Table 3.

Blood glucose monitoring and treatment strategy around exercise

Pre-exercise blood glucose level (mg·dL−1)	Carbohydrate intake recommendation
<90	For typical activities, consume 10–30 g of fast-acting CHO prior to start of exercise For brief or very high-intensity activities, consider no additional CHO intake For prolonged activities consume an additional 0.5–1.0·g·kg−1·h−1 of exercise based on BG monitoring Or, delay exercise until blood glucose is >90 mg·dL−1 and monitor closely for hypoglycemia
90–124	Consume 10 g of glucose before starting aerobic exercise Can start anaerobic or high-intensity interval exercise right away
125–150 (alternate 125–180*)	Start consuming 0.5–1.0 g·kg−1·h−1 of exercise at onset of exercise May need to adjust based on type of exercise and insulin
150–250 (alternate 180–270*)	Delay carbohydrate intake until BG levels are below 150 mg·dL−1 Consume non-CHO-containing fluid to prevent dehydration
250–350	Test for ketones Delay intense exercise until BG levels are below 250 mg·dL−1
>350 with no ketones	Consider conservative insulin correction (eg, 50%) before exercise Initiate mild- to moderate-intensity exercise Delay intense exercise until BG levels are below 250 mg·dL−1
>250+ ketosis	Avoid exercise if moderate to large amounts of ketones are present

BG, blood glucose; CHO, carbohydrate.

^*Guidelines from different groups have recommended different ranges for blood glucose monitoring in exercise.^16,53,87