Basal Insulin and a 60-Minute Session

Proceed - with preparation, not casually. 98 mg/dL with basal insulin on board and a meal two hours ago is a workable starting point, but she is on the low side of where you want to begin a long session, and she has documented hypoglycemia in the last month.

Before she starts:

• For someone on insulin, a pre-exercise glucose under roughly 100 mg/dL is a common trigger for 15–20 g of fast-acting carbohydrate before moderate-intensity work. At 98, have her take ~15 g and start the first 10–15 minutes easy.
• Confirm she has fast-acting glucose with her: tablets, gel, or juice, 15–20 g. Know where it is.
• Ask whether she carries a glucagon kit and where it is. You are not going to administer it, but you need to know.

During:

• Recheck glucose at roughly the 30-minute mark on a 60-minute session, and any time she reports symptoms.
• Know the signs: shakiness, sweating, palpitations, hunger, confusion, irritability, slurred speech. Stop the session, treat, recheck in 15 minutes.
• Hydrate; avoid exercising within 1–2 hours of a rapid-acting insulin dose; she should not inject into a limb she is about to train.

After: remind her that glucose can drop for many hours afterward and to check before bed on training days.

Treat "numb sometimes" as possible peripheral neuropathy until a clinician says otherwise. You cannot screen for it; a physician or podiatrist can. Recommend a foot exam and say why.

Practical changes:

• Inspect her feet before and after sessions - skin integrity, blisters, redness, hot spots she cannot feel. Neuropathy means she may not notice friction or pressure injuries until they are advanced.
• Footwear matters more than usual: well-fitting shoes, synthetic moisture-wicking socks, no barefoot training, no worn-out soles.
• Cut high-impact work: no plyometrics, no jumping, no prolonged running or work on hard surfaces early on. Favor cycling, elliptical, rowing, and controlled resistance work. Unnoticed repetitive trauma is the mechanism behind diabetic foot ulcers.
• Avoid extreme heat: hot yoga, hot tubs, and heavy sweating without hydration are poor choices.
• Include balance training. Neuropathy raises fall risk; single-leg work, progressive and supported at first, is protective.
• Prioritize low-impact aerobic volume and resistance training - both improve insulin sensitivity and glycemic control, which is the point.

Her own walking program is fine in principle; make sure she has appropriate shoes and knows to check her feet afterward.

Delayed effect: exercise increases insulin-independent glucose uptake and then depletes muscle glycogen, so glucose can keep falling for many hours - commonly cited as up to 24 hours, and the risk is highest overnight after an evening session and after a new or longer bout. Her low-blood-sugar episode after an evening walk fits that pattern exactly, and it is worth flagging to her physician when she reports it.

Practical rules to teach:

• Check glucose before bed on training days, particularly evening sessions, and follow whatever her physician advises about overnight checks.
• Keep fast-acting carbohydrate within reach at the bedside.
• A post-session snack containing carbohydrate plus protein is reasonable after long or hard sessions, but the specifics are her physician's or diabetes educator's call.
• Log readings around exercise and bring the log to appointments. Insulin dose adjustments are explicitly not yours to make.

15-15 rule: take 15 g of fast-acting carbohydrate - glucose tablets, 4 oz juice or regular soda, 1 tablespoon sugar or honey - wait 15 minutes, recheck. Repeat if still low. Once above 70 mg/dL and stable, eat a snack if the next meal is more than an hour away. Do not resume training until she is stable and above 70.

Also set the boundary: refer to her physician or a diabetes care and education specialist for a full exercise and medication plan, and get that in writing.