II. Efficacy: Benefits of Exercise in Diabetes Mellitus
-
Exercise lowers Serum Glucose
- Benefits Type I Diabetes Mellitus
- Benefits Type II Diabetes most significantly
-
Exercise augments Insulin effect
- Facilitates Glucose transport across cell
-
Exercise reduces heart disease and stroke risk
- Increases HDL
- Lowers LDL
- Lowers Total Cholesterol
- Decreases SBP and DBP
-
Exercise improves general wellness
- Increases self esteem
- Improves socialization
III. Adverse Effects: Risks of Exercise in Diabetes Mellitus
-
Hypoglycemia
- Use caution in Scuba Diving
- Use caution in rock-climbing
- Use caution in long-distance swimming
-
Retinopathy
- Avoid weight lifting
- Avoid mountain climbing
-
Neuropathy
- Avoid weight bearing Exercises
- Choose stationary bike or water sports
-
Autonomic Dysfunction
- Abnormal hemodynamic response to Exercise
- Inappropriate Heart Rate response
- Inappropriate Blood Pressure response
- May not experience Anginal symptoms with Exercise
- May not experience hypoglycemic symptoms
- Abnormal hemodynamic response to Exercise
-
Diabetic Nephropathy
- Avoid Resistance Training
- Cardiovascular disease
- Consider Stress Testing prior to Exercise program
IV. Approach: Starting Exercise
- Evaluate coronary, nephropathy, Neuropathy, Retinopathy
- Confirm no contraindications to starting Exercise
- Goal Energy Expenditure (See METS)
- No weight loss intended: 1000 KCal/week
- Weight loss intended: 2000 KCal/week
-
Progressive Resistance Training
- Low resistance (40-60% of 1 repetition maximum)
- Low intensity
- Gradually increase to 15-20 repetitions
V. Approach: General Exercise Tips in Diabetes Mellitus
- Preparation for regular Exercise
- Check feet for lesions related to Exercise
- Pre-Exercise evaluation (consider Stress Test)
- Medic-Alert tag
- Exercising diabetics must use Glucometer
- Pre-planned strategy for Hypoglycemia
- Evaluate Exercise Energy Expenditure (METS)
- Time Exercise appropriately
- Avoid late-evening Exercise in Type I Diabetes
- Aerobic Exercise recommended 6 to 7 days per week
- Duration: 20 to 60 minutes
- Level: 60-80% of maximum Heart Rate
- Allow time for warm up and cool down
- Reduces injury risk
- Reduces post-exercise Arrhythmia risk
- Perform light activity throughout the day
- Rise from sitting every 30 minutes
VI. Management: Blood Sugar in the peri-Exercise period
- Check pre-exercise Blood Sugar
- Blood Sugar <100 mg/dl
- Snack 15-20 grams carbohydrate before Exercise
- Blood Sugar 100 to 250 mg/dl
- No snack needed
- Blood Sugar >250 with Ketones (or >300 without)
- Delay Exercise
- Check Serum Ketones
- Treat Hyperglycemia and Dehydration
- Blood Sugar <100 mg/dl
- Pre-ExerciseInsulin
- Decrease risk of Hypoglycemia
- Avoid Exercise during times of peak Insulin activity
- Consider Humalog Insulin
- Insulin injection site may affect absorption rate
- Avoid Sulfonylurea
- Be aware of your own Blood Sugar response to Exercise
- Carry an activity pack while exercising
- Personal identification
- Mobile phone
- Adequate water and carbohydrate source
- Blood Glucose monitor
VII. Complications: Post-exercise Hypoglycemia
- Delayed Hypoglycemia
- Occurs 6 to 28 hours after strenuous Exercise
- Occurs despite normal Blood Sugars during Exercise
- Occurs regardless of age or illness severity
- Often occurs at night
- Mechanism
VIII. Resources
- Diabetes, Exercise and Sports Association
- Mountains for Active Diabetics (extreme sports)
IX. References
- Whaley (2006) ACSM's Guidelines for Exercise
- White (1997) Lecture: AAFP Sports Medicine, Dallas
- Baraz (1994) Clin Diab 12(4):94-8 [PubMed]
- Fahey (1996) Am Fam Physician 53:1611-7 [PubMed]
- Landry (1992) Clin Sports Med 11:403-18 [PubMed]