Diabetics & Fitness: Exercise Can Save Your Life (cont.)

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.

In some cases, night exercise will cause blood sugar to drop overnight and then rebound in the morning. My experience with patients is that it does help keep morning fasting blood sugars lower, but it varies from person to person. If you exercise at night, your blood sugar may drop to hypoglycemia overnight, so do discuss this issue with your diabetes educator or physician and make whatever insulin adjustments are necessary. This is a good idea to try, just be sure you are safe.

I have type 1 diabetes. What are the best foods to eat before exercise and, after exercise, how can I prevent my blood sugar from going low without my having to eat all the time?

To prevent exercise hypoglycemia without eating, which, by the way, is a problem for many people with type 1 diabetes, you need to work with your diabetes educator or physician on aggressive insulin management, which is to say that you need to reduce the amount of insulin you take before the exercise to prevent the hypoglycemia.

These adjustments should be made with the approval of your educator or physician, that's their responsibility, to help you. This situation is very common, but very manageable with the right insulin adjustments, so you can do this. Again, I've written a number of articles on blood sugar management for people with diabetes, and you can find these at the Diabetes Self-Management magazine website, in the fitness section.

I'd also encourage you to check out the Diabetes Exercise and Sports Association website, where every member of this organization has diabetes and is a physically active person. It's a wonderful organization, and I encourage you to join and receive their newsletter, and you will find many other people with the same challenges in terms of diabetes, exercise, and blood sugar management. So go ahead and have a look at DESA.

I have read that it's not good to exercise with readings over 300 -- why?

The guidelines used to be that if your blood sugar was over 240, you should not exercise. The reason is that if your blood sugar is high, it typically means that you don't have a lot of insulin on board.

When you exercise, the liver produces glucose and if your muscles don't burn the glucose faster than the liver produces it, then your blood sugar can go up. This is especially so if you start exercise with a high blood sugar.

However, the guidelines have been modified, and so what we recommend is if your blood sugar is high, say 250, 275, or even 300, and you do not have ketones, then it's okay to exercise. But what we recommend is that you exercise for only 15 minutes, test your blood sugar again, and if it is going down then it is okay to continue exercising, but if your blood sugar goes up after 15 minutes then you need to stop, and if you are concerned about how high it is going, then you need to call your physician or diabetes educator.

In general, exercise is almost always a good thing, and you are correct to assume that exercise in most cases will cause the blood sugar to go down, but you need to take prudent caution to make sure you are safe. We want you to exercise, but we also want to make sure your blood sugar is going in the right direction.

If it's high and you don't have ketones, you can start exercising, test 15 minutes later, and if it's going down you're okay to continue, but if it's going up you must stop.

I'm a 170 pound man. My mom and dad and all my uncles and sister have diabetes -- how can I avoid getting it?

Considering one million new cases of diabetes are diagnosed each year this is a great question.

The good news is that in the diabetes prevention program conducted by the National Institutes of Health, it was found that in more than 3,000 people, walking five times a week for 30 minutes each session or 150 minutes per week, and losing 7 percent of body weight, reduced the risk of diabetes by 58 percent.

The people who took medicine to prevent diabetes only reduced their risk by 31 percent. Now, if you are already at a healthy weight and don't need to lose 7 to 10 percent of your body weight, then all the evidence points to the 150 minutes per week of moderate to brisk exercise, and specifically, the people in the study did walking as their main activity.

So the proof is that diabetes can be prevented through an active lifestyle and maintaining a healthy weight. If you think about five 30-minute sessions of physical activity each week, it's really not that much, and you get an enormous benefit.

So I encourage you to go ahead and start, if you have not already, a regular program of physical activity. This could also extend to not only walking, but resistance exercise, like weight lifting. You can also go to the American Diabetes Association website, where they now have a pedometer program and you can keep track of your physical activity right on their website.

You're on the right track by asking about preventing diabetes, and physical activity has certainly and clearly been proven to prevent it. I encourage you to get started.

Richard, do you have any final words on exercise for us?

I want to encourage all of you to maintain a physically active lifestyle, not only for your diabetes but for your general health and well-being. Diabetes simply doesn't mean that you cannot live an active, healthy and fit lifestyle.

I've worked with hundreds of individuals, athletes, and others, who have diabetes, people who have run marathons, climbed mountains, competed in triathlons, and all of them have been able to accomplish whatever it is they set their minds to. Diabetes sometimes made it inconvenient, but they were able to conquer it and do the things that gave them great satisfaction.

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