Advice For Personal Training Clients With Diabetes

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There are many things to consider when it comes to personal training clients with diabetes, both medically and in terms of the exercises you choose.

You must understand the precautions to take with diabetic clients and know how to alter sessions to better fit the needs of this demographic.

In this guide, we’ll look at:

• What You Need To Know Before Training Clients With Diabetes
• 7 Tips For Working With Clients With Diabetes
• Skills To Prioritise When Working With Clients With Diabetes

Before we get onto our tips and advice, the best way you can develop your knowledge to provide greater care for clients is by completing our Level 4 Nutrition Qualification!

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What You Need To Know Before Training Clients With Diabetes

Before you make money as a personal trainer by helping diabetic clients, it's important to understand it.

According to diabetes.org, 3.9 million people have been diagnosed with diabetes in the UK. This means you’re likely to train some clients with either Type 1 or Type 2 diabetes.

With this in mind, it’s important to know the signs of when a diabetic personal trainer clients blood sugar level becomes too low or too high and how you can help them manage their condition.

But before we begin, here’s a quick explanation of the terminology we will be using throughout this article:

High Blood Sugar in Personal Training Clients With Diabetes

A high blood sugar level (hyperglycemia) is a common issue for people with Type 1 and Type 2 diabetes. This means there’s too much sugar in the blood because the body lacks the insulin required to regulate it.

If a diabetic personal trainer client has been deprived of insulin for 12-48 hours, their blood sugar levels can be aggravated by exercise.

This is why, as a personal trainer specialising in diabetes, it’s important to always have clients take blood sugar readings before a session to determine the safe level of exercise they can do.

After examining a client’s blood sugar readings and using your judgement as a personal trainer specialising in diabetes, you can decide on the intensity of the training.

Although those with diabetes may have an individual blood glucose target, blood sugar levels are usually considered ‘high’ when they’re above 160 mg/dL.

Strenuous physical activity, combined with low levels of insulin, promotes the production of other hormones. This means blood sugar is elevated rather than lowered as these substances cause the liver to release more glucose into the blood, often the case after a high-intensity workout.

If a client is at risk of their blood sugar rising too high, you should adapt training to avoid this and lower the intensity of your planned workout.

Low Blood Sugar in Personal Training Clients With Diabetes

Hypoglycemia is the opposite of this, when blood sugar levels fall dangerously low. Blood sugar is considered low when it falls below 70 mg/dL.

It can often be worsened during or after exercise when there’s a shortage of insulin.

If someone relies on insulin, physical activity may lead to serious hypoglycemia if their carbohydrate intake or medicine dosage isn’t altered to suit the intensity of the exercise. 

Those with Type 2 diabetes are at a slightly higher risk of experiencing hypoglycemia during or after exercise. However, this isn’t to the extent of those who rely on insulin treatments.

As a personal trainer specialising in diabetes, you can help clients treat low blood sugar during sessions by using the 15-15 rule.

The steps to this are as follows:

• Have them check their blood sugar
• If it’s lower than 100 mg/dL, give them 15 grams of carbohydrates to raise it
• After 15 minutes, check their blood sugar again
• If it’s still below 100 mg/dL, repeat the process until it’s above this number

This process allows you to help clients continue their workout while ensuring their condition isn’t worsened.

Key Warning Signs To Look For In Your Diabetic Clients

While symptoms vary between Type 1 and Type 2 diabetics, some common signs of high or dangerously low blood sugar you should look out for in your clients are:

These symptoms may be a sign your client is experiencing either hyperglycemia or hypoglycemia and are at risk of their condition worsening.

However, not every client will experience all of these symptoms! These will vary in levels of severity and frequency between individuals.

This is why it’s important to be attentive when personal training clients with diabetes as immediate treatment for these symptoms reduces the risk of more serious ones developing.

7 Tips For Working With Clients With Diabetes

When you have personal training clients with diabetes, it’s important to do what you can to help them manage their condition both during and outside of sessions. Here are some tips to help you do exactly that.

#1 - Understand the Meaning of Different Blood Sugar Levels

According to the NHS, 90% of adults with diabetes in the UK have Type 2, meaning it’s far more common than Type 1 diabetes.

