As with all other people with health conditions, it is very important that diabetics get clearance from their physician before initiating a fitness program. It is also a good idea to speak with a diabetes educator prior to starting a new fitness regimen.Diabetes impacts many millions of Americans. According to the 2011 National Diabetes Fact Sheet, 25.8 million children and adults in the United States have diabetes and an another 79 million people have pre-diabetes. People with pre-diabetes have blood glucose levels that are higher than normal but not as high as the level for a diagnosis of diabetes. However, many people have pre-diabetes before developing type 2 diabetes.Diabetes is a disease characterized by high blood glucose levels caused by an inability of the pancreas to produce insulin or an impairment or an impairment in the ability to use the insulin which is produced. There are two types of diabetes-type 1 diabetes and type 2 diabetes. People with type 1 diabetes are unable to
produce insulin and therefore insulin therapy is a critical, required component of the treatment plan. People with type 2 diabetes either do not produce enough insulin or they are unable to use the insulin they produce effectively. For type 2 diabetics, depending on the severity of the diabetes, insulin may or may not be prescribed as part of the treatment plan.In addition to insulin, there are many other types of medications which may be prescribed. These medications act in different ways to assist the body with blood glucose management. Here are some of the ways medications function to help diabetics manage their blood glucose levels: 1) stimulate the pancreas to release more insulin 2) reduce the amount of glucose released from the liver 3) help the body to better utilize existing insulin 4) reduce blood glucose levels by preventing the breakdown of starches into sugars in the intestines 5) prevent the breakdown of a naturally occurring compound called GLP-1 which reduces blood glucose.In addition to all of the pharmaceutical treatments available for type 2 diabetics, a healthy lifestyle is a critical component of a type 2 diabetes management plan. A fitness program can greatly improve a diabetics’ quality of life. Dedication to a fitness lifestyle can have amazing results in helping diabetics manage their diabetes. The primary goals of a fitness lifestyle for type 2 diabetics are glucose control, weight loss and long term weight management. About 80% of type 2 diabetics are overweight. Losing weight through exercise significantly helps type 2 diabetics manage their diabetes over the long term. It is important to emphasize that for type 2 diabetics, exercise is extremely important for helping to control glucose levels and ultimately for helping prevent serious complications.The complications of diabetes are real , serious and common for sedentary, type 2 diabetics with uncontrolled glucose levels –complications such as heart disease and stroke, Kidney failure, blindness and leg amputations. Diabetes is the number one cause of kidney failure, non-traumatic lower-extremity amputations, and blindness among adults age 20-74 according to the National Center for Chronic Disease Prevention and Health Promotion. These serious complications can be avoided by making a commitment to a fit lifestyle. Exercise increases insulin sensitivity in type 2 diabetics and lowers blood pressure and cholesterol levels which helps prevent cardiovascular disease.
When initiating a new fitness lifestyle it is a good idea to get a baselineHbA1c test completed. If you haven’t already had this test done, ask your doctor or diabetes educator about it. It is a good test for evaluating longer term glucose management. The American Diabetes Association’s stated HbA1c goal for diabetics is less than 7%.
For diabetics who are taking insulin, it is especially critical that you measure your glucose levels pre and post exercise because with insulin injections and increased exercise you are at increased risk of hypoglycemia-a condition in which your blood glucose levels are too low. Diabetics should keep a rapid acting carbohydrate with them (e.g. juice or a piece of candy) during exercise in case they develop hypoglycemia. Also, before exercising, diabetics should not inject insulin into a major muscle that is being used during the exercise session because there is a risk that the insulin will be absorbed too quickly and result in hypoglycemia. It is very important that your glucose levels are carefully monitored. If your pre-exercise blood glucose is below 100mg/dL than exercise should be postponed until your blood glucose is increased with the consumption of a carbohydrate snack. Target glucose levels for diabetics as stated by the American Diabetes Association are:
Preprandial Glucose Levels (Before Meals): 70-130 mg/dl-should be at least 100 mg/dL before exercising
Postprandial Glucose Levels (After Meals): Less than 180 mg/dl
Diabetes Risk Factors:
Below are the common Diabetes Risk Factors which are listed in two categories-risk factors which you can’t control through medication and lifestyle and risk factors which you CAN control. If you do not have diabetes but you have many of the risk factors which you can’t control, you should carefully review the risk factors which you can control and make a commitment to live a healthy lifestyle. While living a healthy lifestyle won’t guarantee that you will avoid developing diabetes, you will certainly be helping yourself improve your chances of avoiding diabetes and you will be improving your overall health.
Also an important part of daily diabetes fitness is foot care. Neuropathy (lack of some feeling in the extremities) which is a common symptom of diabetes can result in a serious foot infection if you do not carefully inspect your feet daily. Foot care is an important part of your overall treatment plan.
Inspect your feet daily. Check the bottoms of your feet for bumps, swelling or sores. If you can’t see the bottoms of you feet, ask someone for help or use a mirror.
Keep your skin soft and dry. Use a moisturizer on the tops and bottoms of your feet but NOT between your toes.
Protect your feet from hot and cold exposure
Promote healthy blood flow to your feet. Move your ankles and wiggle your toes two or three times a day and if you smoke-QUIT SMOKING!!!!
