The facts and myths about diabetes are plenty especially on the kind of foods one should have or not have, whether one should exercise to control diabetes etc etc. But, it’s when I saw my dad exercising one day and a thought struck me is it not important to test a diabetic before exercise? Is diet all that one needs to focus on?

What if he exercises vigorously and his sugar levels drop down, at what sugar levels should we allow or not allow a person to exercise? What should be the intensity and frequency of exercise? What type of exercise should a Diabetic do?

These questions obviously led me to explore and research more about diabetes and exercise. I would like to share some information about what Diabetes is, what are its types and how regular exercise can control your Diabetes.

What is Diabetes?

Diabetes is a chronic disease wherein there exist high levels of sugar in the blood either due to less of insulin sensitivity or because of low insulin secretion or no insulin levels in the body.

There are three major types of diabetes. The causes and risk factors are different for each type:

• Type 1 diabetes -can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown.
• Type 2 diabetes makes up for most of the diabetes cases. It most often occurs in adulthood, but teens and young adults are now being diagnosed because of high obesity rates. In such cases either the body becomes less sensitive to insulin or insulin secretion decreases.
• Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes. And disappears once the pregnancy is over.

Diagnosis

Blood tests:

• Fasting blood glucose level – 70-100mg/dl
• Post Prandial – Less than 140mg/dl
• Haemoglobin A1c test -Normal: Less than 6%

After understanding the different types of diabetes and ways to diagnose them let’s get to the core area of exercise.

We all know that exercise has multiple benefits for a healthy human being but, did we know the benefits of exercise on a diabetic?  So let’s understand the benefits of exercise for a diabetic in brief first.

How does Exercise Help in Diabetes?

1. Lowers blood sugar levels.
2. Helps you feel better.
3. Help maintain proper body weight.
4. Help keep the heart rate and blood pressure lower.
5. Help keep blood fats levels normal.
6. Improves insulin sensitivity.
7. Help maintain normal blood circulation in the feet.

Now that we know seven of the many reasons why exercise is important for a person with diabetes, let’s know which exercise benefit diabetics.

Which kinds of Exercise are Best?

Expert agree you need either

1. 30 minutes of “moderate intensity” aerobic activity – 5 days a week.
2. “Vigorous intense” aerobic activity 20 minutes or more a day – 3-5 days a week.

In addition, you should add flexibility and strength training to your routine.

1. Flexibility activities 5-7 days a week.
2. Strength training 8-10 exercise, 10-15 repetitions of each exercise, 2-3 days a week.

Calories Per hour and the types of moderate and vigorous exercises

Moderate physical activity for one hour	Calorie burnt per hour
Hiking	370
Light gardening / Yard work	330
Dancing	330
Golf(walking and carrying clubs)	330
Bicycling (<10mph)	290
Walking  (3.5mph)	280
Weight lifting (light workout)	220
Stretching	180
Vigorous physical activity for one hour
Running / Jogging (5mph)	590
Bicycling (>10mph)	590
Swimming (Slow freestyle laps)	510
Aerobics	480
Walking (4-5 mph)	460
Heavy Yard work (chopping wood)	440
Weight lifting (vigorous effort)	440
Basket ball (vigorous)	440

Source – Dietary Guidelines for Americans – 2005 *(These values are not specifically for Indians as they are taken from American journals)

When should we Exercise?

The best time to exercise will vary with our schedule.  Preferably we should pick up the same time for exercise each day so that if on insulin the adjustment of insulin dosage is manageable.

1. Morning exercise may cause your blood glucose to drop less than if you exercised later.
2. If you are on insulin or taking pills that work by making more insulin, evening exercise may result in low blood glucose while you sleep.

Remember -Your Diabetes Management can be adjusted to suit your lifestyle. Your lifestyle does not have to be adjusted to fit your diabetes.

After knowing what kind of exercise and at what time we should do them, let’s see what precautions should be taken while doing them.

Safety Tips for Active Diabetics

1. Get your doctor’s okay before you start exercising.

This is especially important if you are older than age 35, have had diabetes for more than 10 years, have any complications of diabetes, have not exercised in a long time, or have heart disease.

