Voice of the Diabetic

Voice of the Diabetic

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WHY I EXERCISE (AND WHY YOU SHOULD TOO)

by Sheri Colberg, PhD

Photo: portrait. Caption: Sheri Colberg.

Treatment of diabetes has gone through dramatic changes in the

past two decades. Previously, exercise was often overlooked as a “cornerstone”

in its treatment as it was difficult to maintain blood sugar levels with the

additional variability introduced by physical activity, especially for individuals

with type 1 diabetes. However, with blood glucose meters now being readily available

and affordable, exercise can be done safely and without fear of severely upsetting

an often delicate glucose balance.

Diagnosed with diabetes myself at the age of four in what I

call the “Dark Ages” of diabetes (1968), I went through childhood,

adolescence, and early adulthood without the benefit of a blood glucose meter.

I still participated in a variety of sports and physical activities “pre-meter,”

including swimming, running, racquetball, soccer, tennis, weight training, gymnastics,

volleyball, cycling, aerobics, dancing, stair master, hiking and backpacking,

canoeing, football equipment managing, snow shoeing, cross country and downhill

skiing, horseback riding, sailing, snorkeling, and sky diving. I did many of

these activities, however, feeling less than my physical best. Since I could

not test my blood sugars, tightly managing them to prevent highs and lows was

virtually impossible. Growing up I always experienced that exercise of any kind

made me feel better overall, although at the time I did not understand human

physiology well enough to know why. I felt I had more control over my diabetes

when I exercised as well. Consequently, I began exercising regularly on my own

and through participation in sports as a young teen-ager and have continued

this participation (albeit recreational only at this point) throughout my adulthood.

Not until I had my first blood glucose meter in 1986 did I realize how much

better I felt during exercise when my blood sugars were in a more normal range.

Keeping them normal (with the help of a blood glucose meter) has totally been

a trial-and-error learning process! At the time I got my meter, there were very

few guidelines or books that could offer me any guidance on exercise control.

I did eventually learn to control my blood sugars for various activities; but

every time I tried a new or unusual one, it was like starting over again. Over

time, I met a lot of other active individuals who happened to have diabetes.

I discovered I could learn so much from others' experiences that could hopefully

make my trial-and-error process shorter and easier. With this experience in

mind, I eventually got the idea and motivation for my book, THE DIABETIC ATHLETE

(Human Kinetics, 2001), which covers the basics about exercise, understanding

your body's responses, the effects of insulin and other diabetic medications

on exercise, eating for exercise, exercise guidelines for type 1 and type 2

diabetes, and diabetic regimen changes for over 85 sports and physical activities,

including real-life athlete examples of changes they make.

I have always found that knowledge is power when it comes to

managing diabetes. I searched out information for years, which finally resulted

in me earning a doctoral degree in Exercise Physiology from the University of

California, Berkeley! While you do not need a PhD to understand how your body

adapts to exercise, you do need to understand the basics in order to make knowledgeable

and safe changes in your diet or medications to get the most out of your workouts.

It is my belief this combination of basic (the why of exercise) and experiential

(the how of exercise) information can benefit all of us in maintaining blood

sugars during any physical endeavor! For example, when you learn to determine

what energy systems and fuels your body is using during the exercise, then you

can closely predict what your blood sugar response is likely to be and what

action you need to take to maintain normal sugars during and following the activity.

It is important to understand the types of medications and regimens

you use to either replace insulin or improve its production and action. Your

body's level of circulating insulin in your blood will be greatly affected by

differing insulin regimens, timing of exercise, and sensitivity to insulin.

For example, exercise in the morning usually results in a much smaller decrease

in blood sugars compared with later in the day, as your body is more resistant

to insulin after fasting overnight. Also, given the variety of insulin regimens

and oral diabetic medicines that people use now, strategies that work well for

one individual may not work well for another. I, myself, prefer my latest insulin

regimen, the insulin infusion pump. Using my insulin pump (the ANIMAS R-1000),

I can easily decrease the amount of insulin circulating in my blood by altering

the basal rate of insulin delivery, and I can easily compensate for changes

in my body's sensitivity to insulin after exercise by choosing a basal rate

profile programmed with lower rates.

“Fitness” can be defined many different ways. Probably most important

to overall health is aerobic fitness, or physical conditioning resulting from

prolonged aerobic activities such as brisk walking, jogging, cycling, swimming,

rowing, and aerobic dance. An aerobic exercise program incorporates all the

following components in determining the level of fitness you achieve: the type

of exercise you choose to do (mode), how often (frequency), how long (duration),

and how hard (intensity) you exercise, and your rate of progression. The current

recommendations include doing aerobic exercise a minimum of three to five days

a week, for 20-60 minutes (continuously, or for a minimum of 10 minute sessions

throughout the day), at a moderate intensity (one that feels at least "somewhat

hard"), and progressing as able. Try to incorporate some resistance or

weight training into your regimen two to three days as well to help maintain

your muscle mass and insulin sensitivity. An exercise prescription should be

developed with careful consideration of your health status (diabetes control,

complications, and other health problems), risk factors for cardiovascular disease,

personal goals, and exercise preferences. Also keep in mind that while the intensity

of an activity determines most of the overload on your muscles and your subsequent

fitness gains, it additionally influences your blood sugar responses if you

have diabetes.

If you are already an avid exerciser, then you are aware of

most of the benefits of exercise on your physical health and your diabetes control.

If you are still in the thinking stage about incorporating regular fitness activities

or sports into your lifestyle, then you have a lot of positive changes to anticipate.

In addition to the little treats you may be able to allow yourself occasionally

after working out, exercise can help you build muscle and lose body fat, suppress

your appetite, eat more overall without gaining fat weight, enhance your mood,

reduce stress and anxiety levels, increase your overall energy level, improve

your immunity, keep your joints and muscles more flexible, and generally improve

the quality of your life! Individuals who engage in regular moderate exercise

are at lower risk for many chronic health problems as well, including heart

disease, obesity, hypertension, type 2 diabetes, certain cancers, and other

metabolic disorders.

The usual health benefits of exercise apply to individuals with

diabetes as well, perhaps even more than normal. Much of what we attribute to

the aging process really results from disuse (for example, muscle atrophy, or

loss of flexibility in joints). Diabetes, especially when blood sugars are poorly

controlled, accelerates the normal aging process, as well as certain disease

processes such as heart disease. Thus, regular exercise can help slow aging

and reduce long-term complications associated with poor blood sugar control

and diabetes. These diabetes-related benefits can not be understated! Not only

can you enjoy your favorite physical activity, but also you can help your diabetes

and health too. In fact, regular exercise is the most important activity you

can do to slow the aging process, manage your blood sugars, and reduce your

risk of diabetic complications.

Diabetic complications are, unfortunately, a reality for many individuals with

diabetes; exercise can usually still be done, but certain precautions may be

needed to make your exercise more safe. If you have any complications such as

eye or heart disease, make sure you follow the exercise guidelines related to

your condition to prevent it from worsening with exercise. It is also important

that you recognize all the potential symptoms of low blood sugar (hypoglycemia),

especially if you have not experienced it often, as its symptoms may differ

during exercise and after you become conditioned. Likewise, remember that proper

warm-ups, cool-downs, and stretching are especially important for diabetic exercisers

for prevention of injuries.

Most of all, lose the excuses! Whether you are interested in

just recreating or want to be a serious competitive athlete, it is time to get

out there and start exercising! Your body will thank you.

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