The Diabetic Exercise Program

An important part of any diabetic management program is regular exercise. The benefits of exercise are the same for everyone, whether they have diabetes or not. Improved physical fitness, improved emotional state, weight control and improved work capacity are all benefits of exercise.

Diabetics exercise increases the uptake of glucose by muscle cells, potentially reducing the need for insulin. Exercise also reduces cholesterol and triglycerides, reducing the risk of cardiovascular disorders. People with diabetes should consult their primary health provider before beginning or changing an exercise program.

The ability to maintain an exercise program is affected by many different factors, including fatigue and glucose levels. It is as important to assess the diabetic's usual lifestyle before establishing an exercise program as it is before planning a diet. Factors to consider include the diabetics usual exercise habits, living environment, and community programs. The exercise that the person enjoys most is probably the one that he or she will continue throughout life.

Everyone with diabetes should follow the guidelines set forth by the ADA when undertaking an exercise program. These include the use of proper footwear, inspecting the feet daily and after exercise, avoiding exercise in extreme heat or cold, and avoid exercise during periods of poor glucose control. The ADA further recommends that people over the age of 35 have an exercise-stress electrocardiogram prior to beginning an exercise program.

Exercise for Type 1 Diabetics.

In the person with type 1 diabetes, glycemic responses during exercise vary according to the type, intensity, and duration of the exercise. Other factors that influence responses include the timing of exercise in relation to meals and insulin injections, and the time of day of the activity. Unless these factors are integrated into the exercise program, the person with type 1 diabetes has an increased risk of hypoglycemia and hyperglycemia. The following are some general guidelines for an exercise program.

• People who have frequent hyperglycemia or hypoglycemia should avoid prolonged exercise until glucose control improves.

• The risk of exercise-induced hypoglycemia is lowest before breakfast, when free insulin levels tend to be lower than they are before meals later in the day or at bedtime.

• Low-impact aerobic exercises are encouraged.

• Exercise should be moderate and regular; brief, intense exercise tends to cause mild hyperglycemia, and prolonged exercise can lead to hypoglycemia.

• Exercising at a peak insulin action time may lead to hypoglycemia.

• Self monitoring of blood glucose levels is essential both before and after exercise.

• Food intake may need to be increased to compensate for the activity.

• Fluid intake, especially water, is essential.

Young adults may continue participating in sports with some modifications in diet and insulin dosage. Athletes should begin training slowly, extend activity over a prolonged period, take a carbohydrate source such as an energy drink after about one hour of exercise, and monitor blood glucose levels for possible adjustments. In addition a snack should be available after the activity is completed. It may be necessary to omit the usual regular insulin dose prior to an athletic event; even if the athlete is hyperglycemic at the beginning of the event, blood glucose levels will fall to normal after the first 60 to 90 minutes of exercise.

Exercise for Type 2 Diabetics.

An exercise program for the type 2 diabetic is especially different. The benefits of regular exercise include weight loss in those who are overweight, improved glycemic control, increased well being, socialization with others, and a reduction of cardiovascular risk factors. A combination of diet, exercise, and weight loss often decreases the need for oral hypoglycemic medications. This decrease is due to an increased sensitivity to insulin, increased caloric expenditure, and increased self esteem. In fact regular exercise may prevent type 2 diabetes in those at high risk for getting this form of diabetes.

Here are some guidelines for type 2 diabetics undertaking an exercise program.

• Before beginning the program, have a medical screening for previously undiagnosed hypertension, neuropathy, retinopathy, nephropathy, and cardiac ischemia.

• Begin the program with mild exercises and gradually increase intensity and duration.

• Self monitor blood glucose before and after exercise.

• Exercise at least three times a week or every other day, for at least 20 to 30 minutes.

• Include muscle-strengthening and low-impact aerobic exercises in the program.