Blood
sugars will usually be lowered by regular,aerobic
exercise.Aerobic exercise is the most beneficial in
con-trolling blood sugar levels.This includes walk-ing,
stationary cycling, swimming or aqua-exer-cise, low-impact
aerobics, and other exercisesutilizing large muscle
groups that are performedfor extended periods.
People
with diabetes are encouraged to exercise regularly
for better blood sugar control and to reduce the risk
of cardiovascular diseases. The reason for this is
that muscles which are working use more glucose than
those that are resting.
Muscle movement leads to greater sugar uptake by muscle
cells and lower blood sugar levels. Additional benefits
of exercise include a healthier heart, better weight
control and stress management. There are some exercise
precautions which people with diabetes must take,
however, when done safely, exercise is a valuable
aid to optimal health.
Safety in general, there are 4 areas of safety to
consider with exercise. Exercise precautions are designed
to help people with diabetes avoid problems which
can result from unwise exercise choices Hypoglycemia
can occur if a person who is taking blood sugar lowering
medication has:
- Eaten too little carbohydrate (fruit, milk, starch)
relative to the exercise.
- Taken too much medication relative to the exercise
- Combined effect of food + medication imbalances
relative to the exercise
Those who do not take diabetes medication do not need
to take these precautions.
Precautions
Precautions to take if you take insulin or oral diabetes
medication:
If your blood sugar level is less than 100 mg/dl prior
to exercise, take a carbohydrate snack prior to beginning
the exercise. A good rule of thumb is to add 15 grams
of carbohydrates (1 Carbohydrate Exchange) to your
usual diet for each 30 minutes of moderate exercise,
or for each 15 minutes of intense exercise.
If your
blood sugar level is higher than 100 mg/dl before
exercise, it is probably not necessary to take the
carbohydrate snack before a light exercise session,
but you may need extra carbohydrates 1/2 hour to 2
hours following the exercise. Add 15 - 30 grams of
carbohydrate (1 - 2 Carbohydrate Exchanges) to the
next meal or snack if your blood sugar dips below
70 mg/dl within an hour or more following exercise.
If you
experience hypoglycemia, follow the Carbohydrate Treatment
guidelines. Follow up with your doctor. You may be
advised to lower your medication on days you exercise
if your blood sugar levels are well-controlled and
usually within target range.
For long
duration and/or high intensity exercise sessions,
plan extra carbohydrate snacks during the activity.
An additional 15 to 30 grams of carbohydrates is suggested
each 30 - 60 minutes of exercise (e.g., soccer game,
hiking, biking, skating, etc.)
Always
carry a fast-acting carbohydrate food (juice, hard
candy, raisins) or glucose tablets when exercising
in the event blood sugar drops too low and hypoglycemia
symptoms develop during exercise.
Wear an
ID which identifies you as having diabetes whenever
you are exercising alone (or anytime) so that others
may help you appropriately in the event something
unexpected happens. (Timi Links above go to: Carbohydrate
Exchanges...the 1 page summary Carbohydrate Treatment
section for hypoglycemia Hypoglycemia section of acute
complications)
Severe
Hyperglycemia (with or without Ketoacidosis)
Can occur when:
Too little
insulin is available to counteract the liver's production
of sugar which is stimulated by exercise hormones
Too little insulin is available to assist glucose
enter muscle cells quickly during exercise
Too much fat is utilized for exercise because sugar
is unable. Ketones levels rise in the blood.
Precautions to take:
Do not exercise if: Your blood sugar is above 300
mg/dl, especially with positive urine test for ketonuria.
Follow your doctor's advice to lower blood sugar before
recommencing exercise.
You are sick with flu, infection or another illness
that is worsening blood sugar control.
If your blood sugar level is above 250 mg/dl but less
than 300 mg/dl prior to exercise, your insulin activity
is low.
If you
exercise, choose one of light to moderate intensity
(walking, light biking), rather than a high intensity
exercise (running, weight lifting, tennis).
Drink plenty of water before, during and after exercise
to stay well-hydrated.
Worsening Complications
Foot Problems can occur when:
Shoes fit poorly
Socks are not worn or are not absorbent
Friction or pressure points develop on feet
Precautions to take:
Inspect feet daily for signs of friction or pressure
sores.
Speak with your physician, podiatrist or diabetes
educator about proper foot care procedures.
Buy shoes which are well-made for the type of exercise
you do and which fit you.
Consult a shoe retailer who specializes in exercise
foot wear.
Buy cotton, absorbent socks.
Here are
some rules you can follow:
- Don't
make a secret of your diabetes. If you get injured
or suffer sudden hypoglycaemia people who may come
to your aid need to know you take insulin or that
you are a diabetic. Tell your instructor beforehand,
and wear a medical ID bracelet, or sports band ID
when you are exercising.
- Choose
a type of exercise you are going to enjoy, and one
that fits into your daily schedule.
- Choose
an exercise of moderate intensity like walking,
light cycling, or swimming. Try and avoid high intensity
exercises such as weight training, running, or tennis.
- Always
warm up and cool down before and after a session
- Have
someone with you when you exercise. You may need
help if your blood sugar drops to an unsafe level.
- Wear
appropriate clothing. Loose fitting breathable garments
are ideal.
- Exercise
at the same time and for the same duration each
day-if possible. This can help keep your blood sugar
levels in the same range.
- If you
want to increase your exercise, only increase the
intensity, or time spent exercising by small amounts.
- Avoid
exercising at times when your blood sugar level
is low.
- Don't
exercise if you feel unwell or are suffering from
flu etc.
- Exercise
can affect your blood sugar, so closely monitor
your levels before and after you exercise to measure
the effect exercising has on your body.
- Always
have a fast acting carbohydrate food with you during
and after exercise (raisins, juice etc) in case
hypoglycaemia symptoms occur. Low blood sugar symptoms
can occur up to 24 hours after exercising.
- Drink
extra liquids during and after exercising to prevent
dehydration. It also helps prevent erratic blood
sugar levels and combats heatstroke.
- Exercise
lowers blood sugar, so you may need to eat extra
food, or adjust your medication accordingly.
- Wear
proper fitting shoes and cotton absorbent socks.
- Check
feet daily for any signs of pressure sores or friction,
blisters, etc..
- For
longer exercise sessions make sure you take extra
carbohydrate snacks during the session.
- If you
experience hypoglycaemia, you should see your doctor.
You may be advised to adjust your medication on
days that you exercise.
