Lactate is a key metabolite in cellular respiration, and elevated levels usually indicate tissue hypoxia or metabolic dysregulation. The real-time detection of lactate levels is particularly important in situations such as exercise, shock, severe trauma, and tissue injury. Conventional lactate assays are insufficient to address today’s complex and variable testing environments, and thus, there is an urgent need for highly sensitive biosensors. This review article provides an overview of the concept and composition of electrochemical lactate biosensors, as well as their recent advances. Comparisons of popular studies on enzymatic and non-enzymatic lactate sensors, the surface-related materials used for modifications to electrochemical lactate biosensors, and the detection methods commonly used for sensors are discussed separately. In addition, advances in implantable and non-implantable miniaturized lactate sensors are discussed, emphasizing their application for continuous real-time monitoring. Despite their potential, challenges such as non-specific binding, biomaterial interference, and biorecognition element stability issues remain during practical applications. Future research should aim to improve sensor design, biocompatibility, and integration with advanced signal processing techniques. With continued innovation, lactate sensors are expected to revolutionize personalized medicine, helping clinicians to increase treatment efficiency and improve the experience of their use.