Diabetes and Exercise

Greetings Healthy Boilers!

Did you know that one in 10 adults is living with type 1 or type 2 diabetes and approximately one in three adults is living with prediabetes? Millions of people are dealing with this chronic condition and trying to keep blood glucose, or blood sugars, in check. Along with nutrition and medications, frequent physical activity can help lower blood sugars and decrease hemoglobin A1c levels. Keep reading below to find out about:

  • The benefits of physical activity for people living with diabetes
  • Tips on how to be safe while exercising
  • Risks associated with exercise and blood sugars and how to prevent them

Physical Activity Recommendations

The Physical Activity Guidelines for Americans state that: “Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity.” Examples of moderate-intensity activities include walking briskly (at 2.5-4 mph), raking the yard, vacuuming and mopping. Some vigorous-intensity exercises are playing soccer, jogging at 6 mph, hiking and carrying heavy loads. In addition to aerobic exercise, the Physical Activity Guidelines states that “adults should do muscle-strengthening activities of moderate or greater intensity … on two or more days a week.”

Benefits of Physical Activity for People Living with Diabetes

Once you get into the habit of exercising on a regular basis, you will start enjoying some of the benefits that are associated with increasing physical activity. Some health benefits are described below:

  1. Weight management – Increasing exercise helps you burn more calories, which directly impacts weight management. Part of being at a healthy weight is being mindful of how many calories you are eating and how many calories you are burning. Decreasing your weight can also prevent people with prediabetes from developing diabetes. According to a report by Evert, et al in 2019, people with prediabetes should aim to lose seven to 10 percent of their body weight to prevent the disease from progressing to type 2 diabetes. For people with type 2 diabetes, the goal is to lose five percent of their body weight to obtain clinical benefits.
  • Increase insulin sensitivity – In people with type 2 diabetes, muscle cells are insulin resistant. This means that the amount of insulin the body is producing is not enough for cells to respond and take in glucose in the blood to use for energy. Exercising causes muscles to move more, therefore increasing the need for energy or glucose. Cells can transport glucose across the cell membrane to be used as fuel more efficiently during and after exercise.
  • Improved control of blood sugars – Since cells utilize glucose more efficiently during and after physical activity, people typically see a decrease in blood sugars for approximately 24 hours after exercise. Depending on how frequently exercise is performed, physical activity can help decrease hemoglobin A1c levels as well.
  • Lower blood pressure and blood lipid levels – Participating in regular physical activity helps strengthen your heart. Thus, putting less strain on veins and arteries and leads to lower blood pressure. Currently, the mechanism of how exercise impacts blood lipids is unclear. Whatever the mechanism, exercise has been shown to influence lipid levels in a positive way. HDL levels increase and triglyceride levels decrease.
  • Decreased risk of cardiovascular disease – People living with diabetes are at a higher risk of developing cardiovascular disease compared to people who do not have diabetes. As mentioned earlier, physical activity can strengthen your heart, improve certain lipid levels and help with weight management. Therefore, it is especially important for people with diabetes to develop and maintain an exercise routine to prevent cardiovascular disease.
  • Decreased stress and improved sleep – Physical activity increases endorphins, which are “feel good” neurochemicals that act as a pain reliever and provide a feeling of euphoria. Physical activity can be a type of meditation. By focusing on moving your body and using your energy, worries and stressors from the day can be alleviated. Exercise not only relieves stress, but also works your body so that you are physically tired at the end of the day. The combination of working your muscles plus the release of endorphins helps people get a more restful sleep.

Risks of Exercise and Diabetes

Even though there are so many benefits of exercising with diabetes, hyperglycemia and hypoglycemia can occur. Therefore, if you are starting an exercise program or starting to become more active, it is important to carefully monitor blood sugars before, during and after exercise. It is always a good idea to consult your physician before starting a new exercise regimen.

When an individual exercises with poorly controlled blood sugars, the lack of insulin can cause hyperglycemia. During exercise, cells use glucose for energy. When they are not able to get enough glucose from the blood, the liver starts to produce glucose to supply the fuel needed for those cells. The glucose produced is released into the bloodstream to travel to muscle cells. When there is not enough insulin, the muscle cells are not able to take in the glucose from the bloodstream and blood glucose continues to rise. Thus, leading to hyperglycemia.

Hypoglycemia can also be a risk with exercising with diabetes. This usually occurs if the amount of time you exercise is an hour or greater or if the exercise is very strenuous. As muscle cells take in glucose more efficiently, the available glucose in the bloodstream becomes depleted as exercise intensity and length increases. This, then, leads to a low amount of glucose in the bloodstream, or hypoglycemia. This can be very serious, if not treated appropriately.

To prevent hypoglycemia from exercise, follow the 15-15 Rule:

  1. Measure your blood glucose.
  2. If the blood glucose is  below 100 mg/dL, eat 15-20 grams of carbohydrate. This can be 4 oz (1/2 cup) of juice or three to four glucose tablets.
  3. Wait 15 minutes after consuming the 15-20 grams of carbohydrate and measure the blood glucose again.
  4. If the reading is still below 100 mg/dL, repeat steps 2 and 3. Make sure your blood glucose is at least up to 100 mg/dL before beginning to exercise.

