Richard Weil, MEd, CDE
Biography

	Does exercise sometimes elevate the blood sugar? I have neuropathy in my feet. Is walking for exercise a problem? Would exercise in the evening help use up glucose that builds up at night? Why is it not good to exercise with readings over 300?
	Exercise Helps Diabetes Live Longer

Exercise is great for everyone, but if you have diabetes a regular fitness routine can be a true life saver. Where do you begin, and what special concerns exist for someone with diabetes who wants to take that first big step? We talked about it when WebMD's own fitness guru and diabetes educator Richard Weil, MEd, CDE, joined us in the Student Lounge on Oct. 12, 2004.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome, Richard. Do specific types of exercise (such as aerobic or weight lifting) help in diabetes control, or is it merely exercise duration and frequency?

WEIL:
Research shows that aerobic exercise and resistance exercise are both effective for people with diabetes, but a combination is better for blood sugar control.

Aerobic exercise reduces the risk of heart disease and stroke, which people with diabetes are at a higher risk for, and resistance exercise builds lots of muscle, muscle being important for burning fat and glucose.

Of course, burning glucose is very important for people with diabetes, so I recommend a combination of aerobic and resistance exercise. For people over the age of 70, I recommend slightly more resistance exercise because at that age and older, you tend to lose more muscle and building muscle is very important for:

• Strength
• Posture
• Balance
• Blood sugar control

MEMBER QUESTION:
I have a bad back and even walking can be too hard; what can I do to get some exercise?

WEIL:
Bad back problems afflict many Americans. Some of the time the back trouble is simply from weak abdominal muscles and poor posture. When there is something structurally wrong with your back, like a herniated or bulging disk or some muscular problem, non-weight bearing activities like a stationary or recumbent bicycle might be better than activities where you pound, like jogging or dancing.

One of the best activities is swimming, because the water supports your weight and there is very little pounding, especially in your back. You can check in your region to see if there are swimming pools available, as well as water aerobic exercises, which in addition to swimming, would be a wonderful way of doing aerobic and resistance exercise, because water serves as resistance, so in a sense, it's like weight lifting.

Diabetes will respond whether you do weight bearing or non-weight bearing activity. Check the Arthritis Foundation web site, because the foundation sponsors water classes all over the country.

"Burning glucose is very important for people with diabetes, so I recommend a combination of aerobic and resistance exercise."

MEMBER QUESTION:
I exercise three to four times a week and my diet has not changed in the past 90 days. There has been some stress, two deaths in the family and a failed relationship and my A1C went from 7.6 to 8.5. My care provider wants me to go on insulin but I would rather try a different regimen of oral meds.

WEIL:
Exercise is one of the cornerstones of diabetes treatment, however, even with regular exercise in some cases you need to go on to medication for diabetes.

If your A1C has risen 1 point or more, it tells the doctor that your blood sugar really has not been in good control and a more aggressive treatment may be necessary. Now, with all the stress in your life recently, it's a good thing that you have been exercising, because exercise helps reduce that stress.

It also keeps blood sugar under control and keeps the A1C down. It may simply be a transient effect of the stress that's caused your blood sugar to rise, but you will need to discuss the next step carefully with your physician. Keep up the exercise, because in the long run and the short, it's one of the very best things you can do to manage your stress and your diabetes.

MEMBER QUESTION:
Does exercise sometimes elevate the blood sugar in diabetes patients?

WEIL:
Yes, blood sugar can go up after exercise. The reason is that the liver is constantly making glucose and pumping it into the blood stream. In response to exercise, the liver makes even more glucose and if you do not burn the glucose faster than the liver produces it, the blood sugar can go high after exercise.

Now, generally weight lifting makes blood sugar after exercise go higher and aerobic exercise makes it go lower. If aerobic exercise is making your blood sugar go up, you need to be sure to test your blood sugar before the exercise, and if you can detect the pattern of when the blood sugar rises, you may need to take just a small amount of insulin before exercise to keep it from rising.

Discuss this with your diabetes educator. Also, I've written a number of articles on managing blood sugar during exercise, and if you go to the Diabetes Self Management magazine web site, you will find my articles in the fitness section and it will help you learn how to manage your blood sugar during exercise.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.