Diabetes, Exercise and Caregiving
By Sean M. Kenny

The benefits of exercise for people with diabetes can be quite substantial. With both forms of diabetes, type 1 and type 2 (insulin dependent and non-insulin dependent respectively), exercise can play a vital role in the prevention of costly, uncomfortable and sometimes fatal complications.

First, exercise can help control blood glucose and insulin sensitivity. In type 2 patients, consistent exercise can completely control glucose and carbohydrate metabolism. Many people are concerned that since type 2 runs in their family, they will inevitably get it as well. Regular exercise can protect you from ever developing this common metabolic disease by helping to fight insulin resistance and obesity. While complete glycemic control in Type 1 patients is not possible, and insulin must still be utilized, they can often decrease the amount used.  

A second reason for exercise is the prevention of coronary problems. Cardiovascular disease is the leading cause of death for people with diabetes. Regular exercise can improve heart and lung function, cholesterol, blood pressure, and help improve circulation, especially vital in diabetic trainees. (KATE what is a diabetic trainee?)

Special care needs to be taken when designing an exercise program for the person with diabetes. First and foremost, consult your clients’ physician for an examination. Special attention will be given to heart, blood vessels, eyes, kidneys and nervous system. A foot examination will also be needed as many patients experience loss of the protective sensations in the feet. Often times, the primary caregiver will be asked to perform regular foot exams for sores and blisters. If your loved one does not have a problem with mobility, you may be asked to help make selections in quality athletic shoes and socks as well. Comfort and fit, not style is what matters. Foot care is of paramount concern in active diabetics.

Cardiovascular training should be the foundation of the exercise program. Aim for at least 20 minutes of sustained activity three to five days per week. If one suffers from loss of sensitivity in the feet, avoid exercises such as prolonged walking, jogging or step exercises. Better choices for cardiovascular exercise would be swimming, bicycling, rowing, chair exercises and other non-weight bearing activities. Fluid intake is important during exercise, and especially so with cardiovascular activity and the diabetic exerciser. Consider a high-glucose sports drink like Gatorade or fruit juices over water,  which can help keep blood sugar from going too low. Drink fluid before, during and after exercise.

Resistance training has been shown an effective way to help promote circulation and control obesity in people with diabetes. Care should be taken to avoid strenuous, heavy lifting; especially in individuals who suffer from diabetic retinopathy complications. Find a comfortable weight with which one can perform two to three sets of 10-12 repetitions with good form. If the exercise form on lifts gets “sloppy”, go down in weight. Stress the fact to your client that form is always more important than how much weight one can lift.

Unlike cardiovascular exercise, weight training should only be done every other day. You may also want to keep a high carbohydrate food handy or some fruit juice available during lifting to keep blood sugar up.

Finish off each exercise session with some light stretching exercises. These can also add in enhancing circulation. It is also a great way to cool-down after exercise

Some items to address when designing a diabetic exercise program

  • Avoid exercise if fasting glucose levels are >250 mg/dl.

  • Be sure to check the blood sugar before, and after exercise, regularly. Consider checking it one hour before, as well as immediately before (did he mean before or after here?) exercise, so you can tell which way your sugar is heading. Usually, people with four injections a day are taking Regular or Lispro insulin (Humalog®) before meals as part of their program. The ADA suggests that people on pre-meal Regular (or lispro) decrease the dose of Regular (or lispro) at the meal before the exercise by one-half. Sometimes the dose of Regular (or lispro) at the following meal also needs to be decreased (depending on the blood sugar level at that time).

  • Use the abdomen or buttocks (rather than an extremity that you’ll be using during the exercise) for your shot before exercise.

  • If your exercise will occur a long time after a meal, be sure to have a snack that’s high in carbohydrates before starting the exercise. Ingest added carbohydrates if glucose levels are less than 100 mg/dl.

  • Carry some carbohydrate food with you while exercising, in case you feel like you’re starting to “crash”.

  • Though it may not be realistic for most people, it’s best if you can exercise at the same time every day.

When caring for diabetics, realize that they can lead full and active lives with a few modifications. In fact, many people with diabetes have competed at the professional level of sports. The benefits of exercise are many. With a little attention to detail, these benefits can belong to all of us!


 

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