Exercise has the same effect on blood glucose as insulin. It lowers blood glucose, making you more sensitive to insulin. This is a benefit of exercise that can also pose a problem if it lowers your blood glucose too much.

2. Avoid low blood sugars

Low blood sugars are when the glucose levels dip below <70mg/dl.

Common symptoms include shakiness, weakness, abnormal sweating, and anxiety, tingling of mouth and hunger, headache, visual disturbance, confusion, seizures, coma. Blood glucose monitoring before and following exercise, especially when beginning or modifying the exercise program is prudent.

Always keep a 15g of fast-acting carbohydrate (powdered sugar / Glucose tablets 3-4) with you to treat Hypoglycemia.

3. Check your blood glucose levels pre and post workout

If you blood glucose is below 70 –

1. Take 5g of carbohydrate right away
2. Wait for 15 minutes
3. Check again – if still below 70 have another 15grams.

It should work now.

If the blood glucose is high – Fasting is>250 and ketosis is present.

Or >300 with or without ketosis.

Avoid exercise with such high blood sugar levels.

4. Eat before heavy exercise

If you’re going to exercise around mealtime you should eat the meal first. When possible, allow half an hour for digestion. Solid foods, such as whole grains vegetables etc are digested slowly then liquids and provide protection for at least 2-3 hours.

When it is possible to choose the exercise time, try to begin the exercise 30-60 minutes after a meal or snack.

Remember – Nothing works better than experience and frequent blood glucose testing. 

5. Diabetic complications 

1. Retinopathy – Patients with retinopathy are at risk for retinal detachment and vitreous haemorrhage associated with vigorous-intensity exercise.

Thus for those with retinopathy, vigorous aerobic and resistance, weight-bearing exercises should be avoided.

1. Nephropathy: Should not indulge in vigorous-intensity exercise as protein excretion increases post-exercise.
2. Peripheral Neuropathy – Should take proper care of feet to prevent foot ulcers.

Feet should be kept dry.

Avoid the wrong type of socks and shoes. Avoid tight elastic bands and ill-fitted shoes (they reduce circulation). Should not wear thick or bulky socks (they can fit poorly and irritate the skin). Rather wear light coloured cotton socks that dissipate heat faster.

Moisturize your feet – but not between your toes- that could encourage a fungal infection.

Use a moisturizer daily to keep dry skin from itching or cracking.

Consider non-weight bearing activities as they may be better tolerated and aid healing.

6. Stay hydrated

Proper hydration is essential during exercise. Exercising during hot weather requires special attention. Drinking extra fluids should begin an hour or two before starting to exercise. A general rule is to drink 8ounces of fluid for every 30 minutes of vigorous activity. 

7. Check your pulse rate

It’s important to check the pulse periodically to see if you are exercising within your target zone. Right after you exercises take your pulse – count your pulse for 10 secs and multiply the no by 6.

Compare the numbers on the right grouping in the table below.

Age	Target Heart range zone
20 years	100-150 beats/min
25 years	98-146 beats/min
30 years	95-142 beats / min
35 years	93-138 beats/ min
40 years	90-135 beats/min
45 years	88-131 beats/min
50 years	85-127 beats/ min
55 years	83-123 beats/min
60 years	80-120 beats/min
65 years	78-116 beats/ min
70 years	75-113 beats / min

Source: Exercise and Your Heart, NationalHeart, Lung, and Blood Institute/American Heart Association, NIH Publication No. 93-1677.

Therefore the good news is that if someone regularly exercises these benefits can be permanent, and for someone with diabetes it can mean reducing medication. If younger members of families with a predisposition to diabetes exercise regularly they could avoid diabetes altogether.

A single bout of exercise can benefit the body’s sensitivity to insulin for 16-18 hours and therefore have effects on blood glucose control (glucose absorption) for 24-48hours.

But these effects wear off by 60-72 hours. Therefore keeping active most of the time is the best.

I just want to convey that Diabetes cannot take your hope, faith, attitude, courage, happiness, and happy life away from you. We are author of our own health and disease. Let’s overcome it, no matter what type or what level of disease it is. Let’s help others and ourselves to be active most of the time. Exercise can permanently remove or reduce medication.