Physical Fitness For Diabetes Patients
Almost everyone, whether or not they have diabetes, will benefit from exercise. But regular exercise also has special advantages for people with type 1 and 2 diabetes and is an important part of their treatment plan.
Type 1 diabetes
As people with type 1 diabetes know, many factors influence blood glucose levels. While exercise has been shown to improve blood glucose management in people with type 2 diabetes, the story is more complicated with type 1 diabetes. In people with type 1 diabetes, blood glucose levels vary considerably depending on the type of activity, duration, intensity of activity, as well as the amount and timing of insulin administration and carbohydrate intake. Low- to moderate-intensity exercise lowers blood glucose levels both during and after the activity, increasing the risk of hypoglycemia. In contrast, high-intensity exercise raises blood glucose levels during and immediately after the activity. The stress of competition and even heat can also affect the delicate balance between glucose and insulin. These effects on blood glucose levels can be addressed by carefully matching carbohydrate intake to insulin and planning the type and timing of exercise. Self-monitoring of blood glucose before, during and, especially, for many hours after exercise is critical for establishing how your body responds to exercise. This information will help you make the right adjustments to exercise, medication or carbohydrate intake to avoid high or low blood glucose.
Type 2 diabetes
Almost everyone, whether or not they have diabetes, will benefit from exercise. But regular exercise also has special advantages for people with type 2 diabetes and is an important part of their treatment plan. A key feature of type 2 diabetes is insulin resistance — the body’s inability to respond properly to the actions of insulin.
Specifically, glucose builds up in the bloodstream. Glucose is the body’s fuel, and muscles need this fuel to work. When we exercise, our muscles’ demand for fuel increases. The liver responds to this demand by releasing some of its glycogen stores, which are broken down into glucose that our muscles can use. As we continue to exercise, our muscles use up the available glucose in the blood and eventually the glycogen stores in the liver become depleted. At this point, the body looks for another source of fuel and starts burning fat to supply the muscles with the needed energy. Exercising muscles also appear to be able to use glucose more efficiently. Studies have even shown that previously exercised muscles are able to take up glucose more quickly over the next few days. This is why regular exercise is so important.
Some advice before taking that first step :
With so many good reasons to be physically active, it’s time to get started! However, if you have been inactive for some time and want to start begin an exercise program that is more strenuous than brisk walking, you should first see your doctor. He or she will want to ensure that you don’t have any conditions or complications that might be aggravated by exercise. It you are at high risk of heart disease, you may undergo a stress test (a test to determine how well your heart handles work). This test monitors your heart rate while you walk on a treadmill. If you have neuropathy (nerve damage), retinopathy (eye disease), very high blood pressure or very high blood glucose your doctor may want you to avoid some kinds of exercise or take special precautions. While a thorough physical exam is important, for most people the risks of not exercising are far greater than any risks associated with becoming more active.
What kinds of exercise are best?
Both aerobic and resistance exercise are important for people with diabetes. Aerobic exercise (such as walking, running, swimming, dancing, hockey, skiing) works your heart and lungs and carries oxygen to your muscles, while resistance exercise builds muscle. Resistance exercises (such as weight training) increase muscle strength and complement the benefits of aerobic exercise. If you decide to begin resistance exercise, you should get some instruction by a qualified exercise specialist. You should start with low weights and one set of 10 to 15 repetitions. The goal is to build up to 3 sets of 8 repetitions with the highest weight that can be lifted three times per week.
Tips for safe exercising :
Once you get the green light from your doctor, take a few common-sense steps to ensure you get the most out of your work-outs and minimize the risks of getting injured :-
- Make sure you have the right shoes. This is so important for people with diabetes. Buy your shoes from a reputable store with knowledgeable staff that can ensure a proper fit. Buy the right shoes for your activity (e.g. tennis shoes for tennis, walking shoes for walking, and pool shoes for swimming).
- Dress appropriately for the weather.
- Wear your medical alert bracelet or necklace.
