Help Patients Exercise Safely

By Jennifer Wimpee, RD, LD, CDCES
Clinical Territory Manager | San Antonio, TX

Exercising for a person with diabetes can present some challenges. Exercise can sometimes cause glucose values to decrease. Insulin can also cause glucose values to decrease, which can contribute to a greater risk of hypoglycemia during activity.

Here are some tips to consider when exercising while using SmartGuard™ Auto Mode:1*

  • Less basal may be needed when exercising. Therefore, use the Temp Target feature of 150 mg/dL and set it 1-2 hours before exercising. Allow it to run while being active as well as 1-2 hours after exercise.  
  • Once the Temp Target is set, if glucose values rise above 150 mg/dL, Auto Basal will begin to increase to help bring the glucose value back to the 150 mg/dL target (instead of 120 mg/dL target).
  • If lows persist even with the use of the Temp Target, consider suspending the pump for part of the exercise time and consider supplemental carbs as needed.
  • Assess the use of uncovered carbs ahead of exercise as well. It is important to note that carb loading too far in advance of exercise in order to raise glucose causes Auto Basal to increase which may be counterproductive and may result in lows during exercise.
  • Bolus insulin typically peaks about 90 mins after it is delivered. Practice caution if exercising while active insulin is still onboard.
  • Always keep carbs available during exercise to help prevent and treat hypoglycemia. Examples include juice, a sports drink, apple sauce or fruit snacks.

Here are some tips to consider when exercising while using the InPen™ Smart Insulin Pen:

  • Check the glucose prior to exercise and check the InPen™ app for active insulin. Practice caution if exercising while active insulin is still onboard.
  • Consider 10-15 grams of carbs at the beginning of exercise if the glucose is at or below 100 mg/dL.2
  • Check or monitor glucose values frequently during exercise. If they begin to drift down, consider adding fast-acting carbs like apple sauce, fruit snacks, juice, or a sports drink.
  • Continue to add 10-15 grams of carbs every 30-40 mins of exercise, if necessary.

Conversely, if prior to exercise a glucose is high for unknown reasons (greater than 270 mg/dL), it is important to avoid the activity until the glucose is back in target range.3 In order to help decrease the likelihood of diabetic ketoacidosis (DKA), whether using an insulin pump or insulin pen, check for urine ketones and deliver a correction dose based on the prescribed insulin settings. If ketones are present, do not exercise. Instead, follow the protocol for treating hyperglycemia and preventing DKA.4 As always people living with diabetes should discuss appropriate exercise guidelines with their HCPs.


Some user interaction is required; individual results may vary.


Protocol for Hybrid Closed Loop Therapy: Situations Requiring Special Consideration & Resource Documents. 2nd Edition. Medtronic Diabetes.


American Diabetes Association, Accessed 07/07/2021


Riddell et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377–90


Pumping Protocol: A Guide to Insulin Pump Therapy Initiation for Insulin-Taking Patients with Type 1 or Type 2 Diabetes. Medtronic Diabetes.