DOCTOR'S VIEW ARCHIVE
Exercise Therapy in Type 2 Diabetes: Part 2
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Part 1 of this Diabetes and Exercise discussion focused on the benefits of exercise for patients who have diabetes . In this section, we will review specific concerns regarding diabetes and exercise and what you should be aware of as you try to maintain a healthy lifestyle.
Hypoglycemia is a condition that occurs when blood sugars fall to excessively low ranges (usually less than 60mg/dl). With hypoglycemia, patients experience confusion, sweating, shakiness, and in severe cases, coma and seizure. Exercise can induce hypoglycemia, particularly in patients who are taking insulin, although patients on oral agents are also at risk. In part, this decrease in blood sugar results from an increase in the muscles' use of glucose and because the liver's production of glucose is impaired.
Studies have shown that patients taking insulin who reduced the dose of their short-acting insulin by 33 to 50% before exercising were able to prevent the onset of exercise-related hypoglycemia. While hypoglycemia can occur during or directly after activity, it can also occur 6 to12 hours after exercise. Caution is therefore recommended during this period as well.
For patients who exercise regularly and need insulin therapy, an insulin pump is a great option for delivery. The pump provides a constant infusion of insulin that can be adjusted and allows for an extra amount to cover meals. With the aid of a doctor or nurse trained in pump therapy, the dosing can be adjusted to fit exercise regimens. The only activities for which the pump may not be well suited are swimming and sports involving vigorous movements. These activities can dislodge the cannula, the tube through which the insulin is infused into the body.