by Dr. Sheri Colberg, Ph.D., FACSM
Another new year is upon us, and being more active should be on the top of your lists of things to do this year. Whether you’re new to exercise or a sports enthusiast, diabetes can create an obstacle to being regularly physically active. As one of the world’s leading experts on diabetes and exercise, I recently put my extensive knowledge to use in founding a new information web site called Diabetes Motion (www.diabetesmotion.com), the mission of which is to provide practical guidance about blood glucose management to anyone who wants or needs to be active with diabetes as an added variable.
All of the evidence suggests that being physically active is good for the body, heart, and mind. If you are already an avid exerciser, then you know the benefits of exercise for your health and diabetes control. If you are just thinking about getting serious about sports or fitness activities, then you have a lot of positive changes to look forward to. Exercising regularly can help you build muscle and lose body fat, suppress your appetite, eat more without gaining fat weight, enhance your mood, reduce stress and anxiety, increase your energy, bolster your immune system, keep your joints and muscles more flexible, and improve the quality of your life, all while allowing you to live a better longer life. For many with diabetes, being physically active has made all the difference between controlling diabetes or letting it control them.
Do you know what type of exercise or physical activity you should you be doing or how much of it is recommended for optimal health and blood glucose control? Luckily, you can get different (but all good) benefits from doing a variety of types of daily movement, which gives you a lot of options. In fact, exercising regularly is likely the single most important thing you can do to slow the aging process, manage your blood sugars, and reduce your risk of diabetic complications.
Need help with revving up your exercise? If your exercise performance been less than you’d hoped recently, here are some potential causes of fatigue (and solutions):
Inadequate rest time: If you’re not feeling up to par when working out, it may be as simple as not allowing enough rest time to restore muscle glycogen (stored carbs you use during exercise), repair muscle damage (caused by every workout), and fully recover. It can take 24 to 48 hours (or even longer, depending on your carb intake) to fully replace the glycogen you used during your last bout of exercise. Cut back on your workouts (“taper”) for at least 1-2 days before a big event, and keep your blood glucose in good control to restore glycogen optimally.
Blood glucose and glycogen stores: To restore your muscle glycogen between workouts, you have to both eat enough carbs and have enough insulin on board to effectively promote its storage. Doing longer and harder workouts can deplete glycogen stores, and you may simply just not be restoring them fully fast enough due either to inadequate carb intake or blood glucose control. Your carb intake doesn’t have to be tremendous—probably just 40% of your total calories coming from carbs will suffice. You may need more if you’re not eating enough calories, but in either case you have to keep your blood glucose in good control for your muscles to store all the carbs you need to exercise optimally.
Iron: Having low iron stores can cause you to feel tired all the time, colder than normal, and just generally lackluster. Get a simple blood test done to check both your hemoglobin (iron in red blood cells) and your overall iron status (serum ferritins) since it’s possible to be iron deficient without having full-blown anemia. If your body’s iron levels are low (due to diabetes or non-diabetes causes), taking iron supplements can help, along with eating more red meat since it has the most absorbable form of iron.
Magnesium: You may have a magnesium deficiency, especially if you take insulin or your blood glucose levels are not well controlled. This essential mineral is involved in over 300 enzyme-controlled steps in metabolism, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. If you’re deficient, your exercise will be compromised and you may even experience muscle cramping (unrelated to dehydration). Eat more magnesium-rich foods—such as nuts and seeds, dark leafy greens, legumes, oats, fish, and even dark chocolate. If you need more, take a supplement (magnesium in the aspartate, citrate, lactate, and chloride forms is absorbed better than magnesium oxide and sulfate). Low magnesium can also lead to potassium imbalances, which can additionally affect your workouts.
B vitamins: With diabetes, thiamin deficiency is also a likely culprit for exercisers, especially if you’re not eating properly. The eight B vitamins are integrally involved in metabolism and even red blood cells formation. Thiamin (B1) in particular can be depleted by alcohol intake, birth control pills, and more. People who take metformin to control diabetes may also end up deficient in vitamins B6 and B12, both of which are essential to nerve function and muscle contractions. Taking a generic B complex vitamin daily can help you avoid these issues, and excesses of most of the B vitamins are harmless.
Insulin delivery: While insulin pumps can help manage blood glucose acutely, they deliver rapid-acting insulin analogs like Humalog, Novolog, and Apidra, and we now know that these altered insulins are metabolized in the body differently than the long-acting basal one called Lantus. Rapid-acting ones have little to no insulin-like growth factor (IGF) affinity, and most adults are reliant on IGF to stimulate muscle growth and repair rather than human growth hormone (which is high only in youth). Lantus does stimulate IGF-1, though, so you may want to talk with your doctor about combining insulin pump use (for meal boluses) with Lantus (for basal insulin coverage) to get more IGF activity to promote muscle repair. Choose Lantus over Levemir, though, as the latter insulin is less effective at raising levels of bioactive IGF.
Thyroid issues: Many people with diabetes also experience thyroid hormone imbalances, and lower levels of functional T3 and T4 can cause early fatigue and poor exercise performance, among other things. However, it may not be enough to just check your main thyroid hormones (TSH, T3 and T4); you may also want to consider getting your thyroid antibodies checked if your thyroid hormones levels are normal and nothing else is helping your exercise (specifically check for antibodies to thyroid peroxidase), especially if you have celiac disease.
Still having problems exercising? If you’ve been through this whole list and had everything check out normal, consider other possible issues that may be affecting your workouts, such as your hydration status, daily carb intake (adding even just 50 grams per day to your diet may help), other possible vitamin and mineral deficiencies (vitamin D, potassium, etc.), statin use (some statins cause unexplained muscle fatigue), frequent hypoglycemia, and hypoglycemia-associated autonomic failure.
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