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Managing Diabetes Magazine - diabetes

Healthy Eating for Active People with Diabetes

If you are physically active, you probably know that good nutrition is essential for peak athletic performance. Those with diabetes are particularly aware of how food affects health and ability.


Drinking enough water is probably the most important way to encourage your best possible health and performance. You lose water every day from your skin, respiratory tract, urine, bowel movements, and of course, through sweat. Daily fluid losses can average about two to three litres. Almost everything your body does – breathing, bringing energy and nutrition to cells, removing waste products from cells – requires water.

It is simple to monitor your water status (hydration). You can 'test' without a lab, for free! Simply check the color, odour, and volume of your urine. If it is dark in color (yellow), with a strong odour and small volume, you do not have enough water in your system. In other words, you are dehydrated. If it is light in color with above normal volume, this means you are adequately hydrated.

Unfortunately, the body has a very poor system for signalling dehydration. By the time you realize you need water, dehydration is usually quite advanced. It is easy to mistake the body's signal for water as hunger. Your grumbling stomach may actually be telling you to drink more. Knowing this, you can stay in tune with what your body is trying to say!

It is important to stay hydrated before, during, and after exercise. In addition to the minimum one to two litres of fluid required each day, drink 250 to 500 millilitres (mL) of fluid two hours before exercising. As you exercise, drink enough to replace the volume of sweat that you lose. This will be about 250 mL of fluid each hour for an average activity.

You are not done yet! Weigh yourself before and after exercise to monitor how much weight you have lost through sweat. You also need to drink 250 to 500 mL of fluid for every pound of body weight lost during exercise.

Why exercise?

Though everyone needs to be physically active, exercise is a key part of managing diabetes.

Physical activity improves cardiovascular fitness, energy levels, blood glucose control, cholesterol levels, sleep, alertness, and mental wellness. It reduces insulin resistance and helps control weight.

If you are not physically active, please get medical clearance from your health care provider before you start. Discuss your current diabetes treatment plan.

Tailoring your diet and medication to fit your exercise routine can prevent low blood glucose (hypoglycemia). Your health care provider can also show you how to schedule blood glucose testing into physical activity. This is especially important if you use insulin as part of your treatment plan

Carbohydrate and exercise

The availability of carbohydrate stores in your muscle, liver, and blood glucose plays a critical role in athletic performance. The intensity and length of exercise, your physical state, and the quality of your diet determine which type of fuel you use during exercise.

Carbohydrate supplies almost all of the energy for high-intensity exercise (weight resistance training, sprinting, and field events). During moderate exercise (soccer, basketball, hockey, skiing, cycling), about half of the energy is supplied by carbohydrates. Energy for low to moderate intensity activities (hiking, walking, jogging, and cycling) mainly comes from fat stores.

The longer you spend exercising, the more the body relies on fat as the energy source. For moderate-intensity exercise, fat can supply as much as 60 to 70 per cent of your energy needs. As the length of the exercise increases, the intensity must decrease, as a limited supply of stored carbohydrates is available. When muscle stores of carbohydrate become low, most energy needed for exercise comes from fat breakdown.

During training, a carbohydrate-rich diet is needed to build and maintain the supply of muscle glycogen (carbohydrate stored in muscle cells). Heavy training or a weekend tournament will slowly lower stored glycogen. If you do not consume enough carbohydrate daily between training sessions or games, your glycogen stores will gradually decline. This affects training and performance. That sluggish feeling, often thought to come from overtraining, may actually be due to a lack of proper carbohydrate refuelling. It can take the body anywhere from 12 to 48 hours to replace glycogen lost during exercise or athletic events.

What kind?


Carbohydrate Protein Fat
Non-fat milk: 1 cup
(250 mL)
15 grams 8 grams 0 grams
Fruits: small apple,
1/2 large banana,
1/3 cantaloupe, small orange, 1/2 cup juice,
1 cup watermelon
15 grams 1 gram 0 grams
1 slice whole wheat bread, 1/2 bagel, 1/2 cup pasta,
3 cups popcorn, 1/2 cup rice, 1 small potato
15 grams 3 grams 0 grams
*You can certainly eat more than this at one time, as these are just for reference.

Selecting the right type(s) of carbohydrate is critical. Choose nutrient-dense carbohydrates – those high in B and C vitamins, as well as fibre and minerals. See the table above for some good examples.

How much?

