Do diabetics need to worry about risks of exercise?
This article will discuss exercise risks for people with type 2 diabetes.
Not all diabetics need to undergo extensive evaluation before beginning exercise. Read below to find out about all pre cautions that you may need to take before beginning exercise
If you are a young and otherwise healthy diabetic (type 2), not on insulin or insulin secretagogue drugs , you exercise related risks are likely to be similar to any other individual similar to you. Even then you should take a PARQ test, to check your fitness for exercise and seek doctor’s advice if the test result suggests so
If however, you have long standing diabetes (more than 10 years) your disease is not well controlled (HbA1c>7) you should undergo the ‘Health check up for diabetics‘ and get your doctor’s advice before beginning exercise
Diabetics with known complications have to be more careful in choosing the exercises they can do
Diabetics having CAN (Cardiac Autonomic Neuropathy):
Individuals with CAN should receive physician approval and possibly an exercise stress test before exercise initiation
Those having peripheral neuropathy affecting feet:
If you have a foot injury or open sore or ulcer, you should stick to non weight bearing physical activity, seek your doctor’s advice
Individuals without acute foot ulcers can undertake moderate weight bearing exercise such as walking
Those having diabetic nephropathy /kidney dysfunction :
Exercise training increases physical function in individuals with kidney disease and may even be undertaken during dialysis sessions but these patients may need exercise tolerance testing and cardiac evaluation before commencing with regular exercise
Those having diabetic retinopathy :
Individuals having advanced retinopathy (proliferative or preproliferative retinopathy or macular degeneration) should not do high-intensity exercises, head down activities or jumping or jarring activities, all of which increase the risk of retinal hemorrhage
It is important to undergo eye test including fundoscopy if your diabetes is long standing or uncontrolled or you have problems of vision before beginning exercise
Diabetics with known heart disease or CVD
Often older diabetics have CVD; they may have had angiography/angioplasty or even a heart attack. These people would presume their risk of exercise to be too high and try to stay away. But, in this group aerobic exercise is one of the few factors proven to be associated with better longer and more functional life.
Therefore exercise is especially helpful if you fall in this group, but you should start exercising under guidance of an expert team of your doctor and physical activity trainer in a monitored environment; such teams are hardly available with ease in India, but make sure to discuss with your doctor how you can pursue exercise
Hypoglycemia and exercise in diabetes: should people with diabetes exercise before or after meal?
The risk of hypoglycemia (dangerously low blood sugar level) is negligible for diabetics who are not on insulin or drugs that cause hypoglycemia
If you are on insulin or anyone of these drugs, you should know how to look for and manage hypoglycemia
- Measure your blood sugar level before exercise, if it is lower than 100, you should eat a snack such as a banana (having one carb choice =15 grams or carb) and begin exercise
- Also, eat food which has 1-2 carb choices during and within 30 min after exhaustive/vigorous aerobic or resistance exercise session but intense, short exercise requires lesser or no carbohydrate intake during the session
- Medication dosage adjustments may be required for insulin or drugs mentioned above, if exercise leads to hypoglycaemia often. Therefore, measure your blood levels after exercise a few times up to 24 hours or so, or at any time you have symptoms of hypoglycaemia and discuss with your doctor
- Once you have monitored your before and after exercise sugars a few times you will know whether you need to boost your sugars for exercise, the aim is to keep your sugar before, during and after exercise within 70-100 mg/dL
- In general everyone is advised to exercise after 3 hours of having a full meal, this advice is valid for diabetics also
- Similarly, exercise on an empty stomach is best avoided, if you exercise in the morning you should have a snack (banana is best) before beginning your workout
What about the other drugs that diabetics may be taking?
Most drugs prescribed for concomitant health problems do not affect exercise, with the exception of alpha blockers and some diuretics which are prescribed for high blood pressure and statins which are prescribed for lowering blood cholesterol
If you are on any of these, especially statins, watch out for severe muscle pain when you start exercising and consult your doctor if you get such pain
Hope this post has given you more confidence about getting on with exercise ! Read about ‘Exercise recommendations in diabetes‘ and check out ‘beginner’s guide to aerobic‘ and ‘strength training‘ and ‘HICT’ here
CHECK OUT: Our references for diabetes mellitus
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