Wash your feet daily and carefully dry them-especially between your toes
Diabetes Stretching Guidelines:
Stretching is important for maintaining flexibility-range of motion, better overall mobility and as part of a warm-up to help prevent injury before starting your aerobic exercise routine. Since weight loss or weight management is a primary goal of people with type 2 diabetes , the aerobic exercise part of the fitness routine requires moderate to high intensity aerobic workouts. When participating in moderate to high intensity exercise, stretching is especially important for promoting flexibility which can help prevent injury during the aerobic sessions. Stretching is also very valuable after an aerobic work-out. Stretching after a workout is effective because the elevated tissue temperature just after an aerobic workout facilitates more flexibility while stretching. In general, stretches should be held for a minimum of 15 seconds and up to 30 seconds. Stretches should be repeated two-four times.
Diabetes Strength Training Guidelines:
Strength training is important to maintain muscle composition. As stated in the General Fitness Guidelines section, after age 25 without regular strength training, we lose 1/2 pound of muscle every year. This can be prevented with strength training to maintain muscle. An increase in muscle, increases your overall physical strength, increases muscle composition and leads to increased bone strength. Increased muscle composition also increases your metabolic rate to promote weight loss. General guidelines for strength training include: Alternate every other day upper body and lower body or complete an overall body strength training regiment every other day. Lift weights for larger muscles before smaller muscles because the smaller muscles are needed to assist the larger muscles. Lift reps to exhaustion-also called Max resistance-to build muscle strength. For weight loss goals you should lift high reps and lower weight -12-20 reps to fatigue. Complete 1-2 sets with 1-2minutes rest between sets.
A weight lifting circuit training routine is a great idea for weight loss because with weight lifting circuit training you are building muscle and revving your cardiovascular system. With weight lifting circuit training, you perform a series of weight training exercises, from 4-10 stations, with little rest in between. You then repeat the circuit 3-5 times. Many different kinds of activities can be used to build muscle strength-free weights, nautilus machines, Resistance band stretching, body weight lifting exercises-e.g. pull-ups, push-ups and squats. It is important to find strength training exercises that you enjoy.
It is important that diabetics check their glucose frequently when performing aerobic activities. Check your glucose levels before, during and after exercising. If your pre-exercise blood glucose level is lower than 100 mg/dL than you should curtail your exercise and consume carbohydrate prior to exercising. If you are taking insulin and your pre-exercise glucose level is less than 100 mg/dL, then it is recommended that you consume 20-30 grams of carbohydrate prior to exercise. Exercise should also be curtailed if your pre-exercise blood glucose is above 300mg/dL or above 240mg/dL with urinary ketones.TYPES OF EXERCISE:In general, the best exercises for someone with type 2 diabetes are metabolism boosting cardio exercises-non-weight bearing exercises such as bike riding, and water activities-swimming and water aerobics or weight bearing such as power walking, jogging, group aerobics or any exercise which you enjoy during which you get your heart rate up.EXERCISE DURATION:With type 2 diabetes you should begin a new exercise program, exercising for a duration of 20-30 minutes per session but over several weeks, gradually work up to 40-60 minutes.INTENSITY: You should start a new exercise program at an intensity of 50-60% of max heart rate and gradually work up to an intensity of 60-80% of max heart rate. Interval workouts are a great idea in which you vary your workout intensity during your workout session. Here is an example: Start out with a warm up of 10 minutes at a lower intensity-50-60% of max heart rate. After the warm up increase your intensity for 10 minutes to a higher intensity of 60-70% of max heart rate. Then further increase your heart rate to 75% of max heart rate for 3 minutes. After the 3 minutes of high intensity exercise,
reduce your intensity to 65% of max heart rate for 10 minutes and then increase back to 75% of max heart rate for 3 minutes. This approach helps you to extend your workout duration while also exercising at a high intensity.Frequency: You should exercise 5-7 days per/week. The more frequently the better!!!While exercising always listen to your body and ease up if you feel an injury. You should change up your exercise routine to prevent overuse injuries.
If you have Diabetes you do not need to consume a strict, special diet comprised of sugar free foods. You need to eat healthy to be healthy and you need to carefully monitor your glucose levels and adjust your diet depending on your glucose meter readings. Diabetics and the general population should consume carbohydrates which have a low glycemic index(GI). Low GI foods are foods which result in a slow increase in blood glucose when consumed. Healthy examples of low GI foods are Beans (pinto, kidney, navy, black bean to name a few), leafy green vegetables, citrus fruit (such as oranges and grapefruit), tomatoes, blueberries, strawberries, sweet potatoes and whole grains. Since weight loss and weight management are an important part of diabetes management, a low saturated fat and high complex carbohydrate (low GI) diet is the best diet for people with diabetes. If you crave sweet food, you might choose a food sweetened with an artificial sweetener. By eating artificially sweetened food or beverages, you avoid the blood sugar spike of sugar sweetened food and beverages and you also avoid the extra calories. Most importantly, eat a balanced, healthy diet and monitor your glucose to prevent episodes of hypoglycemia or hyperglycemia.
