Managing Diabetes Highlights
- If you haven’t exercised for a while, check in with your doctor first.
- Even 10 minutes at a time counts! Do what you can and build from there. Aim for 2.5 hours of moderate to vigorous exercise each week, with no more than two days off in a row.
- Exercise helps manage diabetes, prevents complications and supports heart health.
- Mix up the types of exercise. Aerobic exercise gets your heart and lungs working. Resistance exercise builds strength.
- Know what to do if you have a sudden spike or drop in your blood glucose level.
Want to lower your blood glucose, prevent or reduce diabetes complications, feel better and live longer? Your first move is to add physical activity into your lifestyle. Exercise is one of the most important aspects of managing diabetes well. To exercise the right way, you need to know how much exercise you need, what type of exercise to do, and how to do it safely. No matter what your fitness level, getting active can help you to control your diabetes.
Regular exercise makes a difference to diabetes
Research shows that regular exercise has many benefits. The Look AHEAD study found that exercise improves factors that put the heart at risk, such as blood pressure and cholesterol. It also helps prevent foot and kidney complications related to diabetes, while improving quality of life.
To get the most benefit out of exercise, Diabetes Canada recommends 150 minutes of moderate to vigorous exercise per week, with no more than two days off in a row. Exercising for 150 minutes each week can feel like a lot for anyone new to physical activity.
Remember, even some exercise is better than none. If you can only do 10 minutes at a time, that is a good place to start. Do what you can and build from there.
Choose a mix of exercise activities
- Aerobic exercise – Most people think of this type of exercise as cardio. Aerobic exercise uses big groups of muscles for at least 10 minutes at a time. Walking, jogging, swimming, or riding a bike all qualify. If you think aerobic exercise might be challenging, start with 10 minutes of walking on a flat surface, outside on the sidewalk or inside at a mall. Gradually increase that amount of time as you get used to it.
- Resistance exercise – This type involves doing short sets of exercises using weights, weight machines, and resistance bands. The best way to perform resistance exercise is to do three sets of eight to 12 repetitions of each exercise. For instance, you could do eight dumbbell curls, three times with each arm, with a short break between each set of eight. Choosing the right amount of weight is important. If you can do more than 12 repetitions in a row, the weight is too light. If you cannot do at least eight in a row, the weight is too heavy. It can take time to find the right amount of weight. Over time, as you exercise and get stronger, you will probably need more weight. This helps with tone, not bulk, and will leave you looking great.
- Interval training – Here, an exercise is done at high intensity for one to two minutes, followed by a short break, and then done again. Interval exercises include brisk walking, sprinting, rowing, and jumping jacks. There is some evidence that interval training is better at lowering A1C than continuous aerobic exercise. However, it is not usually the best type of exercise for beginners.If you get chest pain or persistent shortness of breath, see your doctor.
- Stretching – Take the time to stretch before and after exercise to help increase your flexibility. Even if you are not able to do moderate to vigorous exercise, stretching each day can be helpful.
Take an activity break
No matter how much you exercise, a sedentary lifestyle (sitting or lying down for long periods of time) increases A1C, blood pressure, and cholesterol. Standing or walking for as little as two minutes every half hour can have huge benefits for your health. If you spend a lot of time sitting, set a timer to remind yourself to stand up and go for a short walk around the office or your home.
Before you start exercising
If you are exercising for the first time or starting a new exercise program, it is important to begin by talking with your doctor. Although regular physical activity is good for your health, your diabetes must be considered. Depending on your current medical conditions, your doctor may want you to have a few tests. These could include an ECG and an exercise stress test to assess your cardiovascular health. If you have foot complications from diabetes, your doctor is likely to do a foot exam and check that you have shoes that provide support and fit well. If you plan to start high-intensity interval training, scheduling an appointment with your eye doctor may also be beneficial.
No matter what type of diabetes you have, what medications you take, or how good your diet is, exercise is a crucial part of managing your diabetes. Here are some key points to remember.
There is no doubt that physical activity will benefit your health. However, having diabetes adds some risk to exercising. Staying mindful of issues that may arise can help you to avoid them.
- Dehydration – Anyone who exercises can become dehydrated. To avoid dehydration, exercise in a cool, well-ventilated area, and drink lots of water. Certain diabetes medications, such as SLG2 inhibitors, will make this more important.
- Hypoglycemia – A sudden drop in blood glucose is the biggest risk of exercising for anyone with diabetes. This is a particular risk for those with type 1 diabetes, but can also affect people with type 2 diabetes who use insulin or certain medications. Hypoglycemia is not just an issue during exercise. It often occurs at night, six to 15 hours after exercise, but can be delayed by as much as 48 hours after exercising. Ask your doctor or diabetes team about ways to prevent hypoglycemia. One way is to have a snack after exercising. Another option is to do short bouts (about 10 seconds) of high-intensity exercise every few minutes during long aerobic exercise. Be sure to check with your doctor before exercising, as changes to your medications may be recommended.
- Hyperglycemia – High blood glucose is also a bigger risk for people with type 1 diabetes. High intensity activities, including interval training or heavy resistance training, can cause hyperglycemia. Adding a cooldown period to the end of your workout can help to counter it. Again, check with your doctor or diabetes team before exercising for tips on avoiding hyperglycemia.
- Overuse injuries – Anyone who exercises can experience this type of injury. It is caused by exercising too much. This is especially true for people who switch very quickly from little regular exercise to a lot. To avoid an overuse injury, start with a reasonable amount of exercise and increase it gradually. Stretching after exercising can also help to prevent these injuries.
What are hypoglycemia and hyperglycemia?
Hypoglycemia means a blood glucose level that is too low (3.9 or less on your blood sugar monitor). Symptoms include feeling lightheaded, weak, hungry, and shaky. Severe hypoglycemia can cause drowsiness, confusion, and seizures. If you start to experience any of these symptoms during exercise, stop the activity. Sit down and eat some carbohydrates or drink some juice. If you have a monitor, recheck your blood sugar in 15-20 minutes. If your blood sugar stays low or you continue to have symptoms, call your doctor or go to the emergency department.
Hyperglycemia means the blood glucose is too high. Technically a random blood sugar over 11.1 on your monitor is hyperglycemia, but for many, it is simply blood glucose that is higher than normal. You may not notice hyperglycemia. The symptoms can include feeling thirsty and peeing a lot. If you develop hyperglycemia while exercising, stop the activity and drink a large glass of water. Recheck your blood sugar in about 15 to 20 minutes and stay hydrated. If your blood sugar continues to stay high, call your doctor or go to the emergency department.
Starting to exercise can seem daunting. However, you do not have to have a perfect exercise routine right away. Begin with a manageable amount of exercise and build from there. Keep moving, doing something you enjoy, either on your own or with friends.
Your body will thank you.
WRITTEN BY: Matthew Lowe, MD, working in emergency medicine in Dartmouth and Truro, Nova Scotia.