Blood sugar control: Exercise helps to lower blood sugar in two ways. First of all, exercise decreases insulin resistance, the hallmark of type 2 diabetes. Secondly, exercise increases glucose disposal. An exercising muscle simply uses more sugar than a resting muscle.
Weight control: Besides burning glucose, exercise burns fat, which helps with weight control. Excess body fat increases insulin resistance and worsens type 2 diabetes. Achieving and maintaining a reasonable weight is a key to preventing and treating type 2 diabetes. Even losing 5 to 10 pounds can improve insulin action.
The Health Benefits of Exercise are Numerous
*Exercise improves insulin sensitivity and helps to lower blood glucose levels.
*Exercise is an important component of weight control.
*Exercise strengthens the heart and lungs.
*Exercise helps lower LDL cholesterol.
*Exercise helps lower triglycerides.
*Exercise helps raise HDL cholesterol.
*Exercise improves circulation.
*Exercise helps to lower blood pressure.
*Exercise reduces the risk of heart disease and stroke.
*Exercise improves strength and endurance.
*Exercise helps to tone and build muscles.
*Exercise improves bone density and reduces the risk of osteoporosis.
*Exercise relieves stress.
*Exercise improves sleep.
*Exercise provides entertainment and socialization.
*Exercise makes you feel good about yourself!
*Exercise improves overall health and well-being.
*Exercise might help to prevent type 2 diabetes in those at risk for developing diabetes.
Can you think of any other single intervention that can do so much? Exercise is a prescription for good health. It’s okay to start modestly and then build an exercise routine little by little. The most important step is getting started!
An exercise stress test is recommended for:
*Anyone who is over 35 years old
*Anyone who has had type 2 diabetes for more than 10 years
*Anyone with heart disease
*Anyone with risk factors for developing heart disease
*Anyone with microvascular complications such as retinopathy or nephropathy
*Anyone with macrovascular disease or circulatory problems
*Anyone with neuropathy
Blood Glucose Monitoring
Monitoring the glycemic response to exercise can be a real source of motivation for sticking with it. I recommend checking the blood glucose before and after exercise to see the blood glucose lowering benefits.
It’s critical for patients who take insulin or hypoglycemic oral agents to monitor their blood glucose to minimize the risks of low blood sugar. Significant amounts of exercise can have a blood sugar-lowering effect for several hours after the workout both because of improved insulin sensitivity and because of glycogen repletion.
Once exercise habits are well established, medication doses often need to be decreased to prevent hypoglycemia. The combination of exercise, weight loss, and attention to diet may be enough for some individuals to be taken off medications entirely.
Individuals, who take medications that can cause low blood sugar, should always carry some form of carbohydrate that can be eaten to prevent or treat hypoglycemia. Fruit juice, fresh fruit, dried fruit, glucose tablets, or hard candies are examples of appropriate treatment choices for low blood sugar.
Individuals who don’t take hypoglycemic agents are not at risk for hypoglycemia, and a pre-exercise snack is probably not needed. In fact, snacking unnecessarily may mean burning the snack for fuel instead of burning unwanted body fat stores.
Tips for Increasing Physical Activity
*Do stretching exercises while watching the news or any favorite program.
*Do sit-ups or leg lifts during all television commercial breaks.
*Limit the amount of time spent in front of the television.
*Take the dog for a walk.
*Take the stairs instead of the elevator or escalator.
*Get off the elevator one flight early and walk up the last flight.
*Do errands on bicycle or go by foot.
*Park the car at the far side of the parking lot.
*Get off the bus one stop away and walk the rest of the way.
*Put the home exercise equipment in a location that will encourage its use.
*Take an after-dinner walk with family or friends.
*When at work, spend part of the lunch hour taking a walk.
*Take a walk around the perimeter of the mall before shopping.
*Schedule family time doing something active.
Building the Exercise Regimen
For individuals who have not been engaging in regular physical activity, it is important to do what is comfortable and gradually build the frequency, intensity, and duration of their workouts.
The eventual goal should be an aerobic exercise session that is sustained for 20-45 minutes with a 5-10 minute warm-up period before the main exercise session, and a 5-10 minute cool-down period at the end.
For cardiac fitness and blood sugar control its best to exercise at least 3-4 days per week, preferably every other day. For weight loss, exercise should be done 5-7 days per week. The Surgeon General recommends that we all get 30 minutes of physical activity everyday, whether all at once, or accumulated throughout the day.
It’s fine to use pulse monitors or count the number of heartbeats and compare to target heart rate, but most people don’t want to bother. People tend to be good judges of what is comfortable for them. As far as the intensity of the workout, you should be able to carry on a conversation without huffing and puffing. However, if you can sing the national anthem, then you probably aren’t pushing yourself hard enough! Basically, you should be able to feel that your pulse and breathing are up a bit from your usual resting state. Forget the old saying “no pain, no gain.”
Strategies for Staying with It
*Set up a reward system. At the end of each month (or week, whatever you choose) give yourself a reward for achieving your exercise goals. (No, chocolate cake isn’t the best reward!) Rewards should be nonfood items.
*Set up a buddy system. If your friend is in the park waiting for you to show up for your scheduled walk, you’re less likely to blow it off. Besides, it’s nice to visit while you exercise.
*Join an exercise class. There’s something very motivating about being surrounded by a group of people who are working out together. Find an exercise class with people whose exercise abilities match your own.
*Join a club. Walking clubs, bird-watching groups, bicycling clubs, and so on, are all good ways to get exercise and see interesting sights at the same time.
*Exercise videos. Check out an exercise video from the local library, or buy your own copy. Plug it into the VCR and exercise in the privacy of your home. If you don’t have a VCR, tune in to a television exercise program.
*Join a gym. Gyms offer a variety of exercise options, classes, and equipment. A trained staff member will usually show you how to use the equipment safely and can help you plan an exercise routine.
*Take advantage of community pools. Call local high schools, colleges, and recreational centers to find out if their pools are open to the public. Hours are often set aside for lap swimming. Sometimes water aerobics classes are held at community pools.
*Structure family time around physical activity. Set aside some time every week for family members to do something active together. Spending active time together is good for everyone’s health. You will also create lasting memories.
*Track your progress. Keep an exercise diary. Record your exercise sessions and keep track of other data that shows your progress, such as improved blood sugar levels and changes in weight.
SHERRI SHAFER received her BS in Nutrition and Dietetics from the University of California at Berkeley. She has been a Dietitian at UCSF Medical Center for 10 years. Sherri specializes in medical nutrition therapy counseling for individuals in adult and pediatric diabetes clinics, and is an Instructor for classes on diabetes self management for Type 1 and Type 2 diabetes. She has just completed her first book, Diabetes Type 2 Complete Food Management Program from Prima Publishing.