- Living with Diabetes
Diabetes Mellitus, long considered a disease of minor significance, is now emerging as one of the main threats to human health in 21st century. Ignoring diabetes and taking poor care of it does not free anyone from its ill effects. But, while with some other elements .You have diabetes and still have a long, happy and productive life. This involves knowing exactly where, how and when problems may occur and taking action to prevent them from occurring. You need to combine a healthy life style regular and systematic exercise, a good meal plan, regular monitoring and visits to your doctor – with a positive outlook on life.
Exercise whether at work or play, is as much a treatment of diabetes as any other form of therapy. Nowadays nobody is getting enough to do exercise. I have no time……, I am too busy……the questions and answers will go like this. In fact, those who are passing through a busy life and getting more stress should have to yield the benefits from exercise.
A majority of our housewives will say we are doing the house hold works, but actually we can’t categorize those activities exercise program. After all what they are doing much, only switching on and off the machines for household works, right?
Physical activity plays an extremely important role in overturning the clusters of symptoms (obesity, insulin resistance, hyper insulinemia, cardiac problem) that accompany diabetes.
Exercise need not be unpleasantly aggressive to be beneficial. It doesn’t mean that you have to join a health club or spend some money for buying exercise machines. But focusing on an activity that is enjoyable and incorporating it in the daily activities can be pleasant as it is gratifying.
Exercise really help diabetes?
The answer is very definite ‘Yes’. Exercise can help to reduce your insulin requirements in two principal ways,
- Exercise increases body’s sensitivity to insulin.
- Exercise enhances more efficient use of blood glucose for energy, thereby lowering it.
This possibly reduces the amount of medication required to control diabetes. Here are some other beneficial effects that you can yield from regular exercise,
- Exercise will improve you cardio – pulmonary endurance thereby reducing the risk of getting heart problems.
- Exercise lowers the bad cholesterol in our body at the same time helps in improving the HDL (good cholesterol) level.
- Exercise has helps in controlling blood pressure.
- Exercise when combined with a well-balanced diet, can help reduce your body fat. This is of particular importance to the overweight diabetic.
- Exercise can improve your blood circulation especially I the arms and legs, where people with diabetes can have vascular problems.
- Exercise helps in maintaining or increasing the bone density there by preventing easy fractures (more common in females after menopause)
- Exercise increases, the strength, endurance and flexibility of the muscles.
- Exercise helps in reducing the impact of stress.
- Exercise promotes a total physical and mental wellbeing and make the individuals more productive during their activities.
Exercise with Diabetes
Physical activities beneficial to people with diabetes
- Brisk walking
- Running or jogging
- Bicycling (including stationary)
- Stair climbing
Types of Activity
As a guideline, the most effective exercise for people with diabetes is “aerobic” or “Cardio Vascular exercise”. They are the rhythmic, repetitive, sub maximal, dynamic movements of the large muscle groups in our body. This helps to burn calories especially from body fat.
- Swimming etc.
Most of the exercise effects can be attained by doing these types of exercise in a systematic way. There are another group of exercise which are named “anaerobic exercises”. They are quick, repetitive movements for a short period of time with or without external resistances for example,
- Weight training using dumb bells;
- Power lifting;
- Sprint etc.
In these type of exercise. There the need for large amount of energy within no time. So the body utilizes glucose for energy production. But the harm is that there will be more lactic acid accumulation as a metabolic waste product in our body. It is a harmful substance which can cause fatigue and soreness of the muscles.
But this can be neutralized in the liver later on. This doesn’t mean we shouldn’t do the anaerobic exercise. This is also helpful, as it will contribute towards building up our muscle mass as well as our power. But care should be taken in case of other coexisting illness like retinopathy, nephropathy and cardiac problems.
Get Start Safely
It is good to do the exercise in the morning as you won’t be that much weak and the good effects of exercise will keep you more active and productive throughout the whole day. Keep in mind that you can increase your physical activity at any time of the day if you wish.
- Before you start your exercise.
- Have a complete Physical evaluation.
