The Healing Handbook for Persons with Diabetes

Excercise is important for persons with diabetes.Chapter 7: Exercise

Exercise is an important factor in your diabetes control program. Besides improving muscle tone and keeping your heart, blood vessels, and lungs healthy, exercise lowers blood cholesterol and triglyceride levels and burns calories to help people with non-insulin dependent diabetes achieve and maintain ideal body weight. Exercise aids in diabetes control by stimulating insulin functioning, and may reduce your need for medication. A balanced exercise program reduces stress and tension, improves concentration, and decreases appetite.

Exercise Programsfor People with Diabetes

The best activities for you are vigorous aerobic exercises. Aerobic exercises use the large muscle groups, and improve stamina and overall health. Ask your diabetes educator for more information about aerobic exercise, or take a look at Exercise & Diabetes, a pamphlet-workbook by Jean Kapetanios (order from Area Health and Education Center, 81 Plantation Street, Worcester, MA 01605) or The Diabetic's Sports and Exercise Book by June Biermann and Barbara Toohey.

Aerobic Exercise Options 

Here are some aerobic activities you might enjoy:

Walking

Hiking

Jogging

Skating

Tennis

Rowing

Jumping rope

Aerobic Dancing

Ice hockey

Cross-country skiing

Swimming

Bicycling

Basketball

Stationary cycling

Stationary running

The following are NOT considered aerobic activities:

Baseball/Softball

Bowling

Football

Volleyball

Horseback riding

Golf

There are many practical ways to increase your activity. Walking is one of the easiest: you can walk to the store instead of driving, walk the dog, park farther from your destination and walk the rest of the way, get off the bus a stop or two early and walk the extra few blocks. Walking is an ideal exercise no matter what your age. It's safe and inexpensive, requires less strength than many sports, and you don't need lessons to begin. You can walk alone or with others, indoors or outside.

For safe walks, wear appropriate shoes. Never go barefoot. Wear loose-fitting clothing and dress in layers you can remove if you get hot. Start slowly, and increase your distance and pace each week. Take long, easy strides, and breath deeply. Carry some fast acting sugar and be aware of low blood sugar symptoms. In hot weather, bring extra fluids. Always check your feet for injuries after walking.

Walking Burns Calories

Miles Walked Calories Burned
2
3
4
5
150 - 240
240 - 360
350 - 420
420 - 480

In addition to walking, there are other ways of being active that don't even seem like exercise. Take the stairs instead of the elevator. When watching television, get up and move around during commercials. Use hand operated appliances rather than electric ones. Mow the lawn, rake the leaves, wash the car -- even washing windows or floors can provide good exercise and burn calories.

BEFORE BEGINNING ANY TYPE OF EXERCISE PROGRAM SEE YOUR PHYSICIAN FOR MEDICAL CLEARANCE.

WEAR A MEDICAL ALERT IDENTIFICATION BRACELET OR NECKLACE, OR CARRY AN IDENTIFICATION CARD WHEN YOU EXERCISE.

NEVER EXERCISE IF YOU HAVE HIGH BLOOD SUGAR PLUS KETONES. DIABETIC KETOACIDOSIS CAN RESULT.

Monitoring Blood Sugar During Exercise 

When beginning an exercise program, check your blood sugar before, during, and after exercising (see Chapter 5). By monitoring your blood sugar, you can:

  • Learn your body's response to exercise
  • Avoid hypoglycemia
  • Determine an appropriate pre-exercise snack

Exercise for the Overweight Personwith Type II Diabetes

You may not feel like exercising because you are tired, and moving around takes a lot of effort. But you'll feel better when your diabetes is in good control, and you can help make this happen by following your diet and exercising. Exercise decreases your appetite and helps your own insulin work better. Exercise also burns up food calories and calories stored in body as fat. By using more calories than you eat, you'll lose weight, and when you lose weight, you'll be able to move with less effort.

The number of calories burned during exercise depends on your size and on the type, duration, and intensity of your exercise. Exercise frequently. Bowling once a week is not enough. For best results, exercise 5 times a week for at least 30 minutes each time.

Easy Exercises for Beginners 

Bending and stretching exercises are good for beginners because they are easier and less likely to cause injury than more strenuous aerobic exercises. Even after you advance to more strenuous activities, it's a good idea to prepare for each workout with a few minutes of bending and stretching. In addition to bending and stretching, there are safe beginner's exercises you can do lying down on your bed or a floor mat, or sitting in a chair.

Bending and stretching: Standing with legs apart, bend forward, backward, and to each side.
Exercises you can do lying down on your bed or a floor mat:

  • Foot and toe exercises: Wiggle and circle toes of both feet.
  • Then circle each foot, first in one direction, then the other.
  • Knee raises: Lying on your back, bring one knee up as close to your chest as possible, then lower it slowly. Repeat with the other knee.
  • Rolling: Lying on your back, raise arms as high over your head as you can. Stretch, then roll side to side, slowly.
  • Head/shoulder lifts: Lying on your back, take a deep breath. As you exhale, lift your head and shoulders.
  • Leg circles: Lying on your side, raise one leg and move it in a circular pattern. Turn and repeat with the other leg.

