Exercise
and Diabetes
by Deborah L.
Mullen, CSCS
NOTE: This article is due for a revision.
Please check American
Diabetes Recomendations before starting a program.
Exercise has the potential to control the diabetes by nonmedical
means, reduce the severity of the disease, and significantly reduce the
risk of long-term complications. This this article will discuss: what is
diabetes, how exercise can help, who can exercise, footcare,
hypoglycemia, precautions, and recommendations on aerobic and strength
training exercise.
What is diabetes
Diabetes mellitus is a condition where the body has trouble taking
glucose from the blood and delivering it to the rest of the body so that
it can be used as energy. This is because of a lack of, or an inability
to use insulin, the hormone required to "escort" glucose from
the blood to cells of the body. There are two common types of diabetes:
Insulin-dependent diabetes mellitus, also known as Type 1.
People who have this cannot produce insulin and must take insulin by
injection. Because the medical concerns and complications, exercise for
the Type 1 diabetic should be medically supervised.
Noninsulin-dependent diabetes mellitus, or Type 2. These
people are "insulin resistant", meaning that they produce
insulin, but it is not effective in escorting the glucose into the
cells. Eighty to ninety percent of the diabetic opulation is Type 2. A
physician will prescribe oral hypoglycemic agents if blood glucose
levels cannot be controlled. As a last resort, a Type 2 diabetic will be
put on insulin, which is likely if they continue with poor lifestyle
choices such as sedentary living, poor eating habits and weight
gain.
How exercise can help
Aerobic exercise increases insulin sensitivity and, along
with proper nutrition, helps restore normal glucose metabolism by
decreasing body fat. Strength training (a.k.a. resistance or weight
training) also decreases body fat by raising the metabolism. It's main
benefit, however, is increasing glucose uptake by the muscles and
enhancing the ability to store glucose. Exercise can mean the difference
between "medical management" and "lifestyle
management" of Type 2 diabetes.
Who can exercise
The American Diabetes Association recommends that anyone with diabetes
have a thorough medical exam to see if there are risks for
coronary artery disease and that blood glucose control is adequate
before starting an exercise program. The doctor will usually advise
exercise if the patient has:
blood glucose less than 250 mg/dl.
no symptoms of retinopathy, (damage to the blood vessels of the eye),
neuropathy (damage to the nerves and circulation to extremities), or
nephropathy (kidney damage)
no cardiovascular problems such as angina, embolism, or aneurysm
no other condition that makes exercise inadvisable.
Footcare guidelines
For a person with diabetes, there is no such thing a
"just a little blister". An open sore can turn into a serious
infection—proper footwear is a must. Shoes should be comfortable,
well-fitting and appropriate for the chosen exercise. Before putting on
the shoes, check for pebbles or other small objects inside. Smooth, not
nubby socks should be worn during exercise and changed after a workout.
Sweaty socks increase the chance of getting athlete's foot. Feet are to
be checked daily for scratches, cuts, blisters, ingrown toenails, corns,
and calluses. Immediately contact a doctor for ingrown toenails,
athlete's foot, and cuts or sores that are not healing.
Hypoglycemia prevention
Hypoglycemia is a major risk among Type 2 diabetics on oral
medication because of insulin-like effect of exercise. The increased
glucose uptake by the muscles produces low blood glucose levels which
can continue for 12 - 24 hours. The warning signs for mild and moderate
hypoglycemic reactions are: trembling or shakiness, rapid heart rate,
palpitations, increased sweating, excessive hunger, headache,
drowsiness, mental confusion, and abrupt mood changes. In the event of a
hypoglycemic attack:
Take action even if you are not sure you have hypoglycemia--waiting can
make your symptoms much worse.
Take a blood-glucose test to confirm the problem.
Eat or drink foods with sugar such as 1/2 cup of fruit juice, six
lifesavers, 1 small box of raisins, or 3 glucose tablets. (this is only
a sample of effective treatments). Food with fat should be avoided
because it blocks the absorption of sugar into the bloodstream.
