Summary
 For anyone with
diabetes , exercise is important for both short-term management of the disease and
long-term survival (i.e., reducing the risk of heart attack and other causes
of death). However, in addition to the precautions that everyone needs to take when
exercising, there are some special precautions that diabetics need to take. These include
the following:
Seeing the physician who manages their diabetes before
beginning any exercise program
Knowing when to exercise and when to avoid exercise
Testing glucose levels both before and after exercise
Wearing appropriate shoes and socks
Having an exercise partner
Once these precautions have been taken, and keeping their
own chemical balance in mind, people with diabetes can enjoy the many benefits of
exercise.
Why is it important for diabetics to exercise?
Like everyone else, people with diabetes are encouraged to exercise
for at least 30 minutes, at
least three or four times per week. In addition to the overall benefits of staying in
shape, there are a number of important reasons why diabetics need to exercise, which
include the following:
 Reducing the risk of
cardiovascular problems, such as coronary
artery disease (hardening of the coronary arteries) or peripheral
arterial disease (hardening of the peripheral arteries). One study found that high-risk patients with Type II diabetes who did not exercise were seven times more likely to die of a heart attack, than those who exercised.
Increasing levels of HDL (“good”)
cholesterol and decreasing levels of LDL (“bad”)
cholesterol, which reduces the risk of hardening of the arteries (atherosclerosis). What is CHOLESTEROL ?
Improving the body’s ability to use insulin (either
their own natural insulin, or that taken by mouth/injection). This is also known as
decreasing insulin resistance.
Reducing glucose levels.
Losing weight to prevent or treat obesity
(20 pounds over one’s ideal weight), which is
directly related to Type II diabetes. This is important because almost 90 percent of
diabetics are overweight.
Improving blood flow, which reduces the risk of infection
in the lower legs and feet.
What is the relationship between insulin and exercise?
People with diabetes
need to be careful of two possible situations that could occur during exercise :
Insulin levels that are too low. In this situation,
exercise will trigger the liver to produce more glucose to feed muscles. However, the body
cannot use the glucose because there is not enough insulin to absorb the glucose into the
cells. Therefore, levels of glucose in the bloodstream get increasingly higher. High
glucose levels can lead to a variety of symptoms (e.g., blurred vision) in the short-term,
and serious consequences such as heart
attack or stroke in the long-term. Other
long-term consequences include permanent damage to the eyes, kidneys, nerves and blood
vessels. A potentially fatal condition called ketoacidosis may also develop, in
which the blood becomes increasingly acidic as toxic substances build up in the
bloodstream.
Insulin levels that are too high. As in the previous
situation, exercise triggers the liver to release more glucose. However, the high level of
insulin is so effective at using up the glucose in the bloodstream, that there is not
enough glucose to meet the demands of the muscles. As a result, the person could
experience low blood sugar ( hypoglycemia). This can lead to a variety of symptoms, including heavy
sweating and dizziness. Severely low levels may also lead to shaking and/or fainting, which can be very frightening to both the patient and people around him
or her.
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What are
some general exercise precautions?
There are some precautions that everyone
needs to take when exercising, including the following:
Starting slowly and building up to longer/harder workouts
Keeping track of one’s heart rate
Warming up slowly before exercise and cooling down slowly
afterwards
Starting slow and building up to longer/harder workouts.
Most health care professionals suggest that individuals should begin exercising gradually,
working up to longer or harder workouts. Trying to do “too much, too fast” can
lead to serious health risks, such as heart attack,
particularly if an individual has been inactive, has an existing condition, or is overweight. In these cases, it is vital to slowly build the
endurance necessary for a longer and more strenuous exercise program.
Keeping track of one’s heart rate. To make the most of aerobic exercise, people need to determine their target heart
rate (THR), which is 70 to 80 percent of one’s maximum heart rate. The formula
for calculating the maximum heart rate is to subtract one’s age from 220. For
example, the maximum target heart rate of a 20 year old would be 200, and the
person’s target heart rate would be 140 to 160. The target heart rate is the rate at
which exercise “counts.” Exercising at or beyond one’s maximum heart rate
for too long may not be safe. Typically, 30 minutes of exercise while at the target heart
rate is a good workout, but exercises performed below this rate can also be of some
benefit.