As a personal trainer specialising in diabetes, you should have some basic knowledge about the differences between the two conditions and what these different blood sugar levels mean.

It’s crucial you understand the numbers when checking blood sugar levels to know what is and isn’t safe. 

Knowing when blood sugar is low, high, or moderate means you can structure a workout around this and avoid worsening a client’s situation.

For instance, if a client measures their blood sugar before a session and tells you it’s 4.3 mmol/L (77 mg/dL), you need to understand why this needs to be monitored during training.

If you make them engage in high-intensity exercise, they may quickly fall into the low blood sugar or hypoglycemic range. Understanding the importance of these readings is crucial for structuring training to fit their needs and avoid any potentially dangerous situations.

#2 - Monitor Client Blood Sugar Levels

Keeping track of blood sugar levels before, during, and after exercise is necessary to help ensure clients avoid any complications. 

For those without diabetes, the body breaks down stored glycogen for energy, and muscle cells become more receptive to glucose (blood sugar).

However, for those with diabetes, the ability to utilise glucose effectively is reduced which can lead to extreme blood-sugar responses to exercise. 

With high-intensity exercise, the liver may break down glycogen much faster than the muscles can uptake it, causing a sharp increase in blood sugar levels, or hyperglycemia.

In some cases, this may also result in blood glucose levels falling too quickly. This can put clients at risk of hypoglycemia, or low blood sugar.

It should be mentioned that a normal blood sugar level is anything less than 140 mg/dL (7.8 mmol/L). If blood glucose levels fall below 100 mg/dL or rise above 300 mg/dL (or 250 mg/dL with ketones), exercise should be postponed or stopped.

Monitoring these levels can help avoid potentially dangerous scenarios. 

As hypoglycemia can occur as a result of the body’s increased insensitivity to insulin, clients should also be reminded to pay attention to their blood sugar levels in the period of time after completing exercise.

You should ensure clients stay hydrated both during and after training as dehydration can negatively affect blood glucose levels. It may also be a good idea to have clients monitor their blood sugar levels through apps or software.

Free apps such as Glucose Buddy and Diabetes Connect are great ways for your clients to keep track of their blood sugar levels. 

Having this information on their phone also makes it easier for you to keep track of any fluctuations. Clients are also a lot less likely to forget to bring their phone to a session like they may do with a notebook.

#3 - Track Changes In Clients Mood & Energy Levels

As exercise can increase insulin sensitivity, this makes it great for fighting Type 2 diabetes both in the present and long-term, meaning it can bring positive changes your clients should keep track of.

One of the first things you should do when working with a personal training client with diabetes is ensure they track and record physical and mental changes, such as their blood sugar levels and mood.

Having a visual record of these changes can be great for maintaining client motivation and positivity for those who feel they can only rely on their medication to manage their diabetes.

This is also a good way to ensure clients stick to their exercise routines. Seeing the changes and effects of exercise on blood sugar can give them the motivation to continue training to experience these effects.

Noticing both the physical and mental benefits of exercise after sessions is ideal for ensuring clients continue their training.

If changes happen slowly, this means they will notice a positive yet gradual difference and can see the clear benefits of working with their personal trainer. 

To track these potentially positive changes, you should ask them to log their blood sugar levels both before a session and after to better understand the effect of exercise on their body. With cooperation from your client, you could also track this yourself.

This ensures you both know how exactly your client is managing their condition and can plan sessions slightly ahead of time when a client’s blood sugar levels might be higher or significantly lower.

#4 - Diversify Your Workouts For Clients With Diabetes

Improving cardiorespiratory endurance makes it easier to perform daily tasks and can lower the risk of heart disease and strokes - ideal for clients with diabetes!

Some cardiorespiratory exercises include:

• Long Distance Running 
• Cycling
• Swimming 
• Jumping Rope

While cardiorespiratory exercises are great when personal training clients with diabetes, other forms of exercise can be just as effective, if not more!

However, the benefits of strength training (or resistance training) shouldn’t be ignored either.

Both the American Diabetes Association and the American College of Sports Medicine recommend clients with Type 2 diabetes perform resistance training up to three times a week, focusing on all major muscle groups.

