Can you train a type 2 diabetic w/out medical clearance???

A client tells you they have diabetes, hands you their card, signs up for training and then refuses to get medical clearance. Do you keep the money and train them anyway, or do you draw a hard line and risk the refund? We walk through the real decision personal trainers face when safety, ethics, and liability collide, including why “it depends” really means “it depends on your documentation and your preparedness.” 

We break down the types of diabetes (type 1, type 2, and gestational) and what personal trainers are most likely to see in the gym. From there we get practical about diabetes and exercise: how full body strength training can drive glucose into working muscles, how blood glucose can drop into a hypoglycemic state, and what the warning signs can look like in real time. We also cover what actually helps in an emergency, why fast sugar wins, and why solid foods can create a choking risk when someone is woozy or fading. 

Then we zoom out to the professional standard of care: medical clearance, assessment, ACSM style risk stratification, and why a history like a prior heart attack changes everything. We also talk trainer insurance, what happens when things go to court, and how to turn clearance into a networking advantage by building a real relationship with a client’s doctor. 

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Transcript

Should You Train Diabetes Clients?

Diabetes Types And What Matters

Hypoglycemia Risks During Workouts

Refund Story And Legal Liability

Insurance And Worst Case Protection

Real Hypoglycemia Scare In A Lab

High Risk Screening And Doctor Networking

Wrap Up And Listener Callouts

SPEAKER_00 0:01

Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showufffitness.com. Also make sure to check out my book, How to Become a Successful Personal Trainer. Don't forget to subscribe, rate, and review. Have a great day and keep showing up. Howdy, y'all. Welcome back to the Show Up Fitness Podcast. Today we're going to be talking about diabetes. Can you train a client who has diabetes, but you do not have medical clearance? And the answer: it depends. As always, sure, you could take them through a workout. They go hypoglycemic, they fall, they hit the mirror, piece of glass goes under the carotid artery, they die, you go to jail. How does that sound? That's extreme, I know. But I like going through these worst-case scenarios, as I call them the final destination games, because that could technically happen. You need medical clearance. And it can be very challenging, especially if the client doesn't believe in the medical establishment. And this is a podcast addressed today with one of our SUF CPTs, Miss Simone. And she had this exact situation occur, not falling into the mirror and hurting themselves, but the client asked for a refund because she was not willing to train him without medical clearance. I got to give you kudos, Simone, because that takes a lot of guts, but you're looking out for your client's best interest. And I know our finances can take a hit from that, and that can be really challenging, but you have to think about those worst-case scenarios. And that is something that could absolutely happen. So let's talk about this a little bit. There's three types of diabetes. Type one, which is more onset genetic. You usually get that under age of 10. And then type two, about 90 to 95% of the cases, that's what's referred to as insulin resistant because the pancreas is producing insulin, but the body's not recognizing it. And that's typically from lack of sleep, stress, diet, exercise, lack of exercise, a lot more common. And that is 100% reversible. Whereas type one, insulin dependent, you need to take a shot. That is something that you cannot reverse. And then the last one, which deals with pregnancy, gestational diabetes, you put on way too much weight in a short period of time, and it can be very problematic for the kid. Most of the time, what we're going to see is type two. If you have someone who's type one, they're usually a little skinnier. I think of my one of my boy crushes back in the day, Adam Morrison on Gonzaga. He was a type one diabetic. He'll be taking shots at timeouts. That is not as common, and you're probably not going to see a lot of those clients. But if you were, you still need medical clearance. You reach out to the doc, they say it's okay to exercise. Here are some counterindications. You have that on record. And then you make sure you're prepared every single session. And it's the same for type two. If someone comes in, they are type two diabetic and it's been diagnosed. You need medical clearance just because the client could be doing their own route and they could be exercising and doing whatever they think is right because they don't believe in medication. And if they were to have an episode, maybe they come in, they forget to tell you that they ate. And you go through a full body workout, you're pushing, you're pulling, you're squatting, you're hinging. The muscles are taking in a lot of glucose. So then you go hypoglycemic, hypo lack of GLY glide, that's glucose, semias in the blood. So your blood glucose levels drop significantly, and now you're prone to having a seizure. So the last thing you'd ever want to do is take a client through a workout not prepared or not knowing. And then this happens. It's very, very scary. And that's why one, I always suggest to have glucose tablets. In this case, I would ask the client, what's something that I could bring into every single session for a worst-case scenario? Is it a soda? Is it apple juice, Gatorade, whatever it may be? If it were to happen, I'm going to be prepared. The glucose tablets are nice, but they don't give you a ton, meaning you'd have to pop in like 10 to 15 if you were to be in that hypoglycemic state. The glucose tablets are nice because when you start getting a little woozy, you