Playing Pickleball With Diabetes
How pickleball moves your blood sugar, and how to stay safe on court, something even the pros are still working out.
If you play pickleball with Type 1 diabetes, the game rarely leaves your blood sugar where it found it. Steady aerobic movement often lowers glucose, while intense bursts and competitive stress can raise it. Pickleball can complicate planning: it is stop-and-start, it is social enough that a quick session turns into two hours, and a tournament day can stretch across long, unpredictable waits between matches. Responses differ from player to player and day to day, and a high during a game can be followed by a low hours later. The aim isn’t to flatten that movement but to see it coming and plan around it. The practical questions are the same at every level: how much to play, when to stop, and what to do when your body doesn’t respond as expected.
Even the best players live this. In March 2025, after reaching her first singles final of the year, pro Lea Jansen described what the previous months had cost her. “Over the past six months, I’ve been going down these doctor’s office rabbit holes,” she said. “Right before Mesa, I finally got a diagnosis. There’s something neurologically wrong because I’ve been so mismanaged with my diabetes.” The report didn’t identify a specific neurological diagnosis or independently establish its cause. She said she had been referred to a new doctor and felt she was no longer “freezing” on court, and she also credited a new singles coach with improving her forehand.
What follows is general guidance, mainly for adults with Type 1, drawing on the ADA Standards of Care 2026, Diabetes UK, and exercise-specific position statements. Children and people using automated insulin delivery need age- and system-specific plans. This is general guidance, not a medical plan for any one person. Work any change to your insulin, food, targets, or play out with your diabetes care team.
Before and During Play
A casual doubles game, a hard singles match, and a tournament day of long waits make different demands. Learn how your glucose responds to the pickleball you actually play, plan food for long waits with your diabetes team, and carry a separate supply of fast-acting carbohydrate for lows. Check before you play, between games, and after. The 2026 ADA Standards urge a continuous glucose monitor for anyone on insulin, and how often to check is for your care team to set. A CGM measures glucose in the fluid between cells, so readings can lag behind blood glucose during exercise, especially when levels change quickly; the 2020 EASD/ISPAD statement describes delays that vary by device and conditions. If how you feel doesn’t match the number, confirm with a fingerstick, but never delay treating a suspected low.
A pre-play snack is a starting point, not a green light. The ADA suggests about 15 grams of carbohydrate if glucose is below 100 mg/dL (5.6 mmol/L) before activity, especially if you took insulin recently and will play for longer than 30 minutes; it may reduce the risk of a low but does not guarantee you are safe to play. Outdoor heat adds its own twist: it can shift glucose either way, damage insulin left in a hot bag, and loosen a sensor with sweat. Drink water, take cooling breaks in the shade, and ease off or skip play in the hottest conditions. Heat illness and a low can cause overlapping symptoms, including dizziness, sweating and confusion. Stop play, move somewhere cool and check glucose promptly; do not delay treating a suspected low. Confusion, collapse or suspected heat stroke needs emergency help and immediate cooling, whatever the glucose reading. Protect insulin, meters and strips from heat according to their storage instructions, without putting insulin directly against ice or a frozen gel pack.
When Your Glucose Swings
Don’t try to play a low away. If your glucose is below 70 mg/dL (3.9 mmol/L), or you suspect a low and can’t check promptly, stop play. If you are alert and can swallow safely, take 15 grams of fast-acting carbohydrate, preferably glucose, unless your plan says otherwise; fatty foods such as chocolate act more slowly. Recheck after 15 minutes and repeat if you are still below 70.
Don’t restart until your symptoms have resolved and glucose has recovered to the exercise-safe range you agreed with your care team and is stable or rising; a rising number alone isn’t an automatic green light, and you may need more food depending on active insulin and further play. If sensor or blood glucose falls below 54 mg/dL (3.0 mmol/L), the 2020 EASD/ISPAD exercise guidance says not to resume that session; review the episode and your exercise plan with your diabetes team. If confusion or other impairment means you need help treating a low, treat it as a severe low. People using automated insulin delivery may sometimes need less carbohydrate to treat a low, but exercise-related lows can need more, so agree the amount with your team rather than automatically using a smaller dose.
A severe low is an emergency. If someone cannot swallow safely, is unconscious, or has a seizure, give nothing by mouth, use prescribed emergency glucagon if it is on hand, and call 911. The ADA’s 2026 Standards say anyone using insulin should have a glucagon prescription, with ready-to-use forms like a nasal spray or autoinjector preferred. Make sure the people you play with know where it is and how to use it. Any severe low should prompt a review of your treatment plan with your diabetes team.
Highs cut the other way. Treat a high by your plan, not by playing harder. At about 250 mg/dL (13.9 mmol/L) or higher, check ketones and follow your high-glucose plan. If ketones are negative and you feel well, light to moderate play may be fine depending on your individual plan, but hold off on intense play until you are back below 250; avoid vigorous exercise with elevated ketones, and don’t exercise at all with moderate-to-large ketones. Pump users should follow their pump-failure plan, including checking the infusion set. DKA can develop below 250 mg/dL, so check ketones whenever you are unwell or have symptoms, whatever the reading. DKA, a buildup of ketones when insulin runs short, can show as nausea or vomiting, stomach pain, extreme thirst, frequent urination, unusual fatigue, deep or rapid breathing, fruity breath, or confusion. Contact your diabetes team promptly for elevated ketones and follow your ketone plan; suspected DKA (especially vomiting with ketones, difficulty breathing, confusion, or being unable to keep fluids down) needs emergency care, so call 911 for severe symptoms.
After the Final Point
The work isn’t over when the last rally is. Delayed lows can occur overnight and into the next day, and the risk can sometimes last longer, so follow your post-exercise monitoring plan, especially after long or unusually hard sessions. Tell a regular partner, and the tournament desk at events, that you have Type 1 and what helps; because irritability can itself signal a low, agree that if you seem off, a partner checks in and follows your plan. Keep fast-acting carbohydrate such as glucose tablets or gel, a blood glucose meter with strips (even if you use a CGM), and your prescribed emergency supplies in your bag every time.
What One Pro Has Learned
Jansen’s road to that point was long and public. She was diagnosed at 23, she has said, after an unexpected bout of ketoacidosis. In a January 2022 interview, she described rarely monitoring her glucose in her early years in the sport and sometimes leaving court with readings of 400 mg/dL (about 22 mmol/L), and she recalled “kind of” collapsing at a tournament before she grasped how serious it was.
Deciding how much to play was hard, too. In July 2023, she announced she was stepping away from singles on medical advice, describing continuing as “detrimental to my health”; she returned to singles in January 2024. On the PicklePod podcast in 2024, she compared singles to “that ex-boyfriend that you really loved, but was not good for you.”
Her experience points to the same habits this guidance comes down to: check often, plan for the swings, and know your own line for when to stop. Those habits can reduce risk and keep you playing, but even careful management sometimes means sitting out. Stopping when you need to is part of playing safely, not a failure to manage the condition.