Warming up and cooling down. Regardless of the type of exercise performed, people
need to prepare for the workout by gradually increasing their heart rate to their target
heart rate (warming up), exercising at the target heart rate for a given period of
time (working out) and gradually decreasing the heart rate until it nears the
resting rate (cooling down). This places less stress on the heart and muscles. The
key to this process is stretching before and after exercise. Before exercise, it is
important to do light movements of the whole body that gradually speed up the heart rate.
After exercise, the goal is to decrease the heart rate and relax the muscles by doing slow
stretches. These slow stretches focus on movement of particular muscles or body regions,
and help people to wind down.
What are some exercise precautions for diabetics?
There are some special precauations that
someone with diabetes needs to take when exercising.
For example, Type I diabetics should choose an area other than the leg for injecting
insulin if they are about to run or “power walk” a little later. Other special
precautions include the following:
Knowing when to exercise, and when to avoid exercise
Testing glucose levels both before and after exercise
Wearing appropriate shoes and socks
Having an exercise partner, snacks and medical I.D. on
hand
Seeing the physician before beginning any exercise
program. Anyone with diabetes should begin an exercise program only after discussing
it with his or her physician. The physician will probably check the person’s glucose
level, blood pressure, heart, kidneys, eyes, legs and feet before making a decision about the exercise
program. He or she may also advise the patient not to lift weights if the patient has
certain conditions such as diabetic retinopathy (a disease of the eye).
Also, because the blood pressure of diabetics rises higher during exercise than that of
non-diabetics, the physician may recommend a stress test. In this painless
test, an electrocardiogram (EKG) is performed while the patient exercises in a controlled
manner on a treadmill or stationary bicycle at varied speeds and elevations. The reaction
of the heart under exertion can be measured and evaluated to determine a healthy target
heart rate for the patient while exercising.
If the physician approves of the exercise program, he or she may adjust the patient’s
insulin/medication(s) to reflect the higher activity level.
Knowing when to exercise and when to avoid exercise. In people without diabetes,
the standard recommendation is to exercise before meals (on an empty stomach) and more
than one hour after meals. In contrast, people with diabetes are encouraged to exercise
when glucose levels are high (but not over 250) and insulin levels are low. The point at
which these levels are at the right balance depends on whether diabetics are taking
insulin and, if so, which type of insulin is being taken. For example, different types of
oral medications can have different effects on the body, and all oral medications can have
different effects than insulin injections. Therefore, diabetics are encouraged to work
closely with their physician to define the range of glucose levels that develop with
exercise and to adjust their medications accordingly.
Testing glucose levels before and after exercise. For at least the first month of
starting a new exercise program, diabetics should test their glucose levels both before
and after exercise. Experts also recommend testing glucose levels during exercise,
especially the first few times. Before exercise, levels should be high, but diabetics
should also avoid exercising if their glucose levels are very high (over 250 for adults;
over 400 for children). Diabetics should also avoid exercise on a day when their glucose
levels have been up and down, or when they have ketones (toxic substances) in their urine.
After exercise, levels are usually lower but at least 100 for those who use insulin, and
at least 80 for those who take either medication or no treatment. If post-exercise levels
are lower than these numbers, people are encouraged to have a sugared snack (e.g., orange
juice or a piece of high sugar candy).
Wearing appropriate shoes and socks. Because all diabetics need to be careful of
their feet, people are encouraged to wear professionally fitted training shoes with good
arch support, traction and protective toe box. Good quality shoes may cost a little more,
but it is a good investment for long-term health. People are also encouraged to check
their feet after exercise and to call their physician if they see any blisters, warm
areas, redness or cracks in the heels. Care for one’s feet also includes keeping them
clean and moisturized, with properly trimmed toenails cut straight across.
Having an exercise partner, snacks and medical I.D. on hand. Not only is having an
exercise partner a great way to have more fun and keep one’s motivation high, but
that person can also be of great help if needed in the case of low blood sugar (hypoglycemia). People are encouraged to call some of their
local gyms to see which might offer a two-for-one membership. Having high glucose snacks
handy and wearing an medical identification tag/bracelet/necklace at all times are both
essential.
This information can be found by going to www.heartcenteronline.com
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