Exercise for Diabetics

Action plan to manage diabetes

Type 2 diabetes is on the rise in London, costs the NHS billions a year, and is far more common than type 1. If you have diabetes, you'll know that it's even more important that you take regular exercise and eat as healthily as possible. If you have type 2 diabetes, you can manage your condition with exercise and diet, and if you reach a healthy weight, you may even be able to come off your diabetes medication. There are certain foods you should avoid altogether, such as fruit juice, excessive amounts of fruit (more than 2 portions a day), junk food high in refined carbohydrates, sugary drinks, indeed anything that causes a rapid rise in blood sugar.

One of my personal training clients in London with type 2 diabetes eventually managed to reduce his medication after making regular exercise and good nutrition the key to managing his condition. You can do this too. The two things to focus on are cutting out all junk food (particularly refined sugar), and increasing your exercise levels. More on this below.

What is diabetes?

Diabetes is a chronic disorder of the metabolism, which impairs your body's ability to control your blood sugar levels. The result is high blood sugar, because the body either cannot produce insulin (type 1 diabetes) or the cells of the body are resistant to the insulin that is produced (type 2 diabetes). Insulin is a hormone produced by your pancreas (a 6 inch long gland behind your stomach), which enables blood-sugar (ie - glucose) to enter the cells of your body for energy. A sign of diabetes is when someone has to urinate a lot (the word diabetes derives from the greek word meaning 'sweet urine'), which is the body's way of trying to get rid of excess glucose.

When you eat carbs (such as bread, rice, pasta, fruit, honey, porridge oats), they're digested and absorbed into your bloodstream in the form of glucose. To fuel your muscles, the glucose has to get from your bloodstream and into the cells of your body. This is the role of insulin.

If managed properly, type 2 diabetes is much less severe (but much more common) than type 1 diabetes. If you have type 1 diabetes you are dependent on insulin injections for life. With type 2 diabetes, also known as adult-onset diabetes, or insulin-resistant diabetes (because the cells of your body resist the effect of the insulin), your condition can usually be managed with medication in the form of pills, rather than insulin injections. Some people with type 2 diabetes are able to come off medication altogether if they lose enough weight, and continue to take regular exercise and eat healthily.

Think of insulin as a key that unlocks the cells of your body to allow glucose to enter and fuel the cells for energy. With type 1 diabetes there is no key, and with type 2 diabetes the key is not as effective as it should be (either because the key is faulty, or the lock is faulty).

The most common medication for type 2 diabetes is metformin. There are additional medications that are sometimes prescribed, but they can sometimes cause excessive fatigue, and you should liaise closely with your GP if you feel that your medication is sapping your energy levels to the extent that you find it hard to exercise.

But type 2 diabetes isn't just a problem with insulin. It's also a problem with another vital hormone called glucagon, which enables the liver to release glucose back into the bloodstream from a stored form of glucose called glycogen, when blood-sugar levels fall too low.

Whenever you eat more carbohydrates than your body needs at the time (a common occurance for most people!), it all gets converted into glucose and absorbed into the bloodstream. The excess glucose is stored in the liver and the muscles in the form of glycogen. Between meals, when your blood-sugar levels fall, the hormone glucagon (produced by the pancreas) tells the liver to convert some glycogen back into glucose and release it back into the bloodstream to raise blood-sugar levels again.

If you have type 2 diabetes, this glucagon response is impaired, which can lead to hypoglycaemia (low blood sugar), but more of that later.

What are the Signs and Symptoms of Diabetes?

The main symptoms are thirst and regular urination. This is because the body is trying to get rid of excess glucose in the blood. As blood-sugar increases beyond normal levels, the kidneys try to flush it out, hence the increase in urination, thirst, and dehydration. Another common symptom, which makes exercise a real challenge, is fatigue. Other symptoms include blurred vision, numbness/tingling in the legs and feet, and the slow healing of wounds.

The problem is that in the early stages of diabetes, the symptoms are slow to develop, and can easily go unnoticed.

Why is Diabetes a Problem?

Persistent high blood-sugar causes
undue wear & tear on many structures of your body

Apart from the fatigue, which is a problem in itself, because it reduces your quality of life and saps your energy levels (and you need energy to exercise), there are more severe implications of untreated or poorly managed diabetes.

Heart disease is far more common if you have diabetes. Excessive blood sugar levels increase the clogging/narrowing of the arteries from fatty deposits forming on the inside of the walls of your arteries, and also increase the hardening of the arteries. This includes the coronary artery, which supplies blood to the heart itself.

Poor circulation is an associated risk. The hardening and narrowing of blood vessels in the limbs (known as peripheral vascular disease) can result in less oxygen and nutrients reaching the cells of the arms/legs/hands/feet. This can result in slower healing of wounds and sores. The feet are at most risk, being the furthest from the heart.

Kidney damage is a real danger too. Diabetes is the second most common cause of kidney problems, including the need for kidney dialysis, and in extreme cases kidney transplant.

