The American Diabetes Association recommends at least 150 min/week of moderate intensity aerobic activity (activity which increase heart rate to 50 to 70% of maximum heart rate)
Preparing for Exercise
Preparing the individual with diabetes for a safe and enjoyable exercise program is as important as exercise itself. The young individual in good metabolic control can safely participate in most activities. The middle-aged and older individual with diabetes should be encouraged to be physically active. The aging process leads to a degeneration of muscles, ligaments, bones, and joints, and disuse and diabetes may exacerbate the problem. Before beginning any exercise program, the individual with diabetes should be screened thoroughly for any underlying complications.
A standard recommendation for diabetic patients, as for nondiabetic individuals, is that exercise includes a proper warm-up and cool-down period. A warm-up should consist of 5-10 min of aerobic activity (walking, cycling, etc.) at a low-intensity level. The warm-up session is to prepare the skeletal muscles, heart, and lungs for a progressive increase in exercise intensity. After a short warm-up, muscles should be gently stretched for another 5-10 min. Primarily, the muscles used during the active exercise session should be stretched, but warming up all muscle groups is optimal. The active warm-up can either take place before or after stretching. Following the activity session, a cool-down should be structured similarly to the warm-up. The cool-down should last about 5-10 min and gradually bring the heart rate down to its pre-exercise level.
- Strengthens heart & circulatory system. Increases stamina.
- Improves blood glucose control and insulin sensitivity
- Potential reduction in dosage or need for insulin or oral antidiabetic drugs
- Lowers blood pressure
- Lowers weight
- Sense of well-being
Exercise - Precautions
- Initiate & build up exercise program gently
- Use loose, comfortable clothing & correct foot wear
- Do not exercise if blood glucose >250 mg/dL. Check for ketones. Discuss with your doctor before starting the exercise.
- To avoid hypoglycemia during & after exercise
Intensity of exercise should be same
- Carry glucose & medical I-card
- Check blood glucose before & after exercise
- Don't inject insulin into thigh or upper arm before exercise
Do not exercise if you have ….
- Chest pains during exercise
- Insensitive feet
- Any complication of diabetes.
Discuss with your doctor. You need medical evaluation by your doctor before starting exercise.
Exercise and Type 1 Diabetes
All levels of exercise, including leisure activities, recreational sports, and competitive professional performance, can be performed by people with Type 1 diabetes who do not have complications and are in good blood glucose control (note previous section). The ability to adjust the therapeutic regimen (insulin and medical nutrition therapy) to allow safe participation and high performance has recently been recognized as an important management strategy in these individuals. In particular, the important role played by the patient in collecting self-monitored blood glucose data of the response to exercise and then using these data to improve performance and enhance safety is now fully accepted.
Hypoglycemia, which can occur during, immediately after, or many hours after exercise, can be avoided. This requires that the patient have both an adequate knowledge of the metabolic and hormonal responses to exercise and well-tuned self-management skills. The increasing use of intensive insulin therapy has provided patients with the flexibility to make appropriate insulin dose adjustments for various activities
General guidelines that may prove helpful in regulating the glycemic response to exercise can be summarized as follows:
Metabolic control before exercise
- Avoid exercise if Fasting glucose levels are >250 mg/dL and Ketones are present in the urine and /or blood, and use caution if glucose levels are >300 mg/dL and no Ketone is present.
- Ingest added carbohydrate if glucose levels are <100 mg/dL.
Blood glucose monitoring before and after exercise
- Identify when changes in insulin or food intake are necessary.
- Learn the glycemic response to different exercise conditions.
- Consume added carbohydrate as needed to avoid hypoglycemia.
- Carbohydrate-based foods should be readily available during and after exercise
In general, the principles recommended for dealing with exercise in adults with type 1 diabetes, free of complications, apply to children, with the warning that children may be prone to greater variability in blood glucose levels. In children, particular attention needs to be paid to balancing glycemic control
Exercise and Type 2 Diabetes
The possible benefits of exercise for the patient with type 2 diabetes are substantial, and recent studies strengthen the importance of long-term exercise programs for the treatment and prevention of this common metabolic abnormality and its complications.
Benefits of exercise
- Glycemic control
Regular exercise has been shown to improve glycemic control. Regular exercise may prevent type 2 diabetes in high risk patients. Exercise of at least 8 weeks duration has been shown to lower HbA1c by 0.66% in patients of type 2 diabetes. Higher level of exercise intensity are associated with greater improvements in HbA1c.
- Prevention of cardiovascular disease
Regular exercise has been shown to reduce the cardiovascular risk factors like hyperlipidemia, hypertention, obesity etc.
Regular exercise has consistently been shown to be effective in reducing levels of triglyceride.
Effects of exercise on reducing blood pressure levels have been demonstrated most consistently in type 2 diabetes subjects.
Data have accumulated suggesting that exercise may enhance weight loss and in particular tread mill used along with an appropriate calorie-controlled meal plan.
Exercise in the Elderly
Evidence has accumulated suggesting that the progressive decrease in fitness and muscle mass and strength with aging is in part preventable by maintaining regular exercise. The decrease in insulin sensitivity with aging is also partly due to a lack of physical activity. Lower levels of physical activity are especially likely in the population at risk for Type 2 diabetes. A number of recent studies of exercise training have included significant numbers of older patients.
Exercise in case of diabetic's pregnancy
A daily exercise program is an important part of a healthy pregnancy. Daily exercise helps you feel better and reduces stress. In addition, being physically fit protects against back pain, and maintains muscle tone, strength, and endurance. For women with gestational diabetes, exercise is especially important.
Regular exercise increases the efficiency or potency of your body's own insulin. This may allow you to keep your blood sugar levels in the normal range while using less insulin.
Moderate exercise also helps blunt your appetite, helping you to keep your weight gain down to normal levels. Maintaining the correct weight gain is very important in preventing high blood sugar levels.
If you plan to start an exercise program during pregnancy, talk to your doctor before beginning and start slowly. Brisk walking is good for women who need to start exercising and have not been active before pregnancy.
Exercising frequently, 4 to 5 days per week, is necessary to get the "blood sugar lowering" advantages of an exercise program. Don't omit a warm-up period of 5 to 10 minutes and a cool-down period of 5 to 10 minutes. Always stop exercising if you feel pain, dizziness, shortness of breath, faintness, palpitations, back or pelvic pain, or experience vaginal bleeding. Also, avoid vigorous exercise in hot, humid weather or if you have fever.
If you need to be on insulin during your pregnancy, take a few precautions. Because both insulin and exercise lower blood sugar levels, the combination can result in hypoglycemia or low blood sugar. You need to be aware that this is a potential problem, and you should be familiar with the symptoms of hypoglycemia (confusion, extreme hunger, blurry vision, shakiness, sweating). When exercising, take along sugar in the form of hard; sugar-sweetened candies just in case your blood sugar becomes too low. When on insulin, you should always carry some form of sugar for potential episodes of hypoglycemia.