Exercise and Diabetes

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Regular physical activity is an important health promoting life-style habit and helpful in managing diabetes. Getting your health care providers approval should always be the first step before considering an exercise routine. They will have a good idea about your abilities and limitations concerning exercise. If you have diabetes and are at risk for hypoglycemia (low blood sugar), exercise requires a little extra care and planning.

Physical activity can lower blood glucose. Moderate to intense physical activity may lower blood glucose for up to 24 hours. So, if you are taking a medication that lowers blood glucose, there are checks and balances to ensure your glucose levels stay within a safe range. The goal should be to keep blood glucose levels within a safe range before, during and after physical activity.

Dig Deeper into Physical Activity

How much is a good goal?

Recommendations are at least 150 minutes a week or 20-25 minutes a day of moderate-intensity exercise. Additionally, individuals should work the major muscle groups at least twice a week. Individuals who are not currently active can start with lower intensity activities, such as walking and bodyweight exercises, and gradually increase how frequently and how long activities are performed.

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Is it okay to exercise?
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Discuss your personal glucose target levels with your  diabetes care provider before starting an exercise routine. Once you have the “go ahead” there are a few questions to consider before exercising.

Do I know my blood glucose level? 

Check your blood glucose levels before, during and after different types exercise to understand the impact it has on your glucose levels. Your target glucose levels may differ depending on the type of medication and the risk it carries for causing hypoglycemia. Target glucose levels may also vary whether your exercise is aerobic, like walking or jogging, or resistance training, like weight lifting or using exercise bands. Exercise should be delayed if blood glucose levels are outside the safe target range recommended by your diabetes health provider. 

Do I have access to a carbohydrate snack in case of hypoglycemia? 

If you are taking a medication that puts you at risk for hypoglycemia, you shouldn’t be without a fast-acting source of carbohydrate. 

Do I have access to my glucometer for glucose checks? 

Since exercise can sometimes have unpredictable effects on blood glucose it is wise to have access to fast acting carbohydrates. It is especially important when first starting an exercise program. It may take some trial and error to determine how different types and durations of exercise affect your glucose levels. Snack and insulin adjustments may be necessary for physical activity over an extended time period. Regular blood glucose checks are necessary before, during and after exercise. Avoid exercising during peak insulin times. Your diabetes care provider will use these glucose checks to make recommendations to help keep your blood glucose stable. 

In case of emergency can I be identified as a person with diabetes? 

A medical alert bracelet, necklace or some way to alert others that you have diabetes can be a lifesaver in case of emergency. Emergency contacts and an indication of whether you take insulin is also helpful. 

Other Considerations

With diabetes there are times when exercise may not be recommended or when certain exercises should be avoided. 

Presence of Ketones 

During exercise your body uses sugar and stored fatty acids for energy. The exercising muscle needs more glucose in the blood stream to use for energy. If there isn’t enough insulin present to allow the glucose to enter the muscles the body looks for other sources of fuel. When your body breaks down fat to use for energy ketones are produced. If ketones are present in someone with type 1 diabetes it is a sign of a serious lack of insulin and can result in ketoacidosis which is a medical emergency. Exercising with the presence of ketones is not safe and will increase the breakdown of fat for fuel and result in more ketone production. 

Diabetic Retinopathy

Strenuous weight lifting or high impact activities should be avoided with certain types of retinopathy. 

Advanced Kidney Disease

Avoid strenuous activity. 

Diabetic Peripheral Neuropathy

Ulcerations and fractures are a risk with neuropathy, so exercise should be limited to non-weight bearing or lower impact activities. 

High Glucose Levels

Exercising is generally not recommended in type 1 diabetes when blood glucose is 250 mg/dl or higher with the presence of ketones. 

More frequent monitoring and caution are necessary to exercise if glucose levels are 300 mg/dl or higher without the presence of ketones. In type 2 diabetes exercise isn’t recommended when glucose is 400 mg/dl or higher. These are general recommendations and may not be appropriate for you, so always discuss safe exercising blood glucose targets with your health care provider. 

Warm Weather

Exercise tolerance may not be the same in hot weather. Drink plenty of water to stay hydrated. 

Sometimes symptoms of hypoglycemia are harder to recognize when the weather heats up because the symptoms are similar to the bodies response to over- heating. 

Can Exercise Cure Diabetes?  

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Following diagnosis, exercise is one of the first lifestyle modifications that is advised alongside dietary changes. While exercise alone cannot cure diabetes, engaging in frequent exercise can have helpful benefits for those diagnosed with diabetes and prevent complications. 

Benefits of Exercise  

Overall, regular exercise can prevent complications and progression of diabetes. Regular exercise can improve insulin sensitivity and decrease insulin resistance leading to improved glycemic control. For those with Type 1 Diabetes, exercise can optimize long-term protection against cardiovascular disease development.

Additionally, regular exercise leads to benefits with improved body composition, increased strength, and aerobic capacity. These are key components to maintaining independence with increased age alongside daily movement and decreased sedentary time. Overall, regular exercise with a variety of types of movement leads to increased benefits that prevent complications associated with diabetes.  

Complications of Lack of Exercise   

Without exercising, there is an increased risk of the development of complications associated with type 2 diabetes.

  • The most common complication is diabetic neuropathy, found in half of all individuals with diabetes. Neuropathy is nerve damage in your feet and hands as well as nerve systems that control your body.
  • There is also an increased risk of loss of vision, lack of skin integrity, high blood pressure, and stroke.
  • Additionally, there is an increased risk of nephropathy or kidney disease. 

To prevent or delay the progression of all these complications and damage, controlling your blood glucose levels are important. Exercise is a key lifestyle modification that alongside diet and medication is essential in maintaining target blood glucose and decreasing risk of complications.  

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