Eye problems are another potential consequence of diabetes, because high glucose levels block the small blood vessels in your retina, and other vessels in the eye swell and leak blood.

Nerve damage in your limbs is another danger. The resulting loss of sensation in the arms/hands and legs/feet mean that injury/sores can go unnoticed, and this can lead to infection, or in extreme cases gangrene and possible amputation of limbs (usually the feet). That is why diabetics must be meticulous with their foot care in particular, and inspect their feet regularly. To ensure good circulation to your legs and feet, avoid sitting with your legs crossed.

If you have diabetes and you fail to regulate your blood sugar all the time, you are at risk of hyperglycaemia (too much blood sugar, from eating too much high-glacemic carbs, or not taking your medication), or hypoglycaemia (too little blood sugar, more common in type 1 diabetics, caused usually by missing a meal, or too much exercise in one session, or injecting too much insulin if you're type 1).

Symptoms of hyperglycaemia include frequent urination, thirst, hunger, blurred vision. The immediate action required is to stop any activity, stop eating if you're in the middle of a meal,  and take your medication.

Symptoms of hypoglycaemia include shakiness, sweating, heart palpitatons, poor concentration, dizziness, headaches, mood changes, slurred speech, tingling in the face/tongue/lips, poor reactions, and in extreme cases coma and even death. As soon as you feel even mildly hypo, stop any activity you're doing, sit down, and eat something sugary (or drink some fruit juice) to get your blood sugar back up to normal levels. The main problem with hypoglycaemia is insufficient glucose to the brain, but an episode can be corrected almost immediately by drinking some fruit juice.

Even if you're not diabetic, low blood-sugar will make you feel light-headed, brought on if you've not eaten anything all day, and suddenly engage in vigorous physical exercise. But your glucagon response will release glucose stored in the liver, for some instant energy. To avoid this light-headedness in the first place,you should not exercise first thing in the morning on an empty stomach, as it's preferable to have some glucose in your body from a recent meal/snack to fuel your workout.

I have some personal training clients who work for American companies with branches in London, and they train first thing in the morning, because they're often still in the office at 9pm at night because of the time difference, which makes evening exercise impractical. So if you have to exercise really early in the morning, a banana eaten 15 minutes before you exercise should just about fuel your workout, but make sure you eat something more substantial straight after your session.

If it's not managed properly, type 2 diabetes can develop into type 1 diabetes. The insulin secreting cells become exhausted, and insulin production stops altogether. Then you're dependent on insulin injections for life. So it's important to manage your type 2 diabetes effectively, to prevent it developing into type 1.

Excess body-fat combined with inactivity and poor diet,
puts you at much higher risk of developing type 2 diabetes

Exercise for Diabetics

Exercise is vital if you have type 2 diabetes, as it's the primary method of glucose control. (For type 1 diabetics, exercise is vital to reduce risk of long term complications, but glucose control for type 1 is achieved by insulin injections). Exercise decreases insulin resistance in type 2 diabetics, and boosts glucose uptake by the cells of your body. The muscular contractions produced by exercise have an 'insulin-like effect'. Because the insulin you produce is more effective as a result of exercise, this puts less strain on the pancreas, as it doesn't have to struggle to produce as much insulin.

If you are overweight and have type 2 diabetes, weight loss should be your top priority. In some cases, reaching a healthy weight will enable you to come off diabetes medicaton altogether.

Not only will exercise help you control your blood sugar levels, it will also improve your circulation, help you achieve a healthy weight, improve your energy levels and quality of life, and prevent the onset of the long term health complications (heart/kidneys/eyes etc)  listed above. Here are some tips on exercising with diabetes:

1. Consistency: exercise at the same time of day, to build consistency into your routine, so you can plan your meals and medication around your exercise. Make sure you've had a meal including some carbohydrates around 1.5 - 2 hours before your exercise session. If you exercise in the morning, a small breakfast finished one hour before the session should give you enough digestion time.

2. Variety: do a range of exercise, both cardiovascular and muscle-building, but never to the point of exhaustion.

3. Time/Frequency/Intensity: exercise sessions of 20 -40 minutes, three times a week, at 60 - 70% maximum heart rate, are the ideal length and frequency and intensity. Do not miss exercise sessions, as consistent and frequent exercise is vital to maintain the 'insulin-like effect' of exercise.

4. Other Daily Activity: don't just rely on these three exercise sessions a week. Build into every day much more low-intensity activity, such as walking, climbing stairs, gentle gardening.

5. Precaution: have a glucose drink handy in the unlikely event of a hypoglycaemic episode. Wear a medical ID bracelet so that paramedics know you're a diabetic, if they find you unconscious. Don't go too long without eating. And check feet for sores on a regular basis. If you feel dizzy or light-headed, stop exercising until you feel ok again.

6. Water: stay hydrated during exercise by sipping water regularly.

Personal training for diabetics

The key advantage of hiring a personal trainer if you are a diabetic, is to help you stick to a regular exercise programme. Your personal trainer can monitor the length and intensity of your exercise sessions, and advise you on optimum nutrition to manage your condition and improve your health.