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Regular exercise is a cornerstone of healthy living and managing
diabetes. Yet the conversation around exercise with diabetes is often
filled with angst. This is especially true when exercise unexpectedly
causes our blood glucose (BG) levels to spike.
So, what is going on when exercise causes your BG to rise, rather than
fall? And how can you manage this, in order to benefit from and enjoy
working out?
The first-ever official guidelines for safe exercise were published in The
Lancet journal in 2017. And more recently, in 2020, experts released an
international position statement on glucose management for exercise
using continuous glucose monitoring (CGM) in type 1 diabetes.
“It’s critical for your brain and your nervous system to have access to
blood glucose at all times. For that reason, the body has redundant
hormones that raise BG, like glucagon and adrenaline,” explained Sheri R.
Colberg, PhD, professor emerita of exercise science at Old Dominion
University in Norfolk, Virginia, and creator of Diabetesmotion.com. “What
happens with exercise is that glucose-raising hormones are released to
help pump up the amount of BG being released to match what your active
muscles are using.”
Colberg admits, “The system isn’t perfect, though, and doing intense
activity causes an exaggerated release of these hormones. So, when
someone does intense but short activities, BG often rises due to releasing
too many hormones.”
This response is not unique to people with diabetes. Vieira confirmed that
“In a nondiabetic body, the exact same process is happening, but their
bodies produce extra insulin to deal with the extra glucose.”
“Just because blood sugar levels rise during certain types of exercise
doesn’t mean they are bad exercises or that the rise is happening for a
bad reason,” Vieira added. “This is the body’s normal reaction to several
factors that can occur mostly during anaerobic exercise — like weight
lifting, sprinting, spinning classes, competitive moments, etc.”
Since it’s anaerobic exercise that causes BG spikes during activity, you
might think that just avoiding sprints, resistance training, or other
anaerobic activities could be the answer.
So, try to assess the situation in terms of your insulin intake, or insulin on
board (IOB). Maybe you didn’t take enough insulin to cover a meal prior to
your exercise session, or maybe you are working out soon after waking
up, when IOB is at its natural low point.
BG spikes caused by bursts of adrenaline can be hard to anticipate, as
they happen most often smack in the middle of a an exercise session.
This means that rather than treat the spike immediately, you most likely
will need to wait and take additional insulin after the fact.
More insulin is also needed when the spike results from fasted exercise.
Some additional insulin will be needed, but not so much that it leads to a
hypoglycemic episode during or after exercise.
Unfortunately, there are no hard and fast rules for making these insulin
dosing adjustments. Each situation for each person will require an
individualized response. It’s best to work with your medical team to
determine the best response for you.
That being said, both Vieira and Oerum suggest taking notes and tracking
your experience so that you can learn from your experiences. You may
find that for you personally, particular activities have a predictable BG
spike effect. Over time you can develop a routine that allows you to both
get the exercise you need and anticipate those frustrating spikes.
You can also experiment with your own ideal “starting glucose level”
before kicking off exercise. The 2017 guidelines give the general
recommendations of “at-target” levels of 126 to 180 mg/dL, and to
consume 10 to 20 grams of fast-acting glucose before getting started.
You’ll have to monitor your own experience to learn what’s ideal for you.
Once you understand why BG levels spike during exercise, and accept
that this is not necessarily a bad thing, you will hopefully notice a mental
shift, away from being frustrated and disappointed towards appreciating
what you can do in response.
While there is no one-size-fits-all guidance, know that over time you can
build an exercise routine that includes small amounts of glucose and
insulin dosing that keeps your BG levels manageable.
Our experts continually monitor the health and wellness space, and we
update our articles when new information becomes available.
Current Version
Oct 5, 2021
Written By
Corinna Cornejo
Edited By
Amy Tenderich
Medically Reviewed By
Marina Basina, MD
Copy Edited By
Sofia Santamarina
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