We are all aware that the statistics for obesity and diabetes are continuously on the rise which means it is likely that you already work with or will meet a client with diabetes. The first important step to take is to make sure you are qualified and insured to work with clients that have medical conditions in order to protect yourself and look after them. That aside, you also need to make sure you thoroughly screen clients so they meet your inclusion criteria and are safe to perform exercise. You will have covered all of this within your training and are hopefully practising comprehensive screening on all of your clients. So that leads us to refresh your memory on some of the key contraindications and considerations for working with diabetic clients.
Remember contraindications refer to changes in a client’s medical condition which means that they should not participate in exercise, either for that day or until the contraindicated situation is resolved. Considerations are areas you need to address and continuously monitor. This is not an exhaustive list, but we have put together 5 key points we feel you would benefit from remembering.
1) Unstable Glucose Levels
If a client’s blood sugar levels are not under control when they first come to you then you should not accept them as a client, particularly if they haven’t received medical clearance. If their blood sugar levels start to become unstable over the course of time you are training them, then you need to recommend they return back to their doctors to help regain some control. It can be very tempting to offer your services to someone that has unstable blood sugar levels because you feel the exercise routine will help them; however, without medical clearance and without certainty how the client will react, you are putting both yourself and them at risk.
2) Retinal Haemorrhage
This refers to a bleed within the eye. If a client has a bleed within the eye, you are recommended to avoid exercising or if it occurs during exercise to stop the session. To understand more about retinal haemorrhage then read here.
Depending on the severity of the bleed, the client may be able to return to moderate exercise but in more severe cases it makes exercise harder due to the associated changes in blood pressure with exercise. The above article gives you an understanding of appropriate and safe forms of exercise but you must recommend your clients seek medical advice and clearance before resuming.
3) Schedule Exercise Routines
Try and schedule your clients exercise at the same time of day each time they train. This will allow them to get into a good routine for when to eat prior to exercise as well as provide a routine for the body. If you change the time of day around a lot, particularly for Type 1 diabetics, then it could cause issues with their blood sugar levels due to timings of injections plus they may not eat sufficiently before exercising, increasing their risk of a hypoglycaemic attack during the session.
4) Avoid Excessive Exercise Durations
The longer an individual exercises, the more glucose they utilise to supply energy. You need to find the optimal duration for that individual client in terms of how their body responds as everyone is different. They may feel fine during the exercise session but once they finish if they are shaky or appear confused then their blood sugar levels are likely to have dropped too low and they need a fast acting snack. Since your body continues to burn energy at a higher rate following exercise too, you need to ensure you select the appropriate duration and when required, your clients may need to eats following the session.
5) Avoid Injection Areas
It is best to encourage type 1 diabetic clients to choose injection sites away from the areas used during exercise. However, if this is something that can’t be done you need to ensure the client does not use that specific muscle group immediately after injecting. This is due to exercise speeding up the role of insulin, potentially causing lower blood sugar levels. For example, if someone has injected in their arm, don’t start performing arm based exercises straight away.
Those are 5 contraindications and considerations for working with diabetic clients. As mentioned before, this is certainly not an exhaustive list but gives you some key messages to take away and reinforce. If you found this blog useful, you may find our Online Diabetes & Exercise Seminar beneficial to developing your knowledge. It covers the aetiology and pathophysiology of type 1 and type 2 diabetes, highlights the benefits of physical activity and exercise, it explores the exercise prescription framework for diabetes, discusses evidence based research alongside considerations and contraindications. Find out more details about this training here.