The Management and Benefits of Physical Activity with Diabetes

Carol D. Gray, MHAExercise Physiologist

October 15, 2002

Diabetes Mellitus General informationRisks of disease mismanagementExercise benefitsExercise recommendationsSpecial exercise concerns

Diabetes Factoids14 million Americans have

diabetes Many people do not know they

are affected.Complications include…

kidney failure hypertension cardiovascular disease retinopathy neuropathy

Complications . . .

NOT Inevitable resultRisk is reduced by 50% if blood sugars

are kept close to normal.Good blood sugar control can help to

slow complications that have begun.Inevitable when disease state is

mismanaged

What Is Optimal Blood Sugar?Optimal defined as

•Hemoglobin A1c = 7.0 or lower

•Plasma blood sugars less than 180 mg/dl two hours after eating

•Plasma blood sugars less than 140 mg/dl before eating

Risks of MismanagementHastened Complications

Kidney failure Hypertension Cardiovascular Disease Retinopathy Neuropathy Foot ulcers Amputation Blindness

Poor HealthLow Quality of Life

Risks- Cardiovascular DiseaseLeading cause of

premature death among diabetics

65% of diabetics die from heart attack or stroke

Smoking doubles the risk CVD for diabetics

Risks- NeuropathyOne of the most common

complicationsDamage to nerves outside

the brain and spinal cordSymptoms

Muscular weakness Loss of feeling Loss of function not

under conscious control, i.e. digestion

Risks- RetinopathyDamage to retinal

blood vessels causing them to leak fluid/blood into retina

Can lead to blindnessDiabetics have risk of

blindness 25 times greater than healthy persons

What are the benefits of EXERCISE?

Exercise BenefitsStimulates insulin function Easier to maintain

optimal blood sugarAssists in weight

managementDecreased incidence and

severity of complications Increased functional

capacity

Improved muscle toneLower cholesterol and

triglyceridesReduces stress Improved

concentrationDecreased appetiteExercise can not

counter the effects of poor nutrition

Exercise and Proper Nutrition Enable Disease Management To

Be Possible!

Exercise Recommendations

To Begin...

Obtain medical clearance from your physician before beginning exercise.

Wear medical alert identification on a bracelet or necklace

Never exercise if you have high blood sugar High blood sugar = Greater than 300 mg/dl

Next Step… Get Moving!Choose an aerobic activity

you enjoyExamples- walking,

bicycling, swimming, running, jumping rope, tennis, aerobic dance,etc.

Start at an easy paceIncrease your pace and

time spent gradually

Aerobic ExampleWarm up 10-15 min Light PacePick up pace 5 min Light-ModerateMaximum pace 15 min Moderate- Somewhat

HardCool down5-10 min Light 60-90% Max Heart Rate20-40 minutesPerform 4-7 days/week

Time Of Day For ExerciseBe consistent- improves timing of insulin

actionAvoid exercise at time of peak insulin actionEvening- not recommended

Delayed hypoglycemia when sleepingMorning-

After a small snack and before the morning insulin injection may reduce risk of exercise-induced hypoglycemia

Also, greatest influence on maintaining stable blood sugar throughout the day

Increase Overall ActivityDaily activities have benefitExamples:

Walk to the store instead of driving

Walk your dog Take the stairs Push mow the lawn Wash the car

Signs of HypoglycemiaThirstExcessive sweatingFaintnessRapid heart rateIrritabilityUnusual drowsiness/fatigueHungerBlurred/double visionShakiness, Trembling

Signs of Hyperglycemia

ConfusedNauseous, VomitingHeadacheBreath has sweet, fruity

odor

Weight Training

Also beneficial in disease management

Improves insulin sensitivity

Easier to maintain optimal blood sugar

Strength Training . . .

Add after 2 weeks of regular aerobic activityThrough trial and error, find a weight

challenging for 10-15 repetitionsIf additional weight is not available, focus

on increasing repetitionPerform 2-3 sets/exercise2-3 days/week

Strength Training WorkoutWarm up aerobically 5 min.One Arm Bent-Over Row 2 x 15

Wall Slide 2 x 15Side-Lying Hip Abduction 2 x 15Standing Heel Raise 2 x 15Wall/Modified Push-Up 2 x 15Abdominal Crunch 2 x 20

Cool Down aerobically 5 min.Stretch 1 x 30 sec.

Special Exercise Concerns

Appropriate Exercising Blood Sugars

Proper Footwear

Monitor blood sugar

When? Before, during, and after exercise

Why? Learn your body’s response to exercise Avoid hypoglycemia Determine an appropriate pre-exercise

snack

Type of Exercise Blood Sugar Exchanges to AddShort Duration, Low-Moderate Intensity

Walking (1/2 mile) orLeisurely cycling (lessthan 30 minutes)

Under 80 mg/dl

Over 80 mg/dl

2 fruit

1 fruit

Moderate Intensity

Tennis, swimming,jogging, golfing, orleisurely cycling (1 hour)

Under 80 mg/dl80-180 mg/dl

180-300 mg/dlOver 300 mg/dl

½ meat and 2 bread1 fruit or 1 bread

No extra foodDo not exercise

Strenuous

Football, hockey,racquetball, basketball,strenuous cycling,swimming, or shoveling

Under 80 mg/dl80-180 mg/dl

180-300 mg/dlOver 300 mg/dl

1 meat,2 bread,1 fruit,1 milk1 meat and 2 bread

1 meat and 1 breadDo not exercise

Food Exchanges For Exercise

Proper FootwearFoot ulcers commonProtection from ulcers

and orthopedic problems crucial

Running or walking shoes recommended

New Balance, Asics, Mizuno, Adidas, etc.

Exercise is a MUST!

Manage Diabetes Effectively

Avoid ComplicationsAvoid Foot UlcersFeel & Look BetterEnjoy LivingWin battle against

DIABETES

Questions/Comments

References http://www.diabetes.org/main/type1/complications/

neuropathy/neuropathy.jsp http://www.joslin.harvard.edu/education/library/prevent_

complications.shtml http://www.konnections.com/eyedoc/drstart.html http://ndep.nih.gov/control/CVD.htm