by Ann S. Williams, MSN, RN, CDE
This column focuses on providing information to help people make their diabetes care fit their needs and their lives.
The last article in this series discussed three major ideas you need to think about before you actually begin to exercise. To review:
1. Exercise is any form of physical activity, or moving your body;
2. There are many good reasons to include physical activity as part of your diabetes treatment plan;
3. It is important to think through types of exercise you can do, what sort of exercise you would like to do, and when you can work exercise into your schedule, before you begin.
This article will cover the things you need to think about during the first few weeks of exercise.
Once you have already decided on a type of exercise and a time to exercise, you will probably also have decided on a day to begin. If not, you need to set that date. Don’t procrastinate – support your good intentions. Try telling people close to you about your exercise plans – ask them for encouragement! You might ask a family member or friend who also needs to move around more to join you. Try planning your physical activity for first thing in the morning, before you have a chance to get involved in other things. Or, plan your movement for a natural break in your schedule, like right after lunch or supper. You could sign up for a class, like water aerobics or stretching exercises of some sort, and have the support of an instructor and a group. Try using a treadmill or other exercise equipment while watching your favorite television show or listening to your radio program. Pretend your TV or radio receiver won’t work unless you are exercising, as if you had to generate the electricity. The possibilities are endless. Use your imagination – and make your good intentions a reality.
Before starting new physical activity, discuss your plans with your health care team. It’s a good idea to review the signs and symptoms of low blood sugar (hypoglycemia), and be prepared to treat it. Signs and symptoms can include: feeling shaky, sweaty, lightheaded, anxious, weak, hungry, tired, or having blurred or cloudy vision. You might feel any combination of these, or none of them. If you do notice signs or symptoms of low blood sugar, you should test your blood sugar level immediately (and regular testing before, during, and after exercise is a good idea, whether or not you feel any of the symptoms of a “low”). If your blood glucose is below 70, you should eat or drink something with 15 grams of carbohydrate – three or four glucose tablets, one half-cup of fruit juice or regular (sugared) soda pop, a cup of low-fat or skimmed milk, six or seven small hard candies, or a slice of bread. Then wait 15 minutes and check your blood sugar again. If it has not come up, take 15 more grams of carbohydrate. Watch out for over-treating – it’s easy to overdo it and end up with high blood sugar! Everyone with diabetes should carry something that can be used to treat hypoglycemia – especially if you are exercising.
On the first day of a new physical activity, make sure you dress comfortably and appropriately for that activity. If you will be moving around on your feet, pay special attention to appropriate shoes and socks. Wearing shoes that fit you properly and are appropriate for the activity is important for preventing foot injuries; and wearing absorbent socks is important for preventing athlete’s foot and blisters. In general, loose-fitting clothing made of absorbent fabric is good for most forms of exercise.
Right before you exercise, you should check your blood sugar, to make sure it’s not too low or too high to exercise safely. It’s best if your blood sugar is between 100 and 240 before beginning your activity. If you are using insulin, or oral diabetes medications, physical activity could burn enough blood sugar to drive it too low. Make sure your blood sugar is above 100 before you exercise. If you know your blood sugar drops quickly with activity, you may want to make sure it’s about 130 or 150. (Test frequently, and you’ll learn how you, as an individual, respond to exercise.) On the other hand, if your blood sugar is over 240, you might not have enough insulin in your system to allow sugar to move into your cells properly. If this is so, moving your body could cause your cells to burn fat so quickly you could end up with toxic by-products – high levels of ketones in your blood. It would be better to get your blood sugar in control before starting your increased activity. Discuss this with your health care team.
For the first day of starting new activity, and in general for the first week, it is important that you simply begin to exercise; how long, how hard, and how often you move around is less important. So, set a realistic goal; find one for yourself you are sure to reach. For example, if you think you could probably begin with a brisk 20-minute walk, you might plan for a moderate 10- or 15-minute walk, then once you are walking, if you want to go for the full 20 minutes, go right ahead. But, if you walk only 10 minutes, consider it a success! It would be best to exercise a little every day for the first week, to help start a habit; but if you manage to exercise at least three days out of seven, consider it a success!
After you are finished, you should check your blood sugar again. You might see it has dropped some. However, if your first time exercising was short and gentle, you probably won’t see much change, if any. Don’t get discouraged if this happens to you. After you have begun, you can increase the intensity and the length of time you spend exercising. Then, you will see more benefit to your blood sugar, blood pressure, cholesterol levels, and energy levels.
After the first week or two, you should begin to increase the intensity and length of time you exercise. It’s best to do this gradually. For example, if you have been using an exercise bike at moderate intensity for 15 minutes, you might want to increase the intensity just a little, and exercise for 17 or 18 minutes in the third week. By increasing gradually like this, you’ll eventually reach a level of activity that makes a real difference in your blood sugar. You should continue to check your blood sugar before and after exercise, partly to keep yourself safe, and partly to see the difference as you increase the level of exercise.
It’s good to set yourself long-term goals for increasing your exercise intensity, duration, and frequency. You’ll want to aim for a level of exercise that is hard enough to give you many benefits – but you don’t want to exercise so hard you exhaust yourself, hurt your heart, or end up with sore muscles. Discuss the level appropriate for YOU with your health care team, before you begin – and remember, we’re all different! Many experts recommend exercising until your heart is beating at 60%, or 85%, of your maximum heart rate after adjusting for your age, for about 30 to 40 minutes, at least five days a week. The formula to figure out your target heart rate is: 220, minus your age, times 0.6 or 0.7. To find out whether you are getting your heart to that rate, after you have exercised for about 10 minutes, you should take your pulse for 15 seconds and multiply by 4.
There are some easier ways to gauge whether your exercise level is in a good range. One is simply to exercise as hard as you comfortably can, for as long as you comfortably can. If you do this regularly, you’ll soon be able to exercise harder and longer. Another helpful “rule of thumb” is to exercise at a level that makes you breathe a little harder, but not too hard; you should be breathing hard enough that you can’t sing, but you can still talk. And, you should exercise long enough that you are pleasantly tired when you are done, but not totally exhausted. If you’re totally exhausted, or if your muscles get sore enough to hurt, you’ve done too much. Next time, cut back and increase your level of exercise more gradually.
If you take insulin, or any oral medication that increases your body’s own insulin, as you increase your activity, you’ll need to watch out for hypoglycemia. This can happen during or right after the activity, and can also happen several hours later. By watching your own blood sugar patterns as you increase your activity, you can usually figure out when your blood sugar is getting lower, and you can plan to prevent hypoglycemia. For example, if you notice that after 20 minutes of vigorous activity, your blood sugar usually drops low enough to be uncomfortable, you can plan to begin with a higher blood sugar level, or to always carry some glucose or juice when you exercise. If you find that your blood sugar is always lower for about 36-48 hours after you exercise, and you know you have lower blood sugar in the late morning, you can always carry some carbohydrates at that time. Or, if this is a consistent pattern, you can speak to your doctor about lowering your medication, or changing to a medication regimen that is less likely to produce low blood sugar. There are many medication choices available now. Exercise is so beneficial it makes more sense to change the medication to avoid low blood sugar than it does to decrease the exercise.
As you continue your increased activity, it can become a self-maintaining habit. Pay attention to your better blood sugar, blood pressure, and cholesterol readings, increased energy, and overall increased sense of well-being. Notice how much easier it becomes to move around at a level that would have caused you fatigue before you started.
I’d love to hear from any of my readers who have found these articles on exercise useful. If you began to exercise, or increased your physical activity after reading these articles, please write me a note in care of the Voice of the Diabetic office. Let me know what you did, and whether you encountered any problems along the way, and how you solved them. You can write me at: Ann S. Williams, RN, MSN, CDE, c/o Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; e-mail: [email protected]
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