According to the ADA's 2001 Clinical Guidelines' Clinical Statement on Diabetes and Exercise, people with diabetes should undergo "a careful medical history and physical examination [that focuses] on the symptoms and signs of disease affecting the heart and blood vessels, eyes, kidneys and nervous system." This includes:
- Checking for cardiovascular disease if the person is over the age of 35 and has had type 1 diabetes for more than 15 years or type 2 diabetes for more than 10 years, or displays any other factors for heart disease
- A foot check to rule out peripheral arterial disease or peripheral nerve damage
- An eye examination to check for retinopathy
- A test to see if there is too much protein in the urine, which is a sign of kidney disease
- Checking for signs of damage to nerves that regulate areas of the body that function automatically, such as the gastrointestinal system, blood vessels, heart, etc.
Specific complications call for refraining from certain exercises. For example, people with proliferative retinopathy should not undertake strenuous exercise, activities that involve jarring movements or straining, or those that require holding your breath and bearing down (such as in weight-lifting), in order to avoid the possibility of bleeding in the eye or detachment of the retina.
Heavy exercise is discouraged in those with kidney disease, although the ADA guidelines point out that people with microalbumin levels in ranges of more than 200 mg/min often limit themselves for lack of capacity to engage in strenuous tasks.
If you've lost sensation in your feet, avoid weight-bearing exercises. Also, avoid repetitive exercises, which can lead to ulcers or fractures.
Autonomic neuropathy—damage to the nerves that control the areas of your body which function automatically—can increase the risk of having a heart attack during exercise. Because autonomic neuropathy can also interfere with your body's ability to regulate its temperature, avoid exercising in hot or cold environments and be sure to drink plenty of liquids.
Be sure to warm up before exercising and cool down afterward by performing low-intensity aerobic exercise and stretching.
If you have type 1 diabetes, do not exercise if fasting blood-glucose levels are more than 250 mg/dl and ketones are present, and be cautious if blood-glucose levels are more than 300 mg/dl and there are no ketones. If blood-glucose levels are less than 100 mg/dl, eat some carbohydrates.
The following exercise tips will help keep you in top shape:
- Keep your feet dry and cushioned to prevent blisters
- Wear visible medical identification
- Drink plenty of fluids—dehydration can affect glucose levels and heart function
- Keep carbohydrate-based foods available and consume as needed