Strength training increases the muscles’ sensitivity to insulin, allowing them to take in more glucose. Further improvements in glucose uptake can also occur with resistance training as a result of increased muscle mass.

This is why when personal training clients with diabetes, you should include resistance training in your session plans to help with blood sugar control.

These exercises don’t have to be anything too strenuous, they could be at the beginning of a session. 

Strength training can involve simple exercises without the need for equipment, such as:

• Squats
• Push ups
• Sit ups

As these exercises don't require the best gym machines, you can encourage diabetic personal trainer clients to perform them outside of sessions, too. 

#5 - Promote After Meal Activity For Diabetic Clients

According to scientific research, small amounts of exercise up to half an hour after a meal may be effective for managing blood sugar. 

A further study also found post-meal exercise is more effective than longer, one-time daily exercise for controlling glycemia in patients with Type 2 Diabetes.

The results were that a moderate-intensity brisk walk for 15 minutes after a meal was more beneficial in helping control blood glucose instead of a 45 minute walk. 

Shorter bursts of exercise were more effective than longer forms, especially after dinner when large amounts of carbohydrates had been consumed.

When working with clients who have Type 1 or Type 2 diabetes, you should encourage them to engage in some post-meal activity.

However, this doesn’t have to be anything strenuous! A simple 10 minute walk can help keep blood glucose levels in check.

To ensure your personal training clients with diabetes are doing everything they can to help themselves, you can send text message reminders after meal times. 

However, it’s best to avoid doing this daily after every single meal time. Clients may feel pressured or become irritated by feeling they’re constantly reminded of their condition. 

All it should take is a few occasional reminders to establish this activity as part of their routine.

- - - - 

If you have a passion for personal training clients with diabetes, here’s some articles to help you expand into another niche and why you should find one:

• How To Find Your Personal Trainer Niche
• 9 Tips for Personal Training Overweight Clients
• How To Make Money As A Personal Trainer

#6 - Always Address Nutrition For Clients With Diabetes

Now, you don’t have to become a nutritionist or dietitian to understand the basic needs of your clients. 

Many trainers are wary about giving nutrition advice to clients as they’re not dietitians, but it’s important to combine the two things to help improve their blood sugar levels.

Nutrition is crucial in the management of diabetes. It’s important to find the right balance of food groups such as:

• Protein
• Carbohydrates
• Fat 
• Fibre
• Vitamins & Minerals

This can help the body remain in prime condition as well as keep those with diabetes living a healthy lifestyle.

Conditions that can lead to further health issues such as cardiovascular disease include:

• Uncontrolled diabetes
• Obesity
• High-blood pressure

Combining these issues with a poor diet that is high in salt and fat will lead to a deterioration in health over time, especially for those with diabetes.

While you may be tempted to give formal nutritional advice to your diabetic clients, you’re not legally allowed to do this if you’re unqualified. 

If a client follows a specific meal plan you’ve prescribed to them to help alleviate a medical condition and problems arise as a result, this can result in legal issues for you. Only registered dietitians can diagnose health problems and prescribe dietary advice for treatment. 

The differences between a nutritionist and a dietician are that while they’re both considered experts in food and nutrition, dieticians have higher education qualifications and often find employment in the medical field.

However, you can improve your own knowledge of the relationship between exercise and diet by completing a Level 4 Sports Nutrition Course.

To avoid overstepping legal boundaries by giving specific advice, you should direct clients to relevant government websites such as Diabetes UK or the NHS website for more information.

You may decide to work alongside a qualified dietitian to ensure you get accurate workout plans you can combine with your clients diet as this will inform your own recommendations.

For example, if you know they may be having a high-carb meal before a session you can adjust your training accordingly to how their body will react to the level of exercise.

#7 - Familiarise Yourself With Client Medication

There are many kinds of diabetes medications that manage the condition in different ways. 

You should assure any personal trainer clients with diabetes that not all treatments will work for everyone so they shouldn’t worry if they have to stop or change medications.

