MEMBER QUESTION:
I am type 2 and I need to lose significant weight. In my resistance training is there a point where I need to increase resistance? I don't want to build "bulk".

WEIL:
Muscle is very strongly associated with better blood sugar control and prevention of diabetes. If you want to build strength and some muscle, which I recommend, then repetitions should be in the 12 to 15 range. So when you can do 15 repetitions easily, it's time to increase the weight.

As far as mass is concerned, you won't get very big from lifting 12 to 15 repetitions and you won't get very big from increasing the weight when you can do 15 repetitions easily.

So I do recommend that you do increase the weight once you can lift 15 easily. Your strength, your metabolism, will both increase and this will help you stay more active and prevent diabetes.

MEMBER QUESTION:
Newly diagnosed type 2. I am a competitive cyclist who rides about 200 miles a week in the off season, higher in the in season. Will I see any benefit from this level of exercise as I was already at that level when diagnosed?

WEIL:
Yes. You're doing plenty of exercise, and the way to look at it is that if you were not doing any exercise, you would have either developed diabetes sooner or the management of it would have been much more difficult.

In the diabetes prevention program, a three-year government study looked at individuals who walked five days a week for 30 minutes per session. They lost 7 percent of their body weight over a three-year period and reduced their risk of diabetes by 58 percent.

Now, as I mentioned earlier, sometimes exercise doesn't always prevent diabetes and you need to go to medication; however, in your situation, all of the exercise you're doing is extremely beneficial for helping you to manage diabetes and preventing it from getting more difficult to manage down the road.

In addition, reducing your risk of other complications of diabetes, like heart disease, is a real benefit from all the activity. So you're doing plenty, you're doing enough, and I encourage you to keep up with your active lifestyle.

MEMBER QUESTION:
I have terrible neuropathy in my feet. I know walking will benefit in so many ways but is it a concern for the well-being of my feet?

WEIL:
In some cases, when the neuropathy is to the point where you cannot feel your feet, then it is critical that you:

• Have your doctor always inspect your feet
• You always wear proper footwear and socks
• You inspect your own feet for blisters, sores, or other problems

In addition, if you cannot feel the pounding of your feet, like with jumping or running, it could be a problem for foot bones and joints, and if you suspect any of those things or you really cannot feel your feet, then discuss these issues with your physician. It may be that you need to do other activity, like biking, swimming or rowing or other activities that don't stress your feet.

If the neuropathy is not so advanced, then physical activity (including walking) is a very good thing for diabetes and neuropathy because it:

• Keeps the muscles toned
• Keeps the blood flowing to the feet
• Helps improve balance
• Helps increase sensation

Check with your diabetes educator or physician, then you can feel like you are doing the proper exercise for your condition and helping to manage your diabetes.

MEMBER QUESTION:
Does the exercise you do before breakfast speed up your metabolism more than the exercise you do after dinner?

WEIL:
There won't be any difference in the metabolic response, whether you exercise in the morning, afternoon or evening. However, if you take insulin or diabetes pills, and particularly insulin, you may notice that your blood sugar drops less in the morning than it does later in the day.

The reason is that later in the day the muscles have been more active than the morning, when you first wake up. So the muscles need for blood sugar is higher, and it is very common for blood sugar to drop more later in the day than earlier.

This is the least concern for your health or diabetes management, because overall, exercise at any time of day is beneficial. The problem is simply managing the blood sugar for the time of day. With attention to these issues with your diabetes educator or physician, you will be able to manage your blood sugar for exercise any time that you do it.

MEMBER QUESTION:
Do you recommend a particular type of shoes or socks for exercising?

WEIL:
Select a shoe for the activity you're doing. Exercise shoes today are well-designed and task specific. So, for example, if you're playing tennis, where you move side to side, running shoes would not be useful because they offer virtually no lateral stability or support. If you are going to the gym and taking an aerobics class, I recommend a cross trainer or shoe specific for aerobic dance, and then you can also wear that for weight lifting and biking and other activities in the gym. So there is some crossover, you just have to make sure it fits the task or exercise you're selecting.

Athletic socks with some synthetic or polyester tend to dry quicker and cause less friction than 100 percent cotton socks, so the athletic polyester synthetic sock reduces the risk of friction blisters and that's always important for people with diabetes.

In general, foot care for people with diabetes is very important, so I recommend you be thoughtful in your choice of footwear and socks for the activity.

MEMBER QUESTION:
My blood glucose is relatively under control during the day (110-140) but my fasting glucose is high (130-150). Would exercise in the evening be beneficial so my body can use the glucose building up during night?

WEIL:
Yes, it's possible that exercise in the evening might help your fasting blood sugar. If you take insulin at bedtime, you may need to adjust that down if you exercise at night, to prevent overnight hypoglycemia, but discuss this with your diabetes educator or physician.