Q: Dr. Sheri, you’ve done extensive research on exercise metabolism in individuals with Type 2 diabetes. What are some of the most important findings to date?
A: Exercise is good — GREAT, actually! I’m still convinced that it’s one of the most important things you can do to prevent diabetic complications. I have studied changes in skin blood flow in the feet (which is improved by being regularly active), but others have shown improvements in kidney function, a lower risk of clogged arteries, and even improvements in the health of your eyes and nerves with exercise. We also know that regular exercise is critical in improving insulin action in the body, which is a sure-fire way to keep your blood glucose levels under better control.
Q: So what’s the most important advice you give people with diabetes about starting an exercise plan?
A: Everyone is unique, and you have to set realistic goals for yourself when embarking on a new exercise program. The most important thing to remember is to start out slowly, progressing only when you feel ready. If exercise is too hard, you’ll likely end up finding excuses not to do it or, worse yet, injure yourself so that you have to take time off. Start at a lower intensity; increase duration first and then either frequency or intensity later. You’re going to be doing it for the rest of your life, so it’s not a race to the finish.
Q: One of our biggest challenges always seems to be fitting exercise into our busy schedules. When you have diabetes, how important is timing of workouts really?
A: When you exercise is not nearly as important as just fitting it in somewhere. Studies have shown that you can do 10-minute bouts of exercise throughout the day that accumulate to reach the recommended 150 minutes a week. You may not get quite as fit, cardiovascularly speaking, as if you do the exercise continuously, but it will still have the same beneficial glucose-lowering effect. You should keep in mind, however, that pre-breakfast workouts will usually not cause as much of a drop in glucose levels as exercise done after breakfast or later in the day due to higher levels of hormones that increase insulin resistance before eating in the morning.
Q: What’s your principal strategy for avoiding lows?
A: During exercise, the best way to avoid developing hypoglycemia (a "low") is to learn your body’s response to particular types, intensities, and lengths of exercise. You really need to check your blood sugar more often when you start doing new activities. If you check before and after, you can find out your body’s normal response and begin to predict what will happen next time. If you take insulin, you may need to lower pre-exercise doses and/or eat more carbs to compensate.
Q: You’ve had diabetes yourself for over 40 years. Can you tell us how your perspective has changed over the years — especially with regard to exercise?
A: When I was a kid, I started exercising because it always made me feel better (and that was back in the days of not having blood glucose meters). Today, it still makes me feel better both physically and mentally, but with a meter, I can see how beneficial of an effect it has on my blood sugar control as well. I’ve always been an exerciser, and I have no intention of stopping — ever!
A: I do have a full-time job and three kids (two who are teenagers!), so I’m mainly a recreational athlete at this point. I vary my exercise routine because I’ve found that "cross-training," as it’s called, is the best way for me personally to avoid getting tendinitis or other overuse injuries. I also alternate hard and easy days. Right now, two non-consecutive days a week I do heavy resistance training (8-12 reps with the heaviest weight I can lift that many times) and work out hard on conditioning machine, like the elliptical strider, StairMaster, or others. Another day a week I swim laps at a good pace for an hour. The other days of the week, I either ride a stationary bike at home (while reading) for 30-45 minutes (which I consider an easy workout), walk, or rest (at least 1-2 days per week). The real key to keeping insulin action high is to not take off more than one day in a row and to occasionally do some harder workouts, even if it’s just some faster intervals during your exercise session.
Q: You had a book come out a couple of years ago that laid out all the secrets to longevity with diabetes. Can you tell us what those are?
A: When I was doing the research and interviews for the book in 2007, I found a woman living in Washington State who had had diabetes for 83 of her 90 years (since 1924). She just passed away a little over a year ago, but at the age of 92 — who can complain about living that long and well? Most of us only hope to live that long, but doing it with diabetes and for so many years without a blood glucose meter was totally amazing. We profiled her in the book, along with Bob and Gerald Cleveland (living 84 and 77 years with diabetes, respectively), and many other really inspiring people with both Type 1 and Type 2 diabetes. One main secret that I can share is that every one of the longest-living people found regular physical activity and an active life to be a key to longevity. Surprised? I’m totally not.
Q: If you had unlimited time and resources, what would you most like to accomplish for the diabetes community?
A: I’d like to be able to prevent the onset of Type 2 diabetes in everyone, and I’d also strive to help people learn what to do to prevent getting diabetic complications regardless of what type of diabetes they have. Personally, I watched my grandmother suffer through lots of diabetic complications (and with having only "borderline" diabetes, or so they called it back then) that completely obliterated her quality of life for the last six years she lived. I really wish I could help keep anyone from having to suffer like she did, and I want everyone to live a long and healthy life despite having diabetes. I think education is a huge part of accomplishing these goals, so I have and am continuing to do my part to help educate everyone with the time I currently have to spare (and with some I don’t!).
If you have any physical activity, fitness, exercise, or nutrition questions for Dr. Sheri Colberg that you would like to see answered in my next column or two, please e-mail them to firstname.lastname@example.org.
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