Some common medications clients may take include:

• Metformin: Often the first medication prescribed for Type 2 diabetes if lifestyle changes alone aren’t enough to manage blood sugar levels.
• Sulphonylureas: This medication works by stimulating cells in the pancreas to make more insulin. They also help insulin work more effectively in the body.
• Acarbose (Glucobay): Slows down starchy food absorption after a meal, meaning blood sugar levels won’t rise as fast.
• Pioglitazone (Actos): Helps your body use natural insulin better and protect the cells in the pancreas so you can produce insulin for longer.

Knowing what medications a client is currently taking and what exactly it’s supposed to do for them can help determine the workout and help you plan sessions more effectively.

For example, if you’re aware a client is taking sulphonylureas, it’s likely they have high blood sugar. This means you can monitor their levels and adjust the intensity of the workout to avoid the risk of their blood sugar rising too high.

Asking a client about their medication yourself shows you're proactive and are helping to control a situation, rather than just responding to it after the client has told you the information themselves.

Creating an open dialogue about what they can do to manage their condition provides them with confidence in your ability and allows you to display your expertise in this area.

Skills To Prioritise When Working With Clients With Diabetes

While the qualities listed below are important skills required to become a personal trainer, they should be prioritised by any personal trainer specialising in diabetes. 

Sessions must be adapted to suit the needs of clients to ensure their condition is being managed effectively.

#1 - Pay Close Attention to Your Clients Needs

This is arguably the most important skill for a personal trainer specialising in diabetes to have.

You must be able to pay close attention to your clients, ensuring they are managing your workouts successfully.

A client's safety should always be your main priority. However, you may find some clients don’t show or won’t tell you when they’re struggling. This is why it’s important to not only be attentive but also perceptive!

If you sense a client is finding a workout difficult, or is possibly showing symptoms of hypoglycemia or hyperglycemia, stop the session.

Although we’ve mentioned symptoms earlier, common ones for hypoglycemia include:

• Dizziness
• Headache
• Difficulty concentrating
• Looking pale

Symptoms of hyperglycemia include:

• Blurred vision
• Fruity-smelling breath
• Confusion
• Abdominal pain 

While it’s good to challenge clients and push them further than they may initially think they can go, you must also be aware of their limitations. You should never push a client beyond their limits just to prove a point.

If a client is paying you to train them, they should have your full attention. You shouldn’t spend sessions glued to your phone or constantly leave them to speak to other people around the gym, especially if your client is using equipment.

You’re more likely to miss signs or details of your diabetic personal trainer clients which can lead to potentially dangerous situations. While you should treat all personal training clients the same, some do require more care than others.

If someone has paid for an hour of your time, give them what they deserve - your full attention.

#2 - Adapt Workouts For Clients With Diabetes

As a personal trainer specialising in clients with diabetes, you need to be skillful at adapting your training to suit each individual. 

In this situation, what works for one client may not work for another, meaning each session must be tailored to the needs of the individual client.

As mentioned above, this may mean implementing more cardiorespiratory exercise or strength training when working with diabetics as a personal trainer.

This may differ slightly from workouts with other clients, meaning you need to be skilful at tailoring specialised sessions.

Every client is different but recognising this is even more important when it comes to a personal trainer specialising in clients with diabetes. Sessions may differ greatly depending on how a client is managing their condition.

If a client takes a reading of their blood sugar level and it’s on the verge of either rising too high or falling too low, the session must be adjusted accordingly to avoid worsening hypoglycemia or hyperglycemia symptoms. 

This is different for everybody which is why it’s important to take these readings at the beginning of a workout.

This may also mean having to change up a session when a particular client arrives, meaning you have to think on your feet and shift to a routine that is safer and more comfortable for them to engage in.

#3 - Communicate Effectively With Clients

This is a basic skill all personal trainers should have, certainly those working with diabetic clients! 

Not only is it essential for building a positive and trusting relationship, it’s important for ensuring clients don’t injure themselves.

Communication isn’t just about words either. A lot can be conveyed through body language, meaning clear and confident communication is crucial. 

Make sure to look a client in the eyes when speaking to them and refrain from crossing your arms or constantly staring at the ground.

Communicating effectively with personal training clients with diabetes isn’t just about speaking clearly or looking engaged but also involves actively listening to them! 

