July 27, 2000 -- If you have diabetes, you worry constantly about your blood sugar (also called blood glucose) level because you know you suffer when that level goes higher or lower than normal. There are only three things that can directly affect your blood sugar level: food, insulin (either made by your pancreas or introduced into your body from outside), and exercise. This article is about the ways exercise can positively impact your diabetic condition.
Exercise for Treatment and Prevention
If you think that having diabetes will prevent you from having a fully active lifestyle and doing exercises to minimize the effects of the disease, consider all the athletes who have diabetes, including NFL quarterback Wade Wilson and 1950s tennis star Bill Talbert. Diabetes, whether insulin-dependent type 1 or non-insulin dependent type 2, is not a condition that prevents you from being as active as you want to be. The bottom line is that exercise will probably help you keep your diabetes under control because it lowers your blood sugar level, enhances the action of insulin, helps with weight loss, and improves your cardiovascular system.
The point about improving your cardiovascular system is especially important because cardiovascular disease is the leading killer of people with diabetes. In the long run, improving the condition of your heart and circulatory system may be the most important reason for people with diabetes to exercise regularly.
Numerous studies show that regular exercise, especially aerobic exercise, improves the ability of your body to metabolize sugar. That is true even if there is not an accompanying weight loss. There is a possibility that exercise may cause a temporary drop in blood sugar (hypoglycemia), but that doesn?t stop the millions of individuals with diabetes who enjoy the benefits of exercise. Many find that eating some carbohydrates (hard candy, for example) and/or adjusting their insulin dosage prevents blood sugar fluctuations during exercise. To be active and safe, talk with your doctor before starting a new exercise routine or making changes in your food intake or medication level.
Non-insulin dependent diabetes mellitus, often called type 2 diabetes, affects about 10 million Americans, or about 90% of all people with diabetes. Dalynn Badenhop, PhD, a member of the cardiology faculty at the Medical College of Ohio and a fellow of the American College of Sports Medicine, reports that more than half of the patients with type 2 diabetes that he has studied showed decreased blood sugar levels after they began regular exercise programs. Some of those patients who were taking insulin lowered their blood sugar levels so much that they were able to reduce their insulin dosage. Badenhop says unequivocally, "Exercise is definitely therapeutic for people with type 2 diabetes."
It is no surprise then that the NIH and the American Diabetes Association both recommend regular exercise in combination with diet modifications for patients with type 2 diabetes. From all the evidence, people with type 2 diabetes who exercise regularly in addition to observing proper diets are better able to control blood sugar levels and reduce complications related to cardiovascular disease.
Why Is Weight Loss Important?
According to the NIH, approximately 80% of all people with type 2 diabetes are overweight, and though more research is needed before medical science can fully explain the relationship between diabetes and weight, there is no doubt that exercise, in combination with a carefully controlled diet, helps people to lose weight. With weight loss comes improved circulation and lower blood pressure. Furthermore, people who are 20% or more over their normal weight have an increased risk of developing type 2 diabetes. The NIH emphasizes that exercise alone is not usually effective for weight loss unless accompanied by an appropriate reduced-calorie diet.
What Kind of Exercise Is Best?
Recent studies suggest that the ideal type of exercise regimen for individuals with diabetes is one that emphasizes an all around approach. According to the American College of Sports Medicine, exercise programs that address cardiovascular conditioning, muscular strength, and flexibility yield the best total fitness for all people, including those with diabetes. In combination with a controlled diet, this "cross training" is the best way for individuals with diabetes to achieve overall fitness, combat cardiovascular disease, and control blood sugar levels.
So, what exercises should you do? Do something you enjoy so you will stick with it. Make it something you can do at least three days a week, and five would be better. Aerobic exercises are the most effective kind of activity for lowering blood sugar levels and combating cardiovascular disease. To obtain the aerobic training effect, you should be able to do an exercise for a minimum of 20-30 minutes without stopping. Exercise hard enough that you feel invigorated but not exhausted. Badenhop says, "A good way to tell that your exercise intensity is appropriate is that that your breathing rate increases, but you are still able to carry on a conversation."
