EXERCISE AND DIABETES

What you need to know about Physical Activity and Diabetes

Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy. But having too much glucose in your blood can hurt you. When you take care of your diabetes, you'll feel better. You'll reduce your risk for problems with your kidneys, eyes, nerves, feet and legs, and teeth. You'll also lower your risk for a heart attack or a stroke. You can take care of your diabetes by

• being physically active
  
  
• following a healthy meal plan
  
  
• taking medicines (if prescribed by your doctor)

Research has shown that physical activity can

• lower your blood glucose and your blood pressure
  
  
• lower your bad cholesterol and raise your good cholesterol
  
  
• improve your body's ability to use insulin
  
  
• lower your risk for heart disease and stroke
  
  
• keep your heart and bones strong
  
  
• keep your joints flexible
  
  
• lower your risk of falling
  
  
• help you lose weight
  
  
• reduce your body fat
  
  
• give you more energy
  
  
• reduce your stress

Physical activity also plays an important part in preventing type 2 diabetes. A major government study, the Diabetes Prevention Programme (DPP), showed that a healthy diet and a moderate exercise programme resulting in a 5 to 7 percent weight loss can delay and possibly prevent type 2 diabetes.

Four kinds of activity can help. You can try

• being extra active every day
  
  
• doing aerobic exercise
  
  
• doing strength training
  
  
• stretching

Being extra active can increase the number of calories you burn. There are many ways to be extra active.

• Walk around while you talk on the phone.
  
  
• Play with the kids.
  
  
• Take the dog for a walk.
  
  
• Get up to change the TV channel instead of using the remote control.
  
  
• Work in the garden or rake leaves.
  
  
• Clean the house.
  
  
• Wash the car.
  
  
• Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one.
  
  
• Park at the far end of the shopping center lot and walk to the store.
  
  
• At the grocery store, walk down every aisle.
  
  
• At work, walk over to see a co-worker instead of calling or emailing.
  
  
• Take the stairs instead of the elevator.
  
  
• Stretch or walk around instead of taking a coffee break and eating.
  
  
• During your lunch break, walk to the post office or do other errands.

Aerobic exercise is activity that requires the use of large muscles and makes your heart beat faster. You will also breathe harder during aerobic exercise. Doing aerobic exercise for 30 minutes a day, most days of the week, provides many benefits. You can even split up those 30 minutes into several parts. For example, you can take three brisk 10-minute walks, one after each meal.

If you haven't exercised lately, see your doctor first to make sure it's OK for you to increase your level of physical activity. Talk with your doctor about how to warm up and stretch before exercise and how to cool down after exercise. Then start slowly with 5 to 10 minutes a day. Add a little more time each week, aiming for 150 to 200 minutes per week. Try

• walking briskly
  
  
• hiking
  
  
• climbing stairs
  
  
• swimming or taking a water-aerobics class
  
  
• dancing
  
  
• riding a bicycle outdoors or a stationary bicycle indoors
  
  
• taking an aerobics class
  
  
• playing basketball, volleyball, or other sports
  
  
• in-line skating, ice skating, or skate boarding
  
  
• playing tennis
  
  
• cross-country skiing
  
  
• other things I can do: ______________________
  _________________________________________

Doing exercises with hand weights, elastic bands, or weight machines two or three times a week builds muscle. When you have more muscle and less fat, you'll burn more calories because muscle burns more calories than fat, even between exercise sessions. Strength training can help make daily chores easier, improving your balance and coordination, as well as your bones' health. You can do strength training at home, at a fitness center, or in a class. Your health care team can tell you more about strength training and what kind is best for you.

Stretching increases your flexibility, lowers stress, and helps prevent muscle soreness after other types of exercise. Your health care team can tell you what kind of stretching is best for you.

Ask your health care team about the best time of day for you to exercise. Consider your daily schedule, your meal plan, and your diabetes medications in deciding when to exercise.

If you exercise when your blood glucose is above 300, your level can go even higher. It's best not to exercise until your blood glucose is lower. Also, exercise is not recommended if your fasting blood glucose is above 250 and you have ketones in your urine.

If you have diabetes complications, some exercises can make your problems worse. For example, activities that increase the pressure in the blood vessels of your eyes, such as lifting heavy weights, can make diabetic eye problems worse. If nerve damage from diabetes has made your feet numb, your doctor may suggest that you try swimming instead of walking for aerobic exercise.

Numbness means that you may not feel any pain from sores or blisters on your feet and so may not notice them. Then they can get worse and lead to more serious problems. Make sure you exercise in cotton socks and comfortable, well-fitting shoes that are designed for the activity you are doing. After you exercise, check your feet for cuts, sores, bumps, or redness. Call your doctor if any foot problems develop.

Physical activity can cause hypoglycaemia (low blood glucose) in people who take insulin or certain diabetes pills, including sulfonylureas and meglitinides. Ask your health care team whether your diabetes pills can cause hypoglycaemia. Some types of diabetes pills do not.

Hypoglycaemia can happen while you exercise, right afterward, or even up to a day later. It can make you feel shaky, weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. If your blood glucose drops too low, you could pass out or have a seizure.

However, you should still be physically active. These steps can help you be prepared for hypoglycaemia:

• Be careful about exercising if you have skipped a recent meal. Check your blood glucose. If it's below 100, have a small snack.
  
  
• If you take insulin, ask your health care team whether you should change your dosage before you exercise.

• Wear your medical identification or other ID.
  
  
• Always carry food or glucose tablets so that you'll be ready to treat hypoglycaemia.
  
  
• If you'll be exercising for more than an hour, check your blood glucose at regular intervals. You may need snacks before you finish.

• Check to see how exercise affected your blood glucose level.

Check with your doctor. Always talk with your doctor before you start a new physical activity programme. Ask about your medications—prescription and over the counter—and whether you should change the amount you take before you exercise. If you have heart disease, kidney disease, eye problems, or foot problems, ask which types of physical activity are safe for you.

Decide exactly what you'll do and set some goals. Choose

• the type of physical activity you want to do
  
  
• the clothes and items you'll need to get ready
  
  
• the days and times you'll add activity
  
  
• the length of each session
  
  
• your warm up and cool down plan for each session
  
  
• alternatives, such as where you'll walk if the weather is bad
  
  
• your measures of progress

Find an exercise buddy. Many people find that they are more likely to do something active if a friend joins them. If you and a friend plan to walk together, for example, you may be more likely to do it.

Keep track of your physical activity. Write down when you exercise and for how long in your blood glucose record book. You'll be able to track your progress and to see how physical activity affects your blood glucose.

Decide how you'll reward yourself. Do something nice for yourself when you reach your activity goals. For example, treat yourself to a movie or buy a new plant for the garden.

One of the keys to staying on track is finding some activities you like to do. If you keep finding excuses not to exercise, think about why. Are your goals realistic? Do you need a change in activity? Would another time be more convenient? Keep trying until you find a routine that works for you. Once you make physical activity a habit, you'll wonder how you lived without it.