Exercise can improve your health and your outlook on life. Because you have diabetes, however, it pays to be doubly careful not to injure yourself or upset your diabetes control. Follow the safe exercise basic guidelines that everyone who exercises needs to know. And you'll want to add some extra safety steps that take your diabetes into account. These 20 steps to safe exercise will help you deal with both of these needs.
Your doctor should check your:
- blood pressure
- blood fat levels
- A-1-C levels
- Health of heart and circulatory and nervous systems
- Kidney function
Talk to your health care team about what types of exercise are best for you. Diabetes can cause health problems, such as eye or nerve disease, that make certain types of exercise poor choices. For example, if you have lost feeling in your feet, swimming may be better than walking. If you have trouble seeing, exercise indoors. If you have frequent low blood glucose reactions, you may need to check your blood glucose more often. Your health care team can help you choose fitness goals tailored to your health.
Slow and steady wins the race. Trying to do too much too soon can leave you discouraged or even injured.
One way to pace yourself is to count your heart rate and make sure it stays below a certain level. Another is to rate how difficult exercise feels and avoid too much huffing and puffing. Your health care team can teach you how to avoid pushing yourself too hard.
Step up your workout as you become more fit. Gradually increase how long and how hard you exercise. For instance, you may start out walking for just 5 or 10 minutes. Over many weeks, you may build up to 25 or 30 minutes. Work your health care team to adjust your exercise, meals, and medicines as you get in shape.
Warm up with a low-impact exercise like walking. This gets your heart and muscles prepared to work. After you are warmed up, you may want to stretch gently. Stretching helps keep muscles and joints flexible. Tight muscles and joints are more prone to injury.
Slow down gradually, until your breathing becomes more normal. For example, if you've been jogging, walk for 5 minutes to cool down. Some people prefer to stretch at the end of their workout, when muscles are warm and can stretch more easily. When your breathing is back to normal, start your stretching routine.
Almost everyone with diabetes can work out with light weights. If you have eye, kidney or blood pressure problems, check with your health care team first. You can enhance your upper body strength with an exercise program that features many repetitions with light, hand-held weights.
Sweating means you're losing fluid. It's important to drink to replace fluids lost in sweat. Water is usually the best choice. If you are exercising for a long time, you may want the extra fuel from a drink that contains carbohydrate.
It won't help to wear heavy clothes in the warm weather. Sweating more won't help you lose fat, just water weight. In fact, it's unhealthy. You'll just increase your risk of overheating.
In the summer, wear lightweight, light-colored clothes. Be sure to use sunscreen and wear a hat. In winter, dress in layers. Polypropylene, silk, or thin, fine wool make a good first layer. These materials help lift sweat from your body and prevent chafing. Your outer layer should be made of material that can "breathe" and let sweat escape. Be sure to protect your feet, hands, and head from the cold.
Use the safety gear that goes with your sport. If you're cycling, wear a helmet. If you're playing racquetball, wear eye protection.
Avoid exercising when it's too hot or too cold to be outside comfortably. It's unhealthy to exercise outside when air quality is poor.
Wear the right shoes for your sport. This means basketball shoes to play basketball, walking shoes for walking, aerobics shoes for aerobics, etc. Replace shoes when they begin to wear out. Always put on clean, smooth-fitting socks. Check your feet after exercise. Look for blisters, warm areas, or redness. If you see problems, call your doctor.
If you take insulin or oral diabetes medicine, you may have low blood glucose levels during and after exercise. In fact, you may get low blood glucose 12 or more hours after a workout. People who have type 2 diabetes that is controlled by meal planning and exercise usually don't have problems with low blood glucose.
Glucose fuels your muscles during exercise. At the same time, exercise helps pep up insulin's action. Both things lower your blood glucose level. Through careful planning, you and your health care team will learn to adjust your insulin treatment to avoid low blood glucose levels caused by exercise.
If you take insulin or diabetes pills, blood glucose monitoring is the key to avoiding low blood glucose levels.
One good idea is to check your blood glucose twice before exercise. Monitor 30 minutes before and again just before you begin, so you'll know whether your blood glucose level is stable or dropping. If it is dropping, you may need an extra snack.
This is especially important when you are trying a new activity or sport. A check can help you predict how this sport will affect your blood glucose levels.
You should also check if you will be exercising for more than one hour. Generally, you'll want to check every 30 minutes. If your blood glucose starts to fall, stop and have a snack.
Exercise — especially long, hard workouts — can lower your blood glucose for hours after you've stopped. This happens because workouts draw on your body's supply of glucose, stored in your muscles and liver as glycogen. Later, your body rebuilds its stores of glycogen by taking glucose from the blood. For up to 24 hours, your body needs the glucose you get from meals to fill up your glycogen stores. Your health care team can suggest at what times you should do extra checks to avoid low blood glucose.
Exercise makes insulin work harder. Your blood glucose may drop more than usual when you take your normal insulin dose. Exercise can make insulin go to work faster, too.
On the other hand, if you have type 1 diabetes and have too little insulin available, hard exercise sessions can raise your blood glucose. Hard exercise can signal your liver to start breaking down glycogen into glucose. Hard exercise means whatever is difficult for you. Remember to check for ketones whenever your blood glucose levels are too high (see tip 19).
If you take insulin or diabetes pills to control your blood glucose levels, you need to plan your exercise and diabetes care to avoid levels that are too low or too high.
It's best to exercise 1-3 hours after a meal. You should also avoid exercising when your insulin is peaking (at its strongest). Your doctor may suggest that you try decreasing the insulin dose that will be working while you exercise.
In general, exercise lowers blood glucose levels. This can be good or bad, depending on your blood glucose level before you start to work out. If you have type 1 diabetes, and your pre-exercise glucose result is under 100 mg/dl, exercise could lower glucose too much. Have a carbohydrate-containing snack before beginning to work out. Keep another snack handy to avoid low blood glucose levels during to exercise.
On the other hand, people with type 2 diabetes should limit snacking to assist in weight loss. Snacking before exercise can undermine your efforts. It can also work against the power of exercise to lower blood glucose levels. If you are using insulin or glucose-lowering drugs, talk to your doctor about what levels are safe before exercise.
Always carry juice, regular (nondiet) soft drink, glucose gel, raisins, or another source of carbohydrate. If you feel a reaction coming on, stop, check, and treat it right away.
If your fasting blood glucose is more than 300 mg/dl, no matter what type of diabetes you have, it is in poor control. It may be best to bring your blood glucose level back down or to check with your health care team before exercising. If you decide to exercise, use caution. Make sure you are negative for ketones and re-check your blood glucose to make sure it is dropping in 10-15 minutes.
If you have type 1 diabetes and your blood glucose results are 250 mg/dl before exercise, stop and check for ketones. If you have moderate or large amounts of ketones, do not exercise. Ketones are a sign that your insulin level is too low. Exercise could cause the body to make more ketones.
Ketones add acid to the blood. When too many ketones are produced, they disrupt your body's chemical balance. This can be dangerous. Wait until your tests show negative or trace ketone levels before beginning to exercise.
If you take insulin or diabetes pills, talk to your health care team about exercise and your blood glucose levels. Ask your team to tailor exercise guidelines to meet your individual needs. Once you get going in a regular exercise program, you may find that you need less insulin or lower doses of diabetes pills. Your team may also be able to teach you how to change your own insulin dose on days when you plan a different exercise routine.
Exercise with diabetes does demand a few extra safety steps. You'll find that, once you're into regular exercise, these will become a part of your routine. And the rewards of exercise are well worth a little extra effort.
Source: American Diabetes Association
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