The simplest way to exercise aerobically is by walking, especially if you are just getting into exercise. Walk outdoors when the weather is fine, or otherwise pick from a number of indoor possibilities. Besides inside walking tracks at gyms and recreation centers, you can choose from literally thousands of mall-walking programs. To find a mall-walking program near you, contact the National Organization of Mall Walkers, PO Box 191, Hermann, MO 65041. The only thing you need to begin your aerobic walking exercise is a good pair of shoes. Be sure your shoes fit well because diabetic foot neuropathy and reduced circulation could place you at an increased risk for blisters, ulcers, and infections. Foot care is especially important for people with diabetes. Badenhop highly recommends that people with diabetes have two pairs of walking shoes and alternate from day to day between pairs to help keep their feet dry.
Cardiovascular conditioning is the single most important aspect of an exercise program for a person with diabetes. Focus on fitting regular and frequent aerobic exercise into your schedule, but do it safely. Badenhop suggests the following tips for patients with either type of diabetes to insure that they exercise safely:
- Monitor your blood sugar levels before and after exercise.
- Eat foods such as bread, pasta, cereal, and rice 2-3 hours before exercise.
- Don?t exercise on an empty stomach.
- Avoid drinking any alcohol at exercise time.
- Drink plenty of water 1-2 hours before exercise.
- Exercise with someone who knows the warning signs of low blood sugar (see below).
- Be sure to warm up for 5-10 minutes before exercising.
- Check your feet regularly for blisters, scratches, and open wounds.
Badenhop points out that certain conditions associated with diabetes may prevent you from exercising. The following conditions must be corrected before a person with diabetes can exercise safely:
- Hypoglycemia (low blood sugar) -- Signs and symptoms: double vision, fatigue, excessive hunger, tremors, increased pulse rate, nervousness, headache, numbness, slurred speech, excessive sweating.
- Hyperglycemia (high blood sugar) -- Signs and symptoms: increased thirst and/or hunger.
- Ketoacidosis (high ketone levels in the blood) -- Signs and symptoms: abdominal pain, nausea, dehydration, drowsiness, fruity breath, glucose, and ketones in the urine.
- Dehydration -- Signs and symptoms: severe thirst, dizziness, increased pulse rate, confusion, irritability, headaches.
In recent years strength training has come into its own as an essential component of overall fitness training, not just a training method for athletes and body builders. Aerobic conditioning will improve your cardiovascular system, but strength training can keep your muscles from weakening as a result of diabetes and preserve muscle mass during periods of weight loss. Weight training for people with diabetes should begin with light weights until your cardiovascular fitness increases.
The need to exercise regularly is independent of your age. Always warm up first before starting your exercises. If you are older and it is hard to get out, then begin with various small stretches, sitting down if necessary. Gradually work up to taking short walks. After a while you will probably discover that you can do more than you thought you could do. For individuals who have both diabetes and arthritis, exercise is a special challenge, but it is possible. Always warm up and then work on doing exercises that strengthen your muscles and make you feel better.
Even the best fitness program is not safe if complications are not diagnosed and treated, so be sure to obtain a complete medical examination before starting an exercise program.
Exercise Is Hard to Do ?
Starting a more active lifestyle is not easy, and it is even more challenging to stick to it, but rest assured that millions of individuals with diabetes before you have made these important changes in their lives, and you can too. Your first step, following a thorough medical examination, should consist of setting realistic goals with a schedule you feel sure you can maintain. At first your exercises should be fairly easy, perhaps short walks at a specific time each day. Then gradually build up your program and begin to include some cross training by changing elements of your exercise to keep motivated. Exercising with a partner is an especially good idea. Exercising alone can lead to discouragement and losing interest, but an exercise partner can provide the encouragement and motivation to keep you going. Finally, reward yourself whenever you achieve an exercise goal. The reward might be some new clothes or music, but not food!
For more information on how to begin an exercise program, see the ACSM Fitness Book, Human Kinetics Publishers (Champaign, IL, 1998).