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Managing Hypoglycemia During Exercise

Nina Ghamrawi, MS, RD, CDE
November 14, 2023
November 14, 2023

People taking insulin or insulin secretagogues (oral diabetes pills that cause your pancreas to make more insulin) are at risk for hypoglycemia, or low blood sugars, if their food or medications aren’t adjusted to account for exercise.

Checking your blood sugar before and after a physical activity is important to prevent hypoglycemia (low blood sugar). Talk to your diabetes care team (doctor, nurse, dietitian or pharmacist) to find out if you are at risk for hypoglycemia.

It is important to become familiar with how your body responds to different durations and types of exercise.

Checking your blood sugar level more often before and around 30 minutes after exercise can help you see the benefits of activity. You also can use the results of your blood sugar checks to see how your body to reacts to different activities. Understanding these patterns can help you prevent your blood sugar from going too high or too low.

If you experience hypoglycemia with exercise, treat it immediately:

Follow the 15-15 rule:

1. Check your blood sugar.

2. If your reading is 100 mg/dL or lower, have 15-20 grams of fast-absorbing carbohydrate to raise your blood sugar. (Foods that are higher sugar, with little to no fat or protein). This may be:

  • 4 glucose tablets (4 grams per tablet),
  • 1 glucose gel tube (15 grams per gel tube),
  • 4 ounces (1/2 cup) of juice or regular soda (not diet),
  • 1 tablespoon of sugar or honey

3. Repeat these steps every 15 minutes until your blood sugar is at least 100 mg/dL.

4. Check your blood sugar again after 15 minutes. If it is still below 100 mg/dL, have another serving of 15 grams of carbohydrate.

If you want to continue your workout, you will usually need to take a break to treat your low blood sugar. Check to make sure your blood sugar has come back up above 100 mg/dl before starting to exercise again.

Keep in mind that low blood sugar can occur during or long after physical activity. It is more likely to occur if you:

  • Take insulin or an insulin secretagogue
  • Skip meals
  • Exercise for a long time
  • Exercise strenuously

If hypoglycemia interferes with your exercise routine, talk to your healthcare provider about the best treatment plan for you. Your provider may suggest eating a small snack before you exercise or they may reduce your medication(s).

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