Safe Exercise with Diabetes
You should consult with your doctor or healthcare team before starting a new exercise or fitness routine that is more intense than brisk walking. It never hurts to have a checkup to make sure that you don't have any health complications that may affect your ability to exercise safely. Certain types of sports and activities may not be compatible with your health profile. For example, people with retinopathy (a form of diabetic eye disease) should avoid heavy weight lifting and those with peripheral neuropathy should not place undue strain on their feet if they have unhealed ulcers. In addition, conditions such as cardiovascular disease, autonomic neuropathy, or nephropathy (kidney disease) may influence the intensity at which a person can safely work out. Your healthcare provider may recommend diagnostic tests such as a cardiovascular stress test or an electrocardiogram (ECG) to evaluate your heart function or reflex and monofilament tests to assess peripheral neuropathy.
To be on the safe side, you'll need the appropriate gear and guidance to ensure an effective exercise session. Rules to follow:
- Check your blood sugar levels. Self-test blood glucose levels before and after a workout. The ADA recommends avoiding exercise if fasting glucose levels are >250 mg/dl (13.89 mmol/l) and moderate or severe ketosis is present, and using caution if glucose levels are >300 mg/dl (16.67 mmol/l) and no ketosis is present. Most people with type 2 diabetes are unlikely to develop ketones if they are sill making some of their own insulin. If blood sugar levels are below 100 mg/dl (5.56 mmol/l) before exercise in anyone who uses insulin, it may be best to have a small snack that contains 15 grams of carbohydrate and retest in 15 minutes before starting out.
- Keep a log. Tracking your blood sugar response to different activities and environments (e.g., a hot walking track versus a cold ice skating rink) and food intake is important for recognizing trends and making treatment adjustments.
- Carry sweets for safety. Keep a source of fast acting carbohydrates (e.g., glucose gel or tablets; Smarties; Sweet Tarts or hard candy; juice box) on your person for hypoglycemic emergencies.
- No insulin before exercise. Muscles in action take up blood glucose without the need for insulin due to an effect of contractions alone. If you use insulin injections or an insulin pump, you'll likely need to cut back on any short- or rapid-acting insulin given within 2-3 hours before activties, since insulin enhances the glucose lowering effect of exercise even further, posing a very real risk for hypoglycemia.
- Stay hydrated. Staying well-hydrated before, during, and after exercise is important for preventing erratic blood sugars and heat stroke.
- Identify yourself. Always wear a medical identification tag or bracelet in a prominent place on your body when you work out, so if you lose consciousness others will know how to help you. Keep a cell phone handy so you can call for assistance if you need to.
- Warm up and cool down. The ADA recommends a warm-up of 5-10 min of aerobic activity (walking, cycling, etc.) at a low-intensity level and gentle stretching for an additional 5-10 minutes. The cool-down should also last 5-10 minutes until heart rate has returned to closer to pre-exercise levels.
- Dress appropriately. Well-fitting shoes and socks and breathable and weather-appropriate clothing are essential for preventing foot problems and heat stroke.
- Check your feet. After workouts, check your feet for any problem areas (such as blisters), and treat problems early before they have a chance to get worse. If you have trouble checking the bottoms of your feet, either use a mirror to see them better or have someone else look for you. Prevention is the key to staying on top of your foot health.
Reviewed by Sheri Colberg-Ochs, PhD, FACSM 05/13
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