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April 28, 2013

Introducing… Exercise for Diabetes

by alive

Diabetes is very common in Singapore and affects people of all ages and walks of life. It is characterised by high levels of blood sugar (hyperclycaemia), due to insufficient insulin production or the inability of the body to respond to insulin. Complications of diabetes include kidney failure, nerve damage and dysfunction, heart disease, and lower limb amputations. Diabetes is also a leading cause of blindness.


Taking bgIf you have diabetes, you’re probably already familiar with some of its effects. Diabetes is a part of life now, but don’t let that be a limiting factor to living your Life fully! It will take time but you will be able to manage it by making healthy lifestyle changes. Diet and medication come to mind, but exercise is also an indispensable management tool with multiple benefits. If you’re not already exercising, here’s why you should.



Why Exercise


There is a movement that originated in the States called Exercise is Medicine. The thrust of this movement is that exercise, when used in conjunction with medication – or even alone sometimes – is so effective in controlling, limiting or even reversing many medical conditions that it’s almost a medicine in itself.

 Ex is Medicine


Type 2 Diabetes is a good example of such a condition. In concert with diet and medication, exercise plays a large role in controlling your blood sugar level, weight and many of the risk factors for heart disease, cancer and stroke, all of which are often clustered with diabetes.


What’s more, as a natural medicine, exercise appeals to people who don’t like the thought of relying on taking artificial substances into their bodies. For many people, regular exercise helps them decrease the need for medication, and if you have a few conditions, all requiring medication, this does make a difference to your convenience, cost, and sense of well-being.



Benefits of Exercise


Briefly, here’s how exercise can help you manage Type 2 Diabetes:

  • Improve insulin use: Especially important if your pancreas is still putting out insulin
  • Controls blood sugar during exercise and for some time after by shunting sugar from the blood into your cells, independent of insulin. This means that even if your body is not producing natural insulin, or if you have not taken insulin or blood sugar lowering medications, you will still lower your blood sugar during this time.
  • Weight loss: Lower levels of body fat can lead to improved sensitivity to insulin
  • Reduces risk of heart disease and stroke, both of which risk are increased in diabetes


 exercise and bg


Exercise also give you general health benefits like:

  • Improving muscle strength so your daily tasks get easier and lighter to perform
  • Improving bone strength
  • Improving balance and decrease risk of falls
  • Lowering blood pressure
  • Cardioprotective functions, including lower the bad (LDL) cholesterol and at higher exercise intensities, possibly increasing the good (HDL) cholesterol levels
  • General increased stamina, energy and alertness, which improve your ability to work, contribute, learn, and improve your Life!



The Opposite Side of the Coin


With great power comes great responsibility. This applies everywhere, including wielding the power of exercise to control blood sugar.


Exercise can lower blood sugar but that doesn’t mean you should try for a double whammy and combine the two in an effort to lower your blood sugar by mega amounts. That’s because there’s an opposite side of the coin to hyperglycaemia: hypoglycaemia – blood sugar dropping too low.


The reason this is bad? Your brain needs sugar for fuel, and it gets it through nourishment by the blood. If blood sugar falls too low, there’s nothing much the brain can extract and use, and it starts to ‘malfunction’.


What are the symptoms of this ‘malfunction’?  Firstly, there will be symptoms associated with your nervous system (sympathetic) reacting to the hypoglycaemia. This usually takes place when your blood sugar drops below 3.5mmol/L.


Hypo Symptoms 1

–        Weakness

–        Trembling

–        Sweating

–        Nervousness

–        Palpitations

–        Intense feeling of hunger

–        Difficulty speaking


Next as your blood sugar continues falling to 2.8-3 mmol/L and below, you get symptoms (neuroglycopenic) relating to starvation of the brain. At this point symptoms will include

–        Being incoherent/ talking nonsense

–        Confusion

–        Drowsiness

–        Coma


Obviously, none of these sound great. So what can you do about it?


A Few Ounces of Prevention


With Guidance

If you haven’t been exercising, the most ideal introduction would be to enquire at your hospital about their diabetes exercise programs.  Depending on the institution, you may have a choice of introductory classes, ongoing classes, or even individual exercise consults and training.


diabetes consultStage 1: Screening and assessment for any contraindications to exercise. This is especially important if you have concurrent health problems, such as high blood pressure, heart problems, and musculoskeletal injuries.



take blood sugarStage 2: Start exercise with blood sugar monitoring. We want to establish a baseline picture of how your blood sugar reacts to a large number of variables, such as exercise type, intensity and duration.  




exercise shoesStage 3: Once you understand how your body sugar level responds to different exercise situations, and your exercise professionals deem you safe to exercise independently, you should be able to continue on your own! At this stage, you simply need a periodic consult with your clinical exercise professional to check on your progress and ask questions that might arise as you exercise.




If you have already started exercising without assistance and you don’t intend to do so, you should at least be aware of some guidelines for diabetic exercisers.

1. Always stay alert to symptoms of hypoglycaemia as explained above

 Hypo Symptoms


2. Check with your doctor when you should exercise. This cannot be too close to taking blood sugar lowering medication or insulin, as the combination with exercise is likely to lower your blood sugar levels quite a bit, increasing your risk of a hypoglycaemic episode.


3. Drink water throughout the day and also during exercise. Being dehydrated concentrates your blood sugar and they will rise (per unit volume of blood)

drink water


4. Invest in a glucometer. Take your blood glucose reading before and after exercise, especially if you’ve decided to increase your exercise duration or intensity for the first time. 

–        Before exercise: < 5.5mmol/l, take a carbohydrate snack

–        After exercise: < 4mmol/l, take a carbohydrate snack


5. Always have quick-acting carbohydrate with you in case you need it. In the clinic we often have a Yeo’s packet drink and follow the 15-15 Rule: if blood sugar drops too low, 15g of quick-acting glucose, followed by another blood sugar reading 15min later to see if blood sugar has risen to safer levels.

yeos chrysanthemum tea

6. Wear a medical ID tag. Touch wood, but in case you’re exercising alone and something unfortunate happens, an ID tag stating your condition can save the medical team valuable time and help them with the right treatment. A contact number of someone close should be included as well.

diabetes tag

7. Check your feet daily, and also before and after exercise. Look out for cuts, blisters, redness or other abnormal signs. Consult your doctor or podiatrist if you find any.


8. If you have been diagnosed with diabetic retinopathy, you must consult your doctor before starting to exercise, increasing your exercise intensity, or adopting positions that can put too much pressure on the retinal vessels (your doctor or optometrist should advise you more specifically)


So there you have it. A basic guide to exercising with diabetes. Remember, things don’t end because you have diabetes. In fact if you make conscious lifestyle improvements because you have diabetes, you might find that the net benefit far outweigh any cost. It could, in fact, be the beginning


Good luck on your journey!

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