For people with diabetes, the 2008 Canadian Journal of Diabetes Clinical Practice Guidelines suggests that between 45 to 60 per cent of energy in the diet should come from carbohydrate. If you do routine physical activity (30 to 60 minutes, more than five times per week), carbohydrates should provide around 60 per cent of the energy in your diet.

For instance:

  • A 2000 calorie per day diet x 60 per cent = 1200 calories (just from carbohydrate alone!).
  • To find out how many grams of carbohydrates this is, divide 1200 calories by 4 (as there are four calories in each gram of carbohydrate).
  • This equals 300 grams of carbohydrate that should be eaten per day.

An average person who does not routinely exercise should take in anywhere from 120 to 250 grams of carbohydrate each day. The amount depends on height, weight, gender, and daily activity. It is spread out over three meals and one or two snacks per day. A typical meal could include 30 to 75 grams of carbohydrate, and a snack 10 to 30 grams.

Depending on your weight goal, including extra carbohydrates may not be desirable. Adding more to prevent low blood glucose might seem like a good solution. However, a better idea is to talk with your health care team about reducing diabetes medications when exercising. This can prevent hypoglycemia and encourage possible weight loss.

If weight is not an issue and you exercise routinely, you might add an extra 15 to 45 grams of carbohydrate to meals. Snacks should be in the range of 20 to 45 grams of carbohydrate. It may be easier to consume these extra carbohydrates in a fourth daily meal, rather than spreading them out as snacks.

Other considerations

Generally, you should not need to depend on sports drinks or supplements as your main sources of carbohydrate intake. Your nutrition and carbohydrate needs can be met through whole foods alone – the best source! Only consider sports drinks or supplements when you are not able to eat a full meal or are pressed for time. Want to know the secret of expensive sports drinks? Choose a juice, and mix it half-and-half with water.

Also, be careful not to eat right before exercise. Allow enough time for your stomach to digest this food properly, so it can empty. If you eat too much too close to activity, depending on the intensity, your body may choose to bring the food back up!

As well, if your body is busy digesting food, you rob your muscles of extra blood needed for exercising. This blood should bring additional, much-needed oxygen and nutrients to your muscles. Instead, it will be centred on your stomach and digestive system as it tries to digest.

Avoid eating foods that are spicy, high in fat, high in fibre, or high in protein before exercising.

This being said, those using rapid- acting secretagogue or insulin may have to eat closer to activity depending on blood glucose levels. The ability to reduce diabetes medication or insulin ahead of time, and the weight goal, can also be a factor. Also, if a person has not been able to reduce their diabetes medication or insulin beforehand, they may also need to eat closer to activity to prevent possible low blood sugars during activity.

Finally, remember to carry extra glucose with you for hypoglycemia prevention. You could have an unexpected low while exercising. Exercise might also cause delayed hypoglycemia at night or even the next day. Discuss the risk of low blood glucose from your medications with your Safeway pharmacist.

Protein requirements

  • For inactive adults, a daily protein intake of 0.8 grams/kilogram is suggested.
  • For those who routinely exercise, a protein intake of 1.0 g/kg is suggested. A man who weighs 91 kilograms (200 pounds) requires 90 grams of protein each day (91 X 1.0 g/kg = 91 grams of protein).
  • For strength and weight resistance training activities, a protein intake of 1.0 to 1.5 g/kg may be required.

Hold the fat

There really is no reason to increase fat intake along with the amount of exercise you do. Most Canadians already get plenty of fat in their diets. The food itself may contain fat–butter, margarine, sour cream, or salad dressing. Of course, convenient, junk and fast food also have a high fat content.

Watch your blood glucose levels!

Increasing blood glucose testing with exercise is a very good idea. At the very least, test before, during, and after exercise to learn how your body responds. Depending on the intensity and length of the exercise, you might test hourly or even more often as you exercise.

Low to moderate intensity exercise tends to lower blood glucose during and after exercise. In contrast, high intensity exercise tends to increase blood glucose levels. Watch out!

You may need to test before you go to bed, during the night (at two or three a.m.) and throughout the next day, depending on how your body responds. Delayed hypoglycemia is possible, as your muscle cells will be refuelling during the hours following exercise. Remember, it can take 12 to 48 hours to refuel! This response will be even more dramatic if you are adding an activity you have not done for a while.

Final thoughts

Most of us take nutrition and our diets for granted. We assume that just eating, or cooking, or buying meals means we get the best possible nutrition each day. However, drive-through fast foods and energy drinks are no substitute for healthy eating. You are what you eat, and what you put in is what you will get out.

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [DI_MDab15]
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