by Claudia Graham, PhD, MPH, CDE


Claudia Graham, PhD, MPH, CDE, is Director of Managed Care at Vivra Health Advantage. An exercise physiologist for 14 years, Dr. Graham is also a Board Member-At-Large of the American Diabetes Association, California Affiliate, and co-author of the "The Diabetes and Sports Exercise Book". Q. How important is exercise for people with diabetes?

A. It's absolutely critical. Basically, it's a natural way to control blood glucose. By maintaining an optimal weight, the body becomes more sensitive to the insulin it produces. Therefore, people with type I diabetes may not need to take as much external insulin to lower their blood sugar. Also, exercise helps reduce cardiac disease risk factors, which are very high in the type II population, as well as control high blood pressure and make the bones and muscles function stronger. Similarly, in the type I population, exercise helps maintain ideal body weight and reduces cardiac disease risk factors.

Q. What about research which states that exercise can reverse certain types of complications?

A. Exercise can prevent or delay the onset of some complications, alleviate uncomfortable symptoms, and help you cope with life when you have complications. For example, many type Is have neuropathy. Exercise won't reverse the nerve damage, but by strengthening the muscles where the neuropathy is, it allows you to function more independently.

Exercise can reverse peripheral vascular disease, in which constricted blood vessels do not supply enough blood to the legs, resulting in painful charley horses. A prescribed interval walking program, if done consistently, will force the growth of new vessels--and new blood supply--to the leg.

Q. What types of problems should people with diabetes be aware of when exercising?

A. First off, the benefits far outweigh the problems, so don't be afraid to exercise. That said, there are a number of general safety precautions you should be aware of. For people taking insulin, the biggest concern is hypoglycemia. It's not always easy to get the blood sugar balance right, between what to eat, how much insulin to take, and how much to exercise. Don't exercise if your glucose is low; and if you're exercising for more than an hour, you should probably eat some carbohydrates or discuss decreasing your insulin dosage with your physician. Self-monitoring of blood glucose is the key to understanding the effect of exercise on your blood glucose, as well as to ensuring your safety.

In type IIs, exercise can exacerbate an existing, underlying cardiac condition. People who are over 35, are inactive, or have had diabetes longer than 20 years should get a stress test and a risk profile.

Q. The right amount of exercise differs from person to person. How can you tell if you're working hard enough?

A. Focus on duration, not intensity. Technically, you want your heart rate elevated to between 60% and 80% of your maximum age-adjusted heart rate, depending on your doctor's directions. But I also follow a rule of thumb that I call "conversational intensity:" exercise at an intensity that you can carry on a conversation. If you're exercising with a friend and trying to carry on a conversation, but you're huffing and puffing, slow down a little bit! You're working too hard. On the other hand, if you're able to sing, you need to step up the pace!

The "hidden benefit" of exercise is that it can lower your blood glucose for 12-24 hours after exercising. Just remember to monitor, because reactions can also come late. But if you incorporate exercise into your regular routine, eventually your glucose will remain lower, and perhaps you can cut back on your medication--that's what we want to shoot for.

Q. Any final words of wisdom?

A. You don't have to run the Boston Marathon! A little bit is better than nothing at all. The benefits may take a little while to come, so don't expect a miracle overnight. The most important thing is to just do it. Know your risk factors, but get out there and have fun!