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Article by Dr. Sheri Colberg, Phd, FACSM

 

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TYPE 2 DIABETES AND EXERCISE


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Lack of regular exercise can lead to poor control of type 2 diabetes, which, in turn, may contribute to the onset of severe complications. These disorders can range from failing eyesight and blindness to heart disease, deterioration of the kidneys and the need for amputation.

Around 50% of all amputations that don't result from emergencies like accidents and car crashes, for example, are related to diabetes (1). So it's vital to manage the disease as effectively as possible with diet and regular exercise to prevent diabetes causing the onset of severe complications.

Physical inactivity and lack of a balanced diet affects everyone for the worse because it can lead to excess weight and obesity. It increases the risk for various health problems, including cardiovascular disease caused by obesity-related high blood pressure.

Man engaged in physical activityConversely, regular exercise and a nutritious diet leading to weight loss can reverse Insulin Resistance and increase insulin sensitivity, thereby reducing the risk of complications for people with diabetes.

Prior to increasing physical activity, it is essential for individuals with diabetes to obtain approval from their doctor. In order to develop a safe and effective individualized activity program, medical information regarding the health status of the individual is crucial.

There are many factors to address before developing an activity program. When medical approval is recommended, your doctor may take into account your blood glucose control (e.g. glycosylated hemoglobin or HbA1c), medications, physical limitations such as joint mobility and any impairments related to diabetic complications such as heart disease.

Depending on the age of the individual and the duration of his or her diabetes, the doctor may recommend that a stress test be performed before the person can safely participate in physical activity.

Man and woman waling through a fieldThe rationale for recommending a stress test electrocardiography is to assess cardiovascular status, as the risk for heart disease is increased with diabetes. Moreover, the stress test electrocardiography will identify safe intensity limits for persons with or without autonomic neuropathy, as this latter condition can affect the heart rate’s response to exercise.

Given that many persons with diabetes are overweight or obese, providing a doctor with information regarding personal goals and interests is central to a successful and healthy exercise program.

Exercise-induced hypoglycemia (low blood sugar) commonly occurs in people with diabetes. To minimize the chance of low blood glucose, self-blood glucose monitoring (SBGM) is recommended for persons with diabetes who engage in physical activity, especially during the initial activity sessions. Do not begin an exercise session if your pre-exercise glucose level are below 100 mg/dl as exercise could lead to hypoglycemia.

Glucose monitoring is appropriate before and after an exercise bout, lessening the frequency of low blood sugar. The time of day for activity is extremely important to avoid hypoglycemia, especially for Insulin-Dependent individuals with diabetes.

Given the time of insulin administration and nutrient intake, it has been suggested that the best period for this kind of individual with diabetes to exercise is 1-2 hours after breakfast or later during the morning hours. Matching a physical activity program to the health and lifestyle of a person with diabetes is important for achieving a healthy exercise regime.

Man exercising along side of a lakeWhen pre-exercise glucose levels exceed 250 mg/dl, exercise should be postponed as this glucose level equals hyperglycemia and is reflective of poor control. Keep a log of blood glucose values so that glucose fluctuations can be evaluated to address better ways of avoiding such occurrences in the future.

When the blood glucose level is elevated, administration of an appropriate medication dosage is recommended if you are insulin-dependent. Always follow your doctor's instructions regarding medications.

There are numerous factors for people with diabetes to consider before engaging in physical activity. The recommendations below provide an element of safety before, during, and after any physical exertion and should be routinely practiced.

Remember: physical activity is a key therapeutic element for lessening risk for chronic conditions, as well as losing weight to maintain health and quality of life. But persons with diabetes have to exercise caution at the same time.

Self-Blood Glucose Monitoring (SBGM)

Woman in pool participating in an exercise workout using weights.Perform this monitoring before and after each physical activity session. This is excellent training for you to understand individual glucose response to physical activity. It is important to ensure that blood glucose is in relatively good control before beginning higher intensity physical activity.

If blood glucose is:

  • at 250 mg/dl, higher intensity physical activity should be postponed. If your blood sugar is very high, use the test recommended by your doctor to check for your level of ketones, which are substances made when the body breaks down fat for energy. An excess of ketones, called Diabetic Ketoacidosis, is a symptom of the presence of high blood sugar. Do not exercise if your ketones are moderate or high.
  • at 100 mg/dl or less, eat a snack consisting of carbohydrates. Recheck your blood glucose prior to beginning exercise.
  • at between 100-250 mg/dl, physical activity can be performed.

Your healthcare practitioner may suggest slightly different numbers for your particular case, so be sure to check with him or her before commencing a new exercise program.

Keep a Daily Log

Record the value and time of day that the SBGM is performed and the intake of any pharmacologic agent e.g. oral drugs. Also include approximate duration in minutes and effort (say, on a scale of 1-10) of the activity session. This will aid understanding of the type of response to possibly expect from specific bouts of physical activity.

Plan for an Exercise Session

Man leaning against a wall with a towel around his neck.Work out in advance how much activity is anticipated, i.e. time and intensity. If needed, carry along extra carbohydrate feedings in case you experience hypoglycemia. Some experts suggest that if you exercise for a long time, such as more than an hour, you might need a snack halfway through. You may also need a snack if you are working out much harder than usual.

Be Active with a Partner

Initially, people with diabetes should exercise with a partner until their glucose response is known. Ideally, the partner will be a source of social support and encourage continued participation in this healthy lifestyle.

Wear a Diabetes I.D.

Never leave home without it. Hypoglycemia, or other problems, may arise that require an understanding of the condition by other people.

Wear Good Shoes

Proper-fitting and comfortable footwear can minimize foot irritations and sores, while reducing the likelihood of orthopedic injuries to the foot and lower leg.

Practice Good Hygiene

Always take extra care to inspect feet for any irritated spots to prevent possible infection. Tend to all sores immediately. Report hard-to-heal sores to your physician. Prevent irritations when physically active by using Vaseline on feet and wearing socks inside-out or wearing socks without seams.

(1) Twelve Agencies Cooperate to Reduce Amputations in Diabetes
United States National Institute of Diabetes and Digestive and Kidney Diseases.

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