Diabetes

Treatment Options: Physical Activity

•Helps to modulate risk:

◦Post-prandial blood glucose levels

◦Insulin resistance

◦Cardiovascular disease

◦Blood lipids

◦Obesity

◦Other complications

•Connective tissue damage (adhesive capsulitis)

•Joint flexibility, bone strength

•Stress reduction

Physical activity is an important part of therapy strategies for diabetes. Like diet, recommendations for physical activity should be tailored for individual needs and preferences.(15) Here are some of the benefits of exercise for a person with diabetes. It can help to slow carbohydrate absorption and increase glucose utilization, assisting the control of post-prandial blood glucose. Exercise can improve insulin sensitivity, allowing tissues to more efficiently use and store energy. This can reduce insulin resistance and reduce the risk for elevated blood glucose. Exercise can also help to reduce risk factors for cardiovascular disease, including improving lipid metabolism and weight reduction. Elevated blood lipids and obesity are also risk factors for other complications and can be modulated by routine physical activity. Exercise has been shown to lower “bad” cholesterol and increase “good” cholesterol. Risk for other complications, such as adhesive capsulitis, can also be reduced. Additional benefits include joint flexibility and bone strength and even stress reduction.

General Advice

◦ Prior to starting program:

• Stress test and risk factor review

◦ Test blood glucose before and after significant activity

◦ Emphasize warm-up and cool-down

◦ Wear appropriate socks and shoes

◦ Drink plenty of water

◦ Wear/carry an alert identification

This slide shows some important information to share with patients. Before starting any exercise program, an evaluation to determine the appropriateness of an activity level and type can be completed. This evaluation will include family history of heart disease and stroke, smoking history, elevated blood pressure and blood lipids, shortness of breath with exertion, and any other complications of diabetes that might impact physical activity recommendations.

Blood glucose can be tested before and after physical activity to monitor control. The patient should always warm-up and cool-down as a part of their activity. Wearing the right shoes and socks is important to reduce problems of foot tissue injury. Drinking plenty of appropriate fluids, usually water, is especially important in patients with diabetes. When exercising, it can be helpful to wear or carry an alert identification so that appropriate interventions can be instituted in case of a problem, such as hypoglycemia.

There are four main types of activity that can be recommended, such as including activity every day, doing aerobic exercise, including strength training, and stretching.

Aerobic exercise emphasizes large muscle groups in continuous or rhythmic fashion with a preference for low-impact activities. An exercise program may start with efforts to improve duration and stamina and then build in intensity. Building frequency of exercise to daily or almost daily is a goal. Aerobic exercise may include brisk walking, climbing stairs, swimming, dancing, bike riding, and a number of sports. Strength training includes push/pull and lifting activities. Stretching can prevent muscle soreness and improve flexibility and may reduce the risk for injury in exercise programs.

While exercise is important to optimal treatment, there is a risk for hypoglycemia. To reduce this risk, monitoring blood glucose before and after exercise will be important. Adjustments can be made to accommodate the changes in blood glucose metabolism, such as decreasing insulin and other hypoglycemic medications and increasing food intake around exercise plans.

Rick Fields-Gardner

2020