- Listen to your body. While exercising will probably cause some muscle fatigue or even slight discomfort, it should not cause pain. Speak to your doctor if you are very short of breath or have chest pain.
- Plan your exercise sessions so you can take the appropriate measures to exercise safely. Decide on the timing, type, duration and intensity of exercise.
Every person with type 1 diabetes will have a different response to exercise. The only accurate way to determine your response is frequent self-monitoring of blood glucose. Monitor glucose before, during, and many hours after to see how the activity has affected your blood glucose.
If your pre-meal blood glucose level is >14.0 mmol/L and urine ketone level is >8.0 mmol/L or blood ketone level is >3.0 mmol/L, exercise should not be performed as it could cause high blood glucose and more ketone production. Wait until your blood glucose is back in the normal range before exercising.
Estimate how much carbohydrate and insulin you need to keep your blood glucose levels stable. You may need to work with your healthcare team to learn how to do this. A general rule of thumb for most moderate-intensity exercise is 15 to 30 g of carbohydrate every 30 to 60 minutes of exercise.
Avoid injecting insulin into the body part that will be exercising.
If you use an insulin pump, see your healthcare team for more information on how to calculate carbohydrate intake and to adjust the basal and bolus components of your insulin dosage.
Monitor your blood glucose every 30 minutes during and for many hours after (including overnight if necessary) exercising and record the results.
- Keep some form of fast-acting carbohydrate with you at all times in case you need to treat a low blood glucose.
- Drink enough water to stay well hydrated while exercising.
- People who exercise vigorously or who train for competition should work closely with their healthcare team.
The importance of monitoring your blood glucose levels :
Because exercising lowers blood glucose, there is an increased risk of hypoglycemia if you take insulin or certain diabetes pills. It is important to ask your doctor about preventing, detecting and treating hypoglycemia. When you first start a new exercise program, you should monitor glucose before, during and many hours afterward to see how the activity has affected your blood glucose. Be sure to carry some form of fast-acting carbohydrate with you in case you need to treat low blood glucose.
How much exercise is enough?
According to the Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, people with type 2 diabetes should do at least 150 minutes of moderate-intensity aerobic exercise each week, spread over at least 3 nonconsecutive days. The goal is to build up to 4 or more hours of exercise per week. Does this sound like a lot of exercise? Think about how much time you spend in front of the television or computer and decide whether some of this time would be better spent getting fit.You may have to start slowly, with as little as 5 to 10 minutes of exercise per day, and gradually build up to your goal. The good news, though, is that multiple, shorter exercise sessions lasting at least 10 minutes each are probably as useful as a single longer session of the same intensity.
In order to benefit from physical activity, it has to become a part of your life and routine. Habits can be hard to change, so be prepared with a plan in case your motivation starts to fade. Here are tips for staying motivated.
Do something you like! It is hard to stick to an activity that is not fun. There are so many ways to stay active. It may take you a few tries before you find the activity that is right for you.
Have a support network. Some people like to exercise alone, but still need a little push to get off the couch. Ask your family, friends and co-workers to help you stayed motivated. Some people find it very motivating to exercise with other people. Whether it’s a scheduled walk with a friend, or a group of people from a gym or community, try to find a structure and schedule that you will keep you involved and interested.
Set small, attainable goals and celebrate when you reach them. Reward yourself in healthy ways.
If you find it hard to stay motivated, remind yourself of all the health benefits you will enjoy when you are fit. Also, remind yourself of the dangers of not being fit.
Seek out professional help from a gym, personal trainer, or someone knowledgeable who can help you find a fitness regimen that will work for you.
Many things in our lives are out of our control, so when we have an opportunity to take control and make a difference in our health, we should seize it. The decision to start exercising is example of taking control. The risks of not exercising are high. It is never too late to make a positive change in life. Regardless of your age, making the decision to become more physically fit is one of the greatest gifts you can give yourself and the people who love you. Take that first step today.