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Controlling Diabetes: Exercise For All-Around Health
by Milton Hammerly, M.D.Sushruta, an ancient Indian physician viewed by Ayurvedic practitioners as "the father of surgery," prescribed exercise for diabetes some 3,000 years ago. Exercise became widely recommended by physicians for the treatment of diabetes in the eighteenth century. In the 1920's, studies revealed that exercise has an insulin-like effect on blood sugar. Recent research continues to confirm that exercise can help lower blood sugar levels and promote insulin efficiency. Moderate, regular exercise also lowers blood pressure and reduces the risk of heart attack. If you have Type 1 diabetes, exercise might even allow you to reduce your daily dose of insulin. If you have Type 2 diabetes, aerobic exercise may be the most effective means of controlling your diabetes and may reduce, postpone, or even prevent your need for diabetes medications in the future. All in all, exercise is one of the keys to maintaining good health with diabetes.
Nevertheless, the vast majority of diabetics are reluctant to exercise (of course, they're not alone there!) and they're overweight. In fact, the Joslin Diabetes Center at Harvard University recently conducted a survey of 1,000 people with diabetes and found that more than 75 percent said they would rather take daily insulin injections to control their diabetes than exercise on a regular basis. If you're in this category, consider this: Diabetes puts you at increased risk for a host of serious health problems, including kidney failure, heart attack, and stroke, and an exercise program -- even one as simple as walking 15 to 30 minutes a day -- could significantly reduce your risk of diabetes complications in the coming years. Exercise may be even more important than diet in reducing these risks. There's no doubt about it -- exercise will do you good. The American Diabetes Association (ADA) lists the many health benefits of exercise, including:
- You will probably lose weight.
- Your blood glucose levels will be reduced. Physical activity lowers your blood sugar by burning it as fuel. Once blood sugar is closer to normal, you can be more flexible about food choices.
- Your insulin sensitivity will improve. Consistent activity increases a cell's ability to use insulin. You may be able to reduce or even eliminate oral medications you take to lower blood glucose.
- Your glycosylated hemoglobin (GHb) levels will be lower. Steady exercise (for more than 20 minutes) allows your muscles to store more glucose (in the form of glycogen), lowering your blood sugar even after you've stopped exercising. Your body will call on these reserves of glucose when your blood sugar levels become too low.
- You can possibly postpone your need for injected insulin. With exercise, the pancreas does not need to produce as much insulin.
Of course, regular moderate exercise provides a long list of additional benefits:
- Improved circulation
- Improved lung function and endurance
- Decreased triglyceride levels
- Increased "good" HDL cholesterol
- Lowered blood pressure
- Improved sleep
- Conditioning of the cardiovascular system
- Increased muscle strength and flexibility
- Reduced stress
- Improved attitude, sense of well-being, and quality of life
With all these benefits, it's hard to understand why so many people are still glued to the couch.
Making exercise a regular part of your schedule is the single best move you can make toward a longer, healthier life. Taking time out of your day for walking, biking, dancing, or an exercise class can add years -- zesty, healthy years -- to your future.
BEFORE YOU WORKOUT
It's important to check with your doctor before beginning any exercise program, especially if you:
- Are over 40
- Have eye, kidney, or nerve problems associated with diabetes
- Have heart disease or high blood pressure
- Have retinopathy or other eye problems related to diabetes (An annual visit to an ophthalmologist specializing in diabetic eye conditions is important to determine if you are at immediate risk for eye diseases.)
These concerns certainly don't mean that you cannot exercise -- but you need to take special precautions before you begin. When talking to your doctor, the ADA recommends that you ask the following questions:
- How often should I exercise?
- What time of the day would be best for me?
- How long should my workouts be?
- Should I stick with the same routine each day, or vary my routine?
- How should I monitor myself? Should I check my blood glucose levels before and after exercise?
- Are there any types of exercise I should avoid?
- What warning symptoms should I watch out for? (This is especially important if you suffer from heart disease, high blood pressure, or diabetes complications.)
- Should I take special precautions before I work out?
- Will oral medication have the same effect if I exercise?
- Should I reduce my insulin dose before exercising?
- Should I schedule my workout around my injection?
- Should I change the site of the injection before I do a specific exercise?
STARTING YOUR FITNESS PROGRAM
Once you get the go-ahead from your doctor, exercise safely. Don't do too much too soon. Listen to your body. If you experience unusual fatigue, pain (especially in your chest or legs), or shortness of breath, stop immediately and contact your physician.
People with diabetes should keep the following tips in mind when working out:
- Wear a medical ID bracelet or necklace when exercising, whether alone, with a friend, or at a gym. In the unlikely event that you experience a problem, you'll receive the proper treatment.
- Be sure to wear proper clothing when exercising, and make sure your shoes fit correctly and offer good support. You want to avoid chafing your skin or developing blisters that could lead to an infection. Check your feet before and after every session, even if they feel fine.
- Drink plenty of water before and after exercising, whether or not you feel thirsty.
- Monitor your blood glucose before exercising. If it is low, eat a carbohydrate (some toast, crackers, or a piece of fresh fruit) before you begin your workout. If it is extremely high (or if your insulin is scheduled to peak), work out at a later time.
- Monitor your blood glucose after exercising. This information will help you to determine the effects of today's workout and maximize future results.
- When you pack your gym bag, toss in a snack you can take to counteract low blood glucose -- fruit, fruit juice, a soft drink, or hard candy.
MAKE FITNESS FUN!
Make fitness fun, not work, and you'll maintain a positive attitude. Countless people have embarked on an exercise program, only to abandon it shortly afterward. Studies show that many of the dropouts had chosen an activity they didn't enjoy. If you don't like to run, don't take up jogging. Don't swim if you hate it, and avoid aerobics classes if they make you feel undignified or silly.
Consider asking a family member or friend to exercise with you. When you exercise with a partner, you're more likely to continue. You can motivate one another, and it's tougher to break a commitment than it is to skip a solo workout. Outfit yourself with the proper gear, but don't buy expensive equipment until you're sure you like the exercise. How can you be sure you'll like a stair-climber or a stationary bike before you buy it? Most reputable stores will allow you to test equipment. Visit the store in exercise clothes, prepared for a workout. If the thought of exercising in a store embarrasses you, visit a gym or ask a friend if you can try his or her fitness equipment. Don't fall into the trap of furnishing your basement with unused exercise machines. We could probably eliminate the national debt if everyone would sell their unused exercise equipment and donate the money to the government. The only problem with this is that the same equipment would now gather dust in a different set of basements and garages.
By all means, set reasonable goals for yourself, and go at your own pace. Some discomfort and soreness is normal when you are getting back into shape; pain isn't normal. Don't overdo, or you'll be an early dropout.
Source: Diabetes: How to Combine the Best of Traditional and Alternative Therapies by Milton Hammerly, M.D.
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