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Diabetes is one of the commonest and the most sinister lifestyle disease, mankind has to face in modern era. Here we shall discuss on the various aspects of exercise in diabetes as well as prediabetes.
Few hard statistics on diabetes and prediabetes:
Let me disturb you with some frightening data on diabetes. As we are transforming towards a better world, these lifestyle diseases have started creeping it. It has currently reached a global epidemic level.
On year 2015, 30.3 million Americans, or 9.4% of the population, had diabetes.
Approximately 1.25 million American children and adults have type 1 diabetes.
Undiagnosed: Of the 30.3 million adults with diabetes, 23.1 million were diagnosed, and 7.2 million were undiagnosed.
In 2015, more than 84% of US adult population have been pre-diabetic.
The incidence is even more sinister amongst the Hispanics, Indian Americans, Africans, Indians etc. Over 30 million have now been diagnosed with diabetes in India. The prevalence of diabetes in the urban areas of India is thought to be 9 %. In rural areas, the prevalence is approximately 3 % of the total population. The no. is on the rise and the prediabetes and insulin resistance prevalence in India is even more frightening.
For some more disturbing data, please visit http://www.diabetes.org/diabetes-basics/statistics/
And, https://www.diabetes.co.uk/global-diabetes/diabetes-in-india.html
How exercise can benefit in diabetes mellitus:
Besides medications and insulin, exercises play a huge role in control of both diabetes and prediabetes. Read on to know how important regular exercise in diabetes can be…
Lowers blood glucose and blood insulin level – Remember long term blood glucose level is the primary target of the diabetes treatment. Exercise depletes the muscle glycogen and makes the insulin hormone to transport glucose to the muscle and other cells. Insulin level is raised in pre-diabetes due to cellular resistance to the hormone insulin. You can counter that too by exercise too.
Improved oral glucose tolerance – For people with prediabetes /insulin resistance / metabolic syndrome this is the primary cause of fat gain, that too more in the belly area. With exercise, the insulin reaction to oral glucose in prompt and glucose is quickly utilized in the working muscles
Insulin secretion and sensitivity is improved – This is the crux of the exercise benefit. Think of having oral glucose from carb, getting quick insulin response, quickly moved away from blood to cells. This is exactly what you want your body to deal with the damned glucose! A single bout of exercise increases insulin sensitivity for up to 48 hours into recovery. Improved insulin sensitivity thus helps to utilize glucose rather than dumping them as fat.
HDL is increased with decreased LDL and cholesterol – Diabetes is frequently associated with atherosclerosis, coronary heart disease, hyperlipidemia etc. which are the main causes of death or illness. Exercise can keep you disease free without these dangerous disease at a later stage.
Hypertension and obesity control – Other Comorbid conditions where exercise can help a lot. Read my article on hypertension and exercise. https://easyfitnessidea.com/hypertension-and-exercise/
Overall fitness and quality of life improvement – This is a no Brainer. Proper exercise with correct diet and lifestyle can give you a new lease of life. It is seen that these can reduce or even stop the use of insulin or oral medications. It is seen that NIDDM (non insulin dependant diabetes mellows – 90% of the total) is often reversed with weight loss and regular exercise.
How to exercise in diabetes:
Type 2 diabetes mellitus is much common than type 1. Exercise recommendations for both types are almost similar. For type 1 duration is lesser, whereas for type 2 diabetes, you should do it for longer time.
Pre-diabetics and insulin resistant people will also benefit immensely from the same exercise. So, even if you don’t have diabetes but have belly fat, or diabetes running in family you are in for exercise too.
Aerobic or cardio exercise:
Do cardio or aerobics done regularly in a well structured manner. Diabetes and pre diabetes often respond best to this and is the mainstay of the exercise part. Follow these guidelines as much as you can:
Do low impact exercise like cross training, cycling, swimming, brisk walking and even light jogging on treadmill are great choices. Exertion should not be high (preferred 11-14 in RPE scale)
Frequency should be 5 to 7 times a week and duration of 45 – 60 minutes per day. A minimum of 150 minutes of aerobic exercise per week is recommended by ACSM. For type 1 diabetes, duration preferred Is 30 – 40 minutes.
Do aerobics at low to moderate intensity at 40 to 60 % of Vo2 max or 55 – 70 % of your maximal heart rate, as per ACSM guideline. (May be, start with walking increasing it to brisk walk and slow jog later.)
For advanced or experienced people, HIIT has shown to yield good results. It has good improvements on insulin sensitivity and good for well conditioned people. Do HIIT if you are hard pressed for time.
Keep a goal of improved aerobic fitness, increased insulin sensitivity, long term blood sugar control (decreased HbA1C), lower dose and use of insulin and oral antidiabetics, decreased body fat and cardiovascular risk factors like cholesterol, triglyceride, LDL etc.
Weight training:
Weight training has shown to significantly improve insulin sensitivity too beside lots of other benefits like improved balance, coordination, posture, gait etc. But do not try to overdo it or go really hard. You need to be moderate and consistent. Follow these points for best results:
Do it 2 to 3 times a week for best results.
Do not try to lift too heavy, at least in the beginner stage. 60 to 75 % or your 1 rep max is good to start. Slowly increase load as you advance.
Start with 8 – 10 reps per set and slowly increase it to 20 reps.
Do them in a circuit or an interval training pattern.
Keep a goal of increased fat loss, better coordination, improved gait and posture, strength and balance.
Always do warm up and cool down properly. Do the stretching exercises during that time. (Also do stretching and warm up / cool down during the aerobic sessions).
