms of exercise into your plan. Here are a few examples:

• Aerobic exercise: Running, swimming, or biking 
• Anaerobic exercise: Jumping or sprinting 
• Strength training: Yoga or weightlifting 

Regarding the duration for your weekly exercise, the American Diabetes Association (ADA) recommends the following:

• Adults: At least 150 minutes of moderate exercise 
• Children: At least 60 minutes of moderate to vigorous play activity 

You’re encouraged to divide your weekly exercise hours into short sessions every other day (or 48 hours), so your muscles can constantly use glucose for energy.

For example, if your schedule allows, you can try 30 minutes of physical activities five times a week or 50 minutes thrice a week. However, we suggest 5-6 times a week for best results to maintain your blood glucose control.

Each physical activity has a different blood glucose response, and you might end up with a severely high or low blood glucose level if you’re not prepared. So before you start exercising, you should talk to your healthcare provider, especially if you are obese, about the following:

• The type of physical activities you can do 
• How to manage and control your blood sugar level before, during, and after exercise

Before exercising, you should first check your blood glucose levels about 15-30 minutes beforehand. This is especially important if you’ve taken insulin or blood sugar-lowering medication.

You can use a glucometer or a continuous glucose monitoring (CGM) device to test your blood glucose. Here’s how to interpret your pre-exercise blood sugar level:

• Below 100 mg/dL: Your blood sugar is lower than ideal, and you might not be able to exercise safely. Try drinking fruit juice or taking glucose tablets before exercising to raise your blood sugar to the acceptable range. 
• 100-250 mg/dL: This is usually a good range to start exercising safely. The ADA recommends a narrower range of 150-200 mg/dL for toddlers. 
• Over 250 mg/dL: You should wait until your blood sugar returns to normal before exercising. Also, take a ketones urine test, which tells you if your high blood sugar is due to ketoacidosis, a life-threatening condition that needs immediate care.

The most important thing for diabetics during exercise is to avoid hypoglycemia or low blood sugar.

If you’ve planned a long workout session, measure your blood sugar every 30 minutes to ensure it's stable. This is especially important for new activities or high-intensity exercises.

If your blood sugar level during exercise is 70 mg/dL or lower or if you feel shaky, dizzy, or weak, stop exercising immediately. Next, take a glucose tablet, candy, half a cup of fruit juice, or any source of fast-acting carbohydrates to get your blood sugar back up to normal.

Ideally, you want about 15 grams of carbs, so check the nutrition label on whichever food you choose.

After 15 minutes, recheck your blood sugar; if it’s still too low, take another 15 grams of carbs and retest after 15 minutes. Repeat this until your blood sugar reaches 70 mg/dL or higher.

Testing your blood sugar immediately and several hours after exercise is important because physical activity can have a delayed blood-lowering effect.

As your muscles burn through their glucose stores, they draw more glucose from the blood over 4-8 hours, so you might experience hypoglycemia several hours post-workout.

Take a glucose tablet or any carb-rich snack if your blood sugar is low.

Staying hydrated when exercising is important, especially since dehydration often leads to high blood sugar.

Diabetes In Control recommends the following:

• Before exercise: Drink 400-600 ml of water about two hours before exercising. Avoid sugar-containing sports drinks unless you have hypoglycemia. 
• During exercise: Drink 150-200 ml of fluids every 15-20 minutes if your exercise session lasts an hour or more. You can choose between water or sports drinks if you feel your blood sugar may drop. 
• After exercise: This depends on how much water you’ve lost as sweat during exercise, but generally speaking, 400-600 ml should be sufficient if you hydrate during the workout.

Planning and starting an exercise routine is easy, but sticking to it can be a challenge. You’ll need to devise creative ways to motivate yourself to do it.

Here are a few ways you can do to drive children and adults with type 1 diabetes to exercise:

• Make exercise fun: Engage them in activities they enjoy, such as playing tag, riding bikes, or swimming. 
• Involve parents and caregivers: Encourage their parents and caregivers to participate in physical activities with them, such as playing catch or going for walks together. 
• Create a reward system: Offer small rewards or incentives for reaching exercise milestones, such as stickers or treats. 
• Integrate exercise into daily routines: Encourage them to incorporate physical activity into their daily routines, such as jumping jacks while watching TV. 
• Monitor progress: Keep them motivated by helping them track their progress using tools such as pedometers or fitness apps. 
• Making it a habit: Encourage them to exercise by setting aside dedicated daily time for physical activity. 
• Lead by example: Children often learn by example, so let them see you enjoying exercise or physical activity and they’ll likely copy you.

• Do what you enjoy: Choose physical activities you enjoy, such as running, hiking, dancing, or swimming, as long as it doesn’t feel like a chore. 
• Set realistic goals: Set achievable goals for yourself and start slowly, gradually increasing the intensity and duration of your exercise over time. 
• Vary your routine: Mix up your exercise routine so you don’t get bored or plateau. Try new activities, join a fitness class, or workout with a friend. 
• Get professional guidance: Consider getting a personal trainer to design an exercise plan tailored to your needs and abilities. They’ll also give an added level of accountability, keeping you motivated. 
• Join a community: Look for local groups or clubs that enjoy the same exercise activities you do, such as hiking clubs. Exercising with others can provide accountability, support, and motivation. 
• Track your progress: Use wearable devices, mobile apps, or logbooks to monitor your progress.

As a type 1 diabetic, taking your daily insulin shots isn’t enough. You need to make sure you’re getting enough exercise so your body can utilize the insulin doses as efficiently as possible.

Try gradually adding a bit of physical activity to your weekly schedule, and you’ll notice major improvements in your blood sugar in no time!