OTHER






Pre-exercise glucose Recommendation
< 90 mg/dl
(< 5 mmol/L)
AEROBIC EXERCISE (> 30 MINUTES)
  • Ingest 15 - 30 grams of a high glycemic index carbohydrate
  • Start exercise after blood glucose rises to > 90 mg/dl
  • Consume 0.5 - 1 gram of carbohydrate per kg body weight per hour of exercise (0.5 - 1 gram/kg/hour of exercise)

ANAEROBIC EXERCISE OR SHORT-DURATION AEROBIC (< 30 MINUTES)
  • Ingest 15 - 30 grams of a high glycemic index carbohydrate
  • Start exercise after blood glucose rises to > 90 mg/dl
  • Additional carbohydrates may not be necessary depending on prior insulin intake
90 - 150 mg/dl
(5 - 8.3 mmol/L)
AEROBIC EXERCISE (> 30 MINUTES)
  • Consume 0.5 - 1 gram of carbohydrate per kg body weight per hour of exercise (0.5 - 1 gram/kg/hour of exercise)

ANAEROBIC EXERCISE OR SHORT-DURATION AEROBIC (< 30 MINUTES)
  • Additional carbohydrates may not be necessary depending on prior insulin intake
150 - 250 mg/dl
(8.3 - 13.9 mmol/L)
AEROBIC EXERCISE (> 30 MINUTES)
  • Initiate exercise and delay carbohydrate intake until glucose levels are < 150 mg/dl
  • Consume 0.5 - 1 gram of carbohydrate per kg body weight per hour of exercise (0.5 - 1 gram/kg/hour of exercise)

ANAEROBIC EXERCISE OR SHORT-DURATION AEROBIC (< 30 MINUTES)
  • Additional carbohydrates may not be necessary depending on prior insulin intake
250 - 350 mg/dl
(13.9 - 19.4 mmol/L)
  • Check for ketones (blood or urine). See ketone testing below.
  • If ketones are moderate-to-large (blood ≥ 1.5 mmol/L), do not exercise. Initiate appropriate insulin therapy and/or contact health professional.
  • If ketones are negative or small (blood < 1.5 mmol/L), initiate mild-to-moderate exercise. Delay intense exercise until glucose is < 250 mg/dl. Intense exercise may raise glucose levels.
≥ 350 mg/dl
(≥ 19.4 mmol/L)
  • Check for ketones (blood or urine). See ketone testing below.
  • If ketones are moderate-to-large (blood ≥ 1.5 mmol/L), do not exercise. Initiate appropriate insulin therapy and/or contact health professional.
  • If ketones are negative or small (blood < 1.5 mmol/L), consider giving corrective insulin dose at 50% of normal. Initiate mild-to-moderate exercise. Delay intense exercise until glucose is < 250 mg/dl. Intense exercise may raise glucose levels.



Suggested reduction in bolus (premeal) insulin if given within 90 minutes prior to exercise
Exercise intensity Bolus insulin dose reduction
(Duration 30 minutes)
Bolus insulin dose reduction
(Duration 60 minutes)
Mild aerobic -25% -50%
Moderate aerobic -50% -75%
Heavy aerobic -75% No recommendation made
Intense aerobic/anaerobic No dose reduction No recommendation made
Prevention of nocturnal hypoglycemia
(particularly for exercise performed in afternoon or evening)
For first meal after exercise (within 90 minutes)
  • Consider consuming 1.0 - 1.2 grams/kg of carbohydrates
  • Consider reducing bolus (premeal) insulin dose by ∼ 50%
Suggested reductions in basal insulin for prolonged exercise (> 30 minutes)
GENERAL CONSIDERATIONS
  • Prolonged anaerobic exercise may not require any insulin adjustments
  • Mixed activity (anaerobic + aerobic) might require smaller reductions in insulin. Performing anaerobic exercise before aerobic exercise may attenuate the hypoglycemia caused by aerobic exercise.
  • For strenuous prolonged aerobic exercise (e.g. marathon running, cycling, cross-country skiing), increased carbohydrate intake as opposed to insulin reduction may help improve performance

PATIENTS USING MULTIPLE INJECTIONS A DAY
  • Consider reducing the basal insulin dose before prolonged exercise by 20%
  • If nocturnal hypoglycemia is a concern, consider reducing overnight basal insulin dose by 20%

PATIENTS USING INSULIN PUMPS
  • Option one
    • Consider suspending insulin pump during prolonged exercise. Use caution is suspending for more than an hour.
  • Option two
    • Reduce basal insulin by 50 - 80% up to 90 minutes before prolonged exercise



Blood value (mmol/L) Urine value
< 0.6 Negative
0.6 - 1.5 Small to moderate
1.6 - 3.0 Moderate to large
≥ 3.0 Large



Glycemic index Comments
Low GI
  • Consumption of low GI foods before exercise may help prevent hypoglycemia during prolonged activity
  • Consumption of a meal or bedtime snack with a low GI after afternoon exercise may help prevent nocturnal hypoglycemia for up to 8 hours
  • Low-to-moderate GI foods may be preferred for prolonged aerobic activity at low-to-moderate workloads
High GI
  • High GI foods can be used to prevent/treat hypoglycemia during aerobic activity
  • Consumption of high GI foods after exercise may enhance recovery