Exercise your way out of DIABETES

Diabetes is a major concern these days, mainly because so many of us either have it or are at risk of getting it. Exercise plays a vital role in the management of diabetes. Physical activity can help you control your blood glucose, weight and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol. It can also help prevent heart and blood flow problems, reducing your risk of heart disease. Exercise helps you relax, feel better about yourself and increase your overall health.

What are the benefits of exercise?

1. Exercise burns calories, which will help you lose weight and maintain a healthy weight.
2. Exercise can help your body respond to insulin better and may reduce the amount of insulin needed to maintain good blood glucose levels.
3. Exercise can improve your circulation, especially in your arms and legs, where people with diabetes can have problems.
4. Exercise helps reduce stress, which can raise your glucose level.
5. It can lower your risk for heart disease
6. It reduces your cholesterol levels
7. It helps you control your blood pressure.
8. In some people, exercise and a proper diet can control Type 2 Diabetes without the need for medications.

How to start exercising

Now that you know the benefits of exercise, you are ready to start your exercise programme.

But if

• you have recently been diagnosed as having diabetes;
• have been inactive and out of shape;
• have not had experience with diet or insulin adjustment.
• have had complications from diabetes;
• have other health problems such as high blood pressure, heart diseases, joint diseases etc, meet your doctor before you begin an exercise programme. Your doctor can tell you about the kinds of exercise that are good for you depending on how well your diabetes is controlled, any complications you may have had or other health-related conditions.

What kind of exercise should you do?

Most doctors recommend aerobic exercise, which makes you breathe more deeply and makes your heart work harder. Brisk walking, swimming and cycling are few practical options you have.

There is another type of exercise and this improves flexibility, coordination and muscle tone (eg: ankle rotation, arm circles and stretching muscles). Depending on your health status your doctor will recommend the type of exercise that suits you the most. For example if you have problems with the nerves in your feet or legs, your doctor may want you to do a type of exercise that won’t put pressure on your feet. These exercises include swimming, cycling, rowing or chair exercises.

Irrespective of what kind of exercise you do, when you start an exercise programme, go slowly. Gradually increase the intensity and length of your workouts as you get fitter. It is a good practice to do warm up exercise before you start and cool down when you are done. To warm up, spend 5 to 10 minutes doing a low-intensity exercise such as walking. Then gently stretch for another 5 to 10 minutes. Repeat these steps after exercising to cool down.

For most people, it is best to aim for a total of 30 minutes of exercise a day, at least 5 days a week. However one can divide one’s activity for the day into 2 sessions of 15 minutes each. An often heard excuse is that the patient does not have the time to engage in exercise. This is not an acceptable excuse. The lack of time can be addressed in some simple, practical ways:

• by getting off the bus 3 or 4 stops before the regular stop and walking part of the way.
• if one has to do marketing on foot, by taking a circuitous route to get the requisite exercise.
• being extra active can increase the number of calories you burn. There are many ways to be extra active.
• Walk around while you talk on the phone.
• Play with the kids.
• Take the dog for a walk.
• Stop using the remote control; get up to change the TV channel instead.
• Work in the garden.
• Clean the house.
• Wash the car.
• Park at the far end of the shopping centre car park and walk to the store.
• At the supermarket, walk down every aisle.
• At work, walk over to see a co-worker instead of calling or emailing.
• Take the stairs instead of the elevator.

One could use one’s own ingenuity to get the quota of exercise without making it look like a burden.

Exercise and low blood sugar reaction (hypoglycaemia)

If you have diabetes, your health care team will discuss with you about the possibility of low blood sugar reaction (hypoglycaemia) which is a potential risk for a person with diabetes on medication. This usually occurs while exercising or immediately after activity. But you should keep in mind the possibility of having a reaction even a few hours afterwards.

You should be alert to the symptoms of hypoglycaemia and should never ignore the warning signs. When your blood sugar level drops below a critical level you may feel a change in your heartbeat, sweat excessively, get a headache, feel dizzy, become anxious and shaky, and feel irritable. You may also get a tummy pain, nausea or feel very hungry. If you ignore the initial warning symptoms your sugar level will drop drastically and you may even lose consciousness.

At the first sign of these symptoms, you should stop exercising and follow your doctor’s advice about how to treat hypoglycaemia. Your doctor may suggest you keep some toffees, packet of glucose/sugar or juice at hand for an emergency. Make sure you take them as early as possible. Call for help. It is important to remember that if you do have an attack of hypoglycaemia and even if you are treated promptly, it could recur during the course of the day. Be under medical supervision till the episode is clearly behind you.

Some exercise tips

• If you have diabetes and plan to walk or jog, be sure you wear socks and comfortable well-fitting shoes (whenever possible).
• Stretch for five minutes before and after your workout regardless of how intense you plan to exercise
• Start slowly with low-impact exercises such as walking, swimming or cycling.
• Build up the time you spend exercising gradually. If you have to, start with five minutes, do so and gradually increase the duration.
• Drink plenty of fluids while you exercise, especially when it’s hot and humid.
• Dehydration can increase your blood sugar concentration. If you exercise for more than an hour, you may even have to drink carbohydrate-containing beverages rather than plain water.
• Monitor your blood glucose levels before, if possible during (at least initially), and after exercise to assess your requirement for extra food.
• Discuss adjusting carbohydrate intake and medication with your doctor/dietitian.
• In western countries diabetics always wear an identification tag indicating that they have diabetes to ensure proper treatment in case of an emergency.
• Have some chocolate, toffees, fruit juice, sugar tablets or glucose handy in case of low-sugar reaction
• If you experience any warning signs of hypoglycaemia, stop exercising. Inform someone and take your sweets. If you don’t feel better within 15 minutes, seek immediate medical help.
  

The writer is a lecturer at the Faculty of Medicine, University of Colombo.