take two of them and it'll bring you right back to life. And it's good for all your clients. I think it's just something that trainers should keep in their little packet or their belt buckle, whatever, because when in doubt, you have that, that's a worst case scenario. But for a diabetic specifically, I'd want to have a backup stash of soda or something that has a lot of sugar, not protein, not an apple. Takes too long to digest. You have a cool little gland under your tongue, the sublingual gland. And so if you take that glucose tablet or soda or apple juice and you swirl it in your mouth, it's going to get into your bloodstream automatically. Whereas if you were to have a protein shake, water obviously doesn't have any calories. Or if you have an apple, it takes a lot longer to digest. And chewing when you're in that state can be problematic. You give someone a cliff bar, they start chewing, and then all of a sudden they pass out. Now you have to deal with choking as well as being hypoglycemic. So what happened in this specific situation is a client came in, went through an assessment, signed up for training. So there was an exchange in money. Gave her his credit card. She filled it out and did everything. She got the transaction, way to go, got really excited. But then she followed up and said, I need medical clearance. The client said, I'm not willing to do that because I don't want, I don't like the medical establishment dealing with Kaiser, it's just a big headache. I don't want to do it. And so she kind of pushed, not in a negative way by any means, rightfully so. She said, Well, I can't train you unless I get that. And he kind of threw a fit and ultimately wanted a refund for the training. And that could be really tough because again, you're thinking of the money, you want to help this client, you know exercise is the best thing, but without that medical clearance, you're now liable. And that's negligent. Because if the client were to have an episode and it goes to a court of law, they're going to say, show us your medical records. Show us the records that the doctor said it's okay to exercise. Oh, well, um, uh, the doctor said that they should. Where's your clearance? Oh, you don't have that? Okay, let's take a look at your insurance. Oh, oh, I forgot to, I don't have any insurance. I forgot to get it. Well, have fun with that one. The lawyers are gonna be smiling because this is gonna be a great opportunity for them to make a lot of money off of you. Negligence times two. You are a quote unquote certified personal trainer with whatever stupid cert that you have in your bio, and you hurt someone and you didn't get medical clearance, the lawyers are gonna be licking their chops at that one. So you need to look out for your client's best interest, which she was doing, but you also need to look out for worst case scenario for yourself. If you go to our website, shellfitness.com, you can get insure, which is the insurance group that we use. You get 20% off. I think it's like 180, 150 for the entire year. This is something that trainers should have. And I'd be willing to bet a lot of trainers don't. And also, think about if you're working for an Equinox or a lifetime or crunch and something were to happen, yeah, they're gonna go after that big brand, but it's gonna be very easy for that brand just to cut you loose if something were to happen. And now you don't have insurance for that case. That's just something that trainers should absolutely have. It's like car insurance. I was coming out of Equinox about six months ago, and in Santa Monica, there's a ramp. And so when you get to the top of it and you can't really look over, especially if you have a big truck like I do. And I bumped into some fucking stupid Porsche and I barely even scratched. My car was perfectly fine, but I barely even scratched it. But it hit one of these expensive lights, it cost$25,000 to fix. Do I need insurance to drive? Yeah, you technically do, but if I didn't renew it, that's$25,000 out of my pocket. So that's the nice thing about insurance is it protects you in those worst-case scenarios. That's why it's important to have insurance as a trainer for these worst-case scenarios. So, what happens is client comes in and they could be feeling okay. They could tell you, oh, yeah, I ate, but what did they really eat? Maybe they had some eggs or they had a protein shake. So their blood sugar levels are just moderate, and then they start exercising. And you do a push, so pec major, triceps, anterior deltoid, you do a pull, your lats, your biceps, you do a squat, quads, glutes, you do a hinge, erectors, hammies, adductors. They're just soaking up a ton of glucose for the work to be done. So your blood sugar levels drop significantly, and that's where you get that hypoglycemic state. So, at more times than not, what's going to happen is it's not gonna be that first session. It's gonna be later down the line when they forget to tell you or you forget to ask and something happens. So you have that medical clearance, but you're prepared with your drink, your Gatorade, but has a lot of sugar. I don't want no zero calorie Gatorade. I want to have something that has sugar, glucose, so it can get into the bloodstream and revive them. I would be willing to bet most trainers have been presented with some type of hypoglycemic state, and it's not even diabetics. It's just a client who comes in and they're not used to exercising, so their heart's pumping a bunch and a lot of glucose is being extrapolated from the blood, and they get that wooziness, they get the shaking, your eyes can start shaking a little bit. It's a scary situation. I had one when I was teaching at MPTI probably 15 years ago. So, as a teacher, we have our labs and we go out there and exercise. The student came in a little late, so we went over everything, make sure that you ate and everything. And he just got back from uh a trip to I think it was