Exercises you can do sitting up in a chair:

  • Arm circles: Raise both arms in front of you. Make a big circle with each arm, first in one direction and then in the opposite direction. Next, stretch arms out to your sides. Move arms in circles in one direction and then in the opposite direction.
  • Push up: While seated, push down on the arms of your chair and try to lift your body off the seat.

Exercise for People with Type I Diabetes 

Make it a habit to increase your food when you plan extra exercise. Team sports are fun, and there's no reason you shouldn't participate freely.

But you must take extra food every hour during strenuous exercise to balance the calories you are burning. And you must always have fast acting sugar with you in case of a reaction. An insulin reaction is still possible hours after exercising. During prolonged, strenuous exercise (longer than 1 hour) sugar may be borrowed from your muscles and liver. Your body replenishes these stores over the next 12 - 24 hours.

Food Exchanges for Exercise 

Exercise Blood Glucose Exchanges to Add:

Type of Exercise  Blood Sugar  Exchanges to Add 

Short Duration, Low to Moderate Intensity 

Walking (1/2 mile) or Leisurely cycling (less than 30 minutes) 

Under 80 mg/dl

Over 80 mg/dl

2 fruit

1 fruit

MODERATE INTENSITY 

Tennis, swimming, jogging, golfing, or leisurely cycling
(1 hour)
 

Under 80 mg/dl

80-180 mg/dl

180-300 mg/dl

Over 300 mg/dl

1/2 meat and 2 breat

1 fruit or 1 bread

No extra food

Do not exercise

STRENUOUS 

Football, hockey, racquetball, basketball, strenuous cycling or swimming or shoveling 

Under 80 mg/dl

80-180 mg/dl

180-300 mg/dl

Over 300 mg/dl

1 meat, 2 bread, 1 fruit, and 1 milk

1 meat and 2 bread

1 meat and 1 bread

Do not exercise

When you perform strenuous, all-day exercise (painting your house, digging a garden, taking a bike tour, or running a marathon), you may need to decrease your total daily insulin by 30-50%. But decrease insulin only when you absolutely certain the activity will not be rained out or postponed. And be aware that even if you decrease insulin, a drop in blood sugar may occur during strenuous exercise.

CHECK WITH YOUR DIABETES EDUCATOR OR DOCTOR FOR ADVICE ON INSULIN ADJUSTMENTS.

Exercise speeds absorption of insulin, so avoid injecting into parts of your body that will be exercised during your activity. If you are planning leg muscle exercise (jogging, skiing, cycling), inject insulin into the abdomen or arms. For arm muscle activities (scrubbing walls, doing push ups, washing the car), inject into the abdomen or leg. For sports that use all body muscles (swimming, basketball), the safest place to inject is the abdomen.

Always watch for signs of hypoglycemia (see Chapter 8). Don't wait until you finish exercising to treat a reaction. Stop immediately, treat the reaction, and wait 5 minutes before resuming activity. Exercising at the same time each day is beneficial, but not always possible. Keep in mind your insulin peak times and avoid exercising at these times. Also be aware that exercising at very high or low temperatures may cause you to burn more calories.

Charting Your Progress

Keep a log of your exercise program, including activity, duration, before and after blood sugars, and insulin reactions that occur during and after exercising. This information helps you measure your progress and avoid exercise-related reactions. The chart on the next page covers the first 8 weeks of your exercise program. You'll be proud of your progress, and you'll feel healthier and stronger each day!


MY 8 WEEK EXERCISE PROGRAM

Week  Days  Activity  Duration  Blood Sugar Before  Blood Sugar After  Reactions 
1            
2            
3            
4            
5            
6            
7            
8            

Questions and Answers 

How do I choose a good exercise program?

When choosing an activity, ask yourself: Do I enjoy the activity? Can I do it for a lifetime? Can I do it alone? Is it convenient? Can I fit it into my life style? For better health, choose an aerobic activity. Your work out should consist of three phases:

  • A WARM UP is necessary to prepare the body for more strenuous exercise and prevent injuries. Stretching and flexing muscles are good warm-up activities.
  • The AEROBIC PHASE is the period of intense exercise. Heart rate and respiration increase, while blood sugar level and tension decrease, and calories are burned.
  • The COOL DOWN gradually returns your body to it's normal state. Slower, less strenuous exercises prevent pooling of blood in the arms and legs, which can cause fainting.

If I am active on my job, do I need an exercise program?

If your job is truly active -- if your body is constantly moving 8 to 10 hours a day -- it certainly counts as exercise. But off-the-job physical activity can help alleviate work-related stress. If you substitute work activity for exercise, you eliminate an important relaxation technique.

Why do insulin reactions sometimes occur hours after exercising?

During periods of strenuous exercise, your body consumes substantial amounts of muscle and liver glycogen. It can take up to 24 hours to replace this glycogen; during this time your blood glucose level may drop.

To prevent an insulin reaction, eat extra carbohydrate foods (for example, bread, crackers, or juice) after you exercise.

If your blood glucose is high after strenuous exercising, avoid taking extra insulin right away. During the cool down or recover phase, the blood sugar will fall on its own. Extra insulin may cause a severe insulin reaction!

REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort. 

This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical School. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management. 

Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention! 

Copyright 1995-1999 Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. All rights reserved.
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 Dr. Aldo Rossini