Q: I am 42 years old and a diabetic for the last four years. My doctor advised me to do some exercise every day along with taking my regular medicines. Can it harm my body?
Physical activity and exercise are recommended and prescribed to all individuals with diabetes as part of management of glycemia (blood sugar) and overall health. Physical activity is a general term that includes all movement that increases energy use and is an important part of the diabetes management plan. Exercise is a more specific form of physical activity that is structured and designed to improve physical fitness. Both physical activity and exercise are important. Specific recommendations and precautions will vary by the type of diabetes, age, activity done, and presence of diabetes-related health complications.
Recommendations are tailored to meet the specific needs of each individual. Physical activity benefits you not only medically but psychologically as well. It has been shown to help reduce stress, improve sleep and even improve your moods.
Regular exercise improves blood glucose balance, increases insulin sensitivity, improves glucose tolerance, improving HbA1c levels, aids weight reduction, reduces the risk of coronary heart disease and stroke.
Diabetics should engage in 150 minutes or more of moderate to vigorous – intensity aerobic activity (also known as cardio) per week with no more than two consecutive days without activity. Common examples of aerobic exercise are brisk walking, jogging, running, swimming and bicycling.
Diabetics should also engage in 2-3 sessions/week of resistance exercise on non-consecutive days. Resistance exercise is also called anaerobic exercise or strength training. This is short lasting high-intensity activity. Examples of strength training include weight lifting, push-ups, jumping rope. It benefits you because it builds more muscles, which means you will burn more calories while at rest. Scientific research has shown that increasing your muscle mass can reduce insulin resistance.
Stretching in another important part of the exercise programme but remember that one should stretch slowly and smoothly.
All adults, and particularly those with type 2 diabetes should decrease the amount of time spent in being sedentary by briefly standing, walking or performing other light physical activities.
Although, for the most part, the exercise benefits outweigh the risks, the risks can be dangerous.
In individuals taking insulin and/or insulin secretagogues, physical activity may cause hypoglycaemia (low sugar) if the medication dose or carbohydrate consumption is not altered. Individuals on these therapies may need to ingest some added carbohydrate if pre-exercise glucose levels are below 90 mg/dL (5.0 mmol/L). In some patients hypoglycaemia after exercise may occur and last for several hours due to increased insulin sensitivity.
Because of the variation in glycemic response to exercise bouts, patients need to be educated to check blood glucose levels before and after periods of exercise and about the potential prolonged effects.
If proliferative diabetic retinopathy or severe nonproliferative retinopathy (retinopathy is retinal changes occurring in diabetes mellitus) is present, then vigorous-intensity aerobic or resistance exercise may be contraindicated. Consultation with an ophthalmologist prior to engaging in an intense exercise regimen may be appropriate.
Decreased pain sensation and a higher pain threshold in the extremities can result in an increased risk of skin breakdown, infection and Charcot joint (neuropathic joint) destruction with some forms of exercise. Therefore, a thorough assessment should be done to ensure that neuropathy does not alter kinaesthetic or proprioceptive sensation during physical activity, particularly in those with more severe neuropathy.
Studies have shown that moderate-intensity walking may not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear. Anyone with a foot injury or open sore should be restricted to non-weight-bearing activities.
Physical activity can acutely increase urinary albumin excretion. However, there is no evidence that vigorous intensity exercise accelerates the rate of progression of diabetic kidney disease, and there appears to be no need for specific exercise restrictions for people with diabetic kidney disease in general.
However, please consult a diabetologist before beginning any exercise regimen.
Dr Asok Cheriyan is a specialist diabetologist and general practitioner at Al Waha Clinic, Dubai. Got a problem? Our fantastic panel of renowned experts is available to answer all your questions related to fashion, well-being, nutrition, finance and hypnotherapy. Email your queries to firstname.lastname@example.org.