Diabetes and Exercise

Dancing. That's fun. Swimming. That's fun, too. But exercise? That's work. Right? Well, no, exercise can be fun-if you choose to make it that. Exercise doesn't have to be a boring set of jumping jacks. It can be dancing, swimming, walking, and many other fun pastimes that get your body in motion.

The Payoff

Exercise not only can be fun, but also can do a lot for you, including:

•  Helping you lose weight
Helping to control your blood glucose
Reducing, in some cases, how much insulin or oral diabetes medications you take
Cutting your risk of heart disease
Lowering your blood pressure
Improving your health and fit ness
Giving you a greater sense of well-being
Reducing stress

Safety First

You may be an old hand at fitness who's just found out you have diabetes. Or perhaps you’ve been living with diabetes for a while and want to start an exercise program.

Either way, a visit to your health-care team is in order. If you haven't done so recently, you should have a complete medical history and physical examination. You will also want to talk to your registered dietician about adjusting your eating plan and to your doctor about adjusting your medications to keep your blood glucose levels well-controlled once you start exercising. You may want to talk to your doctor or an exercise physiologist for help in finding an activity that's right for you.

Your health-care team should help you answer these questions:

•  How often should I exercise? What times of day are best for me?
•. How long should my exercise sessions be?
•. How hard should I exercise?
Should I stick with the same routine each time, or car I vary the length and intensity of my workouts?
•  How should 1 monitor how hard I exercise? Should 1 count my heart rate? What heart rate should 1 aim for? How often should 1 monitor?
•  Are there types of exercise I should avoid?
Are there symptoms (for hypoglycaemia or heart disease) that I should watch out for?
What special precautions should I take?
Should I take less insulin or change my injection site before I exercise?
How should I modify my meal plan?
Will my medications affect me differently if exercise?

Exercising Safely

The best rule of thumb for a safe workout is to listen to your body. You should not have too much fatigue, pain, or shortness of breath. Doing too much too fast can lead to injuries or even life threatening situations. But how much is too much?

A good workout should inc1ude 5-10 minutes of warm-up exercises and gentle stretching. Follow this with at least 20-30 minutes of aerobic activity, such as walking, jogging, biking, dancing, or swimming. This part should get your heart pumping and blood flowing, but should not be so intense as to cause shortness of breath, weakness, or intense pain. End each session with 5-10 minutes of cool-down exercises and more stretching.

To exercise safely with diabetes, be sure you:

•  Know your blood glucose levels before, during, and after you exercise.
Carry a fast-acting source of carbohydrate with you, such as glucose gel or tablets, a soft drink, or raisins, in case of low blood glucose.
Try to exercise with a friend or, when you exercise alone, let people know when you are going out, where you will be, and when you will be back.
Warm up and cool down each time you work out.
Replace body fluids. Drink water before and after you work out. If your aerobic exercise lasts more than 30 minutes, drink water during the workout, too.
Carry visible diabetes identification and money for a phone call.
Use well-fitting footwear. Check you feet every day and after each exercise session for redness, infected cuts, or open sores.

Diabetes and Blood Glucose

Usually, exercise makes your blood glucose go down. It can go down while you are exercising and for a long time after.

This is a concern if you take diabetes pills or insulin. But if you are prepared, you can exercise safely.

Exercise may make your blood glucose go up if it is already more than 240 mg/dl after fasting.

To avoid exercise-induced low blood glucose if you take insulin:

•  If you are otherwise healthy, try to schedule exercise 1-3 hours after a meal. This is when your blood glucose is elevated.
•  Try not to exercise when your insulin injection is peaking. If you use only regular insulin, this would mean to avoid exercising within the first 1-2 hours after injecting it. Remember that exercise increases blood flow, which speeds up how fast your insulin goes to work.
If your exercise is going to be of moderate to high intensity or you're going to be working out at a more moderate intensity but for a longer time than usual, think about decreasing the insulin dose that will be working while you exercise.
Know your own blood glucose response to different types of exercise. Learn this by monitoring often before, during, and after exercising.
Test your blood glucose twice before you exercise, 30 minutes apart, to know whether your blood glucose level is stable, rising, or dropping.
You may need to eat during or after exercise if you work out hard or for a long time (an hour or more).
Know that you may need extra food for up to 24 hours after exercising, depending on how hard and how long you exercised.

Staying Motivated

It will take several months for your more active lifestyle to become a habit. In the meantime, try these strategies for sticking with it:

•  Schedule your workout and stick to your schedule.
•  Find a workout partner.
Cross train. Alternate among a variety of activities so you won't get bored.
Set realistic, specific goals.
Reward yourself for sticking with it.
Track your progress.
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