in Florida or something, and he went scuba diving within 24 hours, which they tell you not to fly, I believe, but you're not supposed to exercise when you go scuba diving because the whole it just messes with your whole system. And he went through a workout, he didn't eat, and he was a big boy, like 260 pounds, and it went through a push-pull, and within like 15 minutes, I looked over, he was on the ground sitting there, and his eyes were fluttering. And I was talking to him, he could barely communicate. So, we uh the all we had right there is a student gave him as a cliff bar and he started chewing it and then he started nodding his head. I'm like, Oh shit, like spit that out. We got to get you some Gatorade. So he pounded a Gatorade, and then when he felt a little better, then he had the cliff bar. But like again, that case, it could have been really, really bad because the student could have choked. And it took him about 30 to 45 minutes to kind of revive himself. I would ask him questions and he was just kind of slurring his speech like he was drunk. That's what you get when your blood sugar levels get really, really low. And so that's a scary situation. If you're not proactive, or even worst case, the student or the client walks into the bathroom, which is very common to do because they're insecure. They feel like, oh, I don't want to be weak and I don't want to tell anyone what's going on. So they walk into the bathroom, they don't have anything. So then they pass out, they hit their head on the toilet. That's that final destination situation that could happen. So you want to prepare for these events. Worst case, have a liquid. The chews are nice just because they're gonna get in there very quickly. And that's why I started using the chews because of that incident. I looked at you know, the best ways to get glucose into someone's system if they're having a hypoglycemic effect, like this was happening at the student. And that's where glucose tablets came up. And there's a nurse I was talking to, and they said, Oh, yeah, those are great. Swirl in your mouth because then it's gonna get to the bloodstream a lot faster. So you don't want that situation to happen to a diabetic because it'll be even worse. The symptoms will kick in a lot faster because of their metabolic disease. When you review the ACSM risk stratification for cornear artery disease, a red flag, high risk, where you have to refer out metabolic disease, pulmonary disease, cardiac disease, and or any symptoms of corneal artery disease, which will be tachycardia, chest pain, and so forth. This client of hers had a heart attack two years ago. So, again, that's why it's so important to assess. And I cannot give you enough credit, Simone, because you did exactly what you're supposed to do. And it's one of those times where it's like you did what's right, but you almost feel like it's wrong because you lost out on the opportunity to potentially help that person because they got a refund. And now who knows? They could be working with a trainer who doesn't know what they're doing, but took them on, they didn't assess them, and the client could get in significantly better shape. Oh, this trainer's the best. I had diabetes, and all of a sudden they helped me reverse it. That's crazy because that's one anecdote, and they were just lucky, they missed a bullet. So that's what really scares me about trainers who don't assess and use that assessed at parkube as a way of really making sure that the workouts that you're gonna be doing with the client are appropriate. And that's why you make sure to ask those questions during the assessment. Because if they had a heart attack, if they have metabolic disease, you need that medical clearance. Take it as an opportunity to network with the doc, let them know you're a qualified trainer, get them in for a workout, comp the session, let them know how much you charge. Hey, doc, normally I'm 150 an hour, but I'm gonna take you through a workout. You show them that you're professional, you get there on time, use great language, show off a little bit. I like to quiz docs on anatomy because a lot of them have forgot about it. Oh, that's right, the core could break your house is one of the 17 muscles. Oh man, I haven't gone over that since I was in med school. And so it shows that you are a competent trainer, talk about blood pressure, do their blood pressure. And more times than not, you're just gonna get a better relationship with that medical professional. I would still reach out to that client's doc and say, he didn't want to reach, he didn't want to get medical clearance, but I want to make sure in the future, if something were to happen that I am prepared, I'd love to take you to lunch. And so then the long game there, the doc sees that you are a professional, you are a medical professional. We're on the same team here. So if future situations come up where a client who does have type two or type one or another type of diabetes, they know that they refer them to you because you're doing your due diligence. So that's a little breakdown on diabetes and why you need medical clearance. Tough situation, Simone, but I'm proud of you because you did what is right. You're a great trainer and you are looking out for your client's best interest. Rule number one do no harm to your clients. And that's exactly what you did. Unfortunate situation, but you did what's right. If you have certain case examples like this or other challenges with injuries or whatever it may be, shoot us over an email at infoshowfitness.com. Throw this into your story. We love those five stars reviews on Spotify, on Apple, all the podcast channels, trying to get into the top 10 of podcasts. And it all begins with you supporting the channel by throwing it in your story and letting the world know where you go to become a qualified personal trainer. And remember, big biceps are better than small ones, and keep showing up.