Take at least a 10 - 15 minute rest and retest blood-glucose level
before resuming exercise. Don't exercise if it's below 100 mg/dl or you
still don't feel right.
If you do continue to exercise, be on the lookout for any signs that the
hypoglycemic reaction is not over. Take your blood-glucose level at
least every 20 - 30 minutes during your workout. After your workout eat
a complex carbohydrate snack (starchy food).
Insulin sensitivity can remain high for 24 - 48 hours after a person
stops exercising. Late-onset hypoglycemia is is believed to be more
common than hypoglycemia that occurs during or right after exercise. It
is more common among new exercisers or people who exercise strenuously.
You can help prevent late-onset hypoglycemia by asking your doctor about
adjusting your insulin or oral medication before exercise and increasing
your food intake before and after exercise. You should also monitor your
blood glucose for 12 hours after long workouts (longer than 45 minutes)
or when changing the intensity or duration of your exercise--even if
your workout is less than 45 minutes.
Exercise guidelines for the Type 2 diabetic
Let your body get used to exercising. Start out easy and
gradually increase intensity and duration. Warm up and cool down for 5 -
10 minutes each by exercising at a low intensity before and after your
moderate intensity workout. Sufficient warm up and cool down will help
to prevent heart problems as well as make you less susceptible to
injury. Don't exercise outdoors on very hot or humid days. You can get
heat exhaustion or heat stroke. In warm weather, dress in lightweight,
light-colored, loose-fitting cotton clothing or special fabrics that
promote heat loss. Wear a hat and apply sunscreen. To prevent
dehydration, drink a cup of cold water before and after you exercise. If
you exercise longer than 30 minutes or are sweating a lot, drink water
during your workout. Know the warning signs of heart problems: chest,
arm or jaw pain, nausea, dizziness or fainting (also signs of heat
exhaustion or hypoglycemia), unusual shortness of breath during
exercise, irregular pulse.
Exercise, along with good nutrition, helps decrease body fat, which
helps normalize glucose metabolism. Also, exercise helps ower coronary
risk factors like high blood pressure and high cholesterol.
Aerobic exercise
Since many Type 2 diabetics are sedentary and overweight,
low-impact exercise such as walking or stationary cycling is
recommended, along with enough exercise to promote weight management.
Their goal should be to exercise five times per week, up to 40 - 60
minutes per session at a moderate intensity. This level of exercise can
be reached gradually, starting as low as 10 - 20 minutes a few times a
week for a person who has never exercised. Remember to increase only one
factor at a time (days per week, length of session, or intensity).
Strength training
For those who have no other complications, strength training
is safe and can provide many benefits. It can increase lean mass which
will help in weight management, as well as increase glucose uptake by
the muscles and help the body to store glucose. Strength training
programs are designed around a persons needs, desires, level of
conditioning and time factors.
A basic recommendation from the American College of Sports Medicine
is to train a minimum of two times per week, doing 8 - 12 repetitions
per set of 8 - 10 exercises targeting major muscle groups. Safety
precautions must be followed for the exercising diabetic. A personal
trainer can help to set up a program for the Type 2 diabetic and help
them to exercise correctly. With your doctor's permission,
exercise bands are a safe, simple and effective way to exercise at home.
Medication is not enough to make a diabetic feel good and live a full
life. Exercise and good nutrition provide real physical payoffs--they
are essential to controlling diabetes. Exercise can help prolong your
life and improve the quality of your added months and years. Sticking to
an exercise program can be a challenge for anyone, even with strong
medical reasons to exercise.
Measuring your blood-glucose level before and after exercise can be a
motivator. Diabetics who play the "numbers game" commonly see
a twenty percent decrease in their blood-glucose level after exercising.
It is crucial that the exercise be fun and there is some variety. Family
support and exercising with someone are helpful. Order the book Diabetes: your complete exercise guide,
available from Human Kinetics at
1-800-747-4457.
Find exercise
band kits (a simple way to strength train) and other exercise
products at Simple Fitness Solutions.