Different exercises at different intensities for various lengths of time can all affect blood sugars. Make sure to monitor your blood glucose carefully and take measurements before, during and after exercise. Be sure to eat carbohydrates, if needed, or adjust your insulin regimen. Please contact your primary care provider (PCP) if you have any questions, concerns or need help navigating exercise and insulin.

Safety Tips for Exercising with Diabetes

  1. Wear a medical bracelet – In the event that something happens while exercising, it is important to let others, especially medical professionals, know that you are a diabetic in order to provide the best possible care.
  • Inspect your feet often– People with diabetes sometimes do not feel pain in their extremities due to effects that hyperglycemia can have on your nervous system. Make sure you wear comfortable socks and shoes and inspect your feet often for blisters or open sores. Having high blood sugar could also impair wound healing, so talk to your PCP if you notice any slow healing wounds, blisters, sores, or any other issues with your feet. If left untreated, there could be serious consequences.
  • Keep a carbohydrate source close by – Depending on how long you want to exercise or if you feel as though you are experiencing symptoms of hypoglycemia, have a carbohydrate source close by. If you chose to have a sports drink, make sure to check the food label to figure out how many grams of carbohydrates it contains. Most drinks may need to be watered down.
  • Warm up and cool down – Warming up helps get your muscles moving and warms up joints before your work out. The warm-up and cool-down should be lower intensity than the actual work out. Warming up and cooling down can help prevent injuries.
  • Hydrate – Make sure to drink water before, during and after your work out. Proper hydration is not only important to remove metabolic wastes from our bodies, but can also help to regulate processes in our bodies, which includes controlling blood glucose. If you exercise in a hot environment, pay attention to your body and make sure to drink extra fluids to prevent dehydration. Signs of dehydration include feeling thirsty, dark-colored urine, sweating less and feeling tired.

How to Get Started

If you are just starting your exercise journey or are currently not exercising as much as you should, beginning and/or increasing your exercise routine can be very daunting. There are some things that you can do to get you moving a little bit more.

  1. Find something you love to do – When you find an activity that you like to do, it makes working out and sticking with that work out so much easier. If you try to force yourself to go for a run and you hate running, there’s a good chance that you won’t actually go for a run, the work out will not be an effective work out, or you will go for a run and won’t stick with it. However, if you love swimming, for example, it will be easier for you to swim laps and want to go back to the pool again for future work outs.
  • Schedule it in – Some people do not exercise because they feel they are too busy. However, if you schedule it into your day, just like an appointment or a meeting, there is a greater chance that you will actually take the time to work out.
  • Move more – If your workplace will provide it, ask for a standing desk to decrease the amount of time spent sitting. Suggest having walking meetings to increase your activity time during the day. If you work from home, try taking your phone with you for meetings while you walk around the neighborhood. If you are going to the grocery stores these days, consider parking further away from the building. It’ll help with social distancing and help you get more steps in.
  • Get a workout buddy – Identify someone in your life that will work out with you and hold you accountable. Working out with a friend will provide more time for the two of you to bond. Encourage one another to stick to work outs and push each other to go further. Most importantly, having someone to work out with is fun!

The benefits of working out while dealing with diabetes far outweigh the associated risks. Find what activity you enjoy and get moving! As always, if you ever have any concerns or questions about managing diabetes while exercising, please contact your PCP.

Purdue University has health coaches and a registered dietitian available to discuss any diets or eating patterns that might be right for you. Health coaches can also assist with creating an exercise routine and helping you stick with it. Appointments are offered virtually / via phone and in-person and are available to all benefits-eligible employees on all campuses. Call 765-494-0111 to schedule an appointment with health coaches Cheryl Laszynski and Whitney Soto or registered dietitian Megan Shidler. To schedule with Lindsay Bloom, health coach at the Purdue Fort Wayne campus, call 260-481-6651 or email lmbloom@pfw.edu.

Be Kind. Be Well. Boiler Up!

Author: Kathryn Russell, health coach, One to One Health

One to One Health operates the Center for Healthy Living on Purdue’s West Lafayette Campus

Sources:

Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K. H., Macleod, J., . . . Yancy, W. S. (2019). Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care, 42(5), 731-754. doi:10.2337/dci19-0014

Exercise and stress: Get moving to manage stress. (2020, August 18). Retrieved November 27, 2020, from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469

The Importance of Hydration – Type2Diabetes.com. (n.d.). Retrieved November 28, 2020, from https://type2diabetes.com/living/the-importance-of-hydration/

Injury-Free Exercise Tips. (n.d.). Retrieved November 28, 2020, from https://www.diabetes.org/fitness/get-and-stay-fit/getting-started-safely/injury-free-exercise-11-quick-safety-tips

Nahikian-Nelms, M. (2020). Nutrition therapy and pathophysiology. Boston, MA: Cengage.

National Diabetes Statistics Report, 2020. (2020, February 11). Retrieved November 27, 2020, from https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html

Physical Activity Guidelines for Americans 2nd edition … (n.d.). Retrieved November 27, 2020, from https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition_Presentation.pdf

Wang, Y., & Xu, D. (2017, July 5). Effects of aerobic exercise on lipids and lipoproteins. Retrieved November 27, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498979/

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