Do not overdo weight training. Full body workout with low to moderate intensity should be your target for two to three times per week. Try to work the bigger muscle groups for best results. (eg. Squats can help more than curls)
Precautions for exercise in diabetics or pre-diabetics :
Do not exercise in the extremes of temperature like too hot or cold. During hot weather, diabetics and pre-diabetics are more vulnerable to heat and humidity. Also higher amount of water intake is required. Cold weather can be tough too for those have vascular pathologies. You need to be double careful while doing it outdoors when there is extreme. The gym is the best bet, where close monitoring is also possible.
For the insulin guys, do not inject insulin in the muscles or near the muscles worked out most. Insulin injected near the big working muscle can precipitate hypoglycemia. (Eg – not to inject in front of thigh before doing heavy squats) It is safest to inject in the abdomen.
For the beginners, insulin dose reduction is required upto 20 to 40 % before exercise to prevent hypoglycemia. Consultation with your doctor as well as your fitness trainer regarding this is a must. Do not try this arbitrarily.
Dosage of oral antidiabetic medicines should be adjusted too. Diabetes and insulin resistance improves rapidly with exercise and people have better glucose and carb tolerance. Medication dose may be titration accordingly too. Consultation with your doctor regarding this is also required.
Take 10 grams of simple carbs solution like glucose every 15-20 minutes. This is specifically important when the exercise is on the longer side (duration exceeds half hour). Exercise induced hypoglycemia is common and dangerous. You have to avoid it all costs.
Before a specific event or competition like marathon a high carb low protein & fat meal is recommended. Also 10 gm carb solution before and every 15-20 minutes during exercise is or event is good.
Try to avoid exercise induced hypoglycemia at all costs. Keep a glucose solution or fruit juice ready. It should be within hand’s reach to counter any symptom that you may face. Remember not taking too much food, exercising too much and taking too much insulin can all cause hypoglycemia.
Let your gym management and trainer know your condition. Diabetes and pre-diabetes are lifestyle conditions which are more common than you can imagine. Suppressing such fact can precipitate danger at any time. Also the people working out and training around you should have an idea so that they can act promptly in case of any danger.
Do not vary your exercise pattern whimsically. It is seen that diabetes patients respond best in exercise done in a structured manner with predetermined frequency, intensity and time period. Overdoing and undergoing the best recommended schedule can harm you seriously. Consult with your trainer and doctor before changing things.
Do not try exercises which can increase your BP or stress your heart. Hypertension and coronary heart disease are commonly associated with diabetes or even in insulin resistant pre diabetics. Avoid tight gripping of dumbbells, valsalva (forced expiration against closed glottis), breath holding, prolonged overhead weight lifting, straining too much etc. These can cause reflex rise in BP. For details, read my post on exercise in hypertension. https://easyfitnessidea.com/hypertension-and-exercise/
Don’t change the exercise habit after things start improving. Perhaps this is the most understated point. After a certain period people tend to get bored and stop working out. This can wreak havoc in your body. Pre diabetic guy will see belly fat and letharginess coming back. Your body will again become insulin resistant and fat loss can be even tougher later. Think of exercise in diabetes as a lifestyle habit like brushing your teeth, combing your hair or washing hands before food, bathing etc. Just continue the good habits till you die.
Proper foot care is very important. Soft shoes with good cushioning soles are needed. Diabetics may have resistant foot ulceration with chronic local irritation of feet. Remember that ulceration developed becomes extremely resistant to treatment.
Retinal problems need to be screened too and need to be extra careful. Remember those points in point no. 10. Those having retinal problems, due to diabetes can suffer more due to reflex rise of BP in some exercise. Avoid them at all costs.
Do not exercise or postpone if blood sugar level is more than 300 or 240 for Type 1 and 2 DM respectively. Again if blood sugar is less than 80, take a carb source and delay exercise. While starting an exercise programme, your best option is to check blood sugar before and after workout, also during workout if possible. Adjustment of insulin dose and / or oral drugs may be required as per report. As you know your body response, you can be less vigilant later.
Try to avoid strenuous exercise late in the evening. This can cause nocturnal or early morning hypoglycemia. It is better to workout in the morning after you wake up.
Know the signs of hypoglycemia. By now, you already know this is the most important part to be cautious of. If you feel symptoms like dizzy, shaky, headaches, confusion, irritable, sweaty, hungry, vision impairment, always think of hypoglycemia and be extra cautious. Exercise with a partner or personal trainer, we’ll aware of your symptoms, will help even more. During hypoglycemia, glucose or sugar below the tongue can help, if you have alternate consciousness. In case of dizziness or other symptoms, biting a hard candy or having fruit juice can help.
Don’t forget hyperglycemia. They are less common and the symptoms develop much slowly. But their symptoms have many overlaps with hypoglycemia. It is best to keep a glucometer ready and handy to get the actual diagnosis at the time of crash.
Don’t forget proper warm up and cool down and always stretch (try to hold static stretches for 20-30 seconds).
Don’t acquire a negative mindset – You have a hell lot of years before you to enjoy and only one body to live. So don’t forget to exercise, for your own sake.
[…] High fasting insulin indicates insulin resistance and raised HbA1c marks long term blood glucose control. If you get higher values for these, you need to check it later after months of weight loss. As these improve, you can be sure of your body improving insulin sensitivity. Read my post on exercise in diabetes. […]
[…] High fasting insulin indicates insulin resistance and raised HbA1c marks long term blood glucose control. If you get higher values for these, you need to check it later after months of weight loss. As these improve, you can be sure of your body improving insulin sensitivity. Read my post on exercise in diabetes. […]
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