Diabetes and Exercise

The therapeutic use of exercise for diabetes mellitus was prescribed as early as 600 BC by the Indian physician Sushruta, and was widely recommended by physicians of the 18th century. Elliott Joslin identified exercise along with dietary management and insulin administration as one of the three components of good therapy in the 1920’s. Today exercise is recognized as one of the established principles of diabetes treatment.

We all know exercise is important for everyone’s health, and it can be especially important if you have diabetes. In some ways, exercise has greater benefits for a person with diabetes since it has an important effect on blood sugar control.

Diabetes and Exercise

How does exercise work on diabetes?

• Exercise can lower the blood sugar and improve the body’s ability to use glucose. With regular exercise, the amount of insulin needed decreases.
• Exercise can also help reverse the resistance to insulin that occurs as a result of being overweight. There is an increase in the number of insulin receptors improving the body’s ability to utilize insulin.
• Exercise improves risk factors for heart disease and decreases the risk of heart problems, which is a major health concern for people with diabetes. This includes the reduction of low density lipoprotein cholesterol (LDL), or bad cholesterol, which forms plaque that obstructs blood vessels. Exercise promotes the good cholesterol, high density lipoprotein cholesterol (HDL), which is protective against heart disease. Blood pressure is also lowered through exercise and exercise has been shown to improve mild to moderate high blood pressure.
• Exercise, when combined with a meal plan, has the ability to control Type 2 diabetes without the need for other medications.
• Regular physical exercise and activity provides an effective way for a person with diabetes to manage their blood sugars.

Diabetes and Exercise: What can exercise do?

In addition to the benefits specific to diabetes, a person with diabetes will experience the same benefits and enjoyment everyone else gains from exercise.

• Improved Physical Fitness. Exercise increases the efficiency of the heart, lungs and circulatory system both at rest and with exercise. The body’s improved ability to transport oxygen provides increased stamina and endurance. You have more energy for greater productivity at work and reserve energy to do the leisurely things you enjoy each day.
• Weight Control. Exercise can help you to lose weight or maintain your weight. Exercise burns excess calories, which are stored as fat cells. This means that at rest you burn more calories than a sedentary person, increasing your weight loss. An exercise program during weight loss is essential to ensure that the weight lost is fat and not lean body tissue or water weight, which often occurs from dieting alone. As you become leaner, you will look better and feel better.
• Psychological Benefits. Exercise is a means of dealing with life’s everyday stresses. It also aids in relieving depression and building self-confidence. Through exercise, you have more energy, you are more relaxed and you feel less fatigued.

Before beginning an exercise program, it is important to obtain medical clearance. It is absolutely imperative if you are 35 years of age and/or have had diabetes for 10 years or more.

Your blood sugars must be adequately controlled before beginning a new program in order to produce the desired blood sugar results.

So Why Exercise?

Exercise is something that you can do yourself to help your diabetes. A regular exercise program can bring dramatic results. If you exercise properly, you can lower blood sugar levels and improve your blood glucose control. You can also maximize weight loss and decrease your risk of heart disease. An exercise program should be individually tailored and designed to compliment your lifestyle and to achieve your desired goals. This requires the proper adjustment of your insulin and extra food (snack) consumption. Many factors such as the time of day you exercise or the type and duration of your exercise will determine whether adjustments should be made in your insulin dose or your meal plan. Discuss your exercise program with your exercise physiologist to determine the type of adjustments you need to make.

Diabetes and Exercise: Getting Started

Exercise is beneficial for most people. But it is especially important for people with diabetes. There are educators available on the Joslin team to meet with you and determine the best exercise plan for you (in cooperation with your doctor). It does not matter how old you are or how long you have had diabetes — it can still help you better control your blood glucose and overall health. What is important is that you pick an exercise that you enjoy.

Diabetes and Exercise: Tips on Exercise when you have diabetes

1. Consult your doctor before starting any exercise program.
2. If you are over 35 you may need a stress test.
3. Test your blood glucose before and after exercise.
4. Do not exercise if blood glucose is over 250 and there are ketones in your urine.
5. If blood glucose is over 250 but no ketones are present, you should follow these guidelines:

• Type 1: Do not exercise if blood glucose is 300 or more
• Type 2: Do not exercise if blood glucose is 400 or more
• Exercise 1 – 1 1/2 hours after eating
• Check blood glucose before and after exercise and follow snack guidelines
• Always carry a carbohydrate snack with you (Glucose tablets, juice, etc.)
• Drink plenty of fluids
• Wear shoes and equipment that fit well

6. Plan exercise to prevent low blood sugar reactions