This means paying attention after recording their blood sugar level to ensure you provide a successful workout.

You must listen to any concerns or issues they raise during your sessions and act accordingly. The worst thing you can do is constantly interrupt them or disregard what they’re saying.

You shouldn’t limit your communication to in-person meetings either. Other ways to communicate outside of sessions include:

• Phone calls
• Emails
• Text messages 

As mentioned earlier, this is important for sending reminders to clients regarding the promotion of post-meal activity.

It can also promote a more open dialogue, and allow clients to voice any concerns they might have before a session.

#4 - Use Critical Thinking to Form Judgements

This kind of thinking involves:

• Questioning
• Analysing
• Evaluating
• Making reliable judgements based on reliable information

It allows you to break down a problem or piece of information, interpret what it means, and use this information to make a judgement or decision.

By analysing and evaluating issues in order to form judgements, this will make you a great personal trainer specialising in diabetes! 

If your client has Type 1 or Type 2 diabetes, as a personal trainer you can decide on the best workout session for your client to help them reach their fitness goals while prioritising their safety.

Using critical thinking skills are crucial for you to tailor a workout around a client's needs. If a client provides a blood sugar level reading that’s too low or too high, you need to make a reliable judgement on the necessary course of action.

You’ll need to use your critical thinking skills to deduce whether a client is exhibiting any symptoms of hypoglycemia or hyperglycemia and use this information to determine the intensity of the session.

#5 - Be Patient With Diabetic Clients

Being patient is a major skill for a personal trainer specialising in diabetes. As they require slightly more attention and care, you’ll have to adjust your attitude to fit with a less intense session. 

If clients begin showing symptoms of either hypoglycemia or hyperglycemia, it’s likely you’ll have to reduce the intensity of training, or stop it entirely if symptoms are severe. This is where patience is key as you must keep in mind that this isn’t their fault. 

Blood sugar levels often impact how those with diabetes feel and can contribute to mood swings. This can result in low moods, meaning certain clients may find it difficult to motivate themselves for a session. 

You’ll need to be able to motivate your personal training clients and help them continue towards their goals. Of course, this is only if they are healthy enough to complete your workout.

Blood sugars of varying levels may also restrict what exercises can be done, such as avoiding anything too intense if a client's blood sugar is in danger of rising too high. This means changing the workout you’ve already planned, likely just before the session.

If a client is exhibiting early signs of hyperglycemia, they’re likely to be dehydrated and will require frequent water breaks. While continuously stopping and starting workouts can be frustrating, you must keep in mind this is necessary for them to continue with training.

Similarly, clients with low blood sugar levels may have to stop during a workout to complete processes such as the 15-15 rule mentioned earlier. This may mean stopping for 15 minutes or longer to ensure their blood sugar returns to a safe level above 100 mg/dL.

At the end of the day, it’s up to you to ensure you’re equipped with the right knowledge to determine the kind of workout a client needs so they avoid any dangerous situations and don’t have to stop their sessions.

Before You Go!

Now you know everything about personal training clients with diabetes, it’s time to get out there and put your knowledge into practice!

With our Level 4 Nutrition Qualification, you’ll be well on your way to changing the lives of many clients by improving their diet. Simply download our full course prospectus to learn more!

Sources:

1. Reynolds, A.N; Venn, Bernard J., ‘The Timing of Activity after Eating Affects the Glycaemic Response of Healthy Adults: A Randomised Controlled Trial’ in Nutrients, (November 2018, Vol. 10, No. 11), doi: 10.3390/nu10111743
2. Pahra, Daizy et.al, ‘Impact of Post-Meal and One-Time Daily Exercise in Patient With Type 2 Diabetes Mellitus: A Randomised Crossover Study’ in Diabetology & Metabolic Syndrome, (August 2017, Vol. 9, No. 64), doi: 10.1186/s13098-017-0263-8
3. American College Sports Medicine; American Diabetes Association, ‘Exercise & Type 2 Diabetes’ in Medicine & Science in Sports & Exercise (Vol.42, Issue 12) 2282-2303, doi: 10.1249/MSS.0b013e3181eeb61c