Exercising with Diabetes
Regular exercise lowers risk of many diseases in general but it's especially important for those with diabetes. Even a small amount of simple exercise such as walking can improve blood glucose control in people with pre-diabetes, according to research from Duke Health. The six-month study showed a 7 percent improvement of glucose tolerance (a measure of how readily the body processes sugar) in people who walked briskly 11.5 miles a week; those who walked 7.5 miles experienced a 5 percent improvement on average.
How it works
"Exercise is the cornerstone of diabetes management," says Jackie Shahar, MEd, clinical exercise physiologist and a Certified Diabetes Educator with Joslin Diabetes Center, Boston, MA. "When you move you contract your muscles, which requires energy, and we get that energy from glucose. The more exercise you do, the more sugar you're burning." Since we lose muscle over time, this becomes most important as we age. "Muscle is a major site for glucose, so if you have less muscle the glucose has to go somewhere, and it goes into the blood [which raises blood sugar]," Shahar adds. Exercise not only helps control your blood sugar but enables you to better manage your weight as well, says Michele Olson, PhD, professor of exercise physiology at Auburn University Montgomery, AL.
Plan on a 50/50 split between cardiovascular/aerobic exercise and strength training, says Shahar. "Always talk to your doctor first. You need to create a program that takes into account your lifestyle, available equipment, etc." Ideally, plan on two to three days a week of strength training and five days a week of cardiovascular exercise. Be sure to work on creating a gradual progression. "People tend to get very motivated to start and work so hard they can't move the next day," Shahar says.
If it's been awhile since you exercised, start with 10 minutes and increase the duration by adding five minutes the next week and another five the week after, suggests Shahar. Use the "talk test" to determine intensity. A moderate workout enables you to carry on a conversation while you're exercising. If you find yourself gasping for breath or unable to talk easily, you may want to lower the intensity of your routine. Once you start to get in better shape it's fine to bump up the intensity to more vigorous, however, says Olson. "At a moderate to vigorous level you should be able to verbalize short phrases such as, 'Hello, beautiful day.' But your exercise effort should be such that you could not carrying on a typical conversation."
Strength training routines should include exercises that work six to eight body parts, 15 reps per each set, says Shahar. Work up to two sets the following week and incorporate a third set after four weeks, making sure your workouts fall on non-consecutive days to give your muscles time to recover.
Before you begin, it's crucial to check your blood sugar before, during, and after exercise in case it tends to dip quickly, says Olson, who recommends waiting for two hours after eating before testing your blood sugar if you have type 1 diabetes. "If you have type 2 diabetes you can exercise one to two hours following a meal, or when you feel the meal has adequately digested. And keep juice or sugar tablets on you when you exercise in case your blood sugar crashes. I addition, stay well hydrated by drinking plenty of fluids. "Drink water before, during (sip 2-4 oz every 15 minutes), and after exercise," says Olson.
Long duration aerobic exercise lowers blood sugar, but high-intensity workouts may have the opposite effect, says Shahar. "Intense exercise releases counter regulatory hormones, ones that signal the release of glycogen (storage form of glucose), which gets converted to glucose and can increase blood sugar levels." For this reason, it's important to track your blood sugar and plan in advance to avoid problems such as low blood sugar.
Nerve pain or a loss of sensation in your feet can make walking uncomfortable and impact your gait, says Shahar. "Walking is not the only exercise. Using a stationary or recumbent bike can give you excellent results without injury." Check your feet periodically, especially after walking, and make sure to buy well-fitted walking shoes.
"Exercise is truly the best medicine for people with diabetes," says Shahar.