- Have an exercise stress test because of the increased risk of heart disease.
- Consider diabetic complication before selecting the type of exercise.
Estimate energy expenditure so as to help balance energy intake energy output and insulin requirements. Physical therapist or an exercise physiologist can help to create an individualized program to suit particular needs.
- Do not exercise if blood glucose exceeds 250mg/dl and if urinary ketone test shows positive result.
- Eat within 2 hrs of exercising.
- Eat or drink some extra carbohydrates if glucose levels are below 100mg/dl
- Drink enough fluid before, during and after exercise.
- Exercise regularly, ideally at the same time every day.
- Be consistent with the exercise and also with meal time and insulin injections.
- Have a high carbohydrate snack about 15 minutes before exercising.
- Use non exercising body sites for insulin injections.
- Avoid heavy exercise during peak action period of insulin injection.
- Protect your feet by wearing good fitting shoes and cotton socks.
- Always have quick acting high carbohydrate on hand such as hard glucose sweets.
- Carry medical identification card or tag with you.
- If you feel an insulin reaction – coming on while exercising, stop immediately and have some glucose.
- ‘Proliferative retinopathy’ strenuous exercise or excessive straining is not recommended due to the increased risk of possible haemorrhage in the vitreous space in the eye and retinal detachment.
- ‘Peripheral Neuropathy’ increases the danger of injury to the feet.
- If one’s condition is mild suitable footwear can provide sufficient protection, but if it is more severe, weight bearing exercise should be avoided. Select less weight bearing exercise like cycling, rowing or non-weight bearing exercise like swimming or mat exercises if you have a loss of protective sensation.
If you are a type – 1 diabetic and if do not need to lose weight increase your energy intake to much your increased energy expenditure. This is particularly important during strenuous activity when you need to replace the energy you have burned. Always have some fast acting carbohydrate with you to use if you develop low blood sugar.
An Exercise Session
A typical exercise session will be comprised of a warm up, aerobic and a cool down phase. Each of these phase have its own importance to consider.
A warm up phase, usually 5-8 minutes prepares the body for more strenuous activity and helps to prevent injuries. Slow walking, free range of motion exercises, stretching, sit ups etc. Can be included in this phase.
The aerobic phase is the period of more intense exercise (walking, jogging, cycling etc.) Here we are trying to improve our cardio pulmonary endurance. The heart rate and breathing rate increases. Aim to achieve 50%-75% of the maximum heart rate (HR max = 220-your age) and maintain that gradually increase the time by maintaining the higher values in the target heart zone.
The cool down phase (5-8 minutes) gradually returns your body to its normal state. This prevents pooling of blood in the extremities, which could otherwise cause fainting. Stretching, free range of motion exercises to all joints etc. will help for this.
Aim to build up “aerobic session” from 15 minutes to about 30 or 45 minutes at least 5 days per week will help you to get the health benefits. Nearly all people who have diabetes can incorporate upper body strength training with light weight high repetition. But care should be taken in case of associated diabetic complications. Strenuous strength training should be carried out after proper check-up and under supervision only.
- Once you decided to start an exercise programme, it take motivation to continue after the first enthusiasm wanes. Here are some tips for your exercise programme.
- Get a schedule that is designed for you.
- Get a training partner: On days when motivation levels are flagging we are easily tempted to skip our work out. If you have a partner together you can keep you on track.
- Set short term goals and go for it.
- Let family or friends know of your plans. They can encourage you to continue, perhaps exercise with you.
- The intensity and duration of the exercise must be realistic and you shouldn’t overdo it a bad; experience can turn you off the exercise altogether.
- Cross train to avoid boredom. Try to incorporate various activities in your exercise session on the days programme. It not only gives you variety but also decreases the risk of straining the same muscle due to over use.
- Find a pleasant setting for exercise so that bad weather equipment failure, etc. Will not give you an excuse to skip exercise.
- The journey of thousand miles begins with a single step. Exercise work the same way. Taking that first step and letting it keep going is great. Remember still it is not too late….