When personal training diabetic clients, you need to understand the condition, the person, and all possible issues that can arise in a training session with a diabetic person. Here’s what I’ve learned over the years.

Information You Must Know Before You Exercise a Person With Diabetes

Before the first training session, you must know:

  • The medical history of your client
  • The goals of your client
  • Who to call in case something goes wrong
  • Who the client’s doctor is and a contact number for him/her
  • What to do if your diabetic client feels ill
  • What to do if your diabetic client passes out
  • How and when to use a glucagon injection kit (if keeping one on hand is directed by the doctor)
  • How to train a diabetic client as covered in your personal fitness training certification
  • Anything else instructed by the doctor

Type I or Type II Diabetes

There is a difference in training individuals with Type I or Type II diabetes.

A Type I diabetic has been living with the condition their whole life and is a much more “educated” person when it comes to handling the condition. A Type II diabetic is likely to make mistakes and let their blood sugars go awry.

But assume nothing.

You should know how long the Type II diabetic has been a diabetic and fully take the time to understand, for yourself, what brought the condition about and how you can fix it through helping your client with proper diet and exercise.

Does Your Client Really Know What Diabetes Is?

Don’t assume that just because the person has been diagnosed with diabetes, that they have done their homework. I had one client who was a Type II diabetic who walked on the treadmill for 20 minutes and then felt tired. She sat down and I told her to stay there while I get her kit to check her blood sugar to make sure we didn’t get too low. She then said, “Why would it be low?” I said, “Because your body just used the sugar in your blood as energy to walk on the treadmill.”

At that point, I realized that this person, in spite of having the condition for years, didn’t understand the basics of diabetes. It was at that point that we started spending 20 minutes of each exercise session going over the basics of the human body and what this condition actually was.

She didn’t know that the pancreas secreted insulin and didn’t understand what “insulin resistance” meant. We looked at diagrams, I quizzed her, she worked out her own meal plan that had foods low on the glycemic index, and she got brighter and brighter.

As a personal trainer, it is your job to quiz the hell out of your clients to make sure that they understand their medical conditions.

Have anatomy books on hand, personal training books, exercise physiology books, etc. You should have a full bookshelf and, if you’re doing your job, you’ll have tabbies marking your frequented pages.

That is the mark of a trainer who takes responsibility for their clients.

Always Reach Out to the Doctor

With the client’s consent, reach out to their doctor. Whether it is a specialist or a general practitioner, just let them know what you are doing.

This can be a written letter to the doctor, include any questions you may have for them, include a proposed program and an “okay to start a supervised training program” place to sign at the bottom. Add a place at the bottom called “Additional notes:” so that the doctor can write any specific recommendations, modifications, or emergency procedures.

The point is to make it simple for the doctor to fill out. Include your phone number and say that in addition to getting a written okay, that you are open to having a discussion about proper emergency procedures and situations that come up.

Your clients will usually be very receptive to this kind of cooperation between health professionals and you can even offer to go with the client to visit the doctor in person.

Don’t overstep your boundaries, just take responsibility for the client and make sure that you know what the heck to do if they pass out.

When To Check Blood Glucose Levels

Depending on the scenario, you may need to check blood sugar levels before, during and after the exercise session.

I’ve worked with one client with Type I diabetes who checked it several times throughout. This particular client had a stressful job and possibly another medical situation going on that caused their blood sugar levels to fluctuate wildly.

We took no chances. At the minimum, I had them check it before and after the workout session. This also helps make sure that no incidents happen on your watch. We never had to break out the glucagon kit and never had any unmanageable fluctuations in blood sugar levels.

If it is your first client with diabetes, go the extra mile to research the subject in full. Your client will thank you.

Work Out an Emergency Drill

My first diabetic client taught me how to take her blood sugar.

She took me through the steps I would have to take in case she passed out. She said that her blood sugar could be high or low and told me what to do and who to call.

It was also made very clear to me that she would likely be very non-compliant if we ever got to that point.

So, I checked her blood sugar levels over and over until I could practically do it with my eyes closed. Nowadays there are ways you can just pull it up on a smart phone. Back then it was pricking the finger with a needle and taking a blood sample.

I had an emergency glucagon injection kit and some sugary items for her to take when her sugar got too low. Everyone at the gym knew where they were, and they knew not to move them from that specific location.

Watch Your Client’s Indicators

A personal trainer’s most important quality is his/her ability to observe.

You’ve got to be able to spot when your client’s blood sugar levels are off just by watching their indicators.

For example, if their blood sugar is low, they may sweat, start shaking, get angry, or lose their balance. The CDC has a full list of symptoms here.

And while that is a list of what happens when their blood sugar goes low, it may also go high. Various stresses and dietary changes can cause a spike in blood glucose levels. So, just because you’re exercising, don’t assume that it is always going to be low. The client may have had some ice cream just before the exercise session.

Assume nothing. Maintain a high communication level with your client and you won’t be surprised by such things.

Type II Diabetes Can Be Managed Through Proper Diet and Exercise

I have successfully brought multiple clients from a pre-diabetic and diabetic state back into a normal range for their blood glucose levels and A1C.

It is a simple process of education, diet, and exercise.

Every person is different, so don’t think that you can get away with applying some rote formula to your clients. Sometimes it is as easy as educating the person and they end up doing all of the proper dieting for themselves. You just supervise them on the workouts and watch the miracles happen.

Other times it can be difficult. If the person has diabetes and a wild personal life, you may be in for some surprises. These situations need every emergency drill set in stone, a very watchful eye, and regular checks on blood glucose levels.

And even then, you’ll see a person benefit if you give them a good workout.

What if Your Client Doesn’t Know That They Have Diabetes?

There are people who are pre-diabetic and diabetic, but just don’t know it.

Sometimes these individuals will walk into a gym with the purpose of feeling better and they will end up on your lineup. It may not be obvious to you that they have diabetes. You’re just looking at someone who hasn’t worked out in a long time.

This is why gradients are so important. If you’re training a diabetic, it won’t take much physical activity to make their blood glucose levels go low.

I honestly treat new clients with the upmost suspicion. Listen to what they say, but don’t rely on it until you’ve seen them demonstrate it. For example, if a person says that they work out regularly, don’t assume that they can take a full body workout from you and live to tell the tale.

They may just do some light yoga every morning. That is not the same as lifting weights and doing functional exercises.

Keep your eyes on any new clients you pick up because diabetes, among other things, could be present and a disaster could be waiting to happen. It’s always safest to get all of your clients to the doctor for a physical prior to any training program.


Training high risk clients involves much more time, effort, and attention on the part of the personal trainer. But you also get gains that are much, much more than training someone easier.

If you take on these “tough cases” on a regular basis, you will benefit far more in the long run than those who stay away from high-risk clients. By training them, getting good results, and getting experience with diabetic clients, you’ll make yourself more valuable to others with the condition.

By no means is this a comprehensive manual on the subject, but it is a place to start. Get in touch with the doctor, make sure the client is educated and make sure that you are educated.

Approach these situations as a learning opportunity. Take the viewpoint that you, as a personal fitness trainer, should be able to effectively train anyone who walks through that door.

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