Diabetes should not prevent you from reaching your health goals. In fact, many diabetics are amazingly fit, like the Type 1 diabetic triathlon athlete in this study. …..but you may have to put a little love into planning for your exercise sessions in order to perform safely!
Here are a few considerations when planning your routine:
1.) Medical Clearance Regardless of the type of diabetes you have, it is important to obtain medical clearance from your personal healthcare provider. Because cardiac health is a concern among diabetics, along with other issues, you’ll want to be cleared to perform whichever type of exercise you wish to start. You can also take that time to clarify and ask questions.
2.) Blood Sugar A largely reported fear among diabetics who are considering an exercise routine is blood sugar maintenance. Hypoglycemia can occur during exercise for both Type 1 & Type 2 diabetics. It is important to check your blood sugar before, during, and after exercise. The American Diabetes Association recommends that for a blood sugar less than 100 mg/dl prior to working out, a carbohydrate rich snack (of about 15 gm) roughly 20 minutes prior to your workout could help prevent sudden drops in blood sugar. If, however, your sugar is above 240 mg/dl prior to workout, you are at an increased risk of producing ketones. It is recommended to check your urine for ketones and refrain from exercise until consulting with your provider (unless, of course, you already have an established plan in place from your visit for medical clearance!)
Prepare For the Unexpected: Highs and Lows
The Highs: Just as many diabetics find themselves in a low sugar state in relation to exercise, many also experience high sugar levels. Don’t forget to take your insulin and syringes with you. If you are Type 1, and you wear an insulin pump, remember to inspect the site of insertion. Sweat can affect the area and cause dislodgement, so don’t forget to pay attention to your pump while your rocking out to your favorite music!
The Lows: You’ve done everything right. You were medically cleared. You followed the optimal blood sugar protocol (based on your physician’s orders that are unique to you)….and suddenly, as you are in the middle of exercising, you feel dizzy and lightheaded. You recognize that this is a sign of low sugar. But don’t worry! You are prepared………..One of the safest precautions you can make while exercising is to reassess your sugar every 15-30 minutes of working out, and each time you feel symptoms of hypoglycemia. Simply follow your personal protocol (which will likely look a lot like the plan you have for a hypoglycemia episode at home). It may be beneficial to you to have glucose tablets, glucose gel, or a favorite carb-rich snack on hand for a quick assist should a drop in blood sugar levels occur. I recommend planning for several drops in sugar just in case (better to have recovery items and not need them than to not have enough right?!) Do not force yourself to continue working out if you feel the symptoms of low sugar coming on. Your safety is priority over any fitness goals you have set. (I want you to be healthy enough to reach those goals! Once your blood sugar is brought safely back to a exercise-worthy level, provided you feel up to it, you can continue on your merry way! Remember to plan for sugar drops, even AFTER a workout……Madison, my fabulous Type 1 friend, has explained to me that she often experiences what is called Late Onset Post-Exercise Hypoglycemia, a phenomenon that occurs in some diabetics, especially Type 1…her particular drops in blood sugar seem to DEVELOP HOURS AFTER working out. Therefore, she eats a protein snack post-workout (she loves protein bars!) to help keep her levels stable.
Neuropathy and Ulcers One common issue for diabetics that can cause exercise-related problems is neuropathy. If you have difficulty sensing your extremities (such as your feet), it is IMPERATIVE for you to perform self inspections. Many times upon exercising, blisters can form from the friction of shoes. Also, too-tightly laced shoes can contrict bloodflow to the feet. In the healthcare setting, I have seen MANY people with infections, and in some cases amputations, to their feet because they simply couldn’t FEEL that anything was wrong. The sensation of throbbing, burning, etc, is what prompts someone to inspect their feet. Yet, if you have neuropathy, this signal is not necessarily intact for you. Even if everything feels fine, inspect everytime! Also, make sure you have proper shoes for the specific activity you plan to do (ie: running shoes for a run).
Exercise Choices & Safety As far as workouts, many exercise styles can provide great benefits for your health. Walking, yoga, pilates, and some forms of stretching and resistance training can be ideal choices. Many studies, such as this one, have suggested that blending both resistance training and aerobic training have provided maximal results for diabetics (even more-so than just resistance or aerobics alone). Resistance training can be in the form of bodyweight workouts or weightlifting. Two days a week of resistance training, coupled with 2-4 days of aerobic training, can help regulate HbA1c levels in many diabetics. However, if you know you have strained blood vessels in the eye, talk to your doctor before lifting HEAVY weights or doing inverted poses in yoga class.
Some of the latest studies are suggesting that high intensity interval training (HIIT or burst training) can be an excellent choice for diabetics. Intensity level is relative to each person, so make sure you don’t push yourself TOO hard. One example of HIIT is to use a stationary bike to have a 10-45 second burst of a high level, followed by 1-3 minutes of an easier level and pace…then repeat. You can also create a form of burst training with a walking program. For example, walk 3 minutes at a moderate pace, then add speed for a 30-60 second period, followed by a return to moderate pace. Whichever method of exercise you choose, feel good knowing you are becoming stronger and healthier!
It is inspiring to hear stories of diabetics overcoming obstacles and finding a Wellness balance. I hope this information empowers you to take hold of your fitness and conquer any setbacks. You CAN do this, and you DESERVE to feel strong and healthy!
Triathlon Athlete: Bach, C.W., Baur, D.A., Hyder, W.S. et al. Eur J Appl Physiol (2017) 117: 913. doi:10.1007/s00421-017-3575-3
Full Citation: Aerobic & Resistance Exercise: Timothy S. Church, MD, MPH, PhD; Steven N. Blair, PED; Shannon Cocreham, BS; Neil Johannsen, PhD; William Johnson, PhD; Kimberly Kramer, MPH; Catherine R. Mikus, MS; Valerie Myers, PhD; Melissa Nauta, BS; Ruben Q. Rodarte, MS, MBA; Lauren Sparks, PhD; Angela Thompson, MSPH; Conrad P. Earnest, PhD. Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes. JAMA, 2010;304(20):2253-2262 DOI: 10.1001/jama.2010.1710 ……………………………. Website Citation : JAMA and Archives Journals. “Combining aerobic and resistance training appears helpful for patients with diabetes.” ScienceDaily. ScienceDaily, 25 November 2010. Science Daily. 25 April, 2017.
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