Diabetes & Fitness: Get Moving!

Last Editorial Review: 10/20/2004

WebMD Live Events Transcript

Exercise is great for everyone, but if you have diabetes a regular fitness routine can be a true life saver. Where do you begin, and what special concerns exist for someone with diabetes who wants to take that first big step? We talked about it when WebMD's own fitness guru and diabetes educator Richard Weil, MEd, CDE, joined us in the Student Lounge on Oct. 12, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Support for this University course was provided by Medical Mutual.

Welcome, Richard. Do specific types of exercise (such as aerobic or weight lifting) help in diabetes control, or is it merely exercise duration and frequency?

Research shows that aerobic exercise and resistance exercise are both effective for people with diabetes, but a combination is better for blood sugar control.

Aerobic exercise reduces the risk of heart disease and stroke, which people with diabetes are at a higher risk for, and resistance exercise builds lots of muscle, muscle being important for burning fat and glucose.

Of course, burning glucose is very important for people with diabetes, so I recommend a combination of aerobic and resistance exercise. For people over the age of 70, I recommend slightly more resistance exercise because at that age and older, you tend to lose more muscle and building muscle is very important for:

  • Strength
  • Posture
  • Balance
  • Blood sugar control

I have a bad back and even walking can be too hard; what can I do to get some exercise?

Bad back problems afflict many Americans. Some of the time the back trouble is simply from weak abdominal muscles and poor posture. When there is something structurally wrong with your back, like a herniated or bulging disk or some muscular problem, non-weight bearing activities like a stationary or recumbent bicycle might be better than activities where you pound, like jogging or dancing.

One of the best activities is swimming, because the water supports your weight and there is very little pounding, especially in your back. You can check in your region to see if there are swimming pools available, as well as water aerobic exercises, which in addition to swimming, would be a wonderful way of doing aerobic and resistance exercise, because water serves as resistance, so in a sense, it's like weight lifting.

Diabetes will respond whether you do weight bearing or non-weight bearing activity. Check the Arthritis Foundation web site, because the foundation sponsors water classes all over the country.

"Burning glucose is very important for people with diabetes, so I recommend a combination of aerobic and resistance exercise."

I exercise three to four times a week and my diet has not changed in the past 90 days. There has been some stress, two deaths in the family and a failed relationship and my A1C went from 7.6 to 8.5. My care provider wants me to go on insulin but I would rather try a different regimen of oral meds.

Exercise is one of the cornerstones of diabetes treatment, however, even with regular exercise in some cases you need to go on to medication for diabetes.

If your A1C has risen 1 point or more, it tells the doctor that your blood sugar really has not been in good control and a more aggressive treatment may be necessary. Now, with all the stress in your life recently, it's a good thing that you have been exercising, because exercise helps reduce that stress.

It also keeps blood sugar under control and keeps the A1C down. It may simply be a transient effect of the stress that's caused your blood sugar to rise, but you will need to discuss the next step carefully with your physician. Keep up the exercise, because in the long run and the short, it's one of the very best things you can do to manage your stress and your diabetes.

Does exercise sometimes elevate the blood sugar in diabetes patients?

Yes, blood sugar can go up after exercise. The reason is that the liver is constantly making glucose and pumping it into the blood stream. In response to exercise, the liver makes even more glucose and if you do not burn the glucose faster than the liver produces it, the blood sugar can go high after exercise.

Now, generally weight lifting makes blood sugar after exercise go higher and aerobic exercise makes it go lower. If aerobic exercise is making your blood sugar go up, you need to be sure to test your blood sugar before the exercise, and if you can detect the pattern of when the blood sugar rises, you may need to take just a small amount of insulin before exercise to keep it from rising.

Discuss this with your diabetes educator. Also, I've written a number of articles on managing blood sugar during exercise, and if you go to the Diabetes Self Management magazine web site, you will find my articles in the fitness section and it will help you learn how to manage your blood sugar during exercise.

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."

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.

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?

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% of their body weight over a three-year period and reduced their risk of diabetes by 58%.

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.

"Muscle is very strongly associated with better blood sugar control and prevention of diabetes."

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?

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 activities, such as biking, swimming, 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.

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

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 in 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 anytime that you do it.

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

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% 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.

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?

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.

"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."

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 web site, in the fitness section.

I'd also encourage you to check out the Diabetes Exercise and Sports Association web site, 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 OK 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 OK 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 OK 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 1 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% of body weight, reduced the risk of diabetes by 58%.

The people who took medicine to prevent diabetes only reduced their risk by 31%. Now, if you are already at a healthy weight and don't need to lose 7% to 10% 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, such as weight lifting. You can also go to the American Diabetes Association web site, where they now have a pedometer program and you can keep track of your physical activity right on their web site.

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.

"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."

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.

Diabetes simply does not have to stop you. I encourage all of you to visit the diabetes Exercise and Sports Association web site, join that organization, and receive their newsletter and attend their conferences. They are an organization of people, all of whom have diabetes, and all who have a strong interest in physical activity and an active, healthy lifestyle.

Again, I encourage all of you to maintain an active lifestyle. The benefits for people with and without diabetes are well-known and worth all the effort.

Thanks to Richard Weil, MEd, CDE, for sharing his expertise with us. For more diabetes information and support, visit the WebMD message boards, where you can post messages and questions for fellow WebMD members and find expert